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A Clinical Analysis of Surgically Managed Tuberculous Spondylitis.

Yeong Hyeon KIM ; Jin Kyu SONG ; Ho SHIN

Journal of Korean Neurosurgical Society.1997;26(2):223-234.

Fourty three patients with tuberculous spondylitis were surgically treated through the anterior approach at our hospital from January, 1989 to December, 1994. Among them, 32 cases were followed up more than 18 months postoperatively, and were included in this study. The most prevalent location was lumbar region(50%). Paraparesis was frequently seen in patients with middle and lower thoracic spinal lesions and all patients with neurologic deficits improved after decompression of spinal cord. Autogenous rib and/or iliac strut bone grafting was performed, followed by spinal instrumentation. Solid bone fusion was obtained in all patients. There was no need for prolongation of duration of antituberculous drug therapy and no increased incidence of secondary infection due to spinal instrumentation.
Bone Transplantation ; Coinfection ; Decompression ; Drug Therapy ; Humans ; Incidence ; Neurologic Manifestations ; Paraparesis ; Ribs ; Spinal Cord ; Spondylitis*

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Management of Poor-grade Patients with Ruptured Intracranial Aneurysm.

Hyeon Seon PARK ; Yong Sam SHIN ; Seung Gon HUH ; Kyu Chang LEE

Journal of Korean Neurosurgical Society.1997;26(2):215-222.

To formulate treatment strategies for poor-grade patients after aneurysmal subarachnoid hemorrhage(SAH), medical records were analyzed for 166 patients who were in Hunt and Hess grade IV or V among 588 consecutive aneurysmal SAH patients admitted during the past 5 years. Causes for unfavorable outcome(poor or dead) in these 166 patients were carefully evaluated to improve the management outcome. Overall management results were favorable(good or fair) in 71(42.8%), and unfavorable in 95(78 dead, 17 poor). Direct clipping was performed in 90 patients, and the surgical results were favorable in 69(76.7%) and unfavorable in 21(23.3%). Surgery was not performed in 76 patients because of moribund state on arrival in 41, neurological deterioration due to rebleeding in 15, massive brain swelling in seven, serious medical illness in five, severe delayed ischemic deficit in one, and massive cerebral infarction following angiography in one, and refused surgery in six. Seven patients survived from non-surgery group(2 fair, 5 poor). Direct effects of aneurysm rupture(34.8%) and early rebleeding(34.8%) were the causes of unfavorable outcome in grade IV patients, while it was direct effect of aneurysm rupture(91.8%) in grade V patients. It is suggested that since rebleeding is the only preventable factor of unfavorable outcome, urgent management seems necessary to prevent rebleeding, especially for grade IV patients. Grade IV patients should be treated aggressively with direct clipping for non-complex aneurysms or for patients with hematoma, and with coil embolization for complex aneurysms without hematoma.
Aneurysm ; Angiography ; Brain Edema ; Cerebral Infarction ; Embolization, Therapeutic ; Hematoma ; Humans ; Intracranial Aneurysm* ; Medical Records

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Comparative Analysis of Results by Operative Approaches for Thoracolumbar or Lumbar Fractures.

Byung Gil WOO ; Chan Youl PARK ; Oh Lyong KIM ; Seong Ho KIM ; Jang Ho BAE ; Byung Yon CHOI ; Soo Ho CHO

Journal of Korean Neurosurgical Society.1997;26(2):208-214.

A retrospective study of 100 cases with thoracolumbar fractures was performed to compare the results from different surgical approaches and to provide a guide line for surgical treatment. Fifty-three patients were operated through anterior approach and forty-two patients were through posterior approach. All patients were evaluated according to changes in the following parameters: kyphotic angles, compression heights, degrees of canal compromise, neurologic deficits, pain levels, delayed kyphosis and complications. There were no significant differences in kyphotic angles, compression heights, degrees of canal compromise, neurologic deficits, and pain levels between two approaches. Delayed kyphosis occurred in one(2.4%) of 42 cases treated by posterior approach and six(11.3%) of 53 cases treated by anterior approach. Dural lacerations were noted in fourteen(43.8%) of 32 cases associated with lamina fractures and were repaired in all of nine cases approached posteriorly but none of five cases approached anteriorly. In conclusion, posterior approach is simple, less extensive, is associated with lower incidence of delayed kyphosis and better dural repair than the anterior approach. Posterior approach could be, therefore, considered initially for those cases where surgery is indicated for thoracolumbar or lumbar fractures.
Humans ; Incidence ; Kyphosis ; Lacerations ; Neurologic Manifestations ; Retrospective Studies

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Radioisotope Cisternographic Analysis of Post-operative Subdural Hygroma after Aneurysmal Surgery.

Byung Gil WOO ; Byung Yon CHOI ; Seong Ho KIM ; Jang Ho BAE ; In Ho CHO ; Oh Lyong KIM ; Soo Ho CHO

Journal of Korean Neurosurgical Society.1997;26(2):202-207.

Authors analyzed the post-operative subdural hygroma using radioisotope(RI) cisternography in 30 cases following aneurysmal surgery with pterional approach from October, 1995 to March, 1996. Age, CSF flow from basal cisterns, and etent of opening of Liliequist's membrane during operation were significantly related to the development of post-operative subdural hygroma. Computed tomography(CT) scan of brain and RI cisternography were performed in all patients at three weeks following operations. RI diffusion time from the interpeduncular cistern to the cerebral convexity of ipsilateral side with surgically opened Liliequist's membrane was compared with contralateral nonoperated normal side. Diffusion time of ipsilateral side(mean 5.2+/-8.4hr) was faster than that of contralateral one. Age, cerebrospinal fluid(CSF) from basal cistern, and extent of opening of Liliequist's membrane during operation were significantly related to development of post-operative subdural hygroma. Development of subdural hygroma after pterional approach for aneurysmal operations in our series is believed to be caused by stagnation of CSF in the convexity until its absorption into the arachnoid villi. Increased CSF flow from the infratentorial space to the supratentorial space through extensively opened Liliequist's membrane is considered to contribute development of its formation.
Absorption ; Aneurysm* ; Arachnoid ; Brain ; Diffusion ; Humans ; Membranes ; Subdural Effusion*

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Deep Hypothermia and Circulatory Arrest in the Giant MCA Aneurysm Surgery.

Maeng Ki CHO ; Jung Nam SUNG

Journal of Korean Neurosurgical Society.1997;26(2):196-201.

Despite significant advances in neurosurgical and neuroanesthetic techniques, certain lesions such as giant aneurysms still present significant challenge to neurosurgoens. The authors experienced a case of giant MCA bifurcation aneurysm surgery using a technique of deep hypothermia and circulatory arrest with excellent outcome. Cannulation for cardiopulmonary bypass can be done either centrally through a sternotomy(aortic-right atrial), or peripherally through a small inguinal incision(femoral-femoral). In our case, femoral-femoral cannulation was done which can eliminate many serious complications following the sternotomy. The rationale for the application of the deep hypothermia and circulatory arrest in the complex intaracranial aneurysm surgery and the benefits of the femoral cannulation are disccused.
Aneurysm* ; Cardiopulmonary Bypass ; Catheterization ; Hypothermia* ; Sternotomy

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Clinical Analysis of Subarachnoid Hemorrhage with Intraventricular Hemorrhage due to Aneurysmal Rupture.

Myung Hun HYUN ; Kwang Myung KIM ; Kwang Hum BAK ; Hyung Shik SHIN ; Jae Min KIM ; Young Soo KIM ; Yong KO ; Seong Hoon OH ; Suck Jun OH ; Nam Kyu KIM

Journal of Korean Neurosurgical Society.1997;26(2):191-195.

Eventhough the morbidity and mortality rate of subarachnoid hemorrhage(SAH) due to aneurysmal rupture has dramatically decreased, SAH associated with intraventricular hemorrhage(IVH) still shows a high mortality rate. Among total of 419 patients with SAH due to aneurysmal rupture, 43 cases were associated with IVH. Authors conducted a retrospective study on these cases based on age, sex, Hunt-Hess grade, location of aneurysm, presence of intracerebral hematoma(ICH), ventriculocranial ratio, method of treatment, and final outcome. Results were as follows; 1) In patients associated with IVH, initial mental status was poor. 2) Worse the initial mental status, worse the final outcome. 3) A higher mortality rate was associated with those patients with ICH. 4) Severe ventricular enlargement was associated with increased mortality rate. We believe that a better prognostic outcome would result if aggressive therapeutic methods such as ventriculostomy, basal cistern irrigation as well as lamina terminalis opening, are performed.
Aneurysm* ; Hemorrhage* ; Humans ; Hypothalamus ; Mortality ; Prognosis ; Retrospective Studies ; Rupture* ; Subarachnoid Hemorrhage* ; Ventriculostomy

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Medulloblastoma and Primitive Neuroectodermal Tumors: Clinical and Molecular Biological Analysis and Prognosis.

Moon Jun SOHN ; Sang Ryong JEON ; Jae Hee SEO ; Jung Hoon KIM ; Young Shin RA ; Jung Kyo LEE ; In Chul LEE ; Byung Duk KWUN

Journal of Korean Neurosurgical Society.1997;26(2):178-190.

Primitive neuroectodermal tumors(PNETs) and medulloblastoma are common primary malignant brain tumors of childhood. Untreated patients are proven to be fatal, but the current treatment regimens may achieve 50% to 60% cures. However, the prognosis of each individual case can not be accurately determined, because exact prognostic factors have not been established. The aim of this study was to investigate whether various factors were correlated with clinical outcome, and to understand their roles in the oncogenesis. Twenty-five patients with medulloblastoma and nine patients with supratentorial PNETs were reviewed(mean follow-up periods: 25.6 months). We have investigated the prognostic value of p53 protein and other oncogene expression by immunohistochemistry and DNA analysis by flow cytometry on paraffin section of the specimen. We also studied the other prognostic factors such as clinical features, tumoral factors, and treatment modalities as well. The positive expressions of p53 protein, c-myc, and pan-ras were significantly high in these tumors. With DNA flow cytometry, 18 were aneuploid and 8 were diploid. There was no significant prognostic correlation between the immunoreactivity of p53, oncogene expression, and DNA ploidy. Only the stage of tumor(T, M stage; p=0.0002, 0.0418, respectively) and chemotherapy(p=0.0433) were correlated with their prognosis. We conclude that further special investigations should be added to justify the prognostic factors for these highly malignant tumors.
Aneuploidy ; Brain Neoplasms ; Carcinogenesis ; Diploidy ; DNA ; Flow Cytometry ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Medulloblastoma* ; Neural Plate ; Neuroectodermal Tumors, Primitive* ; Oncogenes ; Paraffin ; Ploidies ; Prognosis*

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Acute Sciatica from Sacral Screw Impingement on the Lumbosacral Plexus: Emphasis on the Safe Zones for Sacral Screw Placement.

Jae Won DOH ; Bark Jang BYUN ; Edward C BENZEL

Journal of Korean Neurosurgical Society.1997;26(2):173-177.

The authors present the case of sciatica due to bicortical sacral screw impingement on the lumbosacral plexus across the anterior sacrum. The placement of sacral screw across the anterior sacral cortex carries significant inherent risks to neurovascular and visceral structures. However, the clinical reports of lumbosacral plexus involvement by the misplaced screw are not well documented in the literature. This is an unique case of sciatica due to sacral screw impingement on the lumbosacral plexus after motor vehicle accident(MVA), and confirmed by CT scan and intraoperative electrical stimulation. We reviewed sacral anatomy and preventive measures for avoiding complication of this type are discussed.
Electric Stimulation ; Lumbosacral Plexus* ; Motor Vehicles ; Sacrum ; Sciatica* ; Tomography, X-Ray Computed

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Differentiation of Cerebral Radiation Necrosis from Tumor Recurrence in Patients with Malignant Gliomas Using 18F-FDG Positron Emission Tomography.

Hee Won JUNG ; Sun Ha PAEK ; Dong Gyu KIM

Journal of Korean Neurosurgical Society.1997;26(2):165-172.

The authors evaluated the usefulness of the positron emission tomography(PET) with fluorine-18-fluorodeoxy-glucose(18F-FDG) in diagnosing tumor recurrence and differentiating it from radiation necrosis following external beam irradiation of malignant gliomas. Patients were studied from the time they had first exhibited either clinical or radiological deterioration after an initial period of posttreatment stabilization. Ten studies were performed in ten patients, and 18F-FDG uptake by the lesion was then compared to uptake by adjacent normal gray matter. Four of ten cases demonstrated newly enhanced lesions on magnetic resonance imaging(MRI) and hypermetabolic foci in the PET examinations. All of these patients were diagnosed as tumor recurrence either clinically or histologically, during follow up period of the patients' progress. The remaining six cases had newly enhanced lesions on MRI and hypometabolic foci in the PET studies; five of them were diagnosed as radiation necrosis, but one lesion (0.8cm in diameter) was diagnosed clinically as a tumor recurrence. The overall accuracy of the PET study in differentiating the tumor recurrence from radiation necrosis was 90% and the sensitivity for detection of recurrence 80%. The authors conclude that the PET study with 18F-FDG is useful in differentiating the tumor recurrence from radiation necrosis in patients with malignant glioma and could be used to select the group of patients who may have benefits from antitumor therapy.
Electrons* ; Fluorodeoxyglucose F18* ; Follow-Up Studies ; Glioma* ; Humans ; Magnetic Resonance Imaging ; Necrosis* ; Positron-Emission Tomography* ; Recurrence*

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Lateral Orbitotomy of Intraorbital Tumor: Case Report.

Tae Sung KIM ; Sheung Jin LIM ; Bong Arm RHEE

Journal of Korean Neurosurgical Society.1980;9(2):653-657.

We experienced one case of lateral orbitotomy(Berke's operation) in intraorbital tumor. We performed diagnostic studies for tumor location and vasculature in relation to eyeball and optic nerve, ie, orbital CT and orbital venogram. Tumor mass located in superior lateral region of orbit. Tumor mass was removed completely and successfully through 35 mm lateral skin incision.
Optic Nerve ; Orbit ; Skin

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