• Journal of Biomedical Engineering Research
• /
• v.22 no.5
• /
• pp.413-418
• /
• 2001

We developed shunt valves used to treat patients with hydrocephalus. The valves under development were constant Pressure type ventriculoperitoneal (VP) calves made of silicone elastomer. In vitro experiments showed that our valves had similar Pressure-flow control characteristics to the valved currently available in the market. Our valves also showed competent performance in the 28 days of continuous pumping tests acording to the IS07197 specifications. We artificially inducted hydrocephalus to a 10kg beagle do9. The size of the ventricles of the dog was substantially increased and the dog showed abnormal behavior. After our valve being implanted, the ventricles recovered regular size with the normal behavior observed in the dog. The flow orifice of the shunt valve diaphragm was in the older of 10$\mu$m during calve operation and hence the pressure-flow control characteristics tended to change by a small chance in the valve dimension. Therefore, precision design and manufacturing techniques were necessary for successful operations of the shunt valves .

• Journal of Korean Neurosurgical Society
• /
• v.30 no.4
• /
• pp.425-429
• /
• 2001

Objective : Patients with poor grade aneurysm usually present with increased intracranial pressure(ICP), even those without an intracranial clot. Based on this fact, the present study investigated a significance of intracranial pressure monitoring in those patients. Patients and Methods : A total of 60 patients with Hunt and Hess Grade IV(50 patients) or V(10 patients) were treated for aneurysmal subarachnoid hemorrhage(SAH) during a 3-year-period, and intraparenchymal ICP was measured in the majority, immediately after arrival to the emergency room. Early surgery including intraoperative ventriculostomy was undertaken within 3 days after SAH. An ultraearly surgery was performed without preceding angiogram or ICP monitoring in patients with large sylvian hematomas, highly suggestive of middle cerebral artery aneurysm. Outcomes were assessed by the Glasgow Outcome Scale(GOS) at 6 months. Results : In overall, favorable outcome(GOS scores 1-2) was seen in 27(54.0%) of admission Grade IV and 1(10.0%) of admission Grade V patients. Of the 38 surgical patients with preoperative ICP monitorings, 25 patients (80.6%) exhibiting ICP values of less than 40mmHg showed favorable outcome, however, no patients with ICP values above 40mmHg recovered(Fisher's exact test, p=0.0001). Conclusion : It is concluded that a preoperative ICP above 40mmHg before ventriculostomy indicate significant vital brain destruction as intractable intracranial hypertension, and Grade IV patients at admission with an ICP below 40mmHg can be of benefit from early surgical intervention while Grade V patients still remains unfavorable.

• Clinical and Experimental Pediatrics
• /
• v.50 no.3
• /
• pp.315-318
• /
• 2007

This report describes the long-term follow-up of a 10-year-old female patient with Joubert syndrome with short stature and brachydactyly. She presented with hyperpnea alternated with hypopnea, uncontrolled jerking eye movements, and hypotonia during early infancy. She was diagnosed with Joubert syndrome based on clinical symptoms and typical MRI findings at 5 months of age. Abnormal ventilation and eye movements disappeared at around 4 years of age. Head circumference kept within normal range for her age, but her height and weight growth were markedly retarded. Simple X-ray showed an enlarged skull with increased digital markings, hypoplasia of facial bones, and abnormal enchondral bone formations in hands and feet. This article is the first report of Joubert syndrome with peripheral dysostosis.

• The Journal of Internal Korean Medicine
• /
• v.15 no.1
• /
• pp.80-98
• /
• 1994

According to the original documents, Sagungsan is considered as an effective drug for controlling the hypertensive epistaxis induced by tension of autonomic nerve and it's hyperfunction. The present experiment was designed to understand the effect of Sagungsan extract on the hemostatic action, intracranial pressure, blood pressure and cardiovascular system in experimental animals. And thus the bleeding time, prothrombin time, capillary dilation, blood pressure, Intracranial pressure, and enzymatic analysis of the ATPase activities were studied. The result obtained here were as followings: 1. Sagungsan water extract reduced the bleeding time in mouse, and prolonged the prothrombin time in rabbits. 2. The drug extract increased the tail volume by capillary dilation in rats. 3. The drug extract inhibited the increase of intracranial pressure and arterial blood pressure in rabbits. 4. At the early time, the increase of arterial blood pressure by the drug extract significantly inhibited by pretreated atropin and regitine in rabbits. 5. The drug extract relaxed the smooth muscle by stimulating the Mg2+-Ca2+-ATPase activities of gastric sarcoplasmic reticulum isolated from rabbit stomach. 6. The drug extract stimulated the heart contraction by inhibiting the $Mg^{2+}-Ca^{2+}-ATPase$ activities of cardiac sarcoplasmic reticulum isolated from rabbit heart. The inhibitory mechanism was reversible and noncompatitive. 7. The drug extract increased the hepatic blood volume by stimulating the hepatic total ATPase activities and hepatic metabolism. 8. The drug extract acted as a tranquilizer by inhibiting the neural Na+-K+-ATPase activity. According to the results, Sagungsan water extract dilated the capillaries, stimulated the heart beat, and thus increased the blood flow with decreasing the intracranial pressure and blood pressure. These effects stanches the epistaxis collectively.

• Journal of Yeungnam Medical Science
• /
• v.7 no.2
• /
• pp.173-179
• /
• 1990

Nonsurgical management of four cases of the parasagittal epidural hematoma were experienced. Patients were mildly symptomatic or minimal neurological disturbances on admission. Patients were treated conservatively because of stable neurologic sign. All patients had who diastatic fracture and/or suture have become a complete neurological recovery with satisfactory absorption of EDH over a period of 5 to 12 weeks.

• The Korean Journal of Pharmacology
• /
• v.19 no.1
• /
• pp.123-131
• /
• 1983

1) To delineate the role of central ${\alpha}_2-adrenoceptors$ in the pressor response to raised intracranial pressure(ICP), the influence of yohimbine, an ${alpha}_2-adrenoceptor$ antagonist, on the pressor response to raised ICP was investigated in urethane-anesthetized rabbits. 2) The ICP was raised by infusing saline into a balloon placed in the epidural space. The rise of ICP was slow in the beginning of the infusion but it became sharp as the infusion proceeded. 3) In response to raised ICP, blood pressure(BP) tended to decrease slightly in the beginning and then increased sharply. BP, however, fell abruptly and markedly if ICP was raised further. The maximal pressor response to raised ICP was the increase of $49{\pm}2.4%$ of the original $BP(mean{\pm}SE\;in\;32\;experiments)$, and at this point the volume of saline infused into the balloon was $1.22{\pm}0.15\;ml$, and the ICP $165{\pm}6.4\;mmHg$. 4) Intraventricular yohimbine $(50{\mu}g)$ by itself did not affect BP. After the administration of this dose of yohimbine the increase of both ICP and BP was observed after the infusion of much smaller volume of saline than in the control animals, i.e., after the infusion of $0.83{\pm}0.02\;ml$ of saline the maximal increase of preesor response$(57{\pm}4.5%\;in\;6\;experiments)$ appeared and at this state the ICP was $164{\pm}9.6\;mmHg$. 5) Intraventricular $clonidine(30{\mu}g)$ markedly decreased BP by itself, and in the clonidine-treated rabbits the increase of ICP induced by the infusion was much less than in the control group and the pressor response to raised ICP was hardly seen. 6) The hypotensive effect of intraventricular clonidine was reversed by a susequent intraventricular $yohimbine(500\;{\mu}g)$. At this state the pressor response to raised ICP appeared as in the control animals. 7) These results show that the pressor response to raised ICP was facilitated when ${\alpha}_2-adrenoceptors$ in the rabbit brain was blocked by yohimbine and that yohimbine antagonized the inhibitory effect of clonidine on the pressor response to raised ICP.

• Journal of Biomedical Engineering Research
• /
• v.22 no.5
• /
• pp.403-412
• /
• 2001

The Present study analyzed the pressure-flow characteristics of a Korean shunt valve. Changes in the characteristic currie depending on the design parameters were also investigated. The Korean shunt valve used in the present study was constant pressure type and our analyses were validated through experiments. We applied fluid-structure interaction to solve the flow dynamic Problem because the small diaphragm in the valve was made from flexible silicone elastomers. Considering the material nonlinearity of the hyper-elastic material. the Mooney-Rivlin approximation was employed. The results of the numerical analyses were close to the experimental results The major Pressure drop was observed to happen in the small diaphragm. The slope of the pressure-flow characteristic curve was computed to be 0.37mm$H_2O$.hr/cc, which was similar to the average value of commercial shunt valves. 0.40mm$H_2O$.hr/cc. Therefore. our valves analyzed in the Present study showed a Proper Pressure control characteristics of the constant pressure type shunt valves. The opening pressure could be controlled by adjusting the amount of predeflection of the valve diaphragm. In order to obtain opening pressures of 25mm$H_2O$ and 80mm$H_2O$, respectively, and the required predeflection was found to be 10.2$\mu$m and 35.3$\mu$m. The flow orifice size was found to be within 10$\mu$m during valve operation Therefore, Precision design and manufacturing techniques are necessary for successful operations of the shunt valve. The study indicated the amount of predeflection as well as the magnitude of corner rounding of the diaphragm edge are important design parameters to influence the slope of the pressure-flow characteristic curve.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.5
• /
• pp.644-649
• /
• 2000

Objective : Acute hydrocephalus can be caused by many pathologic conditions such as sub- arachnoid hemorrhage, intraventricular hemorrhage, inflammatory diseases. External ventricular drainage(EVD) through trephination of the skull is essential procedure for progressing or persistent symptomatic acute hydrocephalus. If the EVD can not be removed in short period, the chance of ventriculitis increases and periodic transposition of the draining catheter should be considered. Shunt procedure can not be performed in acute hemorrhage or infectious condition because of the risk of shunt malfunction or intra-abdominal spreading of the infection, respectively. The authors replaced EVD with continuous lumbar drainage(CLD) for the purpose of controlling acute hydrocephalus and preventing ventriculitis simultaneously, or treating ventriculitis more effectively in case of infection which had already broken out. CLD has many advantages over EVD, although, it can complicate disastrous downward brain herniation in patients with elevated intracranial pressure. The authors performed CLD with EVD maintained and then tested the possibility of the brain herniation with quite simple method. If the CLD was proven as safe through the test, EVD could be replaced with it without terrible herniation. Material and Method : Between September 1998 and April 1999, 10 patients underwent CLD in replacement of EVD. Among them, 5 were patients with aneurysmal subarachnoid hemorrhage, 2 were patients with thalamic hematoma and intraventricular hemorhage and 3 were patients with traumatic intracranial hemorrhage. Results : In eight of them the replacements were successfully done and one of them died on account of medical illness. In two of them the replacement could not be performed because of the risk of herniation and all expired owing to ventriculitis. Two patients required permanent shunt operation. Conclusion : This article provides a valuable alternative method of treatment for persistent symptomatic hydrocephalus which can not be managed with shunt operation immediately.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.3
• /
• pp.295-306
• /
• 2001

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.sup1
• /
• pp.79-84
• /
• 2001

To investigate contributory factors of CSF shunt failure, 237 patients, who underwent shunt placement from January 1995 to December 1998 at our hospital, were reviewed retrospectively. The causes of the hydrocephalus were tumor, hemorrhage, infection, congenital anomaly, normal pressure hydrocephalus, trauma and others. One hundred nine revisions of CSF shunting were done during follow up periods. The causes of shunt revisions were mechanical obstruction, malposition, infection and others. The contributory factors of CSF shunt failure and shunt survival rate were analyzed using SPSS. The shunt survival rate at 1, 2 and 3 years after procedure was 77.1%, 75.4%, 74.1% respectively. In the young age group below 10 years old, postinfectous hydrocephalus was the most common high risk factor for shunt revision. In conclusion, the most shunt failures developed in the first year after surgery and the age and causes of the hydrocephalus were major determinant factors of shunt revision.