Objective: Autologous bone grafting for cranioplasty is associated with a high infection rate and bone absorption. Synthetic implant materials for cranioplasty have been developed. In this study, we evaluated the efficacy of titanium mesh-type patient-specific implants (PSIs) for patients with skull defects using the dice similarity coefficient (DSC), clinical outcomes, and artifacts caused by implants. Methods: This retrospective study included 40 patients who underwent cranioplasty with a titanium mesh PSI at our institution. Based on preoperative and postoperative computed tomography scans, we calculated DSC and artifacts. Results: The calculated DSC of 40 patients was 0.75, and the noise was 13.89% higher in the region of interest (ROI) near the implanted side (average, 7.64 hounsfield unit [HU]±2.62) than in the normal bone (average, 6.72 HU±2.35). However, the image signal-to-noise ratio did not significantly differ between the ROI near the implanted side (4.77±1.78) and normal bone (4.97±1.88). The patients showed no significant perioperative complications that required a secondary operation. Conclusion Titanium mesh-type PSIs for cranioplasty have excellent DSC values with lower artifacts and complication rates.

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.
Adult ; Brain ; Brain Stem ; Brain Stem Hemorrhage, Traumatic ; Contusions ; Craniocerebral Trauma ; Head ; Head Injuries, Closed ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Paresis ; Prognosis ; Skull ; Skull Fracture, Depressed ; Spinal Cord ; Spine

Vasospasm has been known as one of the most potent causes of delayed ischemic neurologic deficits (DINDs) after aneurysmal subarachnoid hemorrhage (SAH). An established effective therapy for vasospasm has been used in preventing cerebral ischemia. Nevertheless, several reports suggested the possibility that there may be other causes of DINDs from the cases which couldn't be explained by hemodynamic vasospasm. Authors experienced two cases of thromboembolic infarction as a cause of DINDs after aneurysmal SAH. We propose that thromboembolism can be a considerable cause of DINDs independent of hemodynamic vasospasm.
Aneurysm ; Brain Ischemia ; Hemodynamics ; Infarction ; Neurologic Manifestations ; Subarachnoid Hemorrhage ; Thromboembolism

OBJECTIVE: Recently, the definition of occult osteoporotic vertebral fracture has been established, and its clinical significance has come to our interest. We report the effect of early percutaneous vertebroplasty in occult osteoporotic vertebral fracture. METHODS: From January 2006 to January 2008, we performed percutaneous vertebroplasty for 50 levels in 47 patients. 21 levels (21 patients) of them were classified into occult osteoporotic vertebral fracture group, 29 levels (26 patients) were categorized into control group (not occult osteoporotic vertebral fracture) by the Pham T..s criteria. We obtained VAS score and measured the compression ratio at first hospital day and 1 day, 1 month, 3 months after procedure. RESULTS: There are noticeable improvements in VAS score. The mean VAS score at admission was 6.44 in occult group and 6.15 in control group, which changed 2.23 in occult group and 2.68 in control group after procedure. The compression rate was 1.008, 1.018, 1.016 in occult group and 0.862, 0.891, 0.881 in control group at admission and 1 month, 3 months after procedure. The conservative effect for vertebral height was higher than control group (p=0.011). CONCLUSION: Percutaneous vertebroplasty in occult osteoporotic compression fracture provided significant pain relief and conservative effect for vertebral height. It is probable that it can lower the rate of secondary adjacent vertebral compression fracture.
Fractures, Compression ; Humans ; Vertebroplasty

OBJECTIVE: Neurosurgeons occasionally advocated intraoperative ventriculostomy to prevent traumatic brain retraction because of severe brain swelling in an acute stage of aneurysmal subarachnoid hemorrhage (SAH) surgery. The authors investigated the impact of the intraoperative ventriculostomy on the occurrence of shunt-dependent hydrocephalus in acute SAH. METHODS: The data of 141 ruptured aneurysm patients who underwent aneurysmal neck clipping in an acute stage were retrospectively reviewed. The patients were divided into three groups according to the cerebrospinal fluid (CSF) drainage amount via intraoperative ventriculostomy. Group 1 (n=44) included the patients who were not performed the intraoperative ventriculostomy, Group 2 (n=34) consisted of patients who were drained the CSF less than 40 cc (< 40 cc) via intraoperative ventriculostomy, and Group 3 (n=63) drained the CSF more than 40 cc (> or = 40 cc). By using statistical methods, the authors analyzed the influences of various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, presence of acute hydrocephalus and intraventricular hemorrhage (IVH) at admission on the occurrence of hydrocephalus. And also, we analyzed the relationships among the cisternal drainage, lamina terminalis fenestration, and the shunt-dependent hydrocephalus. RESULTS: Concerning the amount of CSF drainage via intraoperative ventriculostomy, the incidence of shunt-dependent hydrocephalus did not show any difference in three groups (p=0.146). Presence of the acute hydrocephalus, lamina terminalis fenestration, and cisternal drainage did not exert any influence on the incidence of shunt-dependent hydrocephalus, respectively (p=0.124, p=0.168, p=0.452). However, the incidence of shunt-dependent hydrocephalus in patients who had IVH at admission was significantly higher than in who did not have (p=0.010). CONCLUSIONS: Routine intraoperative ventriculostomy dose not increase the incidence of shunt-dependent hydrocephalus. Moreover, it obtains an adequate intraoperative brain relaxation, which results in the decrease of the brain retraction injury and the operation time.
Aneurysm* ; Aneurysm, Ruptured ; Brain ; Brain Edema ; Cerebrospinal Fluid ; Drainage ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Hydrocephalus* ; Hypothalamus ; Incidence ; Neck ; Relaxation ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Ventriculostomy*

PURPOSE: Peritumoral brain edema (PTBE) is a serious causative factor that contributes the morbidity or mortality of brain tumors. The development of PTBE is influenced by many factors, including such tight junction proteins as occludin. We evaluated the PTBE volume and survival time with respect to the occludin expression in various pathological types of brain tumors. MATERIALS AND METHODS: Fresh-frozen specimens from sixty patients who had brain tumors were obtained during surgery and the tumors were confirmed pathologically. The occludin expression was investigated by Western blot analysis. The PTBE volume was measured by using preoperative magnetic resonance (MR) imaging, and the survival time in each patient was estimated retrospectively. RESULTS: Occludin was detected in 41 (68.3%) of the cases with brain tumors and it was not expressed in the other 19 (31.7%) cases. Although the lowest expression was revealed in high-grade gliomas, its expression was variable according to the pathology of the brain tumors (p>0.05). The difference of PTBE volume between occludin-positive and negative brain tumors was statistically significant (2072.46+/-328.73 mm3 vs. 7452.42+/-1504.19 mm3, respectively, p=0.002). The mean survival time was longer in the occludin-positive tumor group than in the occludin-negative group (38.63+/-1.57 months vs. 26.16+/-3.83 months, respectively; p=0.016). CONCLUSIONS: This study suggests that the occludin expression is highly correlated to the development of PTBE in brain tumors and it might be a prognostic indicator for patient survival.
Blotting, Western ; Brain Edema ; Brain Neoplasms* ; Brain* ; Edema* ; Glioma ; Humans ; Mortality ; Occludin* ; Pathology ; Retrospective Studies ; Survival Rate ; Tight Junction Proteins

Telomerase adds telomeric repeats to the ends of telomeres to compensate for their progressive loss. A favorable prognosis is associated with low or no telomerase in some tumors. The authors investigated whether telomerase activity is associated with survival of patients with brain tumors. Sixty-two consecutive patients with brain tumors underwent surgery, and their surgical specimens were investigated. The patients were pathologically categorized as group I (aggressive group) and group II (non-aggressive group). Telomerase activity was examined by the telomeric repeat amplification protocol (TRAP) assay. The median time was calculated in association with overall survival and progression-free survival in each group. The significant difference was noted in telomerase activity between high-grade gliomas and lowgrade gliomas (p=0.022). Telomerase activity was significantly associated with the median overall survival and progression-free survival in all tumors of the aggressive group. On the other hand, the median overall survival in the non-aggressive group was not dependent on telomerase activity, while the median progression-free survival was. Our data suggests that telomerase is an important prognostic indicator of survival in patients with brain tumors.
Adolescent ; Adult ; Aged ; Brain Neoplasms/enzymology/genetics/*pathology ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay/methods ; Female ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction/methods ; Prognosis ; Research Support, Non-U.S. Gov't ; Survival Analysis ; Telomerase/genetics/*metabolism

Recently, it was reported that fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal subarachnoid hemorrhage (SAH). The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus in the ruptured anterior communicating artery (ACoA) aneurysms. The data of 71-ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. Group I (n=36) included the patients with microsurgical fenestration of LT during surgery, Group II (n=35) consisted of patients in whom fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factors. Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 patients (25.4%). The conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. However, there was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms because of the microsurgical fenestration of LT can play a negative role in reducing the incidence of chronic hydrocephalus.
Adult ; Aged ; Female ; Humans ; Hydrocephalus/etiology/*prevention & control ; Hypothalamus/surgery ; Intracranial Aneurysm/complications/*surgery ; Male ; Microsurgery/*methods ; Middle Aged ; Retrospective Studies ; Subarachnoid Hemorrhage/etiology/*surgery ; Treatment Outcome ; Ventriculoperitoneal Shunt/*methods

OBJECTIVE: Acute vertebral burst fractures warrant extensive fixation and fusion on the spine. Osteoplasty (vertebroplasty with high density resin without vertebral expansion) has been used to treat osteoporotic vertebral compression fractures. We report our experiences with osteoplasty in acute vertebral burst fractures. METHODS: Twenty-eight cases of acute vertebral burst fracture were operated with osteoplasty. Eighteen patients had osteoporosis concurrently. Preoperative MRI was performed in all cases to find fracture level and to evaluate the severity of injury. Preoperative CT revealed burst fracture in the series. The patients with severe ligament injury or spinal canal compromise were excluded from indication. Osteoplasty was performed under local anesthesia and high density polymethylmethacrylate(PMMA) was injected carefully avoiding cement leakage into spinal canal. The procedure was performed unilaterally in 21 cases and bilaterally in 7 cases. The patients were allowed to ambulate right after surgery. Most patients discharged within 5 days and followed up at least 6 months. RESULTS: There were 12 men and 16 women with average age of 45.3(28-82). Five patients had 2 level fractures and 2 patients had 3 level fractures. The average injection volume was 5.6cc per level. Average VAS (Visual Analogue Scale) improved 26mm after surgery. The immediate postoperative X-ray showed 2 cases of filler spillage into spinal canal and 4 cases of leakage into the retroperitoneal space. One patient with intraspinal leakage was underwent the laminectomy to remove the resin. CONCLUSION: Osteoplasty is a safe and new treatment option in the burst fractures. Osteoplasty with minimally invasive technique reduced the hospital stay and recovery time in vertebral fracture patients.
Anesthesia, Local ; Female ; Fractures, Compression ; Humans ; Laminectomy ; Length of Stay ; Ligaments ; Magnetic Resonance Imaging ; Male ; Osteoporosis ; Retroperitoneal Space ; Spinal Canal ; Spine ; Vertebroplasty

Intracranial arachnoid cyst is presumed to be a developmental anomaly and its natural history is not well defined. Often it is detected incidentally in a asymptomatic patient and hemorrhagic events of arachnoid cyst following head injury are rarely reported. We report hemorrhagic complications including two intracystic hemorrhages, two subdural hematomas, and an epidural hematoma in 5 patients with intracranial arachnoid cyst after minor head injury and review pertinent literatures.
Arachnoid ; Arachnoid Cysts* ; Craniocerebral Trauma* ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Natural History