Ossification of the posterior longitudinal ligament(OPLL) is a degenerative disease of the spine, usually found in the cervical vertebrae. The etiology and pathogenesis have not been clarified, and its natural course is still unknown. The choice of operative approach, anterior vs. posterior, is still controversial. During the past 13 years, we have operated on 116 patients with myelopathy associated with cevical OPLL; 34 cases(29.3%) were of the continuous type, 30(25.9%) were segemental, 37(31.9%) were mixed, and 15(12.9%) were other type respectively. Forty-six patients underwent anterior cervical decompression by corpectomy, disectomy, and removal of the OPLL, and in these patients, segmental and other types of OPLL were more common and were found in 73% of these cases. On the other hand, 70 patients underwent posterior cervical decompression by cervical laminectomy or expansive laminoplasty; among them, the continuous and mixed type were more common and accounted for 84% of these cases. Surgical outcome was better in patients in whom the duration of pre-operative symptoms was shorter(p<0 .05). Age at surgery, trauma history and surgical approach did not, however, significantly affect the outcome. In conclusion, anterior cervical decompression was seen to give the best results, but was limited to patients with segmental or other types of OPLL, single or two levels of OPLL, and OPLL with herniated cervical disc. The posterior approach, on the other hand, was palliative, and gave better results in patients with continuous or mixed type of OPLL, OPLL of more than level three, and generally compromised patients.
Cervical Vertebrae ; Decompression ; Female ; Hand ; Humans ; Laminectomy ; Longitudinal Ligaments* ; Ossification of Posterior Longitudinal Ligament ; Spinal Cord Diseases ; Spine*

Posterior transarticular screw fixation is known to be one of the best surgical method for the atlanto-axial instability. Between April 1995 and February 1997, this technique was used in the treatment of 21 patients(10 men, 11 women) suffering from this condition. The average age at the time of operation was 39 years(range, 17 to 63). and mean follow-up period was 14(mean 3 to 25) months. The indication for fusion were nine cases, type II-A odontoid process fracture; three cases, type II-P odontoid process fracture; three cases, os odontoideum; three cases transverse ligament laxity due to rheumatoid disease; and three cases, transverse ligament injury without bone fracture. Eleven operations involved cases were operated with posterior C1, 2 transarticular screw fixation using a 3.5 mm cortical screw augmented th interlaminar iliac graft and sublaminar wire fixation. The other ten patients underwent the same surgery without sublaminar wire fixation. In two cases d screw were misplaced; one was placed lateromedially and the other caused widening of the joint capsule space, but there were corrected by reoperation. Patients were ambulated with Philadelphia neck collar on the first post-operation day. At the end of three months follow-up, bone union was seen in all cases, and the following conclusions may be drawn: 1) Immediately after surgery, ambulation is possible; 2) The rate of occurrence of bone union is high; 3) A halo vest is not needed; 4) Sublaminar wiring is also unnecessary.
Follow-Up Studies ; Fractures, Bone ; Humans ; Joint Capsule ; Ligaments ; Male ; Neck ; Odontoid Process ; Reoperation ; Transplants ; Walking

The optimal management of uveal melanoma is still a matter of controversy. To determine the effect of Gamma Knife surgery on patients with uveal melanoma, the authors reviewed the outcome of five operations performed between September 1993 and August 1996. The mean age of the patients was 60.7(range 42 to 76) years; the median follow-up period was 10 months, and four patients were followed up for more than 6 months. The mean tumor volume was 3442mm3(mean diameter 15.3mm) and all patients were irradiated with a mean maximum dose of 74Gy (range 60-80Gy), using a 50% isodose on the tumor margin. In one patient, the tumor disappeared completely 32 months after Gamma Knife surgery; because the tumor did not regress, one patient subsequently required enucleation, and two remained stable. During a mean follow-up period of 10 months, vision was preserved in two patients, but one went blind; in one, enucleation was performed because the tumor did not regress. These results suggest that in cases of uveal melanoma Gamma Knife surgery can effectively control local tumors, can spare the eyeball, and may prevent loss of vision.
Follow-Up Studies ; Humans ; Melanoma* ; Tumor Burden

Temporary vessel occulusion is a useful technique which facilitates aneurysmal dissection and clipping, and reduces the risk of intraoperative aneurysal rupture; It may, however, result in postoperative stroke, and many authors have therefore used various agents for brain protection. Among these, barbiturate is well known. This study was undertaken to retrospectively review the effect of barbiturate on brain protection during short periods of ischemia. It involved patients with 146 anterior circulation aneurysms, who were divided into two groups: 43 who received intraoperative barbiturate burst suppression with sodium thiopental during temporary vessel occlusion and the remaining 103, who did not. Doses of thiopental 5mg/kg, usually singly or occasionally repeated at 10-mimute interval, were administered. All patients underwent general anesthesia using volatile isoflurane; mild hypothermia(32-34degreesC), mild hypocarbia(30-35mmHg), and normotension of 110-130mmHg were noted prior to permanent clipping, and mild hypertension(130-150mmHg) after clipping. In some cases, intraoperative scalp electroencep-halography was monitored. Clinical, radiological, and overall infarction were assessed postoperatively, and statistical analysis was perfomed. With regard to Hunt-Hess grades, number of episodes of occlusion, duration of temporary clip application lasting less than 13 minutes, and period of post-subarachnoid hemorrhage, no significant differences were seen between the two groups. Patients in whom barbiturate burst was suppressed showed a 4-hours delay in mean anesthetic recovery time, and after thiopental sodium was injected intravenously, systolic and mean arterial pressure(MAP), averaging 10-20mmHg, were lowered than in those without this suppression. In conclusion, we had found that under mild hypothermic anesthesia involving less than 13 minutes of temporary vessel occlusion, protection of the brain by barbiturate was not beneficial.
Anesthesia ; Anesthesia, General ; Aneurysm* ; Brain* ; Hemorrhage ; Humans ; Hypothermia* ; Infarction ; Ischemia ; Isoflurane ; Retrospective Studies ; Rupture ; Scalp ; Sodium ; Stroke ; Thiopental

dontoid fractures have been treated either conservatively or by surgical fixation, and whether one method is better than the other is still controversial. Because it more effectively overcomes the problems of fracture instability and nonuinon, operative stabilization is now favored over external immobilization for the treatment of Type IIodontoid fractures. Most surgical stabilizations of such fractures use posterior cervical wiring techniques with C1-C2 arthrodesis; these, however, obliterate the rotation and flexion/extension of the atlantoaxial complex,and in Type II-P fractures, provide little resistance to further posterior subluxation. As no arthrodesis is performed, direct anterior screw fixation of odontoid fractures theoretically stabilizes the atlantoaxial complex and preserves its motion. Between January 1993 and December 1996, we performed eleven anterior screw fixations in patients who had suffered odontoid fractures(Type II, III); these were postoperatively followed up for an average of 27 months. Excepet for two cases of permissible malunion, thought to be due to fixation on a partially reduced state, all eleven cases showed firm union at the fracture site, with no significant disabilities and complications. The results indicate that in odontoid fracture reduction and eventual fracture union, the outcome of anterior screw fixation is excellent; there is, in addition, no decrease in cervical motion, a disadvantage inherent in currently accepted methods of treatment.
Arthrodesis ; Humans ; Immobilization ; Prognosis

During a six-year period, 15 cases of "Talk and Deteriorate"patients who were suffering from delayed traumatic intracerebral hematoma(DTICH) were found retrospectively among 1055 patients with head injuries. All fifteen had suffered initial mild head injury(GCS score, 13-15), and apoplectic events or progressive neurological deficits(GCS<8) requiring surgical intervention developed within 72 hours. Subsequent CT scanning showed worsening of the original contusional lesion in ten cases, new hematoma in six, and new lesion(contusion, ischemia and/or edema) in five. cases. The most common location of DTICH was the frontal lobe(11 cases) and the most common cause of injury was a fall(10 cases). The condition of most of these patients could not be predicted, and there was no clear evidence of secondary insults such as hypoxia, hypotension, anemia, or hypercarbia, but hyperglycemia and coagulopathy were seen. Our results demonstrated that in spite of an initially high GCS score, patients who had been injured during a fall and on initial CT scan showed frontal lobe hemorrhagic contusion and/or swelling should be observed closely for at least three days after the injury. Among patients in the "Talk and Deteriorate"group whose condition was caused by DTICH, early diagnosis and aggressive treatment may be the most important life-saving management strategy.
Anemia ; Anoxia ; Contusions ; Craniocerebral Trauma ; Early Diagnosis ; Frontal Lobe ; Head ; Hematoma* ; Humans ; Hyperglycemia ; Hypotension ; Ischemia ; Retrospective Studies ; Tomography, X-Ray Computed

In order to determine the advisability of surgical intervention, 61 patients aged 66 or over and 481 patients aged 65 or less, who during the five-year period January, 1991 to December, 1995 had undergone surgery for aneurysmal subarachnoid hemorrhge, were retrospectively analysed in terms of clinical characteristics, operative outcome and factors affecting it, and were compared. The overall female to male sex ratio was 1.6: 1 while(1.49: 1 in the younger group and 3.36: 1 in the older group), showing a female preponderance with increasing age. Hunt-Hess admission grades I and II accounted for 61.1% of the younger and 44% of the elderly group. Between the two groups, there was no significant difference in the site of aneurysms, but those measuring 12 to 24mm were more frequently found in the elderly(29.5%) than in the younger group(16%; p<0.05). The incidences of rebleeding and symptomatic vasospasm were not different between the two groups but there was an increased incidence of hydrocephalus in the older group(19.7% versus 8.1% for the younger group)(p<0.05). Favorable outcome, defined according to the Glasgow outcome scale as good recovery or moderately disabled, was 84.2% for the younger group and 72.2% for the elderly group but surgical outcome did not differ according to preoperative grade. The major causes of disability and death were the direct effect of bleed(7%) and rebleeding(7%) in the younger group , and operative complications(14.7%), medical complications(11.5%) in the elderly group. The less favorable outcome among elderly patients was attributed to their poorer admission grades and greater frequency of initial intracerebral hemorrhage. We conclude that for elderly patients presenting with good admission grades and general condition, an aggressive approach with surgical treatment with regard to intraoperative hemodynamic fluctuations and preexisting conditions is indicated.
Aged* ; Aneurysm* ; Cerebral Hemorrhage ; Female ; Glasgow Outcome Scale ; Hemodynamics ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm ; Male ; Preexisting Condition Coverage ; Retrospective Studies ; Sex Ratio ; Subarachnoid Hemorrhage*

Cognitive evoked potential(CEP) is the result of endogenous brain response following cognitive stimulus. There are several kinds of waves, including N1, P2, P3 and slow, but only P3 has wide clinical application. In order to obtain normal data, we studied CEP in 174 normal Koreans using the odd-ball paradigm, and our results concerning the latencies and amplitudes of P3 waves, and their relation to age., were were as follows: 1) The average latency of P3 waves of Fz, Cz and Pz was 332.95, 333.34 and 333.66 msec, respectively, in those aged over 60, P3 latency was more delayed than in other age groups. 2) Among teenager, the average latency of P3 waves of Fz, Cz and Pz decreased by 8.35, 9.58 and 9.58msec/year, respectively, but among those aged over 20, increased by 0.87, 0.90 and 0.91msec/year, respectively. 3) The average amplitude of P3 waves of Fz, Cz and Pz was 14.41, 15.37 and 15.12uV, respectively, and in those aged over 60, P3 amplitude showed a greater decrease. 4) The average amplitude of P3 waves of Fz, Cz and Pz decreased by 0.31, 0.32 and 0.23 uV/year in those aged under 29, decreased by 0.65, 0.63 and 0.67uV/year in those over 50, but was stationary in those aged 30 to 49. 5) Due to wide variation and poor constancy, the amplitude of P3 waves does not appear to be especially useful for initial evaluation of cognitive function; it may, however, be useful for follow-up evaluation of a single subject. For each age group, relatively constant P3 latency data can be obtained, and for the evaluation of cognitive function, P3 waves could therefore be useful.
Adolescent ; Brain ; Evoked Potentials* ; Follow-Up Studies ; Humans ; Reference Values*

This study examined the responses of cultured adult rat trigeminal ganglion neurons to protons and to capsazepine and piperine, two substances known to produce pain and hyperalgesia in humans. Whole-cell patch clamp recordings were performed on cultured adult rat trigeminal ganglion(TG) neurons voltage-clamped near their resting membrane potential(-60mV). Piperine(10nM) caused a sustained inward current associated with either an increase or decrease in membrane conductance. When protons and piperine were coapplied, the membrane currents evoked in piperine-sensitive TG neurons far exceeded the algebraic sum of the responses to the two stimuli applied in isolation. Capsazepine blocked the response of TG neurons to piperine at both physiological and acidic pH. In the presence of capsazepine, responses to the mixture of piperine and protons resembled the response to a low pH stimulus applied alone. Capsazepine had no effect on sustained proton-induced current. These findings suggest that protons enhance piperine current by altering the vanilloid receptor/channel complex or by increasing the length constant of the space clamp. This study reveals that cultured trigeminal ganglion neurons show features of chemonociceptors and may provide a useful model for studying the mechanism of chemical pain production.
Adult ; Animals ; Humans ; Hydrogen-Ion Concentration ; Hyperalgesia ; Membranes ; Neurons* ; Protons ; Rats* ; Trigeminal Ganglion*

Gerstmann syndrome that was caused by a traumatic origin was very rare. We have reported a case of typical Gerstmann syndrome which was caused by a localized head injury. The case showed finger agnosia, right-left disorientation, acalculia and dysgraphia. And also the case revealed amnesic dysphasia and autotopagnosia. The lesion was an egg-shell typed depressed fracture(4 cm in diameter) of the left inferior parietal bone associated with the intracerebral hematoma in the lower parietal lobe which seemed to be the transitional area of the angular gyrus and the second occipital convolution.
Agnosia ; Agraphia ; Aphasia ; Craniocerebral Trauma ; Dyscalculia ; Gerstmann Syndrome* ; Hematoma ; Parietal Bone ; Parietal Lobe