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

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

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: 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*

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

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