OBJECTIVE: This study is designed to analyse the result of cerebrospinal fluid(CSF) leakage due to unintended incidental durotomy in spine surgery and to determine the timing of repair operation for CSF leakage. METHODS: Iatrogenic dura tearing occurred in 114 cases among the 1626 spine operation patients. This study included 29 consecutive patients with postoperative CSF leakage at the operative wound who did not underwent intraoperative dural closure. RESULTS: Of the 29 patients in this study, 24% had clinical symptom after CSF leakage. Four patients reported headache, three reported aggravation of lumbago. Reoperation for dura or wound repair were performed in 12 cases. Incidence of reoperation was higher in patients who underwent total laminectomy including resection of spinous process than in those who underwent partial hemilaminectomy. The CSF obtained at the reoperation was cultured. Staphylococcus aureus were cultured in 5 patients and not in 7 patients. The mean period between reoperation and the first CSF wound leakage was longer in culture positive group(14.8days) than in culture negative group(6.6days). The period between reoperation and the first CSF leakage in all of the culture positive patients was longer than 10 days. CONCLUSION: In case that CSF wound leakage in total laminectomy patients persist longer than 10days in spite of conservative management, we recommend to perform dura/wound repair without delay.
Headache ; Humans ; Incidence ; Laminectomy ; Low Back Pain ; Reoperation ; Spine* ; Staphylococcus aureus ; Wounds and Injuries

We report a case of T3 burst fracture with complete paraplegia that recovered after emergent posterior decompression and reduction. A 17-year-old boy presented with complete paraplegia which had progressed rapidly after motor cycle accident. Emergency posterior decompression and reduction was performed. After operation, lower extremity motor improved and could walk after 6 month. Even with the complete paraplegia resulted from upper thoracic burst fracture on arriving at hospital, we may expect favorable result from emergency posterior decompression and reduction if the patient is young and the motor is not absolutely paralysed at the time of early trauma period.
Adolescent ; Decompression* ; Emergencies ; Humans ; Lower Extremity ; Male ; Paraplegia*

No abstract available.
Acetazolamide* ; Aneurysm* ; Brain* ; Humans ; Perfusion* ; Subarachnoid Hemorrhage* ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVE: Various lesions including tumors occupying in the presellar and suprasellar regions have been traditionally removed by the transcranial approach. The new modified transsphenoidal approaches(TSAs) have been proposed to avoid the craniotomy and to get better surgical view. MATERIALS AND PATIENTS: The sellar floor and presellar anterior cranial fossa were removed through the sublabial transseptal transsphenoidal technique in the "transsphenoidal supradiaphragmatic intradural approach". One tuberculum sella meningioma and a suprasellar Rathke's cleft cyst confined to the pituitary stalk were removed via this approach. RESULTS: The dissection of the anterior intercavernous sinus, diaphragma sella, and arachnoid membrane allowed a wide surgical field of pre- and suprasellar areas and facilitated a safe removal of lesions without significant surgical complications in our cases. CONCLUSION: From the authors' limited experience, the advantages of this technique are as follows: 1) it can be easily applicable through a minor modification of the standard TSA, 2) excellent anatomical exposure of the structures located in the supradiaphragmatic suprasellar cistern, and 3) might be suitable to remove small lesions located in the presellar and adjacent to the pituitary stalk region.
Arachnoid ; Cranial Fossa, Anterior ; Craniotomy ; Humans ; Membranes ; Meningioma ; Pituitary Gland

OBJECTIVES: Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea. METHODS: Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012. RESULTS: The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012). CONCLUSIONS: In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.
Cause of Death ; Child Mortality/*trends ; Child, Preschool ; Communicable Diseases/mortality ; Databases, Factual ; Female ; Humans ; Infant ; Male ; Neoplasms/mortality ; Nervous System Diseases/mortality ; Republic of Korea ; Sex Ratio ; Vital Statistics

OBJECTIVE: There is a broad spectrum of compensated hydrocephalus. Various terms such as long-standing overt ventriculomegaly in adult (LOVA) has been coined, however, even such terms leave diverse aspect of this condition out of account. We have experienced compensated hydrocephalus cases which were considered to be activated after a long time period of quiescent state, and tried to compare their clinical characteristics with the relatively well described entity of LOVA. METHODS: We conducted a retrospective review of 206 patients who underwent ventriculoperitoneal shunt (VPS) between February 2001 and May 2012. Of these, 6 patients had chronic compensated hydrocephalus. The clinical and radiological characteristics are evaluated. RESULTS: Definite triventriculomegaly was observed in two patients. Macrocephaly was observed in two cases, one with aqueductal stenosis (AS), the other with unknown status of aqueduct. All of the cases with triventriculomegaly were normocephalic. Spinal causes were thought as aggravating factor in two. Two endoscopic third ventriculostomy and eight VPS were performed in five patients. Four patients responded well but one took a very complicated course. CONCLUSION: The relationships between macrocephaly, triventriculomegaly, and AS suggested in other studies were inconsistent. Blockage or narrowing of cerebrospinal fluid pathways were observed at various sites. Disturbances of spinal arachnoid pathways were related to the activation in some cases. Treatment is to be tailored individually considering various reigniting event. It is suggested that this entity is to be evaluated for better nomenclature reflecting diverse aspects of this condition. Further study is needed to elucidate underlying pathophysiology and effective management.
Adult ; Arachnoid ; Humans ; Hydrocephalus ; Macrocephaly ; Numismatics ; Retrospective Studies ; Ventriculoperitoneal Shunt ; Ventriculostomy

Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding. PICA preservation is the key to a successful endovascular treatment, based on the premise that a PICA origin aneurysm is well occluded. To secure PICA flow, stenting into the PICA would be the best method, however, it is nearly impossible technically via the ipsilateral vertebral artery (VA) if the PICA arose at an acute angle from the sac. In such a case, a bilateral approach for stent-assisted coiling can be a creative method for achievement of two goals of both aneurysm occlusion and PICA preservation: ipsilateral approach for coil delivery and contralateral cross-over approach for stent delivery via a retrograde smooth path into the PICA.
Achievement ; Aneurysm ; Arteries ; Intracranial Aneurysm ; Pica ; Stents ; Vertebral Artery

BACKGROUND AND OBJECTIVES: Recent data about trans-radial approach showed its usefulness in achieving the high procedural success rate and low local complications even though the size of the radial artery is small compared to that of the femoral artery. Therefore, we want to evaluate the size of the radial artery and the feasibility of the trans-radial coronary angiography as a routine technique. MATERIALS AND METHOD: Trans-radial coronary angiography (TRCA) was successful in 619 cases. The size of the radial artery was measured using 2D-ultrasonography. TRCA was tried with 4 Fr catheters. We divided the cases into two groups; early phase, 106 cases and late phase, 513 cases and compared the procedure time, catheter number used, and complications between 2 groups. RESULTS: The size of the radial artery was 2.7+/-0.4 mm in diameter and this of the men was larger than that of women (p 0.05). TRCA was performed successfully in 513 cases among 521 cases of late phase (98.5%) and crossover to femoral artery occurred in 8 cases (1.5%). The fluoroscopic time and total procedure time of the late phase (6.5+/-4.0 min, 22.9+/-11.3 min) were significantly lower than those of early phase (11.5+/-6.3 min, 31.2+/-13.7 min) (p<0.01). The average number of catheters used for coronary angiography was 1.8+/-1.0. There were 6 cases (1%) of radial artery occlusion and 1 case (0.2%) of radial artery perforation without hand ischemia. CONCLUSION: Based on the adequate size of the radial artery, high success rate and low complications, TRCA might be a safe and become a routine diagnostic technique.
Catheters ; Coronary Angiography* ; Female ; Femoral Artery ; Gangwon-do* ; Hand ; Humans ; Ischemia ; Male ; Radial Artery

Glomus jugulare tumors are usually slow growing, but highly vascularized tumor. The authors report the case of huge glomus jugulare tumor treated by surgical resection with preoperative embolization. A 32-year old male patient presented with a history of right-sided facial palsy and hearing disturbance. Magnetic resonance imaging demonstrated an irregular large mass with multiple signal voids in the right temporal area. Prior to surgical excision of tumor, the patient underwent superselective embolization. Embolization of the tumor and its dominant feeding arteries were achieved. Six days later, the patient underwent an infratemporal fossa approach to remove the tumor. The patient did well postoperatively except CSF leakage that was treated successfully by dura repair. We discuss the usefulness of preoperative embolization and infratemporal approach for the huge glomus jugulare tumor.
Adult ; Arteries ; Facial Paralysis ; Glomus Jugulare Tumor* ; Glomus Jugulare* ; Hearing ; Humans ; Magnetic Resonance Imaging ; Male

No abstract available.
Neural Tube Defects* ; Spinal Canal*