• Journal of Korean Neurosurgical Society
• /
• 제29권8호
• /
• pp.1126-1135
• /
• 2000

Objectives : The goal of surgical management of cerebral arteriovenous malformation(AVM) is elimination of the lesion without development of new neurological deficits. To improve the management results of cerebral AVMs in the future, this article discusses about surgical complications of the AVM and their management. Material and Methods : During the past 18 years, 116 patients with cerebral AVMs were managed by surgery. Among these cases, 7 cases died, 7 cases developed new neurological deficits, 11 cases residual AVM and 5 cases intracerebral hematoma(ICH) after surgery. The author analyzes the causes of those complications and investigates the methods to minimized those complications based on the review of the literatures. Results : One stage removal of AVM and ICH in the poor neurological state were performed in 5 of 7 death cases. Subtotal removal of ICH followed by delayed AVM surgery after recovery is regard as one method to improve the outcome of patient with large ICH. Postoperative new neurological deficits developed owing to normal perfusion pressure breakthrough(NPPB) in 3, judgement error in 2, preoperative embolization in 1 and cortical injury in 1 case(s). Proper management of NPPB, accurate anatomical knowledge and physiological monitoring during operation, and well trained skill for embolization are regard as methods to minimize those complications. Residual AVMs after surgery were noticed in 11 cases, in which unintended 6 cases due to inaccurate dissection of peripheral margin of AVM, and intended 3 cases due to massive brain swelling during operation, 1 cases due to diffuse type and 1 case due to multiple type of AVM. Accurate dissection of peripheral margin of AVM and mild hypotension during operation may help to avoid this complication. Postoperative hemorrhage occurred in 3 cases due to rupture of the residual AVM and in 2 cases due to oozing from the AVM bed. Complete resection of AVM, complete control of bleeding points at AVM bed and mild hypotension during early postoperative period are the methods to avoid this complication. Conclusion : A precise but flexible therapeutic strategy and refined skill for endovascular, radiosurgical and microsurgical techniques are required to successful treatment of cerebral AVM. Adequate timing of AVM resection, accurate anatomical knowledge, proper management of NPPB and accurate dissection of peripheral margin of AVM are the key points for avoiding complications of the AVM surgery.

• Clinical and Experimental Pediatrics
• /
• 제45권8호
• /
• pp.1048-1051
• /
• 2002

저자들은 8세 남아에서 고열, 저혈압, 부정형 피부 발진, 의식저하, 결막염, 구토, 설사, 핍뇨, 혈소판 저하, 혈액배양 음성과 같은 독성 쇼크 증후군의 증상과 함께 관상동맥류를 포함한 가와사끼병의 임상증상을 보인, 독성 쇼크 증후군 증상으로 나타난 비전형적 가와 사끼병 1례를 경험하였기에 문헌고찰과 함께 보고하며, 독성 쇼크 증후군의 치료 중 발열이 지속될 때 가와사끼병의 비전형적인 증상 발현일 수 있음을 염두해야 할 것으로 사료된다.

• The Korean Journal of Pain
• /
• 제8권1호
• /
• pp.159-163
• /
• 1995

Accidental high epidural block is a rare but serious complication. It can result from many factors, which include the volume and concentration of drug, posture, puncture site, age, pregnancy or intra-abdominal mass, and patients' height and weight. We had a case of accidental high epidural block recently. This is a case report which was confirmed by an epiduragram. A healthy 50-year-old woman with a huge uterine myoma was scheduled for a total abdominal hysterectomy under continous epidural analgesia. Epidural catheterization was carried out smoothly. However, an unexpected hypotension was noticed after an epidural injection of 2% lidocaine 25 ml. Thereafter, the patient was intubated and her respiration was controlled during the operation. Using the 5mg of ephedrine, her blood pressure and pulse were well maintained. The scheduled operation was carried out for one hour uneventfully, but after the operation, she felt paresthesia on her hands in the recovery room. To differentiate between the high epidural and the subdural blocks. We injected 5 ml of a water soluble Niopam 300 through the catheter postoperatively. It was observed on the epiduragram that the catheter was placed in the epidural space. It was suggested that the high epidural block was induced from the widespread diffusion through the narrowed epidural space due to the engorgement of the epidural venous plexus by the patient's huge uterine myoma.

• Journal of Chest Surgery
• /
• 제27권9호
• /
• pp.793-797
• /
• 1994

Constrictive pericarditis is often accompanied with ~brothorax and deterioration of cardiac, hemodynamic functions. Surgical relief of fibrous peel causes remarkable improvement in pulmonary, cardiac, hemodynamic function, and subjective symptoms. We experienced 4 cases of constrictive pericarditis combined with bilateral ~brothorax after bilateral pleural effusion caused by tuberculosis and non-specific inflammation. Pleural decortication and pericardiectomy were done at the same time through anterolateral thoracotomy with sternal transection[3 patients] and median sternotomy incision[l patient]. Low cardiac output was the most common complication. With left anterolateral thoracotomy, we could prevent the hypotension from massive retraction for dissecting by median sternotomy, which was good for dissecting from anterior wall of left ventricle to posterior wall of left ventricle and surrounding phrenic nerve. It was enough to dissect the portion being through hard to dissect, right atrium, SVC and IVC.

• Journal of Chest Surgery
• /
• 제18권2호
• /
• pp.279-282
• /
• 1985

Occipital alopecia after Open Heart Surgery under the Cardiopulmonary bypass is an uncommon minor complication. We had experienced Occipital alopecia in 6 cases after Open Heart Surgery. The cause of the alopecia was transient circulatory disturbance due to pressure effect of the patient`s head and intraoperative hypotension. The prodromal symptoms of the alopecia were erythema, itching, and watery discharge, but some patients showed non-specific symptoms. The common site of the alopecia was right occipital region and the size was 2-4 cm in diameter. The regrowth of the hair was completed at postoperative 3 to 5 months without specific treatment except conservative treatment. Fortunately the postoperative alopecia is a self-limiting condition, and spontaneous regrowth of hair is the rule without other complications.

• The Korean Journal of Pain
• /
• 제25권4호
• /
• pp.262-266
• /
• 2012

Several complications are possible after a lumbar epidural block. However pneumocephalus are rare. In this case, we report a case of pneumocephalus. A 68-year-old male patient received lumbar epidural block with the loss of resistance technique using air, and after 35 minutes, apnea, unconsciousness, hypotension, and bradycardia occurred. Immediately, brain CT was done, and we found pneumocephalus. The patient complained of severe occipital headache and itchiness due to pneumocehalus. After conservative treatment, the patient recovered without neurologic complications, and on the seventh day of his hospitalization, he was discharged from the hospital.

• Journal of Korean Neurosurgical Society
• /
• 제58권2호
• /
• pp.144-146
• /
• 2015

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

• The Korean Journal of Pain
• /
• 제9권1호
• /
• pp.283-287
• /
• 1996

Recently, continuous epidural catheter insertion is usually employed in operation and chronic pain control. Delayed migration of an extradural catheter into subdural space or subarachnoid space is a rare but life threatening complication of continuous epidural catheter insertion, especially with out patients. The symptoms may include lower extremity weakness, hypotension, drowsy and respiratory depression. We experienced two cases of lower extremity paralysis due to delayed migration into subdural or subarachnoid spaces at our pain clinic. The tecnical procedures for continuous epidural catheterization went smoothly without any complications. However, clinical signs of lower extremity paralysis and sensory loss developed gradually, about 2 hours and 30 minutes after the continuous epidural injection. Two cases were confirmed by subdurogram and myelogram.

• The Korean Journal of Pain
• /
• 제8권2호
• /
• pp.386-389
• /
• 1995

Combined infusion of local anesthetics and opioids has been a common method for providing postoperative analgesia. Complications that can occur with this method include pruritus, nausea and vomiting, urinary retention, hypotension, and both early and late respiratory depression. Late respiratory depression is a rare but feared complication to epidural opioid therapy. We experienced a case of respiratory arrest during epidural infusion of bupivacaine and morphine.

• 대한치과마취과학회지
• /
• 제11권1호
• /
• pp.55-60
• /
• 2011

When patients with cerebral palsy are put under general anesthesia, there may be problems like difficult endotracheal intubation caused by deviation of respiratory tract due to scoliosis, hypotension related to chronic malnutrition and anemia, and failure of ventilation due to deformation of the thoracic cavity. The main clinical problem of postanesthetic complication is hypoxemia. The patients with cerebral palsy need close monitoring during treatment under general anesthesia and postanesthetic management. The purpose of this report is to evaluate a patient with cerebral palsy and mental retardation appeared to have dyspnea after general anesthesia.