OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*

To compare the regenerative effect of direct end-to-end suture, nerve graft and sutureless fibrin glue repair in the rat sciatic model, forty rats were divided into 4 groups: normal control group(NC-G, n=6), direct end-to-end suture group(DS-G, n=12), nerve graft group(NG-G, n=10) and sutureless fibrin glue group(FG-G, n=12). One half of each group except NC-G was sacrificed 4 weeks later and the other half was sacrificed 14 weeks later. The repair site was assessed by nerve conduction studies and quantitative morphometry. Regeneration index (RI) was defined as a total number of remyelinated axons in one quarter of 3X5 inch sized microphotograph. The comparison among groups was analyzed statistically by Kruskal-Wallis 1-way ANOVA and Mann-Whitney test. Nerve conduction study done 14 weeks later revealed that latency was 1.7ms+/-0.18(DS-G), 2.4ms+/-0.35(NG-G), 2.4ms+/-0.17(FG-G) and amplitude was 20.1mV+/-2.89(DS-G), 12.0mV+/-2.47(NG-G), 13.7mV+/-2.95(FG-G). RI was 281+/-37.5(DS-G), 227+/-14.4(NG-G) and 217+/-22.2(FG-G). There was a statistical difference in the latency, amplitude and RI between three groups(p<0.05), but there was no statistical difference in the latency, amplitude and RI between FG-G and NG-G(p>0.05). Regenerative effect of fibrin glue is not different from that of nerve graft, therefore fibrin glue repair can facilitate inaccessible nerve repairs in skull base or spinal surgery.
Animals ; Axons ; Fibrin Tissue Adhesive* ; Fibrin* ; Neural Conduction ; Rats* ; Regeneration ; Sciatic Nerve* ; Skull Base ; Sutures ; Transplants

OBJECTIVE: Topographic arrangement and morphometric pattern of cauda equina are studied. METHODS: In 10 adult formalin fixed cadavers, the entire dural sac of lumbosacral spine including extradural nerve roots was extracted. After paraffin fixation, serial cross section from sacral nerve roots to conus medullaris was performed. We investigated following structures at each disc level using a slide scanner after haematoxylin and eosin and Masson's trichrome stains: 1) location of filum terminale(FT), 2) arrangement of motor and sensory bundles, 3) morphometric characteristics of sensory bundles to motor bundle of each spinal nerve root. RESULTS: The FT was located in the dorsal half of midline at L2-3 disc level and in the most dorsal portion of midline from the L4-5 disc level and downward. All bundles of each nerve root showed an oblique arrangement. Motor bundle of each spinal nerve root was always located in the anterior or anteromedial portion of the corresponding sensory bundles. At L4-5 and L5-S1 disc levels, S1 to S4 nerve roots were arranged inverted V-shape centered FT. The sensory root was composed of several bundles whereas the motor root was always composed of a single bundle. The areas occupied by sensory bundles were larger than 2 to 4 times in S1-3 sacral nerve roots and 1.9 to 2.4 times in L3-5 lumbar nerve roots compared with those occupied by the corresponding motor roots. CONCLUSION: This study will be helpful to prevent the nerve root injury during the operation of cauda equina and predict postoperative complications.
Adult ; Cadaver ; Cauda Equina* ; Coloring Agents ; Conus Snail ; Eosine Yellowish-(YS) ; Formaldehyde ; Humans ; Paraffin ; Postoperative Complications ; Spinal Nerve Roots ; Spine

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

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

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

OBJECTIVE: The lack of anatomical knowledge for the anterior cervical microforaminotomy is liable to injure the neurovascular structures. The surgical anatomy is examined with special attention to the ventral aspect exposed in anterior cervical microforaminotomy. METHODS: In 16 adult formalin fixed cadaveric cervical spine, the author measured the distances from the medical margin of the longus colli to the medical wall of the ipsilateral vertebral artery and the angle for the ipsilateral vertebral artery. The distances from the lateral margin of the posterior longitudinal ligament to the medial margin of the ipsilateral medial wall of the vertebral artery, to the ipsilateral dorsal root ganglion was measured too. RESULTS: The distance from the medial margin of the longus colli to the ipsilateral vertebral artery was 13.3~14.7mm and the angle for the ipsilateral vertebral artery was 41~42.5 degrees. The range of distance from the lateral margin of the posterior longitudinal ligament to the ipsilateral vertebral artery was 11.9~16.1mm, to the ipsilateral dorsal root ganglion was 11.6~12.9mm. CONCLUSION: These data will aid in reducing neurovascular injury during anterior cervical approaches.
Adult ; Cadaver ; Formaldehyde ; Ganglia, Spinal ; Humans ; Longitudinal Ligaments ; Spine ; Vertebral Artery

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