• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.208-211
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• 2014

Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.25-29
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• 2001

Objective : Intracranial metastasis is responsible for nearly 50% of mortalities of systemic cancers. Although its frequency is increasing and there is little doubt that improving the quality and expectancy of life is the final goal, the mode of treatment is still disputed. The authors report the postoperative motor function after surgery in patients with metastatic tumors around the motor cortex. Materials and Methods : We studied 24 patients with metastatic tumors around the central sulcus during the last 22 months. Motor function was assessed pre- and post-operatively as well as its response to corticosteroids. MRI, neuronavigation system and intraoperative ultrasonography were used for tumor localization and functional MRI and cortical stimulator were used to define the motor cortex. Results : Single metastasis was found in 13 cases(54%) and 11 cases(44%) had multiple foci. Thirteen cases were located in precentral, 7 in postcentral, and 4 in superior or middle-frontal lobe. The most common primary focus was the lung(16 cases). There was no difference in postoperative motor function improvement between the steroid responsive group and non-responsive group(92% versus 90%). Ninty-two percent of the patients showed significant improvement of motor function and lived independently but there was worsening in the upper extremity in one and in another no improvement. Whole brain radiation of 3000cGy was given in all cases and 4 patients died of recurrence in primary or intracranial focus during mean follow-up periods of 14 monthes. Conclusion : Surgery may provide substantial improvement of the motor function and quality of life of the patients with metastatic tumors around the motor cortex.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2005년도 춘계학술대회 논문집
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• pp.1921-1924
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• 2005

In this paper, three-dimensional finite element analysis have been performed to investigate the biomechanics of vertebroplasty in patient. In order to apply various properties of the spine, the functional relation between the well-known apparent density and HU(Hounsfield unit) from CT image were employed and thus real material property can be assigned to each element of FE model. The FE analysis showed similar results with the experiments. With this approach accurate analysis of the spine and the clinical application can be expected.

• Journal of Korean Neurosurgical Society
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• 제48권1호
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• pp.66-69
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• 2010

The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.

• Parasites, Hosts and Diseases
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• 제47권1호
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• pp.53-56
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• 2009

The authors report here a rare case of cerebellar schistosomiasis identified by pathological diagnosis, lacking extracranial involvement. The clinical symptoms included headache, dizziness, and nausea. Studies in blood were normal and no parasite eggs were detected in stool. Computed tomography of brains showed hypodense signal, and magnetic resonance imaging showed isointense signal on T1-weighted images, hyperintense signal on T2-weighted images, and intensely enhancing nodules in the right cerebellum after intravenous administration of gadolinium. A high-grade glioma was suspected, and an operation was performed. The pathologic examination of the biopsy specimen revealed schistosomal granulomas scattered within the parenchyma of the cerebellum. The definitive diagnosis was cerebellar schistosomiasis japonica. A standard use of praziquantel and corticosteroid drugs was applied, and the prognosis was good. When the pattern of imaging examinations is present as mentioned above, a diagnosis of brain schistosomiasis should be considered.

• Korean Journal of Neurotrauma
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• 제13권1호
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• pp.9-14
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• 2017

Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). Furthermore, restoring patients' functional outcome and supplementing external defects helps patients improve their self-esteem. Although early cranioplasty is preferred in recent year, optimal timing for cranioplasty remains a controversial topic. Autologous bone flaps are the most ideal substitute for cranioplasty. Complications associated with cranioplasty are also variable, however, post-surgical infection is most common. Many new materials and techniques for cranioplasty are introduced. Cost-benefit analysis of these new materials and techniques can result in different outcomes from different healthcare systems.

• Journal of Korean Neurosurgical Society
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• 제67권3호
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• pp.315-325
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• 2024

Vascular malformations are structural abnormalities that are thought to result from errors in vasculogenesis and angiogenesis during embryogenesis. Vascular malformations of the scalp present unique management challenges due to aesthetic and functional implications. This review examines the pathophysiology, clinical presentation, and management techniques for six common types of vascular malformations of the face and scalp : infantile hemangioma, capillary malformations, venous malformations, lymphatic malformations, arteriovenous malformations, and arteriovenous fistulas. These lesions range from common to rare, and have very different natural histories and management paradigms. There has been increasing understanding of the molecular pathways that are altered in association with these vascular lesions and these molecular targets may represent novel strategies of treating lesions that have historically been approached from a structural perspective only.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.194-200
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• 2001

Object : Anterior cervical discectomy and fusion is accepted as appropriate surgical intervention for disease processes of the ventral cervical spine. In some cases, however, improvement of symptom following operation develop myelopathy or rhizopathy at longterm follow-up. We studied to clarify the correlation between clinical results and plain radiologic findings at long term follow-up. Methods : A total of 86 patients who underwent anterior cervical discectomy and fusion were grouped into deteriorated and good recovery group. These two groups were compared in lateral functional roentgenograms on the cervical kyphosis and disc height at fused level, sagittal plane rotation and dynamic sagittal canal diameter at adjacent level. Results : The presence of cervical kyphosis and disc height at fused level do not correlate with long term followup results. Sagittal plane rotation of more than 20 degrees were identified in 36% of the cases in deteriorated group, whereas the same findings were identified in 15% of the cases in good group. Sagittal diameter of less than 12mm were identified in 48% of the cases in deteriorated group, whereas the same finding were identified in 8% of the cases in good group. Preoperatively, sagittal plane rotation of more than 20 degrees at adjacent level were identified in 28% of the cases in deteriorated group, whereas the same findings were identified in 13% of the cases in good group. Preoperatively sagittal diameter of less than 12mm at adjacent level were identified in 40% of the cases in deteriorated group, whereas the same finding were identified in 7% of the cases in good group. Conclusion : Large sagittal plane rotation and small dynamic sagittal diameter at adjacent level were factors that might be associated with later clinical deterioration after cervical anterior fusion.

• Journal of Korean Neurosurgical Society
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• 제66권1호
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• pp.72-81
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• 2023

Objective : Ischemia and hemorrhage of pituitary adenomas (PA) caused important clinical syndrome. However, the differences on clinical characteristics and surgical outcomes between these two kinds apoplexy were less reported. Methods : A retrospective analysis was made of patients with pituitary apoplexy between January 2013 and June 2018. Baseline and clinical characteristics before surgery were reviewed. All patients underwent transsphenoidal surgery and were followed up at least 1 year. Results : Total 67 cases (5.8%) among 1147 pituitary tumor patients were enrolled, which consisted of 28 (~2.4%) ischemic PA and 39 (~3.4%) hemorrhagic PA. There were more male patients in the ischemic group compared with hemorrhagic group (78.6% vs 53.8%, p=0.043). However, the mean age, tumor size and functional tumor ratio were significant higher in the hemorrhagic group. Headache was more common in ischemic PA (82.1%) than that of hemorrhagic PA (51.3%, p=0.011). Magnetic resonance imaging findings found that mucosal thickening and enhancement of the sphenoid sinus was observed in 15 ischemic PA patients (n=27, 55.6%), but none in patients with hemorrhagic PA (n=38, p<0.0001). It was worth noting that the rate of pre-surgical hypopituitarism in ischemic PA patients were seemed higher than that in hemorrhagic PA patients, but not significant. The two groups got a total tumor resection rate at 94.1% and 92.9%, independently. No significant difference on the operative time, blood loss in operation and complications in perioperative period was observed in two groups. After operation, cranial nerve symptoms recovered to normal at 81.8% of ischemic PA patients and 82.6% of hemorrhagic PA patients. Importantly, the incidence of postoperative hypopituitarism partially decreased in both groups, among which the rate of hypothyroidism in ischemic PA patients significantly decreased from 46.4% to 18.5% (p=0.044). Conclusion : Patients with ischemic PA presented different clinical characteristics to the hemorrhagic ones. Transsphenoidal surgery should be considered for the patients with neuro-ophthalmic deficits and might benefit for pituitary function recovery of the apoplectic adenoma patients, especially pituitary thyroid axis in ischemic PA patients.

• Journal of Korean Neurosurgical Society
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• 제38권5호
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• pp.359-365
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• 2005

Objective : The study investigates the extent of brain shift and its effect on the accuracy of the stereotaxic procedure. Methods : Thirty-five patients underwent 40stereotactic procedures between June 2002 and March 2004. There were 26 males, mean age 59years old. There were 34procedures for Parkinson's disease, 2 for essential tremor, 3 for cerebral palsy, 1 for dystonia. Patients were divided in four groups based on postoperative pneumocephalus : under 5cc [9 procedures], between $5{\sim}10cc$ [13procedures], between $10{\sim}15cc$ [11 procedures] and more than 15cc [7procedures]. The coordinates of the anterior commissure[AC], posterior commissure[PC], and target were defined in pre-and intraoperative magnetic resonance image scans and the amount of air volume was measured with @Target (BrainLab, Heimstetten, Germany]. Results : The mean AC-PC was 26.5mm for patients with less than 5cc, 26.9mm for $5{\sim}10cc$, 25.8mm for $10{\sim}15cc$ and 26.2mm for more than 15cc. The length of AC-PC line and coordinates of AC, PC was also not statistically different, Euclidean distance as well as ${\Delta}x$, ${\Delta}y$, ${\Delta}z$ of AC, PC, and target were also not statistically different among the groups [p>,1]. There was a variance in target of $0.7{\sim}7.6mm$, Euclidean distance of 2.5mm, related to electrophysiology but not to brain-shift. Conclusion : The amount of air accumulated in the intracranial space and compressing the cortical surface has no effect on the localization of subcortical stereotactic target and landmarks.