No abstract available.
Brain Neoplasms* ; Brain* ; Humans ; Immunocompetence*

No abstract available.
Social Workers

Intracranial lipomas are rare tumor which are usually found along the midline cerebral cisterns. A case of sylvian lipoma located usually at sylvian fissure was diagnosed by CT scanning and was confirmed with operation. Only partial resection could be done. The literature was reviewed and therapeutic options are proposed.
Corpus Callosum ; Lipoma* ; Tomography, X-Ray Computed

An experimental model was devised to elucidate the role of spinal blockade in post-traumatic syringomyelia. 38 White adult rabbits were divided into four groups:in Group 1, eight animals received traumatic injury only to the midthoracic area via the weight-drop method but no further treatment;in Group 2, 12 animals received a traumatic injury following injection of 100mg kaolin suspended in 1cc normal saline into subarachnoid space at the midthoracic trauma level;in Group 3, nine animals received traumatic injury following injection of 200mg kaolin in 1cc of normal saline into subarachnoid space;in Group 4, nine animals without injury received an injection of 00mg kaolin in 1cc normal saline solution into subarachnoid space at the midthoracic level. The subjective criteria for syrinx formation were the presence of a definite round cyst having a smooth margin and an upper or lower extension of more than 2cm from the injured site. Syrinx formation was seen in 12.5% in Group 1, 41.7% in Group 2, 55.5% in Group 3 , and 0% in Group 4(p<0.05). In subarachnoid space, the specimen of trauma and kaolin groups showed neutrophils infiltration and obstruction of subarachnoid space on acute stage. The pathologic changes in subarachnoid space on chronic stage were infiltration of kaolin-laden macrophages and chronic arachnoiditis. In parenchyma, hemorrhagic necrosis of the cord, edema, microinfarcts and liquefaction of hematoma were found on acute stage, and multiple cysts in white mater, cell-debris-laden macrophages in the cyst, formation of foam cells, microcysts, and large yst were shown. In Group 4, the same findings as other groups were shown in the subarachnoid space, but in the parenchyma there was no cyst formation. The results suggest that subarachnoid block secondary to adhesive arachnoidities is important in initiating the extension of the syringomyelia cavity that have already formed at the time of initial injury.
Adhesives ; Adult ; Animals ; Arachnoid ; Arachnoiditis ; Edema ; Foam Cells ; Hematoma ; Humans ; Kaolin ; Macrophages ; Models, Theoretical ; Necrosis ; Neutrophil Infiltration ; Neutrophils ; Rabbits ; Sodium Chloride ; Subarachnoid Space ; Syringomyelia*

Although the operation for the ventral lesion of craniovrtebral junction and atlantoaxial area is considered difficult to perform, the transoral approach made it safer and easier. The authors report 10 cases(9 patients) treated by the transoral approach for the lesion of craniovertebral junction over the past 13 years at the Ajou University Hospital and the Presbyterian Medical Center. Of these 10 cases, there were 4 odontoid type II fractures, 1 atlantoaxial dislocation, 1 os odontoideum, 1 chordoma at lower clival area, 1 rheumatoid arthritis, 1 epidural abscess and 1 wound revision due to slippage of grafted bone after clivoaxial fusion. The surgical methods included 4 cases of anterior decompression and clivoaxial fusion, 2 cases of anterior decompression and C1-2 interarticular joint fusion, 1 case of anterior decompression and clivoaxial fusion followed by posterior fusion, and 3 cases of anterior decompression and posterior fusion. In nonreducible atlantoaxial dislocation or ventral cord compression le sion, if the clivoaxial angle was less than 120 degree, the transoral approach was selected. The appropriate surgical approach must be selected according to the degree of compression of the neural tissue involving the craniovertebral junction and atlantoaxial dislocation.
Arthritis, Rheumatoid ; Chordoma ; Decompression ; Dislocations* ; Epidural Abscess ; Joints ; Protestantism ; Transplants ; Wounds and Injuries

Essential palmar hyperhidrosis is a disease characterized by excessive perspiration on the palms and hands due to the hyperaction of sympathetic nervous discharge. In severe cases, excessive sweating is seen on the face, axilla, trunk, and soles. Several therapeutic modalities were applied but surgical resection of the sympathetic ganglion is the only curative method. Numerous open surgeries of the thoracic sympathetic ganglia for the treatment of palmar hyperhidrosis have been advocated, but they have also produced several complications. A new therapeutic technique for this disorder has been introduced by combining a thoracoscope and video system. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential palmar hyperhidrosis. This technique is safe and easy. It also reduces the operating time and admission period. It has also very few complications. Compensatory hyperhidrosis on the trunk, back, and thigh, etc. is commonly an unwanted and unsolved complication after thoracic sympathectomy. Through my experience of thoracic sympathectomy, I thought that the incidence of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy. So I restricted the extent of thoracic sympathectomy as a T2 sympathetic ganglion from September 1995. From Mar., 1989 To Aug., 1995, T2, T3 sympathetic ganglionectomies were performed for palmar hyperhidrosis patients and from Sept. 1995 T2 sympathetic ganglionectomies were performed. Using questionnaires, I compared these 2 groups. The results of this study are summarized as follows; 1) Using thoracoscopic transthoracic sympathectomy, operating time, admission period and complications could be reduced. 2) The risk of bleeding during the operation(especially bleeding from the hemiazygous vein) could be reduced in the T2 sympathectomy group. 3) The treatment effect of T2 sympathectomy is no different from T2, T3 sympathectomy for essential palmar hyperhidrosis. 4) The incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than in the T2, T3 sympathectomy group. From the above results, I concluded thoracoscopic transthoracic sympathectomy is the treatment of choice for essential palmar hyperhidrosis and the adequate extent for sympathectomy is T2 sympathetic ganglion.
Axilla ; Ganglia, Sympathetic ; Ganglionectomy ; Hand ; Hemorrhage ; Humans ; Hyperhidrosis* ; Incidence ; Surveys and Questionnaires ; Sweat ; Sweating ; Sympathectomy* ; Thigh ; Thoracoscopes

The transoral approach to anteriorly placed lesions at the upper cervical region is not new, but is still infrequently used by neurosurgeons for lesions in this region. The indications and surgical methods vary widely, and there is much room for discussion of the technical details. We are reporting our experience with this technique in two patients; one is a traumatic odontoid fracture and another is a cervical epidural abscess.
Epidural Abscess* ; Humans ; Microsurgery

Authors reviewed the radiographs and medical records of 85 consecutive patients who underwent chemonucleolysis and percutaneous automated discectomy between May, 1986 and Feb. 1988 at the Dept. of Neurosurgery, Presbyterian Medical Center, Chon-ju, Korea. Among 85 consecutive patients, 48 patients underwent Chemonucleolysis and others underwent PAD using nucleotome. The results showed relatively low success rate of 60.3% in chemonucleolysis and 62.2% in PAD. However in PAD using nucleotome, the favorable selection criteria to define the higher successful rate(70-87.5%) included; 1) in young age group under 30. 2) in the group of no motor and sensory deficits. 3) in spine CT findings, which showed mild disc protrusion and no focal central disc bulging pattern. The better results will be obtained when the careful selection of patients is done and operated technique is more developed.
Diskectomy* ; Humans ; Intervertebral Disc Chemolysis* ; Jeollabuk-do ; Korea ; Medical Records ; Neurosurgery ; Patient Selection ; Protestantism ; Spine

The purpose of this article is to identify and explain the role and effectiveness of nurse practitioners(NPs) in the field of neurosurgery. The role of nurse practitioner has expanded over the past 15 years in the areas of administration, clinical activities, counseling, and surgical assistance. One primary activity of the NPs in our department is the frequent periodic neurological examination and rapid detection of deteriorating critical patients. They also improve the rapport between the patients and neurosurgery service and cover wevere manpower shortage or resident staffs. The department of neurosurgery in the hospital can maintain adequate coverage for the neurosurgical patients without increasing the number of residents. The author believes that NPs can improve the quality of care and outcome in a cost-effective manner. Concerns with acceptance and the role of neurosurgical NPs are clearly no longer on issue.
Counseling ; Humans ; Neurologic Examination ; Neurosurgery ; Nurse Practitioners*

This study was performed to evaluate the effects of a special nursing program on the recovery of patients with spontaneous intracranial hemorrhage, and on the level of satisfaction of their families. The experimental group comprised twenty patients selected from A university medical center, and the control group, nineteen patients selected from B university medical center. Patients with cormorbidity were not included. Between 1 October, 1995 and 30 April, 1996, personnel specialized in neurosurgical nursing provided the experimental group with a special nursing program, while the control group was offered general nursing services. The key elements of this special nursing program were close observation to identify potential risk factors ; crisis intervention to prevent gaps in medical service delivery ; patient-centered care emphasizing early recovery, including specific protocols for the prevention of disability and for rehabilitation ; and patient education and counseling to maximize satisfaction. The average length of stay in ICU, neurological status, functional status, impact of complications, and satisfaction level were measured through medical records, the Glasgow Coma Scale, Functional Independence Measurement, patient assessments, and questionnaires, respectively. These data were analyzed by paired t-test, independent-samples t-test, and ANOVA, and the results were as follows : 1) The average length of stay in ICU of the experimental group was significantly shorter than that of the control group. 2) The degree of neurological recovery of the experimental group between admission and the second week after operation was not significantly different from that of the control group. 3) The impact of complications on the control group was greater than on the experimental group. 4) Between the first and second week after operation, the functional status of the experimental group changed more noticeably than that of the control group. 5) The degree of satisfaction with the nursing services was higher among the families of patients in the experimental group than among the other families. These findings indicate that a special nursing program might improve the recovery of patients with spontaneous intracranial hemorrhage and increase the satisfaction of their families. It is therefore suggested that in order to provide comprehensive medical services to patients with spontaneous intracranial hemorrhage, personnel such as neurosurgical nursing specialist be appropriately utilized. In addition, the current medical insurance fee schedule especially in relation to the cost of rehabilitation, should be adjusted to cover broader services.
Academic Medical Centers ; Counseling ; Crisis Intervention ; Fee Schedules ; Glasgow Coma Scale ; Humans ; Insurance ; Intracranial Hemorrhages* ; Length of Stay ; Medical Records ; Nursing Services ; Nursing* ; Patient Education as Topic ; Patient-Centered Care ; Surveys and Questionnaires ; Rehabilitation* ; Risk Factors ; Specialization