• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.129-136
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• 2016

Objective : The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). Methods : A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. Results : Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. Conclusion : The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.192-196
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• 2015

Objective : Tremor is a common movement disorder that interferes with daily living. Since the medication for tremor has some limitations, surgical intervention is needed in many patients. In certain patients who cannot undergo aggressive surgical intervention, Gamma Knife thalamotomy (GKT) is a safe and effective alternative. Methods : From June 2012 to August 2013, 7 patients with an intractable tremor underwent GKT. Four of these 7 patients had medical comorbidities, and 3 patients refused to undergo traditional surgery. Each patient was evaluated with the modified Fahn-Tolosa-Marin tremor rating scale (TRS) along with analysis of handwriting samples. All of the patients underwent GKT with a maximal dose of 130 Gy to the left ventralis intermedius (VIM) nucleus of the thalamus. Follow-up brain MRI was performed after 3 to 8 months of GKT, and evaluation with the TRS was also performed. Results : Six patients showed objective improvement in the TRS score. Excluding one patient who demonstrated tremor progression, there was 28.9% improvement in the TRS score. However, five patients showed subjective improvement in their symptoms. On comparing the TRS scores between follow-up periods of more and less than 4 months, the follow-up TRS score at more than 4 months of GKT was significantly improved compared to that at less than 4 months of GKT. Follow-up MRI showed radiosurgical changes in 5 patients. Conclusion : GKT with a maximal dose of 130 Gy to the VIM is a safe procedure that can replace other surgical procedures.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.517-522
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• 2012

Objective : Meningiomas represent 18-20% of all intracranial tumors and have a 20-50% 10-year recurrence rate, despite aggressive surgery and irradiation. Hydroxyurea, an inhibitor of ribonucleotide reductase, is known to inhibit meningioma cells by induction of apoptosis. We report the long-term follow-up result of hydroxyurea therapy in the patients with recurrent meningiomas. Methods : Thirteen patients with recurrent WHO grade I or II meningioma were treated with hydroxyurea (1000 $mg/m^2/day$ orally divided twice per day) from June 1998 to February 2012. Nine female and 4 male, ranging in age from 32 to 83 years (median age 61.7 years), were included. Follow-up assessment included physical examination, computed tomography, and magnetic resonance imaging (MRI). Standard neuro-oncological response criteria (Macdonald criteria) were used to evaluate the follow-up MRI scans. The treatment was continued until there was objective disease progression or onset of unmanageable toxicity. Results : Ten of the 13 patients (76.9%) showed stable disease after treatment, with time to progression ranging from 8 to 128 months (median 72.4 months; 6 patients still accruing time). However, there was no complete response or partial response in any patients. Three patients had progressive disease after 88, 89, 36 months, respectively. There was no severe (Grade III-IV) blood systemic disorders and no episodes of non-hematological side effects. Conclusion : This study showed that hydroxyurea is a modestly active agent against recurrent meningiomas and can induce long-term stabilization of disease in some patients. We think that hydroxyurea treatment is well tolerated and convenient, and could be considered as an alternative treatment option in patients with recurrent meningiomas prior to reoperation or radiotherapy.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.667-675
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• 2017

Objective : Total resection without consecutive postoperative whole brain radiation therapy is indicated for patients with a single or two sites of brain metastasis, with close follow-up by serial magnetic resonance imaging (MRI). In this study, we explored the effectiveness, usefulness, and safety of this follow-up regimen. Methods : From January 2006 to December 2015, a total of 109 patients (76 males, 33 females) underwent tumor resection as the first treatment for brain metastases (97 patients with single metastases, 12 with two metastases). The mean age was 59.8 years (range 27-80). The location of the 121 tumors in the 109 patients was supratentorial (n=98) and in the cerebellum (n=23). The origin of the primary cancers was lung (n=45), breast (n=17), gastrointestinal tract (n=18), hepatobiliary system (n=8), kidney (n=7), others (n=11), and unknown origin (n=3). The 121 tumors were totally resected. Follow-up involved regular clinical and MRI assessments. Recurrence-free survival (RFS) and overall survival (OS) after tumor resection were analyzed by Kaplan-Meier methods based on clinical prognostic factors. Results : During the follow-up, MRI scans were done for 85 patients (78%) with 97 tumors. Fifty-six of the 97 tumors showed no recurrence without adjuvant local treatment, representing a numerical tumor recurrence-free rate of 57.7%. Mean and median RFS was 13.6 and 5.3 months, respectively. Kaplan-Meier analysis revealed the cerebellar location of the tumor as the only statistically significant prognostic factor related to RFS (p=0.020). Mean and median OS was 15.2 and 8.1 months, respectively. There were no significant prognostic factors related to OS. The survival rate at one year was 8.2% (9 of 109). Conclusion : With close and regular clinical and image follow-up, initial postoperative observation without prompt postoperative radiation therapy can be applied in patients of brain metastasi(e)s when both the tumor(s) are completely resected.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.285-287
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• 2010

Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of a spontaneous regression of a large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow up MRI study 6 months later. The literature is reviewed and the possible mechanisms of spontaneous disc regression are discussed.

• Journal of Yeungnam Medical Science
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• 제18권1호
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• pp.30-38
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• 2001

본 연구는 골 전이암에 대한 치료에 통상적으로 이용되는 방사선치료 후 치료반응을 객관적으로 평가하는 데 필요한 새로운 영상진단 방법의 적용 가능성을 확인하기 위하여 시행되었다. 척추에 혈행성 전이를 일으킨 21명의 환자를 대상으로 방사선치료 전 후에 확산 강조 자기공명 영상을 시행한 10명의 환자에서 방사선치료 전 후에 골수 조직의 신호 강도의 변화가 현저하였으므로 기존의 진단방법인 단순 X-선 촬영, 방사성 동위원소 골 주사, 전산화 단층 촬영 및 스핀 에코 자기공명 영상진단을 보완할 수 있다는 가능성을 확인하였다. 그렇지만 대상 환자의 숫자가 적고 추적기간이 짧기 때문에 이 촬영기법이 척추에 혈행성 골 정기가 의심되는 환자에서 기본적인 검사방법으로 자리잡기 위해서는 더 많은 화자를 대상으로 가능한 병리조직학적 검사를 병행하여 장기간에 걸쳐 전향적인 검토가 필요하다고 생각되었다.

• 대한관절경학회지
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• 제11권1호
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• pp.13-19
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• 2007

목적: 동반 손상이 없는 급성 후방십자인대 손상에 있어서 보존적 치료를 시행 후 자연 경과를 알아보고자 하였다. 대상 및 방법: 1999년 2월부터 2006년 10월까지 본원에서 급성 단독 후방십자인대 손상으로 진단되어 보존적 치료를 시행한21례의 환자를 대상으로 후향적 연구를 하였다. 초기 진찰과 추시 관찰시 이학적 검사, KT-2000TM 관절검사(arthrometer) 및 후방십자인대의 연속성 정도(두께)를 관찰하기 위한 MRI 촬영을 시행하였고, 모든 환자에서 IKDC(International Knee Documentation Committee) knee score와 대퇴 사두근 근력 정도, 수상 전 운동 능력으로의 복귀 여부 등을 조사하였다. 이후 초기 진찰시와 추시 관찰시의 결과를 비교함으로써 보존적 치료를 한 급성 단독 후방십자인대 손상의 자연 경과를 알아보고자 하였다. 본 연구의 평균 추시 기간은 22.7개월이었다. 결과: 초기 진찰시 이학적 검사에서 관찰된 후방 불안정성은 Grade I이 14례, Grade II가 6례, Grade III가 1례였으며, 추시는 Grade I이 18예, Grade II가 3예였다. KT-2000TM 관절검사는 초기 진찰시 건측과 평균 5.7 mm($3{\sim}12\;mm$)의 차이에서 추시에서는 평균 2.7 mm($0{\sim}7\;mm$)의 차이를 보였고, MRI 촬영을 통한 인대의 연속성 정도(두께)는 48.1%에서 69.7%로 증가된 소견을 보였다. 대퇴 사두근 근력은 평균Good등급이었고, 평균 IKDC knee score는 A등급에 가까운 결과를 보였다. 결론: 급성 단독 후방십자인대 손상의 치료에 있어서 급성기 초기에 적극적인 보존적 치료를 시행함으로써 임상적 및 영상의학적으로 만족할 만한 결과를 얻을 수 있었다.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.183-186
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• 2017

A 7-year-old boy, diagnosed with an arachnoid cyst and subdural effusion on initial MRI, was admitted with left limb weakness and no history of head trauma. A subsequent follow-up MRI showed different stages of hematoma within multilayered enhancing membranes and in the arachnoid cyst, which was separated by the cerebrospinal fluid cleft. Craniotomy and fenestration of the cyst wall and hematoma removal were performed. The patient was diagnosed as a having a hemorrhagic rupture of an arachnoid cyst into the intradural space, probably via some one-way valve-like defect, based on the MRI and surgical findings. The MRI features and possible mechanism of this rare disease are discussed within the literature review.

• 대한약침학회지
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• 제14권3호
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• pp.99-107
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• 2011

Objectives : The purpose of this study is to report the image changes of two cases of Lumbar intervertebral Disc Sequestration after oriental medical treatment. Methods : We examined 2 patients with Lumbar intervertebral Disc Sequestration who showed changes on MRI images before/after the treatment. And we assessed clinical symptoms by using numeric rating scale(NRS) and straight leg raising test(SLRT). Results & Conclusions : In this study, the first MRI examination of Lumbar intervertebral Disc Sequestration patients was performed at the first visit and re-examination of MRI was done after treatment. In each case, the size of the disc sequestration was considerably reduced in MRI image. And both patients represented effective improvment in NRS score and SLRT test angle.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.377-383
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• 2012

Objective : Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. Methods : Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. Results : Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. Conclusion : NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.