• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1527-1532
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• 2000

Althogh spinal epidural lipomatosis is relatively rare, it is a widely recognized complication of excess exogenous glucocorticoids. We report 4 cases of epidural lipomatosis. None of the patients had definitive history of steroid treatment, obesity, or diabetes mellitus, but all had sciatica and radiating pain. In all cases, the authors removed excess amount of epidural fat with surgery after which significant improvement of symptoms was noted.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1328-1331
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• 2001

Multiple primary brain tumors of different cell types are rare, accounting for 0.4% of all the primary brain tumors. Phakomatosis, irradiation, trauma and other factors have been associated with multiplicity of brain tumors. When these tumors are close or intermixed, the term "collision" has been used, and in these cases an explanation might be that one tumor stimulating the other. We report a patient with collision tumor of meningioma and anaplastic astrocytoma, who did not have a history of trauma, irradiation, or phakomatosis.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1533-1537
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• 2000

Granulocytic sarcomas are solid tumors resulting from the localized proliferation of myelogenous leukions cells. Epidural involvement of granulocytic sarcoma is very rare in acute myelogenous leukemia(AML). We report a patient with a thoracic epidural granulocytic sarcoma whose presentation with acute paraparesis led to the diagnosis of relapsing of alleged AML. Early recognition of the etiology of the paraparesis and treatment with emergency decompressive, laminectomy, radiation therapy and chemotherapy resulted in an excellent neurological and hematological outcome.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.277-281
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• 2022

Craniocerebral gunshot injuries is gradually increasing in the civilian population with a worse prognosis than closed head trauma. We experienced a case of craniocerebral gunshot injury which a bullet penetrating from the submandibular area into the clivus of a patient. The patient did not show any symptom. However, serial laboratory findings showed an increase in blood lead level. We removed foreign bodies without any problems using an endoscopic transnasal transclival approach. Due to the extremely low frequency, guidelines for definitive management of gunshot injuries have not been presented in Korea yet. We introduce our surgical experience of a craniocerebral gunshot injury with an unusual approach for removing intracranial foreign bodies.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.4
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• pp.380-389
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• 2023

Objective: Middle meningeal artery embolization (MMAe) has burgeoned as a treatment for chronic subdural hematoma (cSDH). This study evaluates the safety and short-term outcomes of MMAe patients relative to traditional treatment approaches. Methods: In this retrospective large database study, adult patients in the National Inpatient Sample from 2012-2019 with a diagnosis of cSDH were identified. Cost of admission, length of stay (LOS), discharge disposition, and complications were analyzed. Propensity score matching (PSM) was utilized. Results: A total of 123,350 patients with cSDH were identified: 63,450 without intervention, 59,435 surgery only, 295 MMAe only, and 170 surgery plus MMAe. On PSM analysis, MMAe did not increase the risk of inpatient complications or prolong the length of stay compared to conservative management (p>0.05); MMAe had higher cost ($31,170 vs. $10,768, p<0.001) than conservative management, and a lower rate of nonroutine discharge (53.8% vs. 64.3%, p=0.024). Compared to surgery, MMAe had shorter LOS (5 vs. 7 days, p<0.001), and lower rates of neurological complications (2.7% vs. 7.1%, p=0.029) and nonroutine discharge (53.8% vs. 71.7%, p<0.001). There was no significant difference in cost (p>0.05). Conclusions: MMAe had similar LOS and decreased odds of adverse discharge with a modest cost increase compared to conservative management. There was no difference in inpatient complications. Compared to surgery, MMAe treatment was associated with decreased LOS and rates of neurological complications and nonroutine discharge. This nationwide analysis supports the safety of MMAe to treat cSDH.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.4
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• pp.390-402
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• 2023

Objective: Chronic subdural hematoma (CSDH) is a neurological complication following clipping surgery. However, the natural course and ideal approach for the treatment of clipping-related-CSDH (CR-CSDH) have not been clearly established. We aimed to investigate the course of CR-CSDH using chronological radiological findings. Methods: We performed a retrospective analysis of 28 (3.8%) patients who developed CSDH among 736 patients who underwent surgical clipping using pterional approach for unruptured aneurysms at our institution between December 2010 and December 2018. Patients underwent follow-up CT scan 6-8 weeks after clipping surgery and decision to pursue surgical intervention rests upon the patient's symptom based on the Markwalder's grading scale (MGS) and numeric rating scale (NRS). Results: Of the 28 patients, 3 patients (10.7%) underwent surgery, while 25 (89.2%) showed spontaneous resolution of CR-CSDH. Eighteen patients (64.2%) had mild headache with MGS of 0-1. The mean maximum hematoma volume was 41.9±30.9 ml (5.8-135 ml), and 26 patients (92.8%) had homogeneous hematoma. The mean time to hematoma resolution was 126.7±52.9 days (46-228 days). Comparing group of CR-CSDH volume ≥43 ml or a midline shift ≥5 mm, the difference in presence of linear low-density area (p=0.002) and age (p=0.026) between the conservative and operative groups were found to be statistically significant. Conclusions: Most CR-CSDH cases spontaneously resolved within 4 months. Therefore, we suggest that close observation should be performed if patient's symptoms are mild and special radiologic findings are present, despite its relatively large volume and midline shifting.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.680-683
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• 2000

Osteosarcoma is the most frequently encountered primary malignant tumor of the bone. But primary osteosarcoma of the skull(POS) is rare. The author presents a case of skull neoplasm identified as osteogenic sarcoma. A twentyseven-years-old male patient was admitted because of painful swelling at left temporal and zygomatic area with impairment of extraocular movement. Chest film and long bone series showed no evidence of abnormality. Skull films revealed round irregular bony destructive area at the left pterional area. CT and MRI revealed expansile destruction of the left sphenoid bone, lateral orbital wall and temporal bone within the hemorrhagic mass lesions which showed wall enhancement. Histologic examination confirmed a rare variant of osteosarcoma of the telangiectatic type.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.6-10
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• 2006

Objective : The purpose of this study is to evaluate the surgical outcomes of bifrontal interhemispheric[BIH] approach and compare them to those of the pterional approach for the treatment of craniopharyngioma. Methods : Seventeen patients had their first operation for the resection of craniopharyngiomas between 2000 and 2004 at our medical center. Eleven patients who had the pterional approach and 6 with the BIH approach were enrolled. The age range at the time of surgery was 5 to 80 years [mean age 35.6 years old]. The presenting symptoms were visual disturbance increased intracranial pressure in 5 patients. Results : The tumors were totally removed in 3 [27 %] and subtotally in 8 [73 %] patients with the pterional approach. Total tumor removal was achieved in 5 out of 6 [83%] patients by the BIH approach, except improved in 4 [36 %] patients treated with the pterional approach and in all patients treated by the BIH approach. Conclusion : The BIH approach for craniopharyngioma surgery may be an effective and safe approach for tumors that extend outside of the sellar-suprasellar region with acceptable outcomes.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.85-89
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• 2008

Objective: The purpose of this study is to identify the factors affecting the failure of trials (<50% pain reduction in pain for trial period) to improve success rate of spinal cord stimulation (SCS) trial. Methods: A retrospective review of the failed trials (44 patients, 36.1 %) among the patients (n=122) who underwent SCS trial between January 1990 and December 1998 was conducted. We reviewed the causes of failed trial stimulation, age, sex, etiology of pain, type of electrode, and third party support. Results: Of the 44 patients, 65.9% showed unacceptable pain relief in spite of sufficient paresthesia on the pain area with trial stimulation. Four of six patients felt insufficient paresthesia with stimulation had the lesions of the spinal cord. Seventy five percent of the patients experienced unpleasant or painful sensation during stimulation had allodynia dominant pain. Third-party involvement, sex, age and electrode type had no influence on the outcome. Conclusion: We conclude that SCS trial is less effective for patients with neuropathic pain of cord lesions, postherpetic neuropathy or post-amputation state. Further, patients with allodynia dominant pain can feel unpleasant or painful during trial stimulation.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.425-430
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• 2005

Objective : Recently, the survival rate and prognosis of spontaneous intracerebral hemorrhage[S-ICH] has improved, and their enhanced survival has become associated with a consequent rise in the recurrence of S-ICH. The aim of this study is to improve the prevention of recurrent S-ICH. Methods : Between January 1999 and March 2004, we experienced 48 cases of recurrence. We classified the patients into the two groups; a double ICH group and a triple ICH group. We investigated their brain CTs, MRIs, cerebral angiographies, and medical records, retrospectively. Results : Majority of patients had the intervals at least 12 months, and most of patients underwent conservative treatment. The most common hemorrhage pattern of recurrence was ganglionic-ganglionic [basal ganglia - basal ganglia], and the second attack was contralateral side of the first attack in a large percentage of all patients. Prognosis of patients was worsened in recurrent attack. Nearly all patients had medical history of hypertension, and most patients have taken antihypertensive medication at the arrival of emergency room. Conclusion : In treating hypertension for S-ICH patients, we stress that blood pressure must be thoroughly controlled over a long period of time.