• 대한간호학회지
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• 제27권3호
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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 Neurosurgical Society
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• 제40권4호
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• pp.239-244
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• 2006

Objective : The present study evaluated overall surgical results for 3,000 patients with intracranial aneurysms, operated on in Busan Paik Hospital institution. Methods : Three thousand aneurysm cases, operated on in Busan Paik Hospital between January 1980 to June, 15th, 2005, were evaluated based on the following criteria; aneurysm form, aneurysm location, surgical results, postoperative complications, and seasonsonality of occuence. 957 cases were anterior communicating artery aneurysms, 776 were internal carotid artery[ICA] aneurysms, 755 were middle cerebral artery[MCA] aneurysms, 96 were anterior cerebral artery[ACA] aneurysms, 128 were vertebro-basilar artery[VBA] aneurysms and 288 were multiple aneurysms. The male to female ratio was 0.7 to 1 Surgical methods included 2.738 clippings, 219 coating and wrappings, 23 aneurysmoraphies, 20 proximal ligations. Results : Rebleeding occured in 5.1% of the early operation group and 16% of the late operation group respectively. Incidence of clinical vasospasm was 166% and angiographic vasospasm was 24.1%. The percentage of the multiple aneurysms was 9.5%, the percentage of the dissecting aneurysm was 6 cases [0.2%], 6 of the total [0.2%];De Novo" aneurysm, the percentage of lobectomies with clipping cases was 9 cases [03%] the percentage were incidental aneurysms; 164 [5.5%]. 88.1% had overall favorable surgical results with a 5.5 % mortality rate. Calcium-channel blocker and "Triple H" therapy did not improve mortality but did significantly improve morbidity. In the old age group, early operation reduced vasospasm, rebleeding and medical complications. The early surgery group exhibited a 86.2% favorable outcome with a 8.1% mortality rate. Intraoperative angiography reduced residual or remained aneurysms in large, giant aneurysm, especially in A.com artery aneurysm. Conclusion : The surgical results for the early surgery group according to surgical timming was better, but there were not statistically significant. ntraoperative angiography was especially useful on large aneurysms of the anterior communicating artery.

• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.125-128
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• 2013

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

• Journal of Korean Neurosurgical Society
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• 제37권6호
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• pp.432-435
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• 2005

Objective: This study was performed to evaluate the usefulness of early operation in children with traumatic subdural hygroma. Methods: The subjects were nine patients (Glasgow coma scale (GCS) score was below 10 and age was below 10 years old) who developed subdural hygroma after trauma between January 2000 to December 2002. Subduroperitoneal shunt was performed in one group and not performed in the other group. We analyzed the GCS score on admission and at 1 year after operation. Overall clinical results were evaluated retrospectively. Results: Patients who underwent operation exhibited higher GCS scores at 1 year after trauma compared to those in the patients who were treated by conservative therapy(p<0.05). Conclusion: The early operation could be an effective treatment to children with subdural hygroma who showed delayed improvement of consciousness and to patients with hygroma that didn't decrease or was above moderate amount.

• Journal of Korean Neurosurgical Society
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• 제43권3호
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• pp.143-148
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• 2008

Objective: Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. Methods: Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. Results: POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 mini, and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. Conclusion: Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.

• Journal of Korean Neurosurgical Society
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• 제37권2호
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• pp.141-145
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• 2005

We report five patients of esophageal injuries confirmed by clinical signs and radiological evidences. They include a partial tear and a perforation which were not noticed during the operation, a perforation which was primarily repaired during the operation, and two perforations which occurred during the reoperations for the removal of mal-positioned screws or plate. The partial tear was not repaired. The perforation which occurred during the operation was primarily sutured and didn't receive further treatment. Two perforations which occurred during the reoperations were treated by irrigation, debridement with surgical drainage, and systemic antiobiotics. One who was diagnosed later after the operation showed the poorest outcome and required longest hospital days among our series. Early detection and appropriate treatment of esophageal injury following anterior spinal surgery can only improve the prognosis by preventing secondary complications.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.191-194
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• 2007

Objective : Homeless patients probably have epidemiologic features that are different from those of general population. However, there have been no published articles about clinical characteristics of neurosurgical homeless patients. The authors tried to assess the clinical characteristics and treatment outcome of homeless neurosurgical patients. Methods : We retrospectively reviewed the medical records and radiological films of 76 homeless patients and 72 non-homeless patients following head trauma who were admitted to our neurosurgical department between June 2001 and June 2005. We compared two groups of the patients with the demographics, the clinical and laboratory characteristics. Also, 3D-day mortality was determined according to Glasgow Coma Scale (GCS) score. Results : Age of homeless patients was younger than that of non-homeless patients. Homeless patients had previous craniotomy evidences in skull x-rays more frequently (10.5% vs. 1.4%). Acute subdural hematoma was the most common type of head injury in the two groups. Moderate and severe head injury, based on GCS score on admission was more frequent in homeless patients (64% vs. 39%). Fifty percent of homeless patients underwent operation for traumatic head injury. However, 3D-day mortality according to GCS score was not significantly higher in homeless patients. Conclusion : Most homeless neurological patients were relatively young men. Also, moderate or severe brain injuries were observed more frequently. However, mortality rate of homeless patients in neurosurgical field is not significantly higher in the present study.

• Journal of Korean Neurosurgical Society
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• 제53권1호
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• pp.52-56
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• 2013

Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.230-233
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• 2014

While there are reports regarding burns occurring to patients during the surgery, there are little reports concerning the incidents of the burns related to neurosurgical operations. Moreover, in Korea, even surveys and statistics on the incidents of burns in operating rooms are not known. This report explores burns occurring to a patient in an electrocautery scenario after disinfecting the surgical site with alcohol during the preparation of a neurosurgical operation in an operating room where there is much exposure to oxygen. The authors show a case of a 33-year-old male patient who undergoing evacuation of hematoma on occipital lesion, suffered second degree burns as a result of surgical fires.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.43-48
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• 2011

Objective: Classical markers of infection cannot differentiate reliably between inflammation and infection after neurosurgery. This study investigated the dynamics of serum procalcitonin (PCT) in patients who had elective spine surgeries without complications. Methods: Participants were 103 patients (47 women, 56 men) who underwent elective spinal surgery. Clinical variables relevant to the study included age, sex, medical history, body mass index (BMI), site and type of surgery, and surgery duration. Clinical and laboratory data were body temperature, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and PCT, all measured preoperatively and postoperatively on days 1, 3, and 5. Results: PCT concentrations remained at <0.25 ng/mL during the postoperative course except in 2 patients. PCT concentrations did not correlate with age, sex, DM, hypertension, BMI, operation time, operation site, or use of instrumentation. In contrast, CRP concentrations were significantly higher with older age, male, DM, hypertension, longer operation time, cervical operation, and use of instrumentation. Conclusion: PCT may be useful in the diagnosing neurosurgical patients with postoperative fever of unknown origin.