• The Journal of the Korean bone and joint tumor society
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• v.12 no.1
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• pp.63-70
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• 2006

Purpose: The purpose of current study was to review the surgical treatment results in patients with a ganglion cyst involving peripheral nerves and to suggest the poor prognostic factor. Materials and Methods: Twelve patients having neurologic symptoms caused by ganglion cyst were treated operatively between 1995 and 2000. The peripheral nerves involved were the tibial nerve in three patients, suprascapular nerve, common peroneal nerve, radial nerve, and ulnar nerve in two patients each, and median nerve in one patient. Pain was present in six patients, sensory disturbance or motor weakness was seen in seven patients each; and sensory disturbance and motor weakness were concurrently present in four patients. Results: In all six patients who complained of preoperative pain, the pain was resolved after surgery. Improvements were seen in five of seven patients who had preoperative sensory disturbance and in all patients who had preoperative motor weakness. Complete sensory recovery was obtained in only two of four patients with preoperative sensory disturbance and motor weakness, indicating a poor prognosis factor. Conclusion: Early accurate diagnosis and early excision of these ganglion cysts causing compression neuropathy could produce excellent clinical results.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.131-139
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• 2008

Purpose: Lipomatous tumor occurred in hand is very rare. There is a broad spectrum of lipomatous tumors including lipomas, variants of lipomas, lipomatosis, liposarcomas and so on. We report the clinical features of 11 cases of lipomatous tumor which occurred in hand. Materials and Methods: Between 1992 and 2008, 11 cases were histologically diagnosed as lipomatous tumor in hand. We reviewed all medical records and clinical photographs retrospectively and ascertained recurrence by telephone interview. Results: Eight cases were ordinary lipomas. Three cases were angiolipoma, fibrolipoma and atypical lipoma respectively. Four cases occurred in finger, two cases in thenar area, two cases in hypothenar area, one case in palm, two cases in wrist. All cases were situated on volar surface. All patients complained of palpable masses. One patient with subungal angiolipoma felt pain. There was no neurologic sign or vascular symptom preoperatively. In one case, postoperative complication (hypoesthesia in $5^{th}$ finger) was developed. There was no local recurrence. Conclusion: In our study, lipomatous tumors occurred in hand did not recur. Patients mainly complained of feeling of lump. Pain was uncommon symptom. Postoperative complication was rare if operation was performed carefully.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.255-260
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• 2002

Paraplegia remains unresolved as the most dreaded operative complication with surgical treatment of descending thoracic and thoracoabdominal aortic diseases. In this study, the neuroprotective effect of trimetazidine that has been used clinically for ischemic heart disease was investigated in a rabbit spinal cord ischemia model. Material and Method: Thirty-three New Zealand white rabbits were randomized as follows: control group undergoing abdominal aortic occlusion but receiving no pharmacologic intervention(Group 1, n= 17); TMZ group(Group 2, n= 16) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta. Ischemia was induced by clamping the abdominal aorta just distal to the left renal artery for 30 minutes. Neurologic status was assessed at 2, 24, and 48 hours after the operation according to the modified Tarlov scale, then the lumbosacral spinal cord was processed for histopathologic examinations 48 hours after the final assessment. Result: The average motor function score was significantly higher in the TMZ group(3.20 $\pm$ 0.77 vs 1.13 $\pm$ 1.25 at 2 hours, 3.50 $\pm$ 0.76 vs 1.45 $\pm$ 1.57 at 24 hours, and 3.91 $\pm$ 0.30 vs 1.86 $\pm$ 1.86 at 48 hours after operation; p value$\leq$0.05). Histologic observations were correlated with the motor scores. Conclusion: The results suggested that trimetazidine reduced spinal cord injury during aortic clamping and that it may have clinical utility for the thoracoabdominal aortic surgery:

• The Journal of the Korean bone and joint tumor society
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• v.19 no.2
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• pp.43-49
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• 2013

Purpose: We analyzed the treatment outcomes of patients with sacral giant cell tumor. Materials and Methods: We retrospectively reviewed 7 patients with giant cell tumor of the sacrum who were treated at out institution between 1990 and 2012. Results: There were 2 men and 5 women with mean age of 23.6 years. The average follow up was 52.3 months (range, 15-73 months). Six patients received surgical treatment. Intralesional curettage was performed for the 5 patients and marginal resection for another one patient. The remaining one patient was received radiation only. The patients who received radiation therapy and marginal excision had no residual or recurrent tumors. Of 5 patients with intra-lesional excision, one patient needs one more operation; two patients need two more operation for local control of the giant cell tumor. The remaining two patients failed to gain local control in spite of additional treatments. Conclusion: For the treatment of sacral giant cell tumor, intralesional resection can be one of the treatments option with minimal neurologic injury. Furthermore, radiation therapy can be recommended when complete excision or curettage is impractical.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.28-32
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• 2010

Purpose: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. Methods: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients (0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of $Medpor^{(R)}$. Clinical symptoms and signs were a little different from each other. Results: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP (visual evoked potential), visual field test, electromyogram. With ophthalmologic test and followup CT, we can rule out the orbital apex syndrome. We gave $Salon^{(R)}$ (methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with $Methylon^{(R)}$ (methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. Conclusion: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.451-455
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• 2001

Objectives : There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is only a little detailed study that documents the range of conus positions in a living adult population, especially in Korean, without spinal deformity. Methods : we made a sequential study of magnetic resonance images of the lumbar spine to determine the variation in position of the conus medullaris in 650 living korean adults population without spinal deformity who checked MRI to identify the cause of low back pain. The study population consisted of patients over the age of 16 years. A T1-weighted, midline, sagittal image was reviewed for identifying the postion of conus. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. Results : The study group consisted of 305 men(47%) and 345 women(53%) with a mean age 45.9 years(range, 16-79 years). The conus existed commonly at the middle third of L1(131cases, 20.2%), at the L1-2 intervertebral space(129cases, 19.8%), and the lower third of L1(123cases, 18.9%). The mean position of conus was the lower third of L1(range, middle third of T12 to middle third of L3). Conclusions : The mean position of conus was at the lower third of L1(range, middle third of T12 to middle third of L3). This results was same as that of foreign study. Our results of living korean adult population could allow for safe clinical procedures such as lumbar puncture, spinal anesthesia, and help to explain the differences among observed neurologic injuries from fracture-dislocation at the thoracolumbar junction.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.575-580
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• 2001

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.998-1003
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• 2001

Objective : The maintenance of the correction of kyphotic deformity is one of the difficult problem in tuberculous spondylitis after anterior debriment and fusion with tricortical bone graft. The goal of this study is to find out the efficacy of titanium mesh cage impacted with autogenous bone chip in tuberculous spondylitis treated with anterior intervertebral fusion. Materials and Method : Twelve patients were treated with anterior intervertebral fusion using titanium mesh cage for tuberculous spondylitis from January 1996 to June 1999. We analized the changes in the correction of kyphotic deformity, changes of ESR and CRP, fusion state and recurrence after anterior intervertebral fusion with titanium mesh cage. Results : Clinical symptoms were improved in all twelve patients without any neurologic complications. The mean kyphotic angle corrected was 7.3 degrees immediately after operation, but the loss of correction of kyphotic angle was 2.2 degrees after 3 months and 2.6 degrees after 6 months. We found that the loss of correction of kyphotic deformity occurred mainly within the first 3 months after surgery. Only one patient, suffered from acute hepatic failure after first operation and had an insufficient anti-tuberculous medication therapy, showed recurrence of tuberculous spondylitis after 6 months. The patient underwent a second operation with posterior fixation procedure with good outcome. The changes of ESR and CRP were not specifically important factor to reveal recurrence of tuberculosis of the spine in our series. Conclusion : The surgical procedure of tuberculous spondylitis using titanium mesh cage with bone chip seems to be an effective procedure to minimize loss of the correction of kyphotic deformity without any aggravating inflammatory change and recurrence with titanium mesh cage, when sufficient debridement and anti-tuberculous chemotherapy are achieved.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1001-1007
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• 2000

Objective : We analysed diverse clinical features of the cavernous angioma. Also, we report the experience in differ-ent methods of the management and their results. Method : Data from 80 patients who were confirmed pathologically or diagnosed radiologically between Jan. 1990 and Sept. 1998 at our hospital were analysed. Variable factors that were examined were : clinical features, effects of treatment, and complications. Results : There were 47 male and 33 female patients. The age at the first presentation was from 3 to 57(mean 34.1) years old. Clinical features were seizure in 28 cases(38%), bleeding in 24 cases(32%), neurologic deficits in 12 cases(16%), headache in 10 cases(14%), and six incidental cases. The locations of lesion were cerebral and cerebellar hemisphere in 45 cases(56.2%), brainstem, basal ganglia, and thalamus in 32 cases(40%), multiple in 3 cases (3.8%). Seizure was common at the third decade and occurred frequently with the cavernous angioma in temporal (43%) or frontal lobe(39%). Bleeding was frequent after the third decade with peak at the fourth decade and had high incidence in brainstem or thalamus. The gamma-knife radiosurgery was done in 47 cases. Rebleeding occurred in 3 cases, but it was within postradiosurgery 1 year. Symptomatic radiation change occurred in 2 cases of 8 radiation change on MRI. On follow-up MRI, no evidence of rebleeding was found in 30 cases. Also, The lesion size was decreased in 3 cases. Resection was performed in 23 cases ; total 20, subtotal 2, partial 1. Postoperative complication occurred in 6 cases(26.1%). After surgery, 7(63.6%) of 11 seizure patients had outcome of seizure-free. Subclinical rebleeding occurred in one of two subtotal resected cases. In 11 patients, conservative management was done. There was neither rebleeding nor symptom aggravation during follow-up period of mean 17.2 months. Conclusion : The solution for prevention of rebleeding is complete removal of the lesion located at noneloquent area or accessible region, especially for the patients who presented symptoms or intractable seizure. However, the Gamma knife radiosurgery is considered when the lesions are located at eloquent area or when severe postoperative morbidity is expected.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.222-230
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• 2000

Purpose : Resection of the epileptogenic zone in the parietal and occipital lobes may be relevant although only few studies have been reported. Methods : Eight patients with parietal epilepsy and nine patients with occipital epilepsy were included for this study. Preoperatively, all had video-EEG monitoring with extracranial electrodes, MRI, 3D-surface rendering of MRI using Allegro(ISG Technologies Inc., Toronto, Canada), and PET scans. Sixteen patients underwent invasive recording with subdural grid. Eight had parietal resection including the sensory cortex in two. Seven had partial occipital resection. Two underwent total unilateral occipital lobectomy. The extent of the resection was made based mainly on the data of invasive EEG recordings, MRI, and 3D-surface rendering of MRI, not on the intraoperative electrocorticographic findings as usually done. During resection, electrocortical stimulation was performed on the motor cortex and speech area. Results : Out of eight patients with parietal epilepsy, three had sensory aura, two had gustatory aura, and two had visual aura. Six of nine patients with occipital epilepsy had visual auras. All had complex partial seizures with lateralizing signs in 15 patients. Four had quadrantopsia. One had mild right hemiparesis. Abnormality in MRI was noticed in six out of eight parietal epilepsy and in eight out of nine occipital epilepsy. 3D-surface rendering of MRI visualized volumetric abnormality with geometric spatial relationships adjacent to the normal brain, in all of parietal and occipital epilepsy. Surface EEG recording was not reliable in localizing the epileptogenic zone in any patient. The subdural grid electrodes can be implanted on the core of the structural abnormality in 3D-reconstructed brain. Ictal onset zone was localized accurately by subdural grid EEGs in 16 patients. Motor cortex in nine and sensory speech area in two were identified by electrocortical stimulation. Histopathologic findings revealed cortical dysplasia in 10 patients ; tuberous sclerosis was combined in two, hamartoma and ganglioglioma in one each, and subpial gliosis in six. Eleven patients were seizure free at follow-up of 6 months to 37 months(mean 19.7 months) after surgery. Seizures recurred in two and were unchanged in one. Six produced transient sensory loss and one developed hemiparesis and tactile agnosia. One revealed transient apraxia. Two patients with preoperative quadrantopsia developed homonymous hemianopsia. Conclusion : This study suggests that surgical treatment was relevant in parietal and occipital epilepsies with good surgical outcome, without significant neurologic sequelae. Neuroimaging studies including conventional MRI, 3Dsurface rendering of MRI were necessary in identifying the epileptogenic zone. In particular, 3D-surface rendering of MRI was very helpful in presuming the epileptogenic zone in patients with unidentifiable lesion in the conventional MRI, in planning surgical approach to lesions, and also in making a decision of the extent of the epileptogenic zone in patients with identifiable lesion in conventional MRI. Invasive EEG recording with the subdural grid electrodes helped to confirm a core of the epileptogenic zone which was revealed in 3D-surface rendered brain.