• Journal of Yeungnam Medical Science
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• v.10 no.2
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• pp.475-484
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• 1993

In order to evaluate the safe ligation time and sites of dural venous sinuses during neurosurgical operation, systemic arterial pressure(SAP), cerebral perfusion perssure(CPP), intracranial pressure (ICP) and intrasinal pressure(ISP) were measured in cats through neuromonitor before and after obstruction of anterior 1/3, middle 1/3, posterior 1/3 of the superior sagittal sinus and the results were as follows. There were no significant increases of pressures after obstruction of anterior 1/3 of the superior sagittal sinus. In the obstructed middle 1/3 of the superior sagittal sinus group, significant increases were seen un the m-SAP within 2, 4 and 6 minutes, the m-ICP within 2-7 minutes, the m-ISP within 1-4 minutes after obstruction. In the obstructed posterior 1/3 of the superior sagittal sinus group, there were significant increases of m-SAP within 2, 4 and 6 minutes, the m-ICP within 2-7 minutes, the m-ISP within 1-3 minutes. In the obstructed Torcular Herophili group, there were significant increases of the m-SAP within 1-2 and 4-7 minutes, the m-ICP within 3-6 minutes and the m-ISP within 1-7 minutes and less significant dercreases of the m-CPP within 5-7 minutes after obstruction. In the obstructed right transverse sinus group, significant increases of the m-ICP and the m-ISP were seen within 1-7 minutes after obstruction, there were no remarkable changes in the obstructed left transverse sinus group.

• Journal of Korean Academy of Nursing
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• v.27 no.3
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• pp.503-509
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• 1997

This study was undertaken to identify optimal head elevation and position in the care of the neurosurgical patient with a cerebral aneurysm. The effects of 0°. 15° and 30° head elevation and three positions (supine, side tying position opposite to the operation site, and side tying position on the same side as the operation site) on ICP was studied in fourteen neurosurgical patients with cerebral aneurysms. The results are as follows : 1. The mean intracranial pressure was significantly lower when the patient's head was elevated at 30° as compared to 0° and 15°. 2. The mean intracranial pressure was significantly lower when the patient was positioned in the supine as compared to side tying position opposite to the operation site and side tying position on the same side as the operation site. The data indicate that head elevation to 30° and the supine position reduce ICP in neurosurgical patients with cerebral aneurysm.

• Journal of Korean Academy of Nursing
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• v.23 no.2
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• pp.245-254
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• 1993

The purpose of this study was to identify effective methods to minimize increases in intracranial pressure(IICP ) during endotracheal suction by means of comparing two methods of hyperventilation and oxygen supply before and after endotracheal suction. In order to evaluate the effects of these two methods, the ICP during suctioning and the sustained time of IICP were measured. For hyperventilation, ambu-bagging was done 10 times for 30 seconds with a tidal volume of 800-900m1. For oxygen supply, 100 percent oxygen was supplied for 2 minutes before and after suction. The subjects for this study were 12 neurosurgical patients who had had a subarachnoid bolt inserted for ICP monitoring and they were all on mechanical ventilatory support in a surgical intensive care unit of Seoul National University Hospital from July 1, 1991 to March 31, 1992. In each patient hyperventilation was performed five times and oxygen supply was given five times and intracranial pressures were measured immediately before and every 30 seconds for 15 minutes after suction. For case assignments counterbalancing and repeated measure designs were combined. And so the total number of experiments were sixty for each group. The effects of hyperventilation and oxygen supply on the IICP and the sustained time of IICP after suction were analyzed by t-test. The results of study were as follows 1. There was a significant difference between the two groups in the increased ICP during suction (t=2.49, p=.014). 2. The sustained time of IICP after suctioning in the oxygen supply group was shorter than that in the hyperventilation group(t=2.35, p=.020) In summary, the Increase in the ICP during suction was lower and the time for the ICP to return to the presuction level was shorter in the oxygen supply group as compared to the hyperventilation group. Therefore, oxygen supply can be re commended before and after endotracheal suction.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.985-991
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• 2001

Objectives : The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. Material and Methods: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M : F=8 : 8, mean age : 43.7 years) and 7 children(M : F=5 : 2, mean age : 10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. Results : The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.

• Proceedings of the Materials Research Society of Korea Conference
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• 2009.11a
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• pp.6.1-6.1
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• 2009

신경외과는 뇌수술과 척추수술로 나눈다. 이중뇌수술 분야에서는 두개강내압 항진시 감압술이라고 '머리의 뚜껑을 연다'라는 표현과 마찬가지로 두개골의 일부분(손바닥크기)을 절제하는 수술이 있다. 이때 과거에는 떼어낸 뼈를 복부의 피하지방밑에 심어서 보관을 하다가 3-6개월 후 환자의 뇌상태가 안정이 되면 다시 꺼내어 제자리에 놓았는데, 골편이 피하지방에서 녹는 경우가 다소 있고, 복부에 이식한 장소가염증이 생기는 경우도 있어서 요즘은 냉동고에서 -70도를 유지하여 보관 후 나중이 복원 수술을 할 때녹여서 사용한다. 이를 '자가골 두개성형술' 이라 한다. 하지만골편의 오염이나 소실 혹은 1차 두개성형술 후 감염 등 어쩔 수 없이 자가골을 사용 못하는 경우에는인공으로 두개골편 모형을 제작하여 '뚜껑'으로 사용해야 한다. 현재PMMA를 이용하여 수술 시 모형을 제작하는 방법이 많이 사용되며 최근 단단한 스펀지 형태의 인공제품이 사용되고 있으나 가격이 매우비싸지만 스펀지 기공내로 자가골이 자란다는 장점이 있다. 척추수술 분야에서는 뼈 대치품을 비교적 많이필요로 한다. 즉 척추 후방고정을 하는 경우 원래 수술의 목적인 감압술이나 교정술 등을 한 후 척추분절간 쇠(티타늄사용)고정을 한 뒤에 뼈조직(자가골이나 동종이식골, DBM, HA stick) 등을 충분히 사용하여덮어줌으로써 분절간 골유합을 유도할 때 많은 양이 필요하며, 척추 전방으로 수술을 하는 경우에도 디스크공간이 빈 상태에서 Cage(추체와 추체를 지지하는 작은 상자모양) 내에뼈조직을 넣어서 척추분절간 골유합이 일어나도록 한다. 최근 HA를 cage 대용품으로 사용한 경우에서 HA가 부서지는 경우가 기사화된바 있다. 또한 경추의 추체 내에 작은 구멍만 뚫고 디스크 수술을 한 후에 그 구멍에 HA+B-TCP 소재를 넣어 천연뼈의 성장 유도를 위해 사용되는 등 신경외과의 다양한 분야에서 생체소재들이 사용되고 있다.

• Journal of Korean Academy of Nursing
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• v.36 no.2
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• pp.353-360
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• 2006

Purpose: This study was done to investigate the effects of backrest elevation of 0 degree and 30 degrees that minimize the risk of increasing ICP when CVP is measured. Methods: Subjects were sixty-four patients who stayed in the neurosurgical intensive care unit after brain surgery at two university-based hospitals. CVP, blood pressure, heart rate and ICP were measured along with position changes in order of backrest position with primary 30 degrees backrest position, 0 degree backrest position and secondary 30 degrees backrest position. For data analysis, one-group, repeated-measures analysis of variance design was used in SAS program. Results: Backrest elevations from 0 degree to 30 degrees did not alter the CVP without increasing the ICP. Therefore, 30 degrees backrest position is a preventive position without increasing ICP. Conclusion: 30 degrees backrest position might be appropriate for brain injury patients when CVP is measured.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.316-321
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• 2001

Objectives : The goal of this study is to evaluate the usefulness of mild hypothermia treatment in patients with increased intracranial pressure(ICP). Material and Method : From November 1999 to May 2001, 11 patients were treated with mild hypothermia ($32-34^{\circ}C$) in whom ICP maintained at higher than 20mmHg in spite of decompressive surgery and high dose barbiturate therapy. The patient's rectal temperature were lowered by external cooling. Hypothermia was maintained for not more than 7 days and then the patients were rewarmed slowly for 24 hours. If increased ICP persisted for 2 days of hypothermia, this treatment was continued for several days. The functional outcome of each patient was assessed according to Glasgow Outcome Scale(GOS). Results : All cases except two cases showed decrease of ICP after hypothermia therapy. In 1 case which was right middle cerebral artery(MCA) infarct, ICP re-increased after 24 hours and in another 1 case, ICP was not controlled initially. Among 11 cases, 3 cases showed favorable outcome. Conclusion : Mild hypothermia treatment in patients with increased ICP was effective in controlling ICP and mortality was so decreased. More clinical experience and controlled study was need to determine the effectiveness.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.240-248
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• 2000

Objective : Spontaneous intracranial hypotension is a rarely reported syndrome of spontaneous postural headache associated with low CSF pressure and has rarely been demonstrated radiographically or surgically. But recently, it is being recognized with increasing frequency. The purpose of this study was to characterize clinical and imaging features, etiologic factors, and outcome in the spontaneous intracranial hypotension. Patients and Methods : We reviewed our experience with documented cases of spontaneous intracranial hypotension in 5 consecutive patients with orthostatic headaches from April 1998 to April 1999. Results : The mean age was 41 years(from 35 to 49 years). All patients had postural headaches, which were completely alleviated by recumbency position. Nausea, neck pain, horizontal diplopia, photophobia, and blurred vision were noted in some of the patients. Brain MRI showed diffuse pachymeningeal gadolinium enhancement, subdural collections of fluid, and descent of the brain. The opening pressure from lumbar puncture was $4cmH_2O$ or less in three of five patients whereas the opening pressure was within normal range in two patients. All patients underwent radioisotope cisternography and computerized tomographic myelography. On radioisotope cisternography, CSF leakage was suspected at the level of cervical area(1 patient), upper thoracic area(2 patients), mid-thoracic area(1 patient). Computed tomography myelography revealed extraarachnoid accumulation of contrast media(compatible finding with CSF leakage) at the level of cervical or thoracic area. In all patients, the symptoms resolved in response to supportive measures or epidural blood patch(1 patient). Conclusion : Spontaneous spinal CSF leakage is increasingly recognized as a cause of spinal postural headache. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine and can be demonstrated by variable diagnostic method. The condition is usually self-limiting and its prognosis is typically good.