No abstract available.
Hematoma*

OBJECTIVE: To elucidate postoperative clinical and radiologic efficacy of unilateral kyphoplasty compared for percutaneous bilateral vertebroplasty. METHODS: One hundred patients with osteoporotic compression fracture at thoracolumbar junction were enrolled in this study. The kyphotic angle and reduction rate were measured to evaluate the vertebral restoration. Visual analog scale (VAS) for pain and short form-36 (SF-36) and Oswestry Disability Index (ODI) for functional outcome were recorded by 1 year postoperatively. Cement extravasation and adjacent vertebral fractures were monitored. RESULTS: Visual analog scale for pain was not statistically different through the follow up in both groups (p=0.38). The preoperative SF-36 and ODI scores were similar (p>0.05) but the difference in ODI score and standardized physical component scale reached statistical significance (p=0.04, p=0.03) and unilateral kyphoplasty group was getting better functional status. Reduction rate of vertebral body was 42.5+/-7.8% for the vertebroplasty group and 66.3+/-8.1% for the unilateral kyphoplasty group (p<0.001) and loss of reduction was 4.5+/-3.5% and 1.7+/-2.5% (p<0.0001) respectively. There were six complications of cement extraosseous leakage into the spinal canal in vertebroplasty only. CONCLUSION: Unilateral kyphoplasty in compare with vertebroplasty is safer for cement leakage and immediately reduces back pain and restore kyphotic deformities in addition to the prevention of subsequent compression fracture.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporotic Fractures ; Spinal Canal ; Vertebroplasty

OBJECTIVE: Intraoperative ventriculostomy is widely adopted to make the slack brain. However, there are few reports about hemorrhagic or parenchymal injuries after ventriculostomy. We tried to analyze and investigate the incidence of these complications in a consecutive series of patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: From September 2006 to June 2007, 43 patients underwent surgical clipping for aneurysmal SAH at our hospital. Among 43 patients, we investigated hemorrhagic or parenchymal injuries after intraoperative ventriculostomy using postoperative computed tomographic scan in 26 patients. After standard pterional craniotomy, ventriculostomy catheter was inserted perpendicular to the cortical surface along the bisectional imaginary line from Paine's point. RESULTS: Hemorrhagic injuries were detected in 12 of 26 patients (46.2%). Mean systolic blood pressure during anesthesia was with in statistically significant parameter related to hemorrhage (p = 0.006). On the other hand, parenchymal injuries were detected in 11 of 26 patients (42.3%). Female and the amount of infused mannitol during anesthesia showed statistically significant parameters related to parenchymal injury (p = 0.005, 0.04, respectively). However, there were no ventriculostomy-related severe complications. CONCLUSION: In our series, hemorrhagic or parenchymal injuries after intraoperative ventriculostomy occurred more commonly than previously reported series in aneurysmal SAH patients. Although the clinical outcomes of complications are generally favorable, neurosurgeon must keep in mind the frequent occurrence of brain injury after intraoperative ventriculostomy in the acute stage of aneurysmal SAH.
Anesthesia ; Aneurysm ; Blood Pressure ; Brain ; Brain Injuries ; Catheters ; Craniotomy ; Female ; Hand ; Hemorrhage ; Humans ; Incidence ; Mannitol ; Subarachnoid Hemorrhage ; Surgical Instruments ; Ventriculostomy

Fungal infections of the spine are relatively uncommon. Moreover, cervical spondylodiscitis due to Candida albicans in non-immunocompromised patient is very rare. We report a case of Candida spondylodiscitis in a 64-year-old woman who complained of neck pain. The clinical feature and treatment option are presented with a review of pertinent literatures.
Candida ; Candida albicans ; Discitis ; Female ; Humans ; Middle Aged ; Neck Pain ; Spine

Recurrent lumbar disc herniation after standard lumbar discectomy was the mostcommon complication among the failed back surgery syndrome. Clinical manifestations and radiologic findings were analyzed in 56 paients who were proved to have recurrent lumbar disc herniation. Comparative analysis with Lumbar Disc Surgery Predictive Score(LDSPS) between 160 patients of failed back surgery syndrome and 56 patients of recurrent disc herniation was performed. LDSPS of the recurrent disc herniation was 81.3. The interval of the reoperation after onset of symptom was considered to be one ofthe major factors in the prognosis of the recurrent disc herniation. The patient must be educated how to prevent lumbar disc herniation. When recurrency was suspected one must diagnose precisely with the help of MRI andreoperate as soon as possible.
Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Reoperation

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.
Abducens Nerve Diseases* ; Abducens Nerve* ; Dura Mater ; Head ; Neck Injuries ; Paralysis ; Skull Fractures ; Spine

OBJECTIVE: The reaccumulation of hematoma is one of the most frequent problems on the chronic subdural hematoma. The aim of this study is to determine the factors affecting the reaccumulation of hematoma and the reasonable site for the burr-hole trephination to achieve a low reaccumulation rate after burr-hole trephination and closed-system drainage METHODS: The authors studied 93 patients with chronic subdural hematoma in whom the location of burr-hole trephination was randomly placed and precisely determined on postoperative brain computerized tomographic scans or skull roentgenogram. Eighty five patients with chronic subdural hematoma were obtained with brain computerized tomographic scans the postoperative 3 day. The location of the burr-hole trephination, the location of subdural catheter tip, the maximum postoperative width of the subdural space, and the percentage of the ipsilateral subdural space occupied by air postoperatively were measured and analyzed the correlation with the postoperative reaccumulation rates. RESULTS: Patients with the parietal trephination had much more subdural air and a higher of chronic subdural hematoma reaccumulation than those with the frontal one. In addition, patients with residual subdural air on brain computerized tomographic scans obtained the postoperative 3 day also had a higher reaccumulation rate than those without subdural air collections. CONCLUSION: The incidence of postoperative subdural fluid reaccumulation can be reduced by the burr-hole trephination on the frontal convexity and by preventing subdural air accumulation during operation.
Brain ; Catheters ; Drainage* ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Rabeprazole ; Skull ; Subdural Space ; Trephining*

OBJECTIVE: The goal of this study was to assess the effect of high-dose simvastatin on cerebral vasospasm and its clinical outcome after aneurysmal subarachnoid hemorrhage (SAH) in Korean patients. METHODS: This study was designed as a prospective observational cohort study. Its subjects were aneurysmal SAH patients who had undergone aneurysm clipping or coiling. They were assigned to 1 of 3 groups : the 20 mg, 40 mg, and 80 mg simvastatin groups. The primary end-point was the occurrence of symptomatic vasospasm. The clinical outcome was assessed with the modified Rankin Scale (mRS) score after 1 month and 3 months. The risk factors of the development of vasospasm were assessed by logistic regression analysis. RESULTS: Ninety nine patients with aneurysmal SAH were treated and screened. They were sequentially assigned to the 20 mg (n=22), 40 mg (n=34), and 80 mg (n=31) simvastatin groups. Symptomatic vasospasm occurred in 36.4% of the 20 mg group, 8.8% of the 40 mg group, and 3.2% of the 80 mg group (p=0.003). The multiple logistic regression analysis showed that poor Hunt-Hess grades (OR=5.4 and 95% CI=1.09-26.62) and high-dose (80 mg) simvastatin (OR=0.09 and 95% CI=0.1-0.85) were independent factors of symptomatic vasospasm. The clinical outcomes did not show a significant difference among the three groups. CONCLUSION: This study demonstrated that 80 mg simvastatin treatment was effective in preventing cerebral vasospasm after aneurysmal SAH, but did not improve the clinical outcome in Korean patients.
Aneurysm* ; Cohort Studies* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Logistic Models ; Prospective Studies* ; Risk Factors ; Simvastatin* ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial*

OBJECTIVE: Ruptured vertebrobasilar (VB) saccular aneurysm is a difficult lesion to treat, and is associated with high rates of morbidity and mortality. The aim of this study is to investigate the risk factors associated with the clinical outcome of ruptured VB aneurysms. METHODS: A retrospective review of 29 patients with ruptured VB saccular aneurysms between 2002 and 2010 was conducted between Jan 2002 and Dec 2010. Univariate and multivariate analyses were performed for determination of the statistical significance of the Glasgow Outcome Scale (GOS) at three months, according to age, initial Hunt-Hess grade, the presence of acute hydrocephalus, and treatment modality. RESULTS: The study included 24 (82.7%) females and five (17.3%) males, with a mean age of 59 years (range, 22-78 years). Seventeen patients were treated with surgical clipping and 12 patients were treated with endovascular coil embolization. No statistical significance was observed between clinical outcome and treatment modalities (clipping or coiling; p = 0.803). Seventeen (58.6%) patients achieved favorable outcome, defined as GOS score of 4-5, at 3 months. Procedure-related complications occurred in seven patients (24.1%). Results of multivariate analysis indicated that initial Hunt-Hess grade and the presence of acute hydrocephalus were independent predictors of unfavorable outcome, defined as GOS score of 1-3 (Odds ratio (OR) = 8.63, Confidence interval (CI) [95%] 1.11-66.84, p = 0.039 and OR = 36.64, CI [95%] 2.23-599.54, p = 0.012, respectively). CONCLUSION: The present study suggests that the clinical outcomes are related to the initial Hunt-Hess grade and the presence of acute hydrocephalus in ruptured saccular VB aneurysms.
Aneurysm ; Female ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Male ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Surgical Instruments

OBJECTIVE: We report on our experience using a compliant balloon for treatment of thrombi resistant to simple mechanical thrombolysis. METHODS: We conducted a retrospective investigation of 46 consecutive acute ischemic stroke patients who were treated by intraarterial thrombolysis (IAT) between January 2008 and July 2010. We compared IAT results between the balloon group (BG) and the simple mechanical thrombolysis (with microcatheter and microguidewire) group (SG). The Thrombolysis in Myocardial Infarction (TIMI) grading system was used for grading of the degrees of vessel recanalization. In addition, a modified Thrombolysis in Cerebral Infarction (TICI) score was used for post-IAT TIMI grade 2 patients. Modified Rankin Scale scores were used at three months for assessment of clinical outcomes. RESULTS: Twenty of the 46 subjects were treated with a compliant balloon. The mean initial National Institutes of Health Stroke Scale score was 15.1 in the BG and 14 in the SG. The mean time from symptom onset to initiation of IAT was 225 minutes in the BG and 177 in the SG (p = 0.004). The overall rate of successful recanalization (TIMI grade 2 or 3) was 85% in the BG and 73% in the SG (p = 0.476). In the TIMI grade 2 group, modified TICI 2b was 90% in the BG and 16% in the SG (p = 0.001). Postprocedure intraparenchymal hemorrhage occurred in two subjects in the BG and 10 subjects in the SG (p = 0.029). No significant difference in clinical outcomes was observed between the BG and SG (p = 0.347). CONCLUSIONS: The compliant balloon showed high potential for recanalization following acute ischemic stroke, especially when simple mechanical thrombolysis had failed.
Cerebral Infarction ; Glycosaminoglycans ; Hemorrhage ; Humans ; Mechanical Thrombolysis ; Myocardial Infarction ; National Institutes of Health (U.S.) ; Retrospective Studies ; Stroke