Comparison of Ventricular Type and Parenchymal Type Intracranial Pressure (ICP) Monitoring for the Severe Traumatic Brain Injury Patients / 대한신경손상학회지

OBJECTIVE: Intracranial pressure (ICP) is one of the critical parameter for the patients of severe traumatic brain injury (TBI) to determine the treatment modalities and predict clinical outcomes. Hence, the ICP monitoring with accuracy and safety is essential for the TBI patients. The purpose of this study is to compare its safety and clinical usefulness of intraventricular ICP monitoring method to the parenchymal type. METHODS: We retrospectively reviewed the medical records and imaging data of 18 severe TBI patients. We used intraventricular ICP monitoring in 10 patients and parenchymal 8 patients. We compared the clinical findings of the two type ICP monitoring methods including procedure time, neurological status, outcome, complications and mortality. RESULTS: The initial Glasgow Coma Scale of intraventricular ICP monitoring and parenchymal ICP monitoring patients were 5.8 (range: 4-7) and 6.5 (range: 3-7) respectively. The Glasgow Outcome Scale after 6 months was a little higher in intraventricular monitoring patients than parenchymal monitoring patients (2.8 vs. 2.0, p=0.25). We could not find any intraventricular catheter related complication in intraventricular ICP monitoring patients. There was no difference in mortality in both groups (p=0.56). CONCLUSION: Our results suggest that intraventricular catheter insertion for ICP monitoring is relatively a safe procedure in the severe TBI patients. We could not demonstrate the significant benefit of intraventricular type ICP monitoring compared with parenchymal type ICP monitoring. Considering intraventricular type ICP monitoring have advantages of the accuracy and extraventricular drainage, intraventricular type ICP monitoring could be considered for severe TBI patients, regardless of hydrocephalus.

The Clinical Characteristics and Treatment Outcomes of Patients with Ruptured Middle Cerebral Artery Aneurysms Associated with Intracerebral Hematoma

OBJECTIVE: The objective of this study is to evaluate the clinical presentation and outcomes of patients with an intracerebral hematoma (ICH) associated with a ruptured middle cerebral artery (MCA) aneurysm, and the correlation factors associated with the aneurysm and characteristics of the hematoma. METHODS: A retrospective evaluation of clinical and radiologic characteristics and outcomes was conducted for 24 patients (11 men and 13 women; mean age, 53 years) with ruptured MCA aneurysms associated with ICH between September 2008 and December 2011. RESULTS: Thirteen (54%) of the 24 patients had a favorable outcome, four (17%) suffered from severe disability, and seven (29%) died. Based on Hunt and Hess grade, one patient was classified as Grade II, three as Grade III, 12 as Grade IV, and eight as Grade V. Patients with an unfavorable outcome had significantly larger aneurysms (p = 0.047) and ICH volumes (p = 0.002), compared with patients in the group with a favorable outcome. The most frequent rupture point of aneurysms was the lateral aspect of the aneurysm (54.2%). When the rupture point is toward the lateral direction, the distribution of ICH tended to be located at the temporal lobe and intrasylvian. CONCLUSION: Results of the present study suggest an association of the initial clinical state, the size of the aneurysm, and ICH volume with outcome. Although no difference was observed between the location of the rupture point and patient outcomes, an accurate assessment of ICH patterns and the rupture point in angiography may help to ensure surgical exposure and a safe aneurysm clipping.

The Complete Surgical Resection Without the Radiotherapy for a Recurred Anaplastic Ependymoma at the Cervicomedullary Junction

The intramedullary anaplastic ependymoma rarely occurs in the cervicomedullary junction. A 45-year-old woman had a history of right arm pain for several months. Magnetic resonance imaging (MRI) of the cervical spine demonstrated an intramedullary tumor with syrinx at the cervicomedullary junction. The patient underwent a partial resection at another institute. Neurologic deficit worsened after the first surgery. The follow up MRI showed that the enlarged enhancing tumor and syrinx still existed with the same size and configuration. Complete surgical resection was achieved in the revision surgery. Final histologic examination confirmed the diagnosis of an anaplastic ependymoma, and since complete surgical resection was achieved the patient did not receive adjuvant radiation or chemotherapy. The patient was followed-up periodically at the outpatient department, and at the 7 months follow-up the muscle tone of the right hand was normal but with mild sensory deficit, and the MRI demonstrated no evidence of recurrent disease. Intramedullary anaplastic ependymoma that occur in the cervicomedullary junction which are completely resected may be followed-up without adjuvant radiation or chemotherapy to attain good clinical outcome.

A Case of Focal Myoclonus Which May be Associated with Spinal Root Lesions

No abstract available.

Submentovertex cephalometric norms in normal adult subjects for diagnosis and evaluation of the prognosis of mandibular condylar fractures

This study was performed to apply the submentovertex cephalometric radiograph to mandibular condylar fractures. Because the left and right structures are not overlaped in the submentovertex radiograph, the dimension and position of mandibular condyle can be clearly identified in this view. The subjects consisted of 40 normal adult patients, twenty healthy males and females with no medical and dental histories. Specific angular and linear measurements were made from each submentovertex radiograph and computerized statistic analysis was carried out. The results were as follows. 1. There was no sexual difference in the angular measurements such as intercondylar angle, angle between condylar axis and mandibular line, and angle between condylar axis and TPA. Though no sexual difference was seen in the linear measurements related to the position of the condyle such as L-TSA, L-TPA, and MSP-Pog, measurements related to the dimension of the condyle such as condylar thickness, condylar width, L-MSP, L-Cpp, MSP-Cpp, and L-Pog were lager in male than female. 2. Statistically, significant difference between right and left values was seen only in the value of condylar width and L-Cpp(p<0.05). But the correlation coefficient of the condylar width between right and left side was very high that it could be thought very useful to compare the left and right side value clinically. 3. In the correlation analysis between left and right side condylar width, L-Cpp, and L-Pog were showed high relation. On the other hand the value of L-TSA was showed low relation. The other measurements were showed relatively high relation. 4. The difference between the maximum and minimum value of each measurement was considerable that the individual variation of measurement was relatively high.

PULMONARY EDEMA INDUCED BY BOSMINE SOAKED GAUZE IN ORTHOGNATHIC SURGER

A clinical study of the blood loss and transfusion on orthognathic surger

A clinical study of the pulp vitality after orthognathic surger: preliminary study