The authors report a case of malignant brain-stem glioma with typical clinical signs in which successful surgical decompression and biopsy were obtained under the surgical microscope, and factors favoring surgical removal of such lesion are discussed.
Biopsy* ; Decompression* ; Decompression, Surgical ; Glioma*

The transverse sacral fracture is rare; however, if it accompanies neurological injury or instability, difficult surgical treatment may be necessary. We performed surgical decompression and laminoplasty in a patient with neurological deficits and anterior displacement of S2 on S1. The patient showed a successful clinical outcome by neurological improvement.
Decompression ; Decompression, Surgical ; Humans ; Sacrum

OBJECTIVE: Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety. METHODS: In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery. RESULTS: The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339). CONCLUSION: DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.
Brain ; Decompression ; Decompressive Craniectomy* ; Dermatologic Surgical Procedures ; Humans ; Methods ; Mortality ; Neurosurgeons ; Skin* ; Skull ; Surgical Flaps ; Surgical Procedures, Operative

No abstract available.
Decompression, Surgical* ; Exophthalmos*

Spinal disease is an important cause of cervical discomfort, low back pain, radiating pain in the limbs, and neurogenic intermittent claudication, and its incidence is increasing annually. From the etiological viewpoint, these symptoms are directly caused by the compression of the spinal cord, nerve roots, and blood vessels and are most effectively treated with surgery. Spinal surgeries are primarily performed using two different techniques: spinal canal decompression and internal fixation. In the past, tactile sensation was the primary method used by surgeons to understand the state of the tissue within the operating area. However, this method has several disadvantages because of its subjectivity. Therefore, it has become the focus of spinal surgery research so as to strengthen the objectivity of tissue state recognition, improve the accuracy of safe area location, and avoid surgical injury to tissues. Aside from traditional imaging methods, surgical sensing techniques based on force, bioelectrical impedance, and other methods have been gradually developed and tested in the clinical setting. This article reviews the progress of different tissue state recognition methods in spinal surgery and summarizes their advantages and disadvantages.
Decompression, Surgical ; Humans

The brain-stem auditory evoked potentials(BAEPs) were evaluated in 5 adult patients with various posterior fossa lesions in the diagnosis and during operative manipulation to determine whether this technique was capable of providing useful information to the operating surgeon. The BAEPs were not only very sensitive noninvasive screening test in the diagnosis of small acoustic neuroma, but also very to preserve hearing during dissection of the tumor from the auditory nerve. In case of large acoustic neuroma, intraoperative BAEPs were helpful to monitor the effect of an operative procedure even on the contralateral brain-stem auditory pathway. Besides BAEP monitoring was also useful for operative manipulation in the region of the 8th nerve such as microvascular decompression of cranial nerve.
Adult ; Auditory Pathways ; Cochlear Nerve ; Cranial Fossa, Posterior ; Cranial Nerves ; Diagnosis* ; Evoked Potentials, Auditory* ; Hearing ; Humans ; Mass Screening ; Microvascular Decompression Surgery ; Monitoring, Intraoperative ; Neuroma, Acoustic ; Surgical Procedures, Operative

OBJECTIVES: The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. MATERIALS AND METHODS: Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. RESULTS: The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to 53.1+/-15.8% of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure 16.4+/-10.5% of the initial pressure(ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to 20.2+/-22.6%(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. CONCLUSION: Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.
Brain Edema* ; Brain* ; Coma ; Decision Making ; Decompression ; Decompression, Surgical ; Decompressive Craniectomy* ; Humans ; Intracranial Pressure* ; Mortality ; Patient Selection ; Postoperative Period ; Punctures ; Ventricular Pressure

We present 15 patients with progressive neurological deterioration while on medical treatment for massive cerebral or cerebellar edema due to large cerebral or cerebellar infarction. Clinical signs of uncal herniation were present in 10 of these patients. Remaining five patients showed progressive neurological deterioration accompanied with impending herniation. Brain CT confirmed mass effect from cerebral or cerebellar edema in all cases. All 15 patients were treated with decompressive craniectomy, duroplasty and/or ventriculostomy. Nine patients showed good results and six patients had poor results. As compared with poor result group, good result group had high score of Glass Gow Coma Scale(GCS) on admission(12.8 vs. 8.3 on average) and time from worsening to operation is shorter(8.8 vs. 21.3hrs on average). Infarction was all on right side and hearniation sign just before operation appeared infrequently in good result group. These results suggest that decompressive surgery can be effective life saving procedure for massive cerebral edema after large brain infarction, especially in cases with right side lesion, high GCS score on admission, and pertinent timing of operation(before occurrance of irreversible brain stem damage due to herniation).
Brain Edema ; Brain Infarction* ; Brain Stem ; Brain* ; Coma ; Decompression, Surgical* ; Decompressive Craniectomy ; Edema ; Glass ; Humans ; Infarction ; Ventriculostomy

Bow hunter's syndrome (BHS) is rare cause of vertebrobasilar insufficiency that arises from mechanical compression of the vertebral artery by head rotation. There is no standardized diagnostic regimen or treatment of BHS. Recently, we experienced 2 cases resisted continues medication and treated by surgical approach. In both cases, there were no complications after surgery and there were improvements in clinical symptoms. Thus, we describe our cases with surgical decompression with a review of the relevant medical literature.
Decompression ; Decompression, Surgical ; Head ; Mucopolysaccharidosis II* ; Vertebral Artery* ; Vertebrobasilar Insufficiency

The author analysed clinical effect of surgical decompression and stabilization on spinal cord dysfunction in 20 cases of atlantoaxial dislocation. Of 20 cases, 10 cases were related with trauma(either recent or remote), 4 with bony anomalies, 3 with inflammatory processes and remaining 3 of unknown etiologies. 9 cases had reducible dislocations and 11 cases were not reduced preoperatively. All cases were decompressed if necessary and stabilized via ventral transoral or posterior approaches. All cases except one, neurological symptoms and sings were improved or stabilized after operations. One patient who had been bedridden and had high preoperative CO2 retention, died 2 months after operation due to respiratory complications. In 3 of 10 ventrally decompressed cases, pharyngeal wounds were disrupted and it took more than 3 months of admission to heal. In 3 of 17 posterior fusion, solid bony fusion could be achieved by second operations. In conclusion, atlantoaxial dislocations can be cured by systematic decompression and fusion, but complication can be serious and troublesome.
Decompression ; Decompression, Surgical* ; Dislocations* ; Humans ; Spinal Cord* ; Wounds and Injuries