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

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

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

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*

The interactive image-guided stereotactic system can provide a real-time surgical localization and guidance for complete removal of the tumor. However, this system has limitation with respect to the resection of deepseated tumors because once the tumor is removed, the brain and the margin of tumors shift toward the area previously occupied by the tumor. We present a new operative technique for determining the resection margin of deep-seated tumors using a visual marker called a 'tailed bullet' to overcome the problem mentioned above. Preoperative enhanced computed tomograms or magnetic resonance imagings were performed with the aid of the Leksell frame. The enhancing margin of the tumor was defined as a resection margin. Several points(10-15) of the tumor margin on the enhanced imaging were chosen and localized. After usual craniotomy, multiple tailed bullets were inserted into the target point just before the opening of the dura. As the tumor was removed, the brain began to move along with the tailed bullets, thus enable us to continue tracking the tumor margin by following the bullet's location. There are substantial benefits of this surgical technique. It can be easily applied to any kind of stereotactic frame without incurring other expenses and it is more cost-efficient than the neuronavigation system. This surgical procedure is also safe and simple to use for overcoming the limitation of neuronavigation system, since the movement of the bullets with the brain can be easily traced thus lowering the mortality and morbidity of brain tumor resection. This surgical technique is especially useful in glioma surgery.
Brain Neoplasms* ; Brain* ; Craniotomy ; Glioma ; Mortality ; Neuronavigation