OBJECTIVE: So called "minimally invasive procedures" have evolved from chemonucleolysis, automated percutaneous discectomy, arthroscopic microdiscectomy that are mainly working within the confines of intradiscal space to transforaminal endoscopic technique to remove herniated epidural disc materials directly. The purpose of this study is to assess the result of endoscopic spinal surgery and favorable indications in the thoracolumbar spine. METHODS: The records of 71 patients, 73 endoscopic procedures, were retrospectively analysed. Yeung Endoscopic Spine Surgery system with 7 mm working sleeve and 25degrees viewing angle was used. The mean follow up period was 6 months (range,3-9). RESULTS: Operated levels were from T12-L1 disc down to L5-L6 or S1 disc. Of 71 cases, 2 patients underwent transforaminal endoscopic surgery twice due to recurrence after initial operation. MacNab's criteria was used to assess the outcome. Favorable outcome, excellent or good, was seen in 78% (57 procedures) of the patients. Among 11 fair outcomes, only 1 procedure was followed by secondary open procedure, laminectomy with discectomy. Two of 5 poor outcomes were operated again by same procedure which resulted in fair outcomes. One patient with aggravated cauda equina syndrome remained poor and a lumbar fusion procedure was performed in other patient with poor outcome. There were 2 postoperative discitis that were treated with conservative care in one and anterior lumbar interbody fusion in the other. CONCLUSION: Evolving technology of mechanical, visual instrument enables minimal invasive procedure possible and effective. The transforaminal endoscopic spinal surgery can reach as high as T12-L1 disc level. The rate of favorable outcome is mid-range among reported endoscopic lumbar surgery series. Authors believe that the outcome will be better as cases accumulate and will be able to reach the rate of standard open microsurgery.
Discitis ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Microsurgery ; Polyradiculopathy ; Recurrence ; Retrospective Studies ; Spine

Many cases of retroperitoneal hematoma related to spine surgery have been reported, however, most of them were caused by major vessel injury related to intradiscal or retroperitoneal procedures. We report an unusual case of a retroperitoneal hematoma followed by surgical excision of the lumbar extradural arachnoid cyst without intradiscal procedure. To our best knowledge, this complication without intradiscal procedure has not been described previoulsly. The pathogenetic mechanism of retroperitoneal hematoma in this report is unclear. We discuss the plausible pathophysiological mechanisms of retroperitoneal hematoma which developed after excision of arachnoid cyst.
Arachnoid* ; Hematoma* ; Spine

Multiple aneurysms arising from the same intracranial artery are rare. A few cases of multiple aneurysms of the anterior communicating artery(ACoA) have been reported in the literature. The authors present a 60-year-old female patient who had multiple aneurysms on the ACoA with systemic vasculitis. There were four aneurysms around the ACoA region. Two sizeable aneurysms had completely separated necks on each side of the ACoA. The ruptured larger aneurysm projected in an anteroinferior direction, whereas the unruptured smaller one projected superoposteriorly. Both aneurysms were surgically confirmed and clipped. Two bleb-like microaneurysms, located on ACoA and perforating artery each, were coagulated and reinforced.
Aneurysm* ; Arteries* ; Female ; Humans ; Middle Aged ; Neck ; Systemic Vasculitis ; Vasculitis

OBJECTIVES: The goal of operation for degenerative lumbar diseases is to relieve radiculopathy and low back pain and to prevent further degeneration. The authors analyzed the surgical results of posterior lumbar interbody fusion(PLIF) and 360degrees fixation to evaluate the proper treatment policy in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. MATERIAL AND METHODS: The authors performed PLIF on 92 patients and 360degrees fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. We retrospectively studied clinical outcomes and subjective satisfaction of these patients by several criteria such as visual analog scale(VAS), Prolo's economic and functional outcome scale, medication usage after operation and questionaire for overall outcome. RESULT: Pre- and postoperative VAS on back pain and leg pain showed decrease of pain from 6.5, 6.7 to 2.2, 2.4 in PLIF group and from 7.0, 7.2 to 2.5, 2.7 in 360degrees fixation group. Excellent and good outcomes on Prolo's scale were 81.5% in PLIF group and 82.6% in 360degrees fixation group. Medication usage after operation was reduced in 79.3% of PLIF group and in 78.3% of 360degrees fixation group. Patients' self-reported overall success of their procedure showed 82% in PLIF group and 84% in 360degrees fixation group. CONCLUSION: Both PLIF and 360degrees fixation showed good outcomes and provided biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Therefore, only PLIF seems necessary and considered a proper surgical treatment for these disorders.
Back Pain ; Humans ; Leg ; Low Back Pain ; Radiculopathy ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

Intracerebral hemorrhage in the brain is the most common complication of hypertension, aneurysmal rupture, or vascular malformation. The occurrence of symmetrically bilateral intracerebral hemorrhage is an unusual clinical event that develops in only a small percentage of all patients who have intracerebral hemorrhage. Even though, the size of contralateral hemorrhage is not too large, majority of patients with bilateral intracerebral hemorrhage in basal ganglia or thalamus have generally a poor outcome. In all cases of this report, the contralateral intracerebral hemorrhage was resulted from an inadequate control of hypertension. Therefore, optimal control of blood pressure must be considered as the most important treatment option to prevent recurrence. Authors report the characteristic clinical and radiologic features of four cases in which mirror-image bilateral intracerebral hemorrhage occurred.
Aneurysm ; Basal Ganglia* ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Hemorrhage ; Humans ; Hypertension ; Recurrence ; Rupture ; Thalamus ; Vascular Malformations

BACKGROUND: Increasing interest in the use of arterial conduites is based on the better patency of the internal thoracic artery(ITA) than the saphenous vein graft and the hope that other arterial conuits will perform similarly over the long term. MATERIAL AND METHOD: Between May 1997 and July 1998, 43 patients underwent coronary artery bypass grafting with ITA and the radial artery(RA). There were 28 men and 15 women with a mean age of 61.5 years(range, 35 to 78). In 43 patents, 30 bilateral ITA(including 7 diabetes mellitus, 5 more older 70 years), 8 bilateral ITA only, 2 left ITA and both RA, 11 left ITA and left RA and 22 both ITA and left RA were used. RESULT: There was 1 hospital mortality. Of the 42 patients alive, 39 patients are asymptomatic. Postoperative complications were postoperative bleeding in 1 patients, and low cardiac output syndrome in 3. Follow-up angiography was performed in 5 patients after the operation(mean 3 months), and all ITA & RA grafts showed excellent results. CONCLUSION: We conclude that complete arterial revascularization with internal thoracic artery and radial artery is technically feasiale with low mortality and morbidity, and but long term follow-up is needed.
Angiography ; Cardiac Output, Low ; Coronary Artery Bypass* ; Coronary Vessels* ; Diabetes Mellitus ; Female ; Follow-Up Studies ; Hemorrhage ; Hope ; Hospital Mortality ; Humans ; Male ; Mammary Arteries ; Mortality ; Postoperative Complications ; Radial Artery* ; Saphenous Vein ; Transplants

Bacterial endocarditis of the native aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when perivalvular tissue was invaded and destructed. The pulmonary autograft is full viable and immune compatible tissue. This paper describes successful Ross operation as total root replacement in 38 years old native valve endocarditis patient with aortic root abscess.
Abscess* ; Adult ; Aortic Valve ; Autografts* ; Endocarditis ; Endocarditis, Bacterial ; Humans ; Mortality

Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending (LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours (mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.
Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Hospitals, General ; Humans ; Mammary Arteries ; Myocardial Revascularization ; Radial Artery ; Saphenous Vein ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Thoracoscopes ; Thoracotomy ; Transplants

Ebstein's anomaly is a complex malformation that can be treated by various surgical techniques, either repair or replacement of the abnormal tricuspid valve, with variable results. The essence of the malformation is the downward displacement of the septal and posterior leaflets into the ventricle, resulting in the formation of an atrialized portion of the right ventricle. The aim of surgical repair is to correct the tricuspid valve dysfunction and to plicate the atrialized portion of the right ventricle A 12-months old female was admitted with the diagnosis of Carpentier type A of Ebstein's anomaly with severe tricuspid regurgitation. She successfully underwent operation with vertical plication of right ventricle and reimplantation of tricuspid leaflets. Postoperatively cardiac size was significantly reduced and tricuspid regurgitation was trivial in echocardiography. She was diacharged the 14th postoperative day.
Diagnosis ; Ebstein Anomaly* ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Infant ; Replantation ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Aortic valve replacement in young patients has its problems. Biologic prosthetic valves degenerate and need replacement. Metalic prosthetic valves are more durable, however, anticoagulation which has its inherent problems is inevitable. The use of Ross procedure in young patients is gaining wider acceptance. The need of foreign pulmonary valve in right ventricular outflow tract (RVOT) will require reoperation due to RVOT obstruction, later. To overcome this problem, we reimplanted the native aortic valve in the pulmonary position in 21 year old female patient operated on utilizing the Ross procedure for aortic insufficiency. We experienced that the diseased aortic valve worked well in the pulmoanry position because of low pulmonary artery pressure and resistance.
Aortic Valve* ; Female ; Humans ; Pulmonary Artery ; Pulmonary Valve* ; Reoperation ; Transplantation, Autologous ; Young Adult