OBJECTIVE: The aim of this study is to determine the factors influencing the surgical outcome following craniotomy for head injury and to establish the criteria for surgical intervention in the age of 65 years or older. METHODS: We retrospectively investigated the mechanism of injury, types of computed tomography lesions, Glassgow coma scale(GCS) score at admission, pupillary reactivity, past medical history and surgical outcome following craniotomy in the elderly during 8 year period. RESULTS: There were 35 men and 21 women with a mean age of 70.7 years(range 65-87 years). The mortality rate at discharge was 58.9%. Good outcome was achieved only in 25 percent of the patients. The cause of injury did not affect on the surgical outcome. All of 19 patients with GCS of 5 or less at admission had poor outcome. Outcome was significantly worse in older patients(more than 75 years) compare to younger patients(less than 75 years). Ninety percent of the patients with pupillary abnormality had poor outcome, whereas 57.7 percent of the patients with bilateral reactive pupil had poor outcome. Past medical history did not affect on the surgical outcome following craniotomy. CONCLUSION: Surgical outcome is unexceptionally poor in the elderly head-injuried patients if the age is 75 years old or older, the GCS is 5 or less and the pupil is bilaterally dilated. Craniotomy under those circumstances is not desirable.
Aged* ; Coma ; Craniocerebral Trauma ; Craniotomy ; Female ; Humans ; Intracranial Hemorrhage, Traumatic* ; Male ; Mortality ; Pupil ; Retrospective Studies

No abstract available.
Fatigue* ; Sciatica*

No abstract available.

No abstract available.
Brain Injuries* ; Child* ; Glasgow Coma Scale ; Humans

Development of new surgical devices and approaches for management of injuries to the cervical spine has offered various methods of treatment available. Making it is not easy in choosing the most suitable method of treatment. We present our experience and results of 90 operations performed during the past eight-year-period(1986-1993) including 10 halo-vest applications. The timing of operation was within 7 days posttrauma in 34.2%, 8-14 days in 27.4%, 15-28 days in 1.0%, and over 28 days in 27.4%. In 18 cases of upper(C1-3) cervical spine injuries, 23 operations were performed, all approached from the posterior. In 5 cases of lower(C4-7) cervical spine injuries, 67 operations were performed, the anterior approach used in 33 patients and the posterior approach in 18 patients. Halo-vest was applied in 6 patients with upper cervical spine injuries and in 4 patients with lower cervical spine injuries. The halo-vest was inadequate in maintaining the stability of the injured spine in 5 out of 0 cases. The complication rate was 23.3% in postrior approaches and 32.4% in anterior approaches. Overall, 27 complications(0%) occurred in 90 operations, and the reoperation rate was 16.4%(85 operations for 73 patients, except for the halo-vest applications). Internal fixation with a variety of devices has become a popular procedure for ervical spine injuries. Despite the popular and wide usage of such devices, the occurrence of complications and the need to reoperate has rendered the procedure to be applied with much caution regarding its technical aspects and possible problems it may pose. In our study, the rate of reoperation and complications following such procedures were quite high. We conclude that in choosing the most proper surgical approach for ervical spine injuries with minimal occurrence of any complications, a stringent criteria should be adhered to rather then easily select the more fashionable, new of fancy devices over the traditional techniques.
Humans ; Reoperation ; Spine*

We present a retrospective study on the results of posterior instrumentation with various devices after thoracolumbar spinal injuries. From Jaunary 1985 to December 1990, we operated 61 patients in Soonchunhyang University Chonan Hospital. Fourty-six patients were followed at least three months(three to 40 months). Rod system was used in 21 patients and pedicle screw system was used in 27 patients. In two patients, both systems were used. We divided them into two group ; Group A for the patients operated with rod system and Group B for the patients operated with pedicluar screw system. We analysed and compared the results of these two groups. There were no significant differences in the age, sex, causes of injury, levels and types of injury, and the incidence of cord injury. The final wedge deformity was less severe in Group B than A(P<0.02). However, the final angular deformity did not significantly differ in two groups. The mean hospital stay of Group B was shorter than that of Group A, but the difference was not statistically significant. Although there was no statistical significance, the final wedge deformity was severe in patients who were older than 40 years of age, who follwed up for more than 300 days, and who had cord injury. The final wedge deformity and angular deformity were severe in patients whose preoperative deformity was great(P<0.05 and P<0.02, respectively). The angular deformity was also severe Group A, in patients who had cord injury, who followed up for more than 300 days, and who were younger than 40 years of age, but these differences lack the statistical significance. Although the rate of complication in Group B(40.7%) was higher than Group A(28.6%), this diference was not significant. The most common complication was rod displacement in Group A and screw fracute in Group B. Pedicle screw system was superior to the rod system in this study. Improving the instruments and accumulating clinical experiences, pedicle screw system will be an effective method for thracolumbar stabilization.
Chungcheongnam-do ; Congenital Abnormalities ; Humans ; Incidence ; Length of Stay ; Retrospective Studies ; Spinal Injuries

Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.
Adolescent ; Adult ; Age Factors ; Aged ; Brain Injuries/complications/pathology ; Child ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/etiology/*pathology/therapy ; Human ; Male ; Middle Age ; Subdural Space/*pathology ; Tomography Scanners, X-Ray Computed

Recent advances in diagnosis and therapy for head injury have brought some changes in concepts, definition of the terms, therapeutic methods and the duration of treatment. In medical certificates, the diagnosis and duration of treatment also need to be changed according to the new concepts. Mixed use of the terms according to the classic and the new concepts may cause confusion. We investigated with a questionnaire to assess the acceptability of the new concepts of head injury, and seeked for a plan to avoid possible confusion in medical certificates. We sent questionnaires for diagnosis and duration of treatment of 10 given examples of head injury to 367 neurosurgeons whose addresses could be identified. Questionnaires were answered by 52 neurosurgeons. The diagnosis described in the questionnaires showed wide variability with a range of 10 to 32 different descriptions, on average 16.8 different descriptions for each case. Duration of treatment also revealed great discrepancy. Coefficients of variation for duration of treatment varied from 33.44% to 54.37%. Cerebral contusion was the most commonly used term. It was described in every 10 given examples, and to take an average, 32.3 neurosurgeons used cerebral contusion or each case. To avoid possible confusion in medical certificates, it is necessary to make a guide for medical certificates for head injuries according to the new concepts, and a chance of training of this guide should be provided.
Contusions ; Craniocerebral Trauma* ; Diagnosis* ; Head* ; Surveys and Questionnaires*

Although the prevalence of infectious disorders has been decreased, tuberculous infections are still common in this country. Therefore epidemiological data for the correct diagnosis of some spinal infections and proper selection of susceptible antibiotics are necessary. We presented a series of 40 patients with primary spinal infection dated from January 1990 to December 1994. Tuberculosis was the most common infection constituting 85% of this series, while pyogenic infection constituted only 10%, and primary discitis shared 5%. In a half of the tuberculous spondylitis, there were histories of previous tuberculosis except the vertebrae. We could identify the pathogenic organisms in only 47.5% o the cases(in 4 of 6 pyogenic infection and 15 of 34 tuberculous infection). Since it is difficult to differentiate the pyogenic and tuberculous infections by clinical or radiological features alone, some pyogenic infections might have been regarded as tuberculous, although the pyogenic spinal infections are rare. Nevertheless the tuberculous spinal infection outnumbered pyogenic ones in this country, which is similar to the patterns of other third-world countries. Therefore, correct identification of the microbial agent is important not only for the proper treatment but also to evaluate the patients of primary spinal infections in this country.
Anti-Bacterial Agents ; Developing Countries ; Diagnosis ; Discitis ; Epidemiology ; Humans ; Prevalence ; Spine ; Spondylitis ; Tuberculosis

The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.
Brain ; Echocardiography ; Heart Ventricles ; Humans ; Sepsis ; Shock, Septic* ; Stroke* ; Thorax ; Thrombosis*