| 제목 | 2012년도 학술활동 | ||
|---|---|---|---|
| 작성자 | 관리자 | 등록일 | 2013-09-26 |
내용
1) 3D T2-wighted turbo spin-echo MR sequence for identifying cerebrospinal fluid leak after endoscopic endonasal pituitary surgery
Acta Neurochir (Wien). 2012 Aug;154(8):1499-503.
Chung SB, Kwag KS, Kim ST, Park K, Kim JH, Kong DS.
Abstract
BACKGROUND: This study aimed to assess the efficacy of MR images with 3D T2-weighted turbo spin-echo (3D T2-TSE) sequences for early identification of postoperative cerebrospinal fluid (CSF) leaks.
METHODS: We analyzed the medical records and radiological reports for 72 consecutive patients who underwent an endoscopic endonasal approach for sellar and parasellar lesions between April 2009 and December 2010. Patients were 38 men and 34 women with a mean age of 46.4 years. All underwent MR scanning within 2 postoperative days, which included 3D T2-TSE sequences as well as a conventional T2-weighted (T2W) protocol. Sequence accuracy in predicting postoperative CSF leaks was assessed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
RESULTS: A postoperative CSF leak was confirmed in 6 of 72 patients (8.3 %). On immediate postoperative MR images, 39 patients were suspicious for CSF leaks on conventional T2W sequences, while 18 patients on 3D T2-TSE. The 3D T2-TSE imaging had superior specificity and PPV (50 % vs. 81.8 %, 15.4 % vs. 33.3 %), while there was no difference in sensitivity and NPV compared with conventional T2W sequences.
CONCLUSION: Compared to the conventional T2W protocol, MR imaging with the 3D T2-TSE protocol provides differential images around the sellar area with improved specificity and PPV for the detection of postoperative CSF leaks.
2) Intraoperative visual evoked potential has no association with postoperative visual outcomes in transsphenoidal surgery
Acta Neurochir (Wien). 2012 Aug;154(8):1505-10.
Chung SB, Park CW, Seo DW, Kong DS, Park SK.
Abstract
OBJECTIVE: The aim of this study was to elucidate the relationship between changes in the intraoperative visual evoked potential (VEP) waveform and postoperative visual functional outcomes.
METHODS: Between February 2009 and December 2010, we performed endoscopic endonasal transsphenoidal surgery for sellar or perisellar lesions in 65 consecutive patients with intraoperative VEP monitoring using scalp electrodes under total venous anesthesia. Among the 65 patients, 53 patients were followed-up with postoperative visual function evaluation. VEP waveforms measured at baseline were compared with those obtained toward the end of surgery and the association between changes in VEP waveforms and visual outcomes measured preoperatively and postoperatively were assessed.
RESULT: Reproducible waveforms were obtained intraoperatively in 95 of 106 eyes (89.6%). Of the 95 eyes with reproducible VEP, 64 eyes had stable VEP during the surgery, 19 eyes showed VEP improvement, and 12 eyes had VEP deterioration. Of 64 eyes with a stable VEP, 42 showed no change in visual acuity postoperatively, 13 manifested improvement, and 9 worsened. Of 19 eyes with intraoperative VEP improvement, 13 exhibited no change, 4 improved, and 2 worsened postoperatively. Among 12 eyes with VEP deterioration, just 2 eyes showed visual worsening while the other 10 did not change or improved. Postoperative visual evaluation revealed no light perception in 2 eyes whose intraoperative VEP waveforms were stable throughout the surgery.
CONCLUSIONS: Intraoperative monitoring of VEP with scalp electrodes under total venous anesthesia had a reproducibility of 89.6% during transsphenoidal surgery for sellar or perisellar lesions. However, the intraoperative VEP waveforms showed no association with postoperative visual outcomes.
3) Injectable hydroxyapatite cement patch as an on-lay graft for the sellar reconstructions following endoscopic endonasal approach
Acta Neurochir (Wien). 2012 Apr;154(4):659-64.
Chung SB, Nam DH, Park K, Kim JH, Kong DS
Abstract
BACKGROUND: Skull base reconstruction after endoscopic endonasal resection of a variety of skull base lesions remains challenging because of some lethal complications such as cerebrospinal fluid (CSF) leaks. We investigated the outcomes of hydroxyapatite (HA) cement patch as on-lay graft for skull base defects following endoscopic endonasal approach (EEA).
METHODS: We analyzed 53 consecutive patients who underwent sellar reconstruction using HA cement following EEA at our institution between July 2009 and March 2011. Patients were composed of 23 men and 30 women with a mean age of 47 years, ranging from 10 to 72 years. Among these patients, 29 patients (54.7%) experienced intraoperative CSF leaks with high-output, 10 patients (18.9%) underwent CSF leaks with low output, and 14 patients (26.4%) experienced no intraoperative CSF leak. Mean follow-up period for clinical outcomes was 8.6 months (range, 3-22 months).
RESULTS: We performed injectable HA patch as on-lay graft over fascia lata for the skull base defects. Routine lumbar CSF drainage was not performed postoperatively in any patients since the introduction of HA. During the follow-up period, three of 53 patients (5.6%) demonstrated meningitis associated with postoperative CSF leaks and underwent re-do reconstruction surgery. There was no allergic symptoms associated with HA cement. At an outpatient clinic, the defects were found to be covered with surrounding nasal mucosa at an average of 14 weeks (range, 3-28 weeks).
CONCLUSIONS: The use of HA cement as an on-lay patch for the reconstruction of sellar defect demonstrated a low incidence of CSF leaks with minimal complications. HA cement may be an alternative option for repair of CSF leaks following EEA.
