The Currarino triad is a unique complex of congenital caudal anormalies including anorectal malformation, sacral bony abnormality, and presacral mass. Histologically the presacral mass has been identified as a meningocele, teratoma, enteric duplication or a combination of this. A Case of female infant with this triad was presented and was successfully treated by surgery. The presacral mass was a lipomyelomeningocele. The clinical features, unique radiologic findings, and importance of a correct diagnosis of currarino triad were reviewed.
Diagnosis ; Female ; Humans ; Infant ; Meningocele ; Teratoma

The authors analysed 140 cases of subdural hygroma developed after head injury and various neurosurgical operations and was treated at Hanyang university hospital from 1983 to 1989. The results were analysed and summarized as follows. 1) The peak incidence was the age over 50 and under 10. 2) 104 cases(74.4%) were bilateral frontotemporoparietal lesions. 3) Causes were head injury(121 cases), operation for intracranial aneurysms(5 cases), ventriculoperitoneal shunt(5 cases), traumatic(2 cases), external ventricular drainage(1 case). 4) Change in mental status without focal sign of brain damage was presenting symptom. 5) Operation was underwent if 63 cases and the reaccumulation rate was high (26.8%) after trephination but outcome was favorable. 6) Mortality rate in traumatic subdural hygroma was low(5.8%) because brain CT could detect subdural hygroma easily in early stage.
Brain ; Craniocerebral Trauma ; Head ; Incidence ; Mortality ; Subdural Effusion* ; Trephining

A technique combining usual interlaminar approach and paraspinal intertransverse approach for exposing far-lateral disc herniations without disrupting the facet is described. This approach is useful because disc fragments can be removed from both intraspinal and paraspinal route with easy retraction and under short skin incision. This approach prevents reherniation by complete removing of residual nucleus pulposus. At the end of procedure the foramen can be explored in order to verify that foramen is opened. This approach is usuful especially in operating the double herniations and extruded far lateral disc herniations.
Skin

OBJECTIVE: The clinical uses of screws are increasing with broader applications in spinal disorders. When screws are inserted repeatedly to achieve optimal position, tips of screw pitch may become damaged during insertion even though there are significant differences in the moduli of elasticity between bone and titanium. The effect of repeated screw insertion on pullout resistance was investigated. METHODS: Three different titanium screws(cortical lateral mass screw, cancellous lateral mass screw and cervical vertebral body screw) were inserted into the synthetic cancellous material and then extracted axially at a rate of 2.4mm/min using Instron(Model TT-D, Canton, MA). Each set of screws was inserted and pulled out three times. There were six screws in each group. The insertional torque was measured with a torque wrench during insertion. Pullout strength was recorded with a digital oscilloscope. RESULTS: The mean pullout force measurements for the cortical lateral mass screws(185.66N+/-42.60, 167.10N+/-27.01 and 162.52 N+/-23.83 for first, second and third pullout respectively: p=0.03) and the cervical vertebral body screws(386.0N+/-24.1, 360.2N+/-17.5 and 330.9N+/-16.7: p=0.0024) showed consecutive decrease in pullout resistance after each pullout, whereas the cancellous lateral mass screws did not(194.00N+/-36.47, 219.24N+/-26.58 and 199.49N(36.63: p=0.24). The SEM after insertion and pullout three times showed a blunting in the tip of the screw pitch and a smearing of the screw surface. CONCLUSIONS: Repetitive screw insertion and pullout resulted in the decrease of pullout resistance in certain screws possibly caused by blunting the screw tip. This means screw tips suffer deformations during either repeated insertion or pullout. Thus, the screws that have been inserted should not be used for the final construct.
Elasticity ; Titanium ; Torque

The authors describe a case with an uneventful outcome following prolonged temporary arterial occlusion during surgery for an aneurysm of the dorsal internal carotid artery(ICA). It has been shown that in various situations arising during aneurysm surgery, temporary arterial occlusion effectively prevents a premature rupture. It is not possible, however, to predict beforehand what the permissible occlusion time for any individual patient might be. During dissection of a blister aneurysm of the ICA, premature rupture developed, and intermittent temporary occlusion of the ICA, which lasted for about 150 minutes, was then undertaken. In addition, intraoperative neuroprotection was effected in several ways, including intermittent reperfusion and the administration of mannitol, thiopental sodium and steroid. There were no significant postoperative neurological deficits. To the authors' knowledge, this report is unusual in that it documents prolonged temporary occlusion without major neurological sequelae in intracranial aneurysm surgery. Permissible temporary occlusion time and neuroprotective methods are also discussed.
Aneurysm* ; Blister ; Carotid Artery, Internal* ; Humans ; Intracranial Aneurysm ; Mannitol ; Reperfusion ; Rupture ; Thiopental

There is an increasing tendency to use three dimentional computed tomographic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCA), CTA and received aneurysmal surgery, all together. Original spiral CT images were studied with helical CT scanner with 120ml of non-ionic contrast material, 3ml/sec injection rate, 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with diting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There were 3 cases(12%) of false negatives in both MIP and SSD images among the ottal 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick, reliable and relatively simple diagnostic tool or screening of intracranial aneurysms, and superior to CCA in evaluating configuration, direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm, calcification, neck shape and adjacent vascular anatomy. On the other hand, the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the external configuration and for planning of surgery.
Aneurysm ; Diagnosis* ; Hand ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Neck ; Silver Sulfadiazine* ; Tomography, Spiral Computed

There is an increasing tendency to use three dimentional computed tomographic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCA), CTA and received aneurysmal surgery, all together. Original spiral CT images were studied with helical CT scanner with 120ml of non-ionic contrast material, 3ml/sec injection rate, 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with diting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There were 3 cases(12%) of false negatives in both MIP and SSD images among the ottal 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick, reliable and relatively simple diagnostic tool or screening of intracranial aneurysms, and superior to CCA in evaluating configuration, direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm, calcification, neck shape and adjacent vascular anatomy. On the other hand, the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the external configuration and for planning of surgery.
Aneurysm ; Diagnosis* ; Hand ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Neck ; Silver Sulfadiazine* ; Tomography, Spiral Computed

No abstract available.

A 6-year old boy was admitted with high fever and redness of the right eyelids and the surrounding area. He had previously suffered cerebral contusion, basal skull fracture and pneumocephalus following a traffic accident which required six months' hospitalization. Since then, and prior to admission, he had twice suffered probable bacterial meningitis and had been treated at an outstanding hospital. At the time of this admission, the patient again developed high fever, with redness of the right eyelid and surrounding area. His symptomatology suggested bacterial meningitis and cerebrospinal fluid culture revealed Streptococcus pneumoniae sensitive to penicillin. In accordance with the clinical course of meningitis and accompanying sinusitis, the appropriate antibiotic and its duration of usage were determined. Recurrent episodes of bacterial meningitis in this child raised the possibility of anatomical defect as an a contributory factor. Computerized tomographic(CT) cisternography suggested leakage of cerebrospinal fluid and revealed herniated frontal brain tissue protruding through a gap in the right frontal skull base, three dimensional CT(3-D CT) confirmed this defect, which was 3X4cm in size. After recovery from meningitis, surery to prevent recurrent meningitis, was performed. To locate pathologic areas, the subfrontal approach,involving bicoronal skin incision and bifrontal bone flap was used. Multiple fracture lines and a large bony defect on the orbital roof were observed, together with a dural defect, through which cerebromalatic tissue was herniated as encephalocele. Using lyophilized dura, the dural defect was made watertight; the bony defect was packed with autologous fats and covered with titanium mesh. The patient improved after surgery. Recurrent meningitis with anatomical pathologic focus after head trauma requires surgical intervention.
Accidents, Traffic ; Brain ; Cerebrospinal Fluid ; Child ; Contusions ; Craniocerebral Trauma ; Encephalocele ; Eyelids ; Fats ; Fever ; Hospitalization ; Humans ; Male ; Meningitis* ; Meningitis, Bacterial ; Orbit* ; Penicillins ; Pneumocephalus ; Sinusitis ; Skin ; Skull Base ; Skull Fractures* ; Skull* ; Streptococcus pneumoniae ; Titanium

Twenty five consecutive patients requiring reoperation due to hemorrhage following surgery for intracranial hematoma removal were identified in a retrospective review of 211 cases of traumatic intracranial lesions treated at our hospital between January 1990 and December 1994. In cases involving head injury, reoperation is nowadays not uncommon. The incidence of cases requiring reoperation was 11.8%, while delayed or recurrent lesions were more common among older patients(mean age=44.39 years). Acute subdural hemorrhage was the most common initial lesion requiring reoperation: in intracerebral and acute subdural hemorrhage, the incidence of reoperation was relatively high(23.1% and 14.7%, respectively): acute epidural hemorrhage was next most common(8.8%). In 88.0% of cases, reoperation was performed within 24 hours. At the time of discharge, good recovery was reported in five cases(20.0%), moderate disability in ten(40.0%), severe disability in two(8.0%), vegetative state in two(8.0%) and death in six(24.0%). The outcome seems to be related to lesions requiring reoperation rather than initial lesions. Furthermore, closed observation and aggressive management can rapidly improve the outcome, even in patients requiring reoperation: it is, in addition, of the utmost importance that CT scans be used early and repeatedly, especially in patients who are at risk of delayed or recurrent lesions.
Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Traumatic* ; Intracranial Hemorrhages* ; Persistent Vegetative State ; Postoperative Hemorrhage ; Reoperation* ; Retrospective Studies ; Tomography, X-Ray Computed