• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.73-78
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• 2001

Objective : Intraoperative rupture of an intracranial aneurysm can interrupt a microsurgical procedure and jeopardize the patient's chance to favorable outcome. The purpose of this study was to analyse and evaluate intraoperative aneurysmal rupture and render ideal prevention and management to intraoperative rupture. Patients and Methods : The authors retrospectively analysed the results of 609 patients who underwent cerebral aneurysm surgery from January 1991 to December 2000. Results : 1) Intraoperative aneurysmal rupture occurred in 73 of 609 consecutive aneurysm surgery, so the incidence was about 12.0% and it was relatively lower than other reports. 2) Aneurysms arising from anterior communicating artery appeared more prone to intraoperative rupture. 3) The size of aneurysm and timing of operation didn't influence intraoperative aneurysmal rupture and temporary clipping didn't reduce the incidence of intraoperative aneurysmal rupture. 4) Intraoperative aneurysmal rupture occured during three specific periods : (1) dissection stage in 61%, (2) clip application stage in 29 %, (3) predissection stage in 10%. 5) In the patients with intraoperative aneurysmal rupture, surgical outcome was relatively good and there was no significant difference in outcome compared with unruptured group. Conclusion : Our suggestion for prevention methods of intraoperative aneurysmal rupture are as follows : 1) minimal brain retraction, 2) sharp and careful aneurysmal neck dissection, 3) gentle clipping with proper clip selection etc. Management methods after intraoperative aneurysmal rupture are as follows : 1) strong aspiration of bleeding point, 2) rapid application of temporary and/or tentative clip, 3) following rapid dissection of neck and proper clip application, 4) use of encircling clip etc.

• Journal of Yeungnam Medical Science
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• 제36권3호
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• pp.163-182
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• 2019

The primary function of intraoperative frozen consultation is to provide an as accurate and prompt diagnosis as possible during surgery and to guide the surgeon in further management. However, the evaluation of frozen section (FS) is sometimes difficult because of suboptimal tissue quality and frozen artifacts compared with routinely processed tissue section. The pathologist responsible for the FS diagnosis requires experience and good judgment. Ovarian tumors are a heterogeneous group of tumors including primary surface epithelial tumors, germ cell tumors and sex cord-stromal tumors, secondary tumors, and other groups of tumors of uncertain histogenesis or nonspecific stroma. Intraoperative FS is a very important and reliable tool that guides the surgical management of ovarian tumors. In this review, the diagnostic key points for the pathologist and the implication of the FS diagnosis on the operator's decisions are discussed.

• Journal of Chest Surgery
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• 제54권4호
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• pp.263-265
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• 2021

Intraoperative events can occur during video-assisted thoracoscopic surgery (VATS) lobectomy due to unfavorable surgical anatomy, such as dense adhesions or calcifications around the pulmonary arteries. Troubleshooting intraoperative complications is essential for performing safe and successful VATS pulmonary resection and lymph node dissection. If continuous bleeding occurs or VATS does not proceed despite all measures, conversion to open thoracotomy should not be delayed.

• Annals of Surgical Treatment and Research
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• 제95권6호
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• pp.312-318
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• 2018

Purpose: Acute normovolemic hemodilution (ANH) is an autologous transfusion method, using blood collected during surgery, to reduce the need for allogeneic blood transfusion. ANH is controversial because it may lead to various complications. Among the possible complications, anastomotic leakage is one that would have a significant effect on the operation outcome. However, the relationship between ANH and anastomotic site healing requires additional research. Therefore, we conducted this prospective study of ANH, comparing it with standard intraoperative management, undergoing gastric anastomosis in rats. Methods: Sixteen Sprague-Dawley rats were randomly assigned to three groups: group A, surgery with ANH; group N, surgery with standard intraoperative management; and group C, sham surgery with standard intraoperative management. ANH was performed in group A animals by, removing 5.8-6.6 mL of blood and replacing it with 3 times as much crystalloid. All rats were enthanized on postoperative day 6, and histopathologic analyses were performed. Results: The mean hematocrit values, after hemodilution were 22.0% (range, 18.0%-29.0%), group A; 33.0% (29.0%-35.0%), group N; and 32.5% (29.0%-34.0%), group C. There were significant differences between groups A and N (P = 0.019, P = 0.009, P = 0.004, P = 0.039, and P = 0.027), and between groups N and C (P = 0.006, P = 0.027, P = 0.04, P = 0.008, and P = 0.009) with respect to inflammatory cell numbers, neovascularization, fibroblast numbers, edema and necrosis, respectively; there were no differences between groups A and N. Conclusion: In rat model, anastomotic complications did not increase in the ANH group, compared with the standard intraoperative management group.

• Neurospine
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• 제15권4호
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• pp.338-347
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• 2018

Objective: Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods: We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. Results: A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). Conclusion: Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

• Journal of Chest Surgery
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• 제33권1호
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• pp.73-78
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• 2000

Background: this study was designed to estimate whether specific risk factors could increase the postoperative complication rate of pneumonectomy for chronic complicated inf-lammatory lung disease. Material and Method: Eighty-five patients underwent pneumon-ectomy for chronic complicated inflammatory lung disease(tuberculosis, 67 ; bronchiecasis 11; aspergio- losis, 4; others, 3) between January 1991 and August 1998. We performed a univariated statistical analysis to identify preoperative and intraoperative risk factors associated with postoperative complications, Result: There was no operative mortality. There were a total of 18 postoperative complications(22.2%) Bronchopleural fistula(BPF) and empyema occurred in 5(5.9%) and 2(2.4%) respectively. General complication rate was significantly higher in patients with right-sided pneumonectomy(p=.029) extrapleural pneu-monectomy(p=.009) and intraoperative pleural spillage due to cavity or lesion perforation (p=.004). The prevalence of BPF and empyema was higher in patients with right sided pneumonectomy(p=.007) extrapleural pneumonectomy(p=.015) and intraoperative pl- eural spillage due to cavity or lesion perforation(p=.003) which is as the same results as gen-eral complication rate. Conclusion: The postoperative complication rate of pneumone-ctomy for chronic complicated lung disease is accptably low. But it is increase in patients with right sided pneumonectomy extrapleural pneumonectomy and intraoperative pleural spillage due to cavity or lesion perforation. therefore more careful and meticulous intra-operatve management are needed in right sided extrapleural pneumonectomy without intra- pleural spillage.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.73-75
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• 2017

The management of mandibular angle fractures is often challenging and results in the highest complication rate among fractures of the mandible. In addition, the optimal treatment modality for angle fractures remains controversial. Traditional treatment protocols for angle fractures have involved rigid fixation with intraoperative maxillomandibular fixation (MMF) to ensure absolute stability. However, more recently, non-compression miniplates have gained in popularity and the use of absolute intraoperative MMF as an adjunct to internal fixation has become controversial. In this article, the history of, and current trends in, the treatment of mandibular angle fractures will be briefly reviewed. In addition, issues regarding the management of the third molar tooth will be discussed.

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.253-256
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• 2013

Spinal intradural hemangiopericytoma is a very rare tumor and can be characterized by massive bleeding during surgeries, frequent recurrence, and metastasis. However, definite radiologic differential points of hemangiopericytoma are not known. We describe an unexpected hemangiopericytoma case with large bleeding and management of the tumor. A 21-year-old man visited complaining of progressive neck pain and tingling sensation in both hands. Magnetic resonance imaging of his spine revealed C1-2 ventral intradural mass. When the dura was opened, the intradural tumor was placed behind spinal accessary nerves. The tumor was partially exposed only after some accessary nerves had been cut. When internal debulking was performing, unexpected bleeding was noted and it was difficult to control because of narrow surgical field and hypervascularity. Intraoperative spinal angiography and embolization were performed. The tumor was completely removed after embolization. Pathological diagnosis was consistent with hemangiopericytoma. When surgeons meet a flesh-red tumor that bleeds unexpectedly during surgery, hemangiopericytoma may be considered. When feeder control is hard due to reciprocal location of spinal cord, the tumor, and feeders, intraoperative angiography and embolization may be a possible option.

• Journal of Veterinary Science
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• 제23권2호
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• pp.34.1-34.7
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• 2022

A 13-yr-old Shih tzu was referred for surgical management of right-sided cranial abdominal mass, which corresponded to large, cavitated renal mass on ultrasonography, and was suspected to represent neoplasia. Intraoperative impression smear cytology (ISC) of the renal mass wall was consistent with benign renal cyst (RC), without evidence of neoplasia or infection. Deroofing and omentalisation were performed and histopathology was consistent with benign RC. Chronic kidney disease was diagnosed 4 mon postoperatively, however, the dog was asymptomatic, without cyst reoccurrence. Intraoperative ISC is an expedient and inexpensive diagnostic technique that can guide most appropriate treatment in dogs with large RCs.

• 대한두경부종양학회지
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• 제14권1호
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• pp.27-34
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• 1998

Objectives, Materials & Methods: To prevent deterioration of postoperative voice due to iatrogenic transection of the recurrent laryngeal nerve during the thyroid surgery, intraoperative medialization of the membranous vocal cord by type I thyroplasty together with direct epineurial neurorraphy was done on 2 cases of benign thyroid lesion. To improve the quality of voice together with complete removal of advanced thyroid carcinoma, intraoperative vocal cord medialization on the lesion side together with total thyroidectomy was done by type I thyroplasty in 2 cases and combined procedure by arytenoid adduction and type I thyroplasty in another 2 cases. Results: The resultant voice of the iatrogenic injury cases was relatively tolerable. The voice of the combined procedure was better than that of type I thyroplasty cases for the intraoperative rehabilitation cases. Not only for the preoperative evaluation of the severity of the nerve lesion but also the prognosis will be expected by use of laryngeal EMG in the cases of thyroid cacer with vocal cord palsy. Conclusion: Intraoperative simultaneous rehabilitation for the vocal cord palsy during thyroid surgery is beneficial for the patients.