• The Korean Journal of Pain
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• 제9권1호
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• pp.126-129
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• 1996

Background: Advantages of paramedian approach over midline approach include less tissue trauma and less dependence on patient's ability to assume a fetal position. When midline approach fails in patients who are difficult to take a position with lumbar spine flexed, paramedian approach to interlaminar space may succeed. Methods: Success rates of spinal anesthesia were measured for 47 flexed patients by midline approach, 48 flexed patients by paramedian approach, 23 straightened patients receiving spinal anesthesia by midline approach, and 23 straightened patients by paramedian approach. Results: Success rates in flexed patients were 100% by midline approach and 100% by paramedian approach. Success rates for straightened patients were 13.0% by midline approach and 78.3% by paramedian approach. For straightened patients there were no correlations between success fate and age, weight, Ponderal Index but there were correlations between height and midline approach of spinal anesthesia. Conclusion: Pertaining to adult Koreans, success rates of spinal anesthesia for strainghtened patients were less than those for flexed patients. Success rate of paramedian approach of spinal anesthesia among strainghtened patients were better than those of midline approach.

• Journal of Korean Neurosurgical Society
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• 제38권2호
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• pp.111-115
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• 2005

Objective : Upper lumbar disc herniation is rare disease, compared with lower. The lamina of this high level lumbar vertebra is narrower than that of low level, and this have taken surgeon into important consideration for surgical methods because partial removal of lamina for discectomy weakens the base of the articular process and may result in fracture. The authors an accurate preoperative diagnosis that enables the surgeon to operative approach for preserving the facet joint. Methods : Thirteen patients with upper lumbar disc herniation have underone surgical procedure by midline approach for removal of ruptured disc fragment and paraspinal approach for removal of residual disc materials simultaneously without instrumentation. All patients who underwent surgery were analyzed and long-term follow-up was conducted. Results : At a mean follow-up of 24months, there were complete resolution of presenting radiating leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. The follow-up radiologic findings of all patients shows that lamina and facet joint have preserved safely and no instability. Conclusion : Simultaneously, paraspinal with midline approach provides highly satisfactory operating methods by simplifying exposure and greatly limiting the risk of complications. This provides the basis for a planned surgical approach in which destruction of the facet joint can be avoided.

• Journal of Korean Neurosurgical Society
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• 제38권5호
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• pp.399-402
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• 2005

Direct anterior approach for lesions located anterior to the thecal sac is definitely superior to lateral or posterior approach in many respects. However, various anatomical obstacles and technical difficulties often hinder direct anterior approach. Thanks to ripe experience of retroperitoneal approach to the lumbar spine for anterior lumbar interbody fusion and total disc replacement, the authors could perform lumbar corpectomy and reconstruction by using midline retroperitoneal approach recently. During this approach, we repaired anterior longitudinal ligament also to reduce the risk of graft extrusion and to prevent erosion of vascular wall due to direct contact between metallic hardware, which was used for reconstruction of vertebral body, and major vessels.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.483-486
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• 2020

Midline clefts of the upper lip are rare, and it is therefore important that surgeons have access to a methodical approach for when these presentations are encountered. We adapted principles of the anatomic subunit approximation for unilateral cleft lip, to the repair of midline clefts. The overt use of anatomic landmarks to define the repair results in a design that inherently adjusts to varying degrees of clefts and can accommodate asymmetries. The "measure twice, cut once" style is an advantage to new surgeons and to surgeons who seldom encounter this presentation. We describe the details of surgical repair in the context of a patient with Pai syndrome and associated nasal hamartomas that resulted in nasolabial asymmetry. This is the first report of surgical outcome following treatment of Pai syndrome and includes early and 5-year follow-up. The system of repair that we describe is applicable to both symmetric and asymmetric midline clefts.

• 대한후두음성언어의학회지
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• 제25권2호
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• pp.90-95
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• 2014

Background and Objectives : Arytenoid adduction procedure is one of the main surgical options addressed for the correction of glottal incompetence in patients with unilateral vocal cord paralysis. Traditionally, a midline approach is used for identifying and suturing around the muscular process, which often needs over-traction of the thyroid cartilage and results in patient's discomfort as well as surgeon's distress. The authors investigated the advantage of a modified procedure, lateral approach, in which the arytenoid cartilage is exposed through the space between strap muscles and sternocleidomastoid muscle. Materials and Methods : Retrospective chart review was performed for 66 patients who received arytenoid adduction surgery at Samsung Medical Center, between the year 1997 and 2014. Operation time, types of anesthesia, voice outcomes and complications were compared between the midline (n=22) and the lateral (n=44) approach group. Results : Operation time was shorter in the lateral approach group ($125{\pm}24min$) than in the midline group ($144{\pm}24min$). Arytenoid adduction was proceeded under local anesthesia in 66% (n=29/44) and 14% (n=3/22) of patients with lateral and midline approach group, respectively. Voice outcomes and complication rates were comparable between the two groups. Injection laryngoplasty in conjunction with arytenoid adduction resulted in more favorable voice outcomes. Conclusion : A lateral approach for the arytenoid adduction procedure showed comparable voice outcomes and similar complication rates with those of a midline approach. However, lateral approach provided less discomfort to the patients and less distress to a surgeon, and therefore, shorter operation time was needed and local anesthesia could be more frequently applied for this modified procedure.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.454-457
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• 2010

Pure ventral midline giant schwannoma is an extremely rare entity. Spinal intradural extramedullary schwannomas commonly occur posterolateral or anterolateral to the spinal cord. A case of a pure midline ventrally situated giant pan cervical extramedullary schwannoma in an 18-year-old male patient with compressive myelopathy and sphincter involvement is presented. Spinal MR imaging showed a midline ventrally situated extramedullary tumor with severe spinal cord compression extending from clivus to C7 vertebra. It was resected through a posterolateral approach. Histology was consistent with a schwannoma. Post operative MR imaging showed no evidence of the tumor. The radiological features, pathogenesis and surgical strategies in management of these difficult tumors are discussed and the relevant literature is briefly reviewed.

• 한국임상수의학회지
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• 제40권1호
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• pp.25-30
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• 2023

The ventral midline approach (VMA) and right flank approach (RFA) are common procedures for the sterilization of bitches. This study compared the different parameters viz. total duration of surgery, recovery time, and length of the incision as well as body temperature, heart rate, respiration rate, and SpO2 in each approach. Twenty (20) bitches were divided randomly for the RFA and VMA. Meloxicam (0.2 mg/kg) was administered subcutaneously half an hour before the induction to provide preemptive analgesia. Diazepam and ketamine were administered intravenously at dose rates of 0.25 mg/kg and 2.5 mg/kg, and 0.17 mg/kg and 3.33 mg/kg, respectively to produce and maintain anesthesia. Each parameter was recorded at the pre-operative, operative and post-operative times. The average duration of surgery and length of incision of RFA (16.1 ± 5.13 min and 2.44 ± 0.83 cm) were significantly lower (p < 0.05) than the VMA (21.3 ± 5.48 min and 3.53 ± 0.7 cm). The operated bitches showed hypothermia (p < 0.05) at 1 hour compared to baseline and 24 hours of surgery. Heart and respiration rates increased significantly (p < 0.05) during traction and severing of ovarian ligaments in bitches within the RFA group, but there was no significant difference within VMA approaches. The sedation score was significantly higher (p < 0.05) at 1 hour after surgery in both approaches. Based on the duration of surgery and length of incision RFA approach was quick and minimal skin wound. Further studies on bitches considering molecular investigations of surgical stress are imperative.

• The Korean Journal of Pain
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• 제27권4호
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• pp.353-359
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• 2014

Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

• 대한감각통합치료학회지
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• 제14권1호
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• pp.41-49
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• 2016

목적 : 본 연구는 뇌성마비 아동에게 신경발달치료 접근법을 기초한 옷 벗기 기술 훈련에 따른 신체중심선과 보호반응에 미치는 효과를 알아보고자 하였다. 연구방법 : 연구대상은 B시에 거주하는 만 3세 5개월 남아와 만 4세 5개월 여아로 뇌성마비 진단을 받았다. 본 연구는 단일대상연구 중 AB 디자인을 사용하였고, 기초선 기간(A) 2회, 중재 기간(B) 10회로 총 12회기를 실시하였다. 중재는 신경발달치료 접근에 기초한 옷 벗기 훈련을 실시하였고, 평가로 신체중심선은 Miller Assessment for Preschoolers(MAP)의 하위 항목인 Stepping 항목을 사용하였으며, 보호반응은 Quality Upper Extremity Skill Test(QUEST) 검사의 하위 항목인 보호반응 항목을 사용하였다. 결과 : 아동의 신체중심선은 기초선 기간과 비교하여 중재기간이 2표준편차 이상으로 감소하였다. 보호반응은 오른쪽과 왼쪽 모두 중재기간 평균점수가 기초선 평균점수보다 높게 나타났다. 결론 : 뇌성마비 아동에게 신경발달치료접근법을 기초한 옷 벗기 기술 훈련이 신체중심선 향상에 효과적이었다. 앞으로 집단 연구를 통하여 그 효과를 확인하는 것이 필요할 것이다.

• Restorative Dentistry and Endodontics
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• 제37권3호
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• pp.165-169
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• 2012

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.