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

OBJECTIVE: We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. METHODS: We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. RESULTS: PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6+/-2.9 and 5.4+/-6.4 in the unresected PARS group, 5.8+/-2.1 and 11.3+/-7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. CONCLUSION: The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.
Arthrodesis ; Body Mass Index ; Humans ; Neurologic Manifestations ; Spine

BACKGROUND: Many patients with type I Diabetes Melitus treated by insulin therapy were observed their blood sugar dropped even after meal. The ecology and treatment for this phenomenon was unknown. A clinical research making an approach to treat this phenomenon is inevitable. METHODS: 9 patients whose blood sugar dropped right after meal (from 15 minutes to 1 hour) were selected among 58 IDDM(Insulin Dependant Diabetes Mellitus) patients admitted in Daejon Sungsim Hospital from March 1999 to Feb. 2000. The subjects were consist of 6 female and 3male, average age was 57.2. Blood samples were taken from their capillaries and measured by Super Glucocard II glucometer. Insulin was injected 30 minutes before breakfast and 50% glucose 30 ml was taken orally 15 minutes after the insulin injection. Breakfast was taken 15 minutes after the glucose taken. Bolld sugar was measured 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 120 minutes and 2 hours after a breakfast. RESULTS: Though average blood sugar dropped after breakfast was 44.5 mg/dl, average blood sugar after taken 50% glucose 30 ml was 114.1 mg/dl. 2 patients had good effect among 3 male patients and every 6 female patients had good effect. CONCLUSION: Taking 50% glucose 30 ml was in oral 15 minutes after insulin injection improved the IDDM patient's blood sugar drop right after meal.
Blood Glucose ; Breakfast ; Capillaries ; Daejeon ; Diabetes Mellitus, Type 1 ; Ecology ; Female ; Glucose ; Humans ; Hypoglycemia* ; Insulin ; Male ; Meals*

STUDY DESIGN: A retrospective analysis of the fatal case who had toxic shock syndrome after spinal fusion. OBJECTIVES: To call orthopaedic surgeon's attention to that toxic shock syndrome may be present despite the absence of clinically apparent infection after orthopaedic surgery. SUMMARY OF LITERATURE REVIEW: Toxic shock syndrome is an acute febrile illness with severe multisystem derangement and the rate of fatality is 10 to 15 percents. It develops most commonly in young women, and is usually associated with menstruating women who use tampons. Orthopaedic procedures have not been considered as risk factor of toxic shock syndrome, and there have been few reports of toxic shock syndrome associated with bone manipulation and implants. MATERIALS AND METHODS: A twenty-seven-year-old woman who was admitted for T12 bursting fracture, right hemothorax, and left distal radius fracture from traffic accident. After resolving of hemothorax, she recieved spinal fusion with pedicle screw instrumentation on three weeks after trauma. At perioperative period, she was in menstrual period and used the tampons. In the evening of the eighth postoperative day, the patient had a temperature elevated up to 39.3degree C, accompanied with malaise, chills, nausea, vomiting, and dehydration. Laboratory evaluation revealed pyuria on urinalysis, but the others were unremakable. The surgical wound had an entirely benign appearance without erythema, fluctuation, and drainage. RESULTS: The patient continued to do poorly, and then she died at ten days after the surgery. CONCLUSIONS: We report a fatal case with toxic shock syndrome after spinal surgery, and also serve to remind orthopaedic surgeons that toxin-producing organisms may be present despite the absence of surgical wound infection.
Accidents, Traffic ; Chills ; Dehydration ; Drainage ; Erythema ; Female ; Hemothorax ; Humans ; Nausea ; Perioperative Period ; Pyuria ; Radius Fractures ; Retrospective Studies ; Risk Factors ; Shock, Septic* ; Spinal Fusion* ; Surgical Wound Infection ; Urinalysis ; Vomiting ; Wounds and Injuries

OBJECTIVE: Subarachnoid hemorrhage(SAH) is still one of the most serious disease with high morbidity and mortality in the neurosurgical field. Clipping of the aneurysmal neck is the gold standard of the surgical treatment of aneurysmal SAH. The purpose of this study was to investigate the role of the postoperative angiography and to assess the risk factors related to the incomplete clipping. MATERIALS AND METHODS: From July 1995 to June 1998, the pre- and postoperative angiography were performed in 50 patients among total 81 patients who have underwent the aneurysmal surgery. We reviewed the various contributing factors including age, sex, Hunt-Hess grade, Fisher grade and the premature rupture of aneurysm during operation retrospectively. Careful evaluation of pre- and postoperative angiography focusing on the size, shape, and remnant neck of the aneurysms and vasospasm was performed. According to the angiographic findings, the patients were divided into two groups; a complete clipping group and an incomplete clipping group. The data were analyzed by using unpaired independent sample t test after F-test to compare the significance between two groups. RESULTS: Incomplete clipping of aneurysms was found in 6(12%) patients through the evaluation of postoperative angiography. Among them, three cases were located on the middle cerebral artery territory. Whereas the patient age, sex, Hunt-Hess grade, and Fisher grade were not significant(p<0.05), an intraoperative premature rupture had a statistical significance(p<0.05). A severe vasospasm occurred in 24(48%) cases and one patient with anterior communicating aneurysm was reoperated due to residual sac. CONCLUSION: According to our experience, the surgeons' judgement is the most reliable factor in deciding the postoperative angiography. During the aneurysmal surgery, the premature rupture always disturbs a complete clipping of aneurysms. Therefore, the temporary clipping of parent arteries is considered essential for a successful clipping. We believe that the postoperative angiography has a role in decreasing the re-bleeding risk due to clip migration and an inaccurate clipping only in the selected cases.
Aneurysm ; Angiography* ; Arteries ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Mortality ; Neck ; Parents ; Retrospective Studies ; Risk Factors ; Rupture

OBJECTIVES: The goal of operation for degenerative lumbar diseases is to relieve radiculopathy and low back pain and to prevent further degeneration. The authors analyzed the surgical results of posterior lumbar interbody fusion(PLIF) and 360degrees fixation to evaluate the proper treatment policy in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. MATERIAL AND METHODS: The authors performed PLIF on 92 patients and 360degrees fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. We retrospectively studied clinical outcomes and subjective satisfaction of these patients by several criteria such as visual analog scale(VAS), Prolo's economic and functional outcome scale, medication usage after operation and questionaire for overall outcome. RESULT: Pre- and postoperative VAS on back pain and leg pain showed decrease of pain from 6.5, 6.7 to 2.2, 2.4 in PLIF group and from 7.0, 7.2 to 2.5, 2.7 in 360degrees fixation group. Excellent and good outcomes on Prolo's scale were 81.5% in PLIF group and 82.6% in 360degrees fixation group. Medication usage after operation was reduced in 79.3% of PLIF group and in 78.3% of 360degrees fixation group. Patients' self-reported overall success of their procedure showed 82% in PLIF group and 84% in 360degrees fixation group. CONCLUSION: Both PLIF and 360degrees fixation showed good outcomes and provided biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Therefore, only PLIF seems necessary and considered a proper surgical treatment for these disorders.
Back Pain ; Humans ; Leg ; Low Back Pain ; Radiculopathy ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis