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Delayed Hemorrhagic Manifestation of Blunt Carotid Artery Injury.

Woo Chang LEE ; Kyung Soo MIN ; Young Gyu KIM ; Dong Ho KIM

Journal of Korean Neurosurgical Society.2005;37(6):449-452.

Blunt carotid artery injury is uncommon, yet not rare. However, it is often underdiagnosed because of inconsistent early symptoms or masking by the presence of coexisting brain and spinal injuries. The delay between the accident and the onset of cerebral ischemic symptoms is variable and has been reported to range from minutes to ten years. However, to our knowledge, there has been no report on a case presented with delayed intracerebral hemorrhage 25months after blunt carotid artery injury. We report on a case with discussion of supporting evidence and possible mechanisms.
Brain ; Carotid Arteries* ; Carotid Artery Injuries* ; Cerebral Hemorrhage ; Masks ; Spinal Injuries

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Detection of Differentially Expressed Genes in Glioblastoma by Suppression Subtractive Hybridization.

Na Mi YU ; Jung Yong AHN ; Eun Jin CHOI ; Yong Kil HONG ; Tai Gyu KIM ; Chang Hyun KIM ; Kyu Sung LEE ; Dong Seok KIM ; Jin Kyeoung KIM

Journal of Korean Neurosurgical Society.2005;37(6):443-448.

OBJECTIVE: A variety of genetic alterations in human glioblastoma comprises signal transduction and cell cycle arrest control of cellular processes. Subtractive hybridization is potentially a faster method for identifying differentially expressed genes associated with a particular disease state. Using the technique of subtraction, we isolated novel genes that are overexpressed in glioblastoma tissue as compared to normal brain tissue. METHODS: We evaluated the differential expression of genes in each of hybridizing tester and driver cDNAs to digested 130 clones. After sequencing of 130 clones and homology search, this study performed to determine mRNA expression of the unknown gene, "clone 47", in brain tissue, glioblasoma, and several cancer cell lines by reverse transcription-polymerase chain reaction (RT-PCR). To test the time course for G0-phase arrest, serum stimulation and expression at various times for RT-PCR performed. RESULTS: We identified 23 novel genes by BLAST of the digested 130 clones. The expressions of "clone 47" mRNA of glioblastoma and several cancer lines were significantly higher than normal brain tissues and several normal cell lines. We confirmed the mRNA expression of "clone 47" was up-regulation for 0.5~1hr of WI-38 cell differentiation. CONCLUSION: The novel gene, "Clone 47" is upregulated in glioblastoma tissue and several cancer cell lines. This gene is time dependent activation during time course of serum stimulation. This result suggests that "clone 47" play a role in brain tumorigenesis and the activation of this "clone 47" may be necessary for the development of cancer.
Brain ; Carcinogenesis ; Cell Cycle Checkpoints ; Cell Differentiation ; Cell Line ; Clone Cells ; DNA, Complementary ; Glioblastoma* ; Humans ; RNA, Messenger ; Signal Transduction ; Up-Regulation

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The Surgical Results of Traumatic Subdural Hygroma Treated with Subduroperitoneal Shunt.

Chang Il JU ; Seok Won KIM ; Seung Myoung LEE ; Ho SHIN

Journal of Korean Neurosurgical Society.2005;37(6):436-442.

OBJECTIVE: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. METHODS: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. RESULTS: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. CONCLUSION: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.
Diagnosis ; Empyema, Subdural ; Frontal Lobe ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Pressure ; Lymphangioma, Cystic ; Magnetic Resonance Imaging ; Rabeprazole ; Seizures ; Subdural Effusion*

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Effectiveness of Early Surgery in Children with Traumatic Subdural Hygroma.

Byoung Ook KIM ; Seok Won KIM ; Seung Myung LEE

Journal of Korean Neurosurgical Society.2005;37(6):432-435.

OBJECTIVE: This study was performed to evaluate the usefulness of early operation in children with traumatic subdural hygroma. METHODS: The subjects were nine patients (Glasgow coma scale (GCS) score was below 10 and age was below 10 years old) who developed subdural hygroma after trauma between January 2000 to December 2002. Subduroperitoneal shunt was performed in one group and not performed in the other group. We analyzed the GCS score on admission and at 1 year after operation. Overall clinical results were evaluated retrospectively. RESULTS: Patients who underwent operation exhibited higher GCS scores at 1 year after trauma compared to those in the patients who were treated by conservative therapy(p<0.05). CONCLUSION: The early operation could be an effective treatment to children with subdural hygroma who showed delayed improvement of consciousness and to patients with hygroma that didn't decrease or was above moderate amount.
Child* ; Coma ; Consciousness ; Humans ; Lymphangioma, Cystic ; Retrospective Studies ; Subdural Effusion*

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Radiological Characteristics of Peritumoral Edema in Meningiomas.

Ki Yeul LEE ; Won Il JOO ; Hyung Kyun RHA ; Hae Kwan PARK ; Kyung Jin LEE ; Chang Rak CHOI

Journal of Korean Neurosurgical Society.2005;37(6):427-431.

OBJECTIVES: The purpose of this study is to evaluate the radiological charactersitics related to the formation of peritumoral edema in meningiomas. METHODS: Fifty patients with meningioma were examined by magnetic resonance images and cerebral angiography. The predictive factors associated peritumoral edema, such as, tumor size, peritumoral rim (cerebrospinal fluid cleft), shape of tumor margin, signal intensity of tumor in T2WI, and pial blood supply were evaluated. RESULTS: Tumor size, peritumoral rim and pial blood supply correlated with peritumoral edema on univariate analyses. But in multivariate analyses, pial blood supply was statistically significant as a factor for peritumoral edema in meningioma. CONCLUSION: In our results, pial blood supply is significant contributing factor for peritumoral edema in meningioma.
Cerebral Angiography ; Edema* ; Humans ; Meningioma* ; Multivariate Analysis

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Anterior Cervical Interbody Fusion with the Carbon Composite Osta-Pek Frame Cage in Degenerative Cervical Diseases.

Kwang Wook HAN ; Joon Soo KIM ; Kyu Hong KIM ; Yong Woon CHO ; In Chang LEE ; Sang Do BAE

Journal of Korean Neurosurgical Society.2005;37(6):422-426.

OBJECTIVE: Different types of interbody fusion cages are available for use in the surgical treatment of degenerative cervical diseases. The purpose of this study is to assess the technical feasibility, clinical efficacy and radiological results of intervertebral fusion with a carbon composite Osta-Pek frame cage (Co-Ligne AG, Switzerland) following anterior cervical discectomy. METHODS: 41patients (25males and 16females) with minimum 6months follow-up were included in the study. Disc height, cervical lordotic angle, segmental angle, and fusion rate were assessed by lateral radiographs. In this retrospective analysis, clinical outcome was assessed as evaluated according to Odom's criteria. RESULTS: Fifty-four cages were implanted in 30 single-level, 9 two-level, and 2 three-level procedures. The mean disc height, cervical lordosis angle, segmental angle were 4.2+/-1.8mm, 23.5+/-7.2degrees, 2.3+/-3.3degrees pre-operatively and 5.3+/-2.1mm, 24.2+/-8.3degrees, 3.8+/-3.5degrees at 6months after the surgery. Six months after surgery, there was radiographic evidence of fusion in 92.7% (38/41) of the patients. According to Odom's criteria, 37 of 41 (90.2%) patients experienced good to excellent functional recovery. CONCLUSION: These clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft after anterior cervical discectomy for treatment of degenerative cervical disease.
Animals ; Carbon* ; Diskectomy ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Transplants

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Long-term Follow-up Results of Short-segment Posterior Screw Fixation for Thoracolumbar Burst Fractures.

Yoon Soo LEE ; Joo Kyung SUNG

Journal of Korean Neurosurgical Society.2005;37(6):416-421.

OBJECTIVE: Despite general agreement on the goals of surgical treatment in thoracolumbar burst fractures, considerable controversy exists regarding the choice of operative techniques. This study is to evaluate the efficacy of short-segment fixation for thoracolumbar burst fractures after long-term follow-up and to analyze the causes of treatment failures. METHODS: 48 out of 60 patients who underwent short-segment fixation for thoracolumbar burst fractures between January 1999 and October 2002 were enrolled in this study. Their neurological status, radiological images, and hospital records were retrospectively reviewed. Simple radiographs were evaluated to calculate kyphotic angles and percentages of anterior body compression (%ABC). RESULTS: The average kyphotic angles were 20.0degrees preoperatively, 9.6degrees postoperatively, and 13.1degrees at the latest follow-up. The average %ABC were 47.3% preoperatively, 31.2% postoperatively, and 33.3% at the latest follow-up. The treatment failure, defined as correction loss by 10?or more or implant failure, was detected in 6 patients (12.5%). 5 out of 6 patients had implant failures. 2 out of 5 patients were related with osteoporosis, and the other 2 were related with poor compliance of spinal bracing. 3 patients with poor initial postoperative alignment had implant failure. 4 patients with screws only on the adjacent vertebrae and not on the injured vertebra itself showed poor initial and overall correction. CONCLUSION: With proper patient selection, adequate intraoperative reduction with screw fixation involving the injured vertebra, and strict postoperative spinal bracing, the short-segment fixation is an efficient and safe method in the treatment of thoracolumbar burst fracture.
Braces ; Compliance ; Follow-Up Studies* ; Hospital Records ; Humans ; Osteoporosis ; Patient Selection ; Retrospective Studies ; Spine ; Treatment Failure

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Efficacy of Unilateral Laminectomy for Bilateral Decompression in Elderly Lumbar Spinal Stenosis.

Yong Cheol JI ; Young Baeg KIM ; Sung Nam HWANG ; Seung Won PARK ; Jeong Taik KWON ; Byung Kook MIN

Journal of Korean Neurosurgical Society.2005;37(6):410-415.

OBJECTIVE: The aim of our study is to evaluate the effectiveness of unilateral hemilaminectomy for bilateral decompression in elderly patients with degenerative spinal stenosis. For this purpose, we studied the co-morbid condition and clinical outcome of patients who underwent decompressive surgery using the unilateral approach technique. METHODS: Thirty-four patients over 65years of age who underwent unilateral partial laminectomy for bilateral decompression from January 2000 to October 2003 were analyzed. These patients were studied for preoperative co-morbid condition and physical status according to the American Society of Anesthesiologists(ASA) classification, postoperative morphometrical change, and clinical outcomes, including visual analogue scale(VAS) score. The mean follow-up was 23months (range 6-48months). RESULTS: A patient's physical status was recorded as class I, II, or III by ASA classification, which correlated to 41.2%, 44.1%, and 14.7% of patients, respectively. The cross-sectional area of the pre- and postoperative dural sac at the level of the stenosis was 52.5+/-19.9mm2 and 110.6+/-18.2mm2, respectively. The outcome was excellent in 8.8%, good in 58.8%, fair in 23.6%, and poor in 8.8% of the patients. The VAS was changed postoperatively to 3.1+/-1.2. There was no operation-related transfusion yet there was no evidence of postoperative instability at the follow-up examination. CONCLUSION: Unilateral laminectomy for bilateral decompression, in spite of the limited exposure, can result in satisfactory decompression of the lumbar spinal stenosis and tolerable clinical outcome. This approach is thought to be appropriate for elderly patients who have a greater surgical burden.
Aged* ; Classification ; Constriction, Pathologic ; Decompression* ; Follow-Up Studies ; Humans ; Laminectomy* ; Spinal Stenosis*

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Surgically Treated Anterior Communicating Artery Aneurysm.

Sang Keun KOO ; Yeung Jin SONG ; Jae Taeck HUH

Journal of Korean Neurosurgical Society.2005;37(6):405-409.

OBJECTIVE: The purpose of this study is to assess the factors related to the outcome of 84 patients who underwent surgery for anterior communicating Artery(ACoA) aneurysms. METHODS: The authors review 84 patients who were undertaken from January 1998 to May 2004. In the management of ACoA aneurysms, the outcome was based on several factors: Clinical condition, Distribution of hemorrhage, Time between aneurysmal rupture and surgery, Direction and shape of the aneurysm. RESULTS: The incidence rate of the ACoA aneurysm was 35%. Seventy four patients were classified as those having a good recovery, but 5 patients suffered from some morbidity and 5 patients died. The rate of good outcome for the patients with Hunt and Hess grade was as follows 100% in grade I, 95% in grade II, 80% in grade III, IV and V. The rate of good outcome for the patients with Fisher grade was as follows 98% in grade I, II and 81% in grade III, IV. Nineteen of 22 patients who underwent early surgery were rated as good, while twenty six of 30 patients for whom surgery was delayed showed a favorable result. The unfavorable outcomes were also attributed by vasospasm or other medical problems. CONCLUSION: For further improvement of the overall surgical outcome: First, early surgical intervention is recommended for good grade patients. Second, active management of poor grade patients should be scrutinized with early surgery. Third, it is also important to step up the effort to minimize the risk of medical complications to enhance surgical results on top of the mainstay of prevention efforts for vasospasm and rebleeding.
Aneurysm ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm* ; Rupture

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Aneurysm of the Posterior Inferior Cerebellar Artery: Clinical Features and Surgical Results.

Jong Kook RHIM ; Seung Hun SHEEN ; Sung Han OH ; Jae Sub NOH ; Bong Sub CHUNG

Journal of Korean Neurosurgical Society.2005;37(6):399-404.

OBJECTIVE: Aneurysms arising from the posterior inferior cerebellar artery(PICA) are uncommon. We review literature on that and surgical results on aneurysmal treatment by choice of surgical approach. METHODS: On the basis of radiologic findings & charts, we review retrospectively the surgical results of 12 cases from Mar 1999 to Dec 2003. RESULTS: The mean age of the 12 patients was 55.8(ranged from 36 to 71) and female was predominant (female: male=8: 4). Locations of PICA aneurysms revealed variously(vertebral artery-PICA junction: 8, lateral medullary segment: 2, PICA-anterior inferior cerebellar artery common trunk: 1, telovelomedullary: 1). Surgical approaches & treatments were attempted in 11 cases and embolization was done in 1 case(Far lateral transcondylar or supracondylar approach & clipping: 9, Far lateral transcondylar or supracondylar approach and trapping: 2, suboccipital approach & clipping: 1). The surgical result were 8 of 12 patients were good outcome, 1 of 12 was severely disabled and 3 of 12 were died. CONCLUSION: First, we choose surgical approach by the laterality of aneurysms and surgical or interventional treatment is attempted as soon as possible. The PICA aneurysm is regarded as having a relatively good surgical outcome without drilling of the posterior arch of the atlas.
Aneurysm* ; Arteries* ; Female ; Humans ; Pica ; Retrospective Studies

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