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Atypical Presentation of Acute Pituitary Apoplex Following Mild Head Injury.

Korean Journal of Neurotrauma.2012;8(1):55-57. doi:10.13004/kjnt.2012.8.1.55

Pituitary apoplexy usually presented with abrupt onset of neurological deterioration of headache, visual disturbance and decreased mental status. Post-traumatic pituitary apoplexy generally occurs in patients who have suffered from severe head injury, but there are rare reports occurred in patients with mild head injury. We describe a rare case of atypical presentation of acute pituitary apoplexy following mild head injury. A 68-year-old woman presented with right parietal scalp swelling after minor head trauma. Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) scans showed multiple contusions in the basal forebrain, falx hemorrhage and a linear skull fracture near the midline. In addition, there was a suprasellar-extended pituitary macroadenoma with suspicious intratumoral hemorrhage. After admission, cloudy consciousness, poor oral intake and high fever continued for several days. On seventh day, her condition has abruptly deteriorated and hypotensive shock developed. She recovered dramatically two days after steroid replacement therapy. The mechanism of pituitary apoplexy after mild head injury discussed with a relevant literature.
Consciousness ; Contusions ; Craniocerebral Trauma ; Female ; Fever ; Glasgow Coma Scale ; Head ; Headache ; Hemorrhage ; Humans ; Pituitary Apoplexy ; Pituitary Neoplasms ; Prosencephalon ; Scalp ; Shock ; Skull Fractures

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Treatment of High-Flow Carotid Cavernous Fistula Using a Graft Stent: Case Report.

Mun Soo KANG ; Jae Hoon KIM ; Hee In KANG ; Byung Gwan MOON

Korean Journal of Neurotrauma.2012;8(1):51-54. doi:10.13004/kjnt.2012.8.1.51

Currently, endovascular treatment of carotid cavernous fistula (CCF) is widely accepted and performed. However, a graft stent is rarely used for the treatment of high-flow CCF. Here we describe our experience using a graft stent to treat CCF and discuss the indications for its use.
Caves ; Fistula ; Stents ; Transplants

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Skull Perforation and Depressed Fracture Following Skull Fixation for Stereotactic Surgery.

Yu Deok WON ; Choong Hyun KIM ; Jin Hwan CHEONG ; Jae Min KIM

Korean Journal of Neurotrauma.2012;8(1):48-50. doi:10.13004/kjnt.2012.8.1.48

We report an unusual case of skull perforation and depressed fracture with epidural hematoma in a 61-year-old woman who has been undertaken a skeletal fixation for stereotactic evacuation of intracerebral hematoma. Most neurosurgeons secure the patient's head in a skeletal fixation device with a three- or four-pronged pin-type headrest for stereotactic procedure or microsurgery. Although a variety of complications have been reported secondary to the use of head fixation devices, these potential complications of skull fixation have been infrequently described in the medical literatures. Consideration of calvarial thickness, tightening force, and adequate location of skull fixation may reduce the risk of skull perforation and depressed fracture.
Female ; Fracture Fixation ; Head ; Hematoma ; Humans ; Microsurgery ; Skull

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Intensive Insulin Therapy after Decompression Surgery for Severe Traumatic Brain Injury.

Moon Seok KIM ; Seung Whan LEE ; Seung Ho YANG ; Jae Taek HONG ; Jae Hoon SUNG ; Byung Chul SON ; Sang Won LEE

Korean Journal of Neurotrauma.2012;8(1):44-47. doi:10.13004/kjnt.2012.8.1.44

OBJECTIVE: The purpose of this study was to compare intensive insulin therapy and conventional therapy in terms of ventilator days, neurosurgical intensive care unit (NSICU) stay, Glasgow Outcome Scale (GOS), and complications for patients with a severe traumatic brain injury (TBI) who underwent decompressive craniectomy. METHODS: Patients who had a TBI and a Glasgow Coma Scale (GCS) score < or =8, and who had been treated with a unilateral or bilateral decompressive craniectomy were enrolled. Twenty-three patients were treated with intensive insulin therapy targeting 80-120 mg/dL of blood glucose level. For comparison, 17 patients with conventional insulin therapy (<200 mg/dL) were extracted from the historical data. RESULTS: There was no statistically significant difference in terms of sex, age, GCS at admission, diagnosis of TBI, and history of diabetes. There was no statistically significant difference between the conventional and intensive groups with respect to total days of mechanical ventilation, NSICU days, GOS, and pneumonia. Hypoglycemic episodes developed more frequently in the intensive insulin therapy group than in the conventional therapy group. CONCLUSION: Intensive insulin therapy with our protocol cannot be recommended over conventional therapy in patients with severe TBI.
Blood Glucose ; Brain Injuries ; Decompression ; Decompressive Craniectomy ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Hyperglycemia ; Insulin ; Intensive Care Units ; Pneumonia ; Respiration, Artificial ; Ventilators, Mechanical

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Comparative Study between the Conventional Method and Small Skin Incision Method for Simple Decompression of Cubital Tunnel Syndrome.

Sung Hoon HAN ; Yong Jun CHO ; Suk Hyung KANG ; Gyojun HWANG ; Dong Hwa HEO ; Seung Hun SHEEN

Korean Journal of Neurotrauma.2012;8(1):37-43. doi:10.13004/kjnt.2012.8.1.37

OBJECTIVE: The purpose of this study is to review the results of two surgical methods of simple decompression for treatment of cubital tunnel syndrome. METHODS: Surgical procedure of simple decompression of the ulnar nerve using the conventional method requires a relatively long incision of 6-8 cm. Later with accumulating experience, we performed simple decompression using a skin incision of 2 cm or less. Between November 2005 and July 2010, simple decompression using the conventional method was performed in 10 elbows (Group 1), and simple decompression using the small skin incision method was performed in 10 elbows (Group 2). The surgical outcome was evaluated and the two groups were compared using a modified Bishop scoring system. We also compared the operation time and hospital stay between the two groups. RESULTS: There were no significant differences in the outcomes between the two groups using the modified Bishop scoring system (p>0.05). Also, there were no significant differences in the postoperative electrodiagnostic study results between the two groups (p>0.05). However, the operation time and hospital stay were significantly shorter in Group 2 (p<0.01). CONCLUSION: Both the methods can be recommended for the treatment of cubital tunnel syndrome due to their advantages including simplicity and safety of the method. However, the small skin incision method is superior to the conventional method due to the shorter operation time and hospital stay.
Cubital Tunnel Syndrome ; Decompression ; Elbow ; Length of Stay ; Lipids ; Quaternary Ammonium Compounds ; Skin ; Ulnar Nerve

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Analysis of Precedents Related to the Medical Accidents of Neurosurgery.

Jae Hyun SHIM ; Kyeong Seok LEE ; Jae Jun SHIM ; Seok Mann YOON ; Jae Won DOH ; Hack Gun BAE

Korean Journal of Neurotrauma.2012;8(1):32-36. doi:10.13004/kjnt.2012.8.1.32

OBJECTIVE: The Korean government has legislated for Medical Dispute Mediation Act in 2011. As a member of medical accident appraisal board, the medical doctor should have well-balanced mind along with the thorough knowledge and experiences on his specialty. METHODS: We evaluated precedents related to the medical accidents of neurosurgery in Korea. We searched precedents in the Korean Supreme Court web site. There were 60 suits of damages in 108 precedents related to the neurosurgery from 1978 to 2010. We found 23 precedents related to neurosurgical treatment. RESULTS: Doctors or medical institutions were liable for damages in 12 precedents including 4 cases of partial responsibility such as solatium. In 11 precedents, liability for damages was disclaimed. The judgment was unrelated to the level of court, dead or disabled, main issue (11 medical error, 7 explanation, 5 negligence and others), or methods of treatment. Liability for damages was usually disclaimed (6 : 2) in 1980s, more frequently claimed (1 : 7) in 1990s, and it became almost same (4 : 3) in 2000s. CONCLUSION: Medical accident appraisal board should be fair in explorations of the accidents. We should prepare to get an expert medical investigator, who has balanced mind, knowledge on the law, and specialized knowledge with experiences on his specialty.
Dissent and Disputes ; Humans ; Informed Consent ; Judgment ; Jurisprudence ; Korea ; Liability, Legal ; Malpractice ; Medical Errors ; Negotiating ; Neurosurgery ; Research Personnel

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The Comparison of Clinical and Radiological Long-Term Outcomes between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy after Modified Midline Splitting Cervical Laminoplasty.

Dong Kwang SEO ; Jin Hoon PARK ; Sang Ryong JEON

Korean Journal of Neurotrauma.2012;8(1):26-31. doi:10.13004/kjnt.2012.8.1.26

OBJECTIVE: Both of ossification of posterior longitudinal ligament (OPLL) and cervical spondylotic myelopathy (CSM) could be treated by cervical laminoplasty. In this study we compared long-term clinical and radiological outcomes in these two disease entities, treated with modified midline splitting laminoplasty (MSL). METHODS: We retrospectively analyzed the outcomes of 21 consecutive cervical myelopathy patients (13 OPLL and 8 CSM) who underwent modified MSL between 2004 and 2008. The mean follow-up duration was 49.5 months. The clinical outcomes were evaluated by the Japanese Orthopedic Association (JOA) score and the radiologic outcomes included the change of cervical lordosis, range of motion (ROM) and spinal canal dimension. RESULTS: The mean JOA scores of overall patient changed from 6.9 to 11.9, resulting in mean calculated recovery rates of 42.3%. The recovery rates of each group was 38.0% in the CSM group and 45.5% in the OPLL group, respectively (p=0.45). The mean cervical lordosis changed from 12.5 to 10.75 degrees in the CSM group and from 11.76 to 9.84 degrees in the OPLL group (p=0.79). The mean cervical ROM changed from 26 to 24.2 degrees in the CSM group and from 28.7 to 26.3 degrees in the OPLL group (p=0.78). The mean canal dimension changed from 201.1 to 285.0 mm2 in the CSM group and from 198.5 to 284.7 mm2 in the OPLL group (p=0.86). CONCLUSION: In the present study, all patients showed good long-term clinical outcomes by modified MSL. No significant clinical and radiographic difference of two disease entities in the same procedure was revealed.
Animals ; Asian Continental Ancestry Group ; Cervical Vertebrae ; Female ; Follow-Up Studies ; Humans ; Lordosis ; Orthopedics ; Ossification of Posterior Longitudinal Ligament ; Range of Motion, Articular ; Retrospective Studies ; Spinal Canal ; Spinal Cord Diseases

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Comparison with Subcutaneous Abdominal Preservation and Cryoconservation Using Autologous Bone Flap after Decompressive Craniectomy.

Byung Sun LEE ; Kyung Soo MIN ; Mou Seop LEE ; Young Gyu KIM ; Dong Ho KIM

Korean Journal of Neurotrauma.2012;8(1):21-25. doi:10.13004/kjnt.2012.8.1.21

OBJECTIVE: After decompressive craniectomy was performed in patients with severe brain swelling, we were able to preserve autologous bone flap as freeze-preserved state or within abdominal subcutaneous tissue. The aim of this study was to compare the freeze-preservation with the subcutaneous abdominal preservation regarding the effectiveness and safety. METHODS: The clinical data of 53 patients who underwent decompressive craniectomy with autologous bone flap cranioplasty in our department were studied retrospectively. 43 patients underwent cranial reconstruction using autologous bone flap stored in deep freezer. In 10 patients cranioplasty was performed to repair bone defect using autologous bone flap preserved in subcutaneous abdomen. The analysis included the rates of infection, bone absorption and other complications and operation time to compare these two methods. RESULTS: Cranioplasty using deep-freezing bone flap showed a low infection rate (2.3%), low bone absorption (2.3%) and no cosmetic problem. The average time of operation is 146 minutes. Cranioplasty using a bone flap banked in the patient's abdominal wall revealed no case of complications. The average time of operation is 130 minutes. The longer period the bone flap was preserved for, the longer time the operation took in both methods. CONCLUSION: This study may be worth considering that both methods of cryoconservation and subcutaneous abdominal preservetion are feasible for the repair of skull defect although abdominal preservation seems to show better result a little. If the deep-freezer is not available, a bone flap banked in the patient's abdominal wall can be used.
Abdomen ; Abdominal Wall ; Absorption ; Brain Edema ; Cosmetics ; Cryopreservation ; Decompressive Craniectomy ; Humans ; Retrospective Studies ; Skull ; Subcutaneous Tissue

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Risk Factors for Reoperation after Traumatic Intracranial Hemorrhage.

Sang Mi YANG ; Sukh Que PARK ; Sung Jin CHO ; Jae Chil CHANG ; Hyung Ki PARK ; Ra Sun KIM

Korean Journal of Neurotrauma.2013;9(2):114-119. doi:10.13004/kjnt.2013.9.2.114

OBJECTIVE: Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI. METHODS: 36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation. RESULTS: Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation. CONCLUSION: Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy.
Brain Injuries ; Edema ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Intracranial Hemorrhage, Traumatic* ; Reoperation* ; Retrospective Studies ; Risk Factors*

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Cervical Pedicle Screw Placement in Sawbone Models and Unstable Cervical Traumatic Lesions by Using Para-Articular Mini-Laminotomy: A Novice Neurosurgeon's Experience.

Sang Duk YOON ; Jong Young LEE ; In Sik LEE ; Seung Myung MOON ; Byung Moon CHO ; Se Hyuck PARK ; Sae Moon OH

Korean Journal of Neurotrauma.2013;9(2):106-113. doi:10.13004/kjnt.2013.9.2.106

OBJECTIVE: This retrospective study was conducted to analyze the novice neurosurgeon's experience of cervical pedicle screw placement by using the technique with direct exposure of pedicle via para-articular mini-laminotomy. METHODS: Fifteen sawbone models of subaxial spine were used (124 pedicles) to evaluate efficacy of repetitive training improving accuracy of cervical pedicle screw insertion. After that, we retrospectively reviewed 9 consecutive patients presented with traumatic cervical lesion. A total 38 cervical pedicle screws had been inserted. We analyzed the direction and grade of pedicle perforation on the postoperative computed tomography scan, and learning curve by using sawbone model. RESULTS: In sawbone model group, the correct position was found in 102 (82.3%) screws, and the incorrect position in 22 (17.7%) screws. The incidence of incorrect screw position was 26.9% in the initial 9 sawbone model, and 0% after that. Among the 38 screws inserted in 9 patients, the correct position was found in 36 (94.7%) screws, and the incorrect position in a 2 (5.3%) screw. There was no neurovascular complications related with cervical pedicle screw insertion. CONCLUSION: In vitro training to insert pedicle screw by using sawbone models could improve an accuracy of cervical pedicle screw placement by using this technique. Preliminary result revealed that cervical pedicle screw placement would be feasible and provide good clinical results in traumatic cervical lesions.
Humans ; Incidence ; Laminectomy ; Learning Curve ; Retrospective Studies ; Spine

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