• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.112-114
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• 2013

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.370-373
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• 2006

The case of postoperative hemorrhage occurring apart from the operative site as a complication of intracranial surgery is a rare malady, especially when it involves the cerebellum after supratentorial aneurysm surgery. In a review of the literature, the possible etiologies for cerebellar hemorrhage are: coagulopathy, intraoperative urokinase irrigation, excessive head rotation on positioning, brain shift due to excessive cerebrospinal fluid[CSF] and epidural hemovac drainage. We experienced six cases of cerebellar hemorrhage after supratentorial aneurysm surgery, and all of the patients were improved by instituting conservative medical treatment. The possible mechanism for the remote cerebellar hemorrhages seen in our series is probably a multifactorial effect, such as excessive epidural hemovac and CSF drainage, and jugular venous compression due to the operative position. The purpose of this report is to alert neurosurgeons to the existence of this syndrome and to suggest several ways of minimizing the possibility of their patients developing remote cerebellar hemorrhage.

• 대한두개안면성형외과학회지
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• 제11권2호
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• pp.95-98
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• 2010

Purpose: CSF (Cerebrospinal fluid) leakage is the most common complication of neurosurgery. Early management with conservative care or surgery must be followed appropriately due to the increased risk of lethal complications, such as meningitis. We report a case of intractable CSF leakage that occurred after a cerebellar tumor resection, which was treated successfully. Methods: A 53-year old male consulted our department for continuous CSF leakage for 3 months after having received conservative care and lumbar drainage. CSF collection was observed in the dead space of the posterior fossa after a cerebellar tumor resection and postoperative radiotherapy. Using a free latissimus dorsi muscle flap, the dead space within the skull was filled and the defects were covered successfully. Results: At 6 weeks after surgery, the follow-up MRI and CT revealed proper coverage and filling in the area where cerebellar tumor had been removed. No CSF leakage was observed at the postoperative 3 month follow-up. Conclusion: Recurrent CSF leakage was treated after cerebellar tumor resection with a relatively satisfactory result. In terms of the patient's treatment, much better results can be achieved by performing dead space filling using a flap with a sufficient size, in addition to coverage of the defects of the dura.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.136-143
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• 2009

Objective: Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. Methods: We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. Results: There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. Conclusion: RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.

• Journal of the Korean Wood Science and Technology
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• 제26권4호
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• pp.86-91
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• 1998

The drainage was used to determine the specific filtration resistance for wood and non-wood fibers. The drainage rate is also affected by factors that can be changed on consistency, pressure drop across the mat, basis weight, additives, and viscosity. Recent development of theoretical studies in flow through porous media and filtration operation emphasize the urgent need for more accurate data for porosity and specific filtration resistance. This study was investigated to determine specific filtration resistance of Hw, Sw-BKP and Kenaf fiber by filtration experimental. Freeness levels selected were 150,250,and $350m\ell$ CSF. The average specific filtration resistance decreased as freeness increased and resistance of Sw-BKP was greater than that of Hw-BKP. The filtrate and porosity increased and specific filtration resistance decreased as particle size of fiber increased.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.467-469
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• 2010

We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/$mm^3$. She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.640-644
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• 2018

Objective : The purpose of this pilot study was to examine the safety and function of the newly developed cerebrospinal fluid (CSF) reservoir called the V-Port. Methods : The newly developed V-Port consists of a non-collapsible reservoir outlined with a titanium cage and a connector for the ventricular catheter to be assembled. It is designed to be better palpated and more durable to multiple punctures than the Ommaya reservoir. A total of nine patients diagnosed with leptomeningeal carcinomatosis were selected for V-Port insertion. Each patient was followed up for evaluation for a month after the operation. Results : The average operation time for V-Port insertion was 42 minutes and the average incision size was 6.6 cm. The surgical technique of V-Port insertion was found to be intuitive by all neurosurgeons who participated in the pilot study. There was no obstruction or leakage of the V-Port during intrathecal chemotherapy or CSF drainage. Also, there were no complications including post-operative intracerebral hemorrhage, infection and skin problems related to the V-Port. Conclusion : V-Port is a safe and an easy to use implantable CSF reservoir that addresses problems of other implantable CSF reservoirs. Further multicenter clinical trial is needed to prove the safety and the function of the V-Port.

• 동의생리병리학회지
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• 제18권6호
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• pp.1896-1903
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• 2004

Anglicae dahuricae Radix (ADR), the dried roots of Angelica Dahurica Benth et Hook (Umbelliferae), is a traditional herbal medicine used to treat colds, headache, skin diseases such as acne and possess analgesic, antipyretic and drainage effects. In the present study, the author evaluated the effect of ADR on regulation of inflammatory reaction. ADR reduced the ear-swelling responses derived from compound 48/80 in dose-dependent manner significantly. ADR inhibited the PMA plus A23187-induced productions of IL (Interleukin)-8, IL-1β, granulocyte macrophage-colony stimulating factor (GM-CSF) and tumor necrosis factor (TNF)-α from human mast cells (HMC)-1. In addition, ADR blocked PMA plus A23187-induced ERK1/2 phosphorylation. Ⅰ suggest that ADR regulates inflammatory reaction through inhibition of inflammatory cytokines such as IL-8, IL-1β and GM-CSF.

• Journal of Mechanical Science and Technology
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• 제15권7호
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• pp.1061-1071
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• 2001

The present study investigated design parameters of shunt valves and anti-siphon device used to treat patients with hydrocephalus. The shunt valve controls drainage of cerebrospinal fluid (CSF) through passive deflection of a thin and small diaphragm. The anti-siphon device(ASD) is optionally connected to the valve to prevent overdrainage when the patients are in the standing position. The major design parameters influencing pressure-flow characteristics of the shunt valve were analyzed using ANSYS structural program. Experiments were performed on the commercially available valves and showed good agreements with the computer simulation. The results of the study indicated that predeflection of the shunt valve diaphragm is an important design parameter to determine the opening pressure of the valve. The predeflection was found to depend on the diaphragm tip height and could be adjusted by the diaphragm thickness and its elastic modulus. The major design parameters of the ASD were found to be the clearance (gap height) between the thin diaphragm and the flow orifice. Besides the gap height, the opening pressure of the ASD could be adjusted by the diaphragm thickness, its elastic modulus, area ratio of the diaphragm to the flow orifice. Based on the numerical simulation which considered the increased subcutaneous pressure introduced by the tissue capsule pressure on the implanted shunt valve system, optimum design parameters were proposed for the ASD.

• Journal of Korean Neurosurgical Society
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• 제45권5호
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• pp.318-321
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• 2009

Tension pneumocephalus may follow a cerebrospinal fluid(CSF) leak communicating with extensive extradural air. However, it rarely occurs after diagnostic lumbar puncture, and its treatment and pathophysiology are uncertain. Tension pneumocephalus can develop even after diagnostic lumbar puncture in a special condition. This extremely rare condition and underlying pathophysiology will be presented and discussed. The authors report the case of a 44-year-old man with a basal skull fracture accompanied by pneumothorax necessitating chest tube suction drainage, who underwent an uneventful lumbar tapping that was complicated by postprocedural tension pneumocephalus resulting in an altered mental status. The patient was managed by burr hole trephination and saline infusion following chest tube disengagement. He recovered well with no neurologic deficits after the operation, and a follow-up computed tomography (CT) scan demonstrated that the pneumocephalus had completely resolved. Tension pneumocephalus is a rare but serious complication of lumbar puncture in patients with basal skull fractures accompanied by pneumothorax, which requires continuous chest tube drainage. Thus, when there is a need for lumbar tapping in these patients, it should be performed after the negative pressure is disengaged.