A retrospective study of predictors determing outcome was carried out in a consecutive series of 104 patients, who had suffered from diffuse brain injury between December 1989 and April 1995, at the Department of Neurosurgery, Soonchunhyang University Hospital. The clinical, laboratory and radiological factors affecting the outcome in patients were analyzed and correlation between the factors and Glasgow outcome scale were statistically assessed. The major results were as follows: Significant predictors of poor outcome were old age, time interval within 5 hours from onset to admission, full dilated pupils or anisocoria, lower Glasgow coma scale, seizure, body temperature above 38 degrees C, PaO2 below 70mmHg, blood sugar above 160mg/dl, platelet count less than 100,000/mm3, prothrombin time less than 80%, lesions in more than 2 locations on CT & MRI and operative cases. Glasgow coma scale, age and temperature were demonstrated as the most significant predictors among the above factors by discriminant analysis. 2) Sex , kind of accidents, associated injuries, systolic blood pressure, pulse rate, respiration rate, PaCO2, base excess, serum sodium, bleeding time, coagulation time, and skull fracure were not significant influences on the outcome. According to the above results, the predictors of poor outcome should be considered as factors in assessing prognosis for treatment of diffuse brain injury.
Anisocoria ; Bleeding Time ; Blood Glucose ; Blood Pressure ; Body Temperature ; Brain Injuries* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Heart Rate ; Humans ; Magnetic Resonance Imaging ; Neurosurgery ; Platelet Count ; Prognosis ; Prothrombin Time ; Pupil ; Respiratory Rate ; Retrospective Studies ; Seizures ; Skull ; Sodium

OBJECTIVE: Microvascular decompression(MVD) for hemifacial spasm(HFS) is well established. However delayed postoperative facial palsy has not been substantially reported. The authors reviewed patients with HFS who underwent MVD in our institution to evaluate the post-operative courses with special attention to the development of delayed facial palsy. METHODS: Records of 144 cases(137 patients) from 1988 to 1997 were reviewed. Of these patients, 12(8.3%) developed delayed facial palsy. Follow-ups via chart and phone records were available for 10 of 12 patients. RESULTS: Reviews of these 12 cases demonstrated that 3 men, 9 women of with average age of 53(range 45-60) had delayed facial palsy. Among them, 2 had repeated operation. The preoperative duration of symptoms averaged 12 years(range 1-30) and 4 patients had mild preoperative weakness. All were improved their HFS within 7 days after MVD. Offending vessels were anterior inferior cerebellar artery(AICA) in 7. Five of these were meatal branches and 2 were sandwich type compressions. One case was combined compression of AICA and posterior inferior cerebellar artery. Three to 7 pieces of Teflon felt were necessary for the decompression of offender. The onset of weakness occurred invariably between postoperative day 6 and 11. Two cases had associated complications. The one was hearing loss and the other was meningitis accompanied by cerebrospinal fluid otorrhea. Ten cases received steroids following the onset of their facial palsies. Duration of follow up of 10 cases was 21months(3months-5years). Three cases showed complete recovery at 4, 8 and 12 weeks, respectively. Four patients have improved to House Grade II at 5 weeks and remaining three showed continuing improvement until last follow-up. CONCLUSIONS: Delayed facial palsy following MVD in HFS patients is not uncommon, being 8.3% in our series. It occurs consistently 1-2 weeks postoperatively. Possible causes include facial nerve exit zone injury with Teflon felt or delayed facial nerve edema. Spontaneous recovery usually occur within several weeks.
Arteries ; Cerebrospinal Fluid Otorrhea ; Criminals ; Decompression ; Edema ; Facial Nerve ; Facial Paralysis* ; Female ; Follow-Up Studies ; Hearing Loss ; Hemifacial Spasm* ; Humans ; Male ; Meningitis ; Microvascular Decompression Surgery* ; Polytetrafluoroethylene ; Steroids

OBJECTIVE: Chronic hydrocephalus is one of the major complications following aneurysmal subarachnoid hemorrhage(SAH). However the incidence and predicting factors requiring shunting after SAH is not precisely known. The authors investigated the incidence of chronic hydrocephalus, timing of shunting procedure, and factors to predict the need for shunting in patients with aneurysmal SAH. PATIENTS AND METHODS: A series of 209 patients admitted to our institute from January 1993 to December 1997, who presented with SAH and underwent craniotomy for aneurysm clipping were studied retrospectively. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after initial hemorrhage and that required shunting. The author divided study group into shunt group(SG, n=20) and non-shunt group(NSG, n=189). Patients were evaluated based on following factors: age, sex, history of hypertension and diabetes mellitus, consciousness at admission, Hunt-Hess grade, the presence of intracranial hemorrhage, Graeb's score, bifrontal index(BFI), Fisher grade, amount of SAH, location of aneurysm, time of aneurysm clipping, rebleeding, and vasospasm. RESULTS: The incidence of chronic hydrocephalus was 9.6%(20/209). The timing of the shunting procedure ranged from 16 days to 150 days after initial hemorrhage with the average being 77(+/-37)days. In a univariate analysis with chi-square test, age, consciousness, Hunt-Hess grade, amount of SAH, BFI, Fisher grade, and Graeb's score were significantly related with the need for shunting(p<0.05). In a multivariate logistic regression analysis, odds ratio was calculated for each variables. If the odds ratio of below 60 year of age was 1.0 then that of above 61 was 5.4(p<0.001). If the odds ratio of alert/drowsy was 1.0 then that of stupor/coma was 4.4(p<0.05). If the odds ratio of 0 of Graeb's score was 1.0 then that of 1-10 was 4.3(p<0.05). If the odds ratio of amount of SAH below score 3 was 1.0 then that of above score 4 was 1.8. If the odds ratio of BFI below 30 was 1.0 then that of above 31 was 1.1. CONCLUSION: The development of chronic hydrocephalus after aneurysmal SAH is multifactorial, but should be strongly suspected in patients with older age, decreased level of consciousness or IVH at admission. The patients require a shunt from 2 weeks to 5 months from the time of their initial hemorrhage.
Aneurysm* ; Consciousness ; Craniotomy ; Diabetes Mellitus ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Logistic Models* ; Odds Ratio ; Retrospective Studies ; Subarachnoid Hemorrhage*

It is important to obtain a good exposure of the root exit zone(REZ) of the facial nerve during microvascular decompression(MVD) for hemifacial spasm(HFS). For this purpose, authors dissected cerebellar cortical artery in addition to exposing the proximal portion of lower cranial nerves. During MVD for HFS, surgeons frequently meet a cerebellar cortical artery along the inferolateral aspect of cerebellar hemisphere. It is usually hemispheric branch of anterior inferior cerebellar artery(AICA) or posterior inferior cerebellar artery(PICA). It is reason that authors have dissected the outside arachnoid membrane attached pia mater of cerebellar cortical artery with a arachnoid knife or microscissor but preserve the inside arachnoid membrane attached dura mater. Microsurgical retractor is placed inferolaterally between cerebellar cortical artery and cerebellar hemisphere and elevated from the floor of the posterior fossa. The subarachnoid cisterns over the lower cranial nerves are opened with sharp dissector and wide operative fields and good exposure of REZ of facial nerve is obtained.
Arachnoid ; Arteries* ; Cranial Nerves ; Dura Mater ; Facial Nerve ; Hemifacial Spasm* ; Membranes ; Microvascular Decompression Surgery* ; Pia Mater

OBJECTIVES: This study was conducted to evaluate the association between workplace violence and depression METHODS: In total, 2236 employees who were providing services at hotels, casinos and amusement halls were used in this study. A structured questionnaire was used to assess exposures to violence, which was classified into physical violence, verbal violence, sexual harassment and bullying together with jobs and sociodemographic factors. Depressive symptoms were assessed using the Korean Beck depression inventory-II (BDI-II). Those with total BDI-II score over 22 points were defined as people with depression. RESULTS: Prevalence of depression among subjects exposed to any violence was higher than those who were not exposed to violence. After adjusting covariates, the odds ratio of depression was 2.47 (95% CI;1.13~5.39) for sexually harassed male subjects (n=72, 4.90%), 3.22 (95% CI; 1.51~6.87) for bullied male subjects (n=570, 38.83%), and 2.57 (95% CI; 1.52~4.32) for bullied female subjects (n=447, 58.20%). CONCLUSIONS: The results of this study suggest that depression can be an important psychological issue to those exposed to workplace violence in Korea. First of all, acknowledgement of the problem should be made in the workplace. Exalting public awareness and transforming work ethics and culture is cardinal to making this a social rather than an individual problem.
Bullying ; Depression ; Female ; Humans ; Korea ; Male ; Odds Ratio ; Prevalence ; Questionnaires ; Sex Offenses ; Violence

Authors report two cases of central neurocytoma with unusual surgical pitfall. The one of these presented with postoperative intraventricular hemorrhage with hydrocephalus. The other case developed motor aphasia and hemiplegia due to brain retration during operation. We describe peripoerative courses of these cases and discuss possible causes of postoperative complications.
Aphasia, Broca ; Brain ; Hemiplegia ; Hemorrhage ; Hydrocephalus ; Neurocytoma ; Postoperative Complications

No abstract available.
Hematoma, Epidural, Spinal* ; Meningioma*

Reported below is a case of traumatic aneurysm of the occipital artery. A 17-year-old man was referred to our hospital with a 2x2x1 cm sized pulsatile mass in the left occipital area which had progressively increased in size during the 25 days after blunt trauma. External carotid angiogram revealed a aneurysm of the left occipital artery. The occipital artery was ligated proximal and distal to the aneurysm and the aneurysm was removed. Pathological examination confirmed a partially thrombosed pseudoaneurysm.
Adolescent ; Aneurysm* ; Aneurysm, False ; Arteries* ; Humans

Using computed tomographic scanners, stereotactic guided brain biopsy usually permits safe and accurate pathologic diagnosis. In our department between 1991 and 1995, 35 patients underwent CT guided stereotactic biopsy and/or craniotomy with CRW stereotactic frame, and following results were obtained. 1) All lesions were supratentorial. As surgical intervention for the diagnosis, biopsy was carried out in 25(71.4%), aspiration of cystic content was in 2(6%), and stereotactic guided craniotomy was in 8 cases(23%) respectively. 2) A positive diagnosis could be obtained in 34 cases(97.1%), and inconclusive diagnosis disclosed in only one case (2.9%). Positive diagnoses included: 10 cases of astrocytoma(28.6%), 4 cases of glioblastoma(11.4%), metastasis, germinoma, and meningioma in that order. 3) It seemed to be difficcult to ascertain a grade and to search for any presence of mixed area in glioma cases, because open craniotomy was not carried out in all cases. 4) The biosy specimens were generally obtained with cup forceps, however a spiral needle core device with outer probe was very useful for obtaining tissue of tumor for an unavailable case with cup forceps. 5) The immediate post-operative CT scan after 3-4 hours of procedure gave information for accurate site of target under location of air bubble, and any evidence of complication such as hemorrhage. This study provides evidence that CT-guided stereotactic biopsy is a reliable, simple, and safe method for obtaining histological diagnosis of intracranial mass lesions.
Biopsy* ; Brain ; Craniotomy ; Diagnosis ; Germinoma ; Glioma ; Hemorrhage ; Humans ; Meningioma ; Needles ; Neoplasm Metastasis ; Surgical Instruments ; Tomography, X-Ray Computed

With improvements in diagnostic imaging techniques for the brain, pituitary tumors without neurological signs or symptoms have occasionally been found. To evaluate therapeutic strategy for incidentally found pituitary tumors ("pituitary incidentaloma"), we analyzed the result of magnetic resonance imaging findings and of ophthalmological and endocrinological studies in 3 cases with follow up. Incidentally found functioning tumors were excluded. All of 3 cases is greater than 10mm in tumor size("pituitary macroincidentaloma"). The follow-up period was 49 months, 16 months and 6 months(mean, 25.3 months) in each case. There was no evidence of tumor enlargement, endocrinological problems and visual field defect during follow-up period. Patients with pituitary incidentalomas usually follow a benign course and neurosurgical intervention is not initially required in the management even those greater than 10mm in diameter. Observation over time may be good approach to the patient with a pituitary macroincidentaloma to avoid the unnecessary risk for surgery in a patients with a stable mass.
Brain ; Diagnostic Imaging ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pituitary Neoplasms ; Visual Fields