• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.108-113
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• 2017

Craniopharyngiomas exhibiting histologic malignancy are extremely rare. Herein, we report the case of a 26-year-old male patient who underwent suprasellar mass excision via an interhemispheric transcallosal approach. Histopathological examination indicated that the craniopharyngioma was of the adamantinomatous subtype. The patient received postoperative medical treatment for endocrine dysfunction and diabetes mellitus without radiation treatment. Two years after the operation, he presented with progressive visual disturbance and altered mentality. Magnetic resonance imaging revealed a huge mass in the suprasellar cistern and third ventricle. He underwent a second operation via the same approach. The histopathological examination showed an adamantinomatous craniopharyngioma with sheets of solid proliferation in a spindled pattern, indicating malignant transformation. Malignant transformation of craniopharyngioma in the absence of radiation therapy has been reported in only five cases, including this one. We present a case of malignant transformation of craniopharyngioma with a brief review of relevant literature.

• Korean Journal of Biological Psychiatry
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• v.20 no.4
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• pp.166-178
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• 2013

Objectives Alteration of epigenetic effects of testosterone during early development was suggested as an ancillary mechanism for the genesis of schizophrenia. EEG coherence was thought to be a marker for cerebral laterality of which important determinant was testosterone during early development. We studied sex-related differences of EEG coherences between patients with schizophrenia and controls to examine the sex effects in the genesis of schizophrenia. Methods EEG was recorded in 35 patients with schizophrenia and 46 healthy controls in the eyes closed resting state. Pair-wise EEG coherences were calculated over delta, theta, alpha, beta and gamma frequency bands. To examine the differences of EEG coherence according to sex in each group, ANCOVA was performed using Statistical Analysis system (SAS, Ver 9.3) and R (Ver 2.15.2). Results Healthy control males showed more increased right intrahemispheric coherences than healthy control females in delta, theta, alpha and beta frequency bands. In patients with schizophrenia, this male dominant pattern in right intrahemispheric coherences was attenuated especially in alpha and beta bands. Healthy control females showed more increased interhemispheric coherences than healthy control males in delta, theta, beta and gamma frequency bands. In patients with schizophrenia, these female dominant patterns in interhemispheric coherences were attenuated especially in delta, theta, and beta bands, which were commonly observed in frontal to central areas. Conclusion Sex differences in resting EEG coherences were attenuated in schizophrenia patients. These results imply that sex-related aberrant cerebral lateralization might exist in patients with schizophrenia, which are partly due to sex hormones via epigenetic mechanisms.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.265-269
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• 2000

Traumatic aneurysm is a rare complication of head trauma. Unfortunately, it is rarely recognized until their presence is heralded by delayed deterioration or intracranial hematoma, etc,. Early diagnosis and surgical treatment are most important for good outcome. We recently encountered a patient who developed a pericallosal aneurysm after major trauma. With a high index of suspicion about traumatic aneurysm, brain MRI and MRA were performed. Definitive diagnosis was made by transfemoral carotid angiography, revealing a aneurysm of the right proximal pericallosal artery. The aneurysm was explored through right interhemispheric approch. A $15{\times}15mm$ sized traumatic aneurysmal sac, located in proximal portion of right pericallosal artery was noted. It was dissected from the falx of cerebri and its neck was clipped. The postoperative course was uneventful. Traumatic intracranial aneurysm should be suspected in any patient who deteriorates after the trauma. Early recognition and prompt treatment are warranted in this setting. Definitive surgical treatment of all traumatic intracranial aneurysm is recommended.

• The Journal of Korean Physical Therapy
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• v.18 no.4
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• pp.1-9
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• 2006

Recently, several investigations revealed that after unilateral brain damage, movement abnormalities were exposed on the ipsilateral side as well as the upper extremity contralateral to the damaged hemisphere. Even the motor abilities had significantly recovered from ipsilateral motor deficits on not only simple sensoriomotor function, also clinical assessments since subacute stage, although could not completely returned. Such motor deficits were detected in a diversity of motor tasks depending on the interhemispheric specialization, further in clinical evaluation and a daily of activities. In the clinical features, muscular weakness, sensory loss and impaired manual dexterity were observed. In a laboratory experiment, there were increasing evidences that the kinematic processing deficits was founded in various-specific motor tasks, which ranged from simple basic element to complex tasks, such as tapping task, step-tracking, goal directional aiming task, and iso(and non-)directional interlimb coordination. In the point of view, the manifest understanding in related to ipsilateral deficits provide the clinicians with an important information for scientific management about brain injured patient's prognosis and therapeutic guidelines.

• Journal of Korean Neurosurgical Society
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• v.60 no.3
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• pp.275-281
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• 2017

Treating diseases in the field of neurosurgery has progressed concomitantly with technical advances. Here, as a surgical armamentarium for the treatment of cerebral aneurysms, the history and present status of the keyhole approach and the use of neuroendoscopy are reviewed, including our clinical data. The major significance of keyhole approach is to expose an essential space toward a target, and to minimize brain exposure and retraction. Among several kinds of keyhole approaches, representative keyhole approaches for anterior circulation aneurysms include superciliary and lateral supraorbital, frontolateral, mini-pterional and mini-interhemispheric approaches. Because only a fixed and limited approach angle toward a target is permitted via the keyhole, however, specialized surgical devices and preoperative planning are very important. Neuroendoscopy has helped to widen the indications of keyhole approaches because it can supply illumination and visualization of structures beyond the straight line of microscopic view. In addition, endoscopic indocyanine green fluorescence angiography is useful to detect and correct any compromise of the perforators and parent arteries, and incomplete clipping. The authors think that keyhole approach and neuroendoscopy are just an intermediate step and robotic neurosurgery would be realized in the near future.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.501-504
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• 2012

Objective : To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping. Methods : A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant ($30{\times}18mm$ sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow. Conclusion : Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.

• Journal of Korean Neurosurgical Society
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• v.44 no.5
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• pp.338-340
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• 2008

A rare case of ruptured aneurysm associated with multiple $A_1$ fenestrations resembling plexiform network was demonstrated by 3D angiography. A 56-year-old female presented with a ruptured aneurysm in the $A_2$ segment of the left distal anterior cerebral artery associated with the right $A_1$ fenestration. The ruptured aneurysm was occluded with surgical neck clipping via interhemispheric approach without neurological deficit. Plexiform fenestrations of the right distal $A_1$. opposite side to the left ruptured $A_2$ aneurysm, were clearly visible on postoperative 3D angiography. Our case may strongly support the theory described by Paget, namely that a remnant of the plexiform anastomosis between the primitive olfactory artery and $A_1$ segment is the source of such fenestration.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.105-108
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• 2008

Cystic glioblastoma multiforme (GBM) is a rare disease. Its exact prevalence has not yet been reported. Also, the mechanism of cyst formation remains to be elucidated. We report a case of GBM with a large peripheral cyst. A 43-year-old woman visited our clinic with a 3-month history of severe headache, memory impairment and general weakness. T1-weighted gadolinium-enhanced magnetic resonance (MR) image revealed a midline enhanced solid mass and bilateral symmetric banana-shaped peripheral cysts. A centrally enhanced mass was measured $2{\times}4$ cm in size and both mass and cysts as $7{\times}7$ cm. Both the frontal lobe and the frontal horn were severely compressed inferiorly and posteriorly. We resected a midline solid tumor and cysts via the bilateral interhemispheric transcortical approach. Histopathologic examination revealed GBM. The patient was subsequently treated with fractionated conventional brain radiation therapy, followed by temozolomide chemotherapy. Eighteen months later, there was no tumor recurrence and no neurological deficits were noted. Our patient showed no tumor recurrence and a long survival at a long follow-up.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.30-36
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• 2024

Objective: This study aims to investigate the efficacy of microsurgery with intraoperative indocyanine green (ICG) angiography as a treatment approach for ethmoidal dural arteriovenous fistula (DAVF). Methods: Between January 2010 and July 2021, our institution encountered a total of eight cases of ethmoidal DAVF. In each of these cases, microsurgical treatment was undertaken utilizing a bilateral sub-frontal interhemispheric approach, with the aid of intraoperative ICG angiography. Results: ICG angiography identified bilateral venous drainage with single dominance in four cases (50%) of ethmoidal DAVF, a finding that eluded detection during preoperative transfemoral cerebral angiography (TFCA). The application of microsurgical treatment, in conjunction with intraoperative ICG angiography, resulted in consistently positive clinical outcomes for all patients, as evaluated using the Glasgow Outcome Scale (GOS) at the 6-month postoperative follow-up assessment; six patients showed GOS score of 5, while the remaining two patients attained a GOS score of 4. Conclusions: The use of intraoperative ICG angiography enabled accurate identification of both dominant and non-dominant venous drainage patterns, ensuring complete disconnection of the fistula and reducing the risk of recurrence.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.423-427
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• 2006

Objective : Postoperative brain swelling after resection of olfactory groove meningiomas by bifrontal interhemispheric transbasal approach is a knotty subject. Pathogenesis and predictive factors were investigated to prevent the problem. Methods : Eighteen patients of olfactory groove meningiomas who had undergone surgery were enrolled and retrospectively analyzed using their clinical and radiological data. Bifrontal inter hemispheric transbasal approach was used in all patients. Magnetic resonance imaging and transfemoral cerebral angiography were available for investigation in 18 and 14 patients respectively. Postoperative clinical course, tumor volume, peritumoral edema, tumor supplying vessels, and venous drainage patterns were carefully investigated in relation to postoperative brain swelling. Results : Seven patients [39%] developed clinically overt brain swelling after surgery. Among them, 4 patients had to undergo decompression surgery. In three patients, attempted bone flap removal was done by way of prevention of increased intracranial pressure resulted from intractable brain swelling and two of them eventually developed brain swelling which could be recovered without sequellae. Abnormal frontal base venous channel observed in preoperative angiography was significant predictive factor for postoperative brain swelling [p=0.031]. However, tumor volume, peritumoral edema, and existence of pial tumor supplying vessels from anterior cerebral arteries were failed to show statistical significances. Conclusion : To prevent postoperative brain swelling in olfactory groove meningioma surgery, unilateral approach to preserve frontal base venous channels or temporal bone flap removal is recommended when it is indicated.