• Journal of Chest Surgery
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• 제27권4호
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• pp.328-330
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• 1994

Brachial plexus injury developing after axillary thoracotomy is an uncommon complication. But if it occurs, it may cause annoying events. We recently experienced 2 patients who developed brachial plexus injury after wedge resection by axillary thoracotomy . The first patient was a 22 year-old man with right spontaneous pneumothorax . After wedge resection of the right upper lung by axillary thoracotomy, he complained total paralysis of the right arm. An electromyogram was obtained at 7 days after operation, with the confirmation of brachial plexus injury. He was discharged at 22days after operation and brachial plexus injury was completely recovered 4 months after discharge. The second patient was a 17 year-old man with recurrent right pneumothorax. He underwent wedge resection of the right upper lung by axillary thoracotomy. Electromyogram confirmed the diagnosis of brachial plexus injury in the immediate postoperative period. He was discharged at 15 days after operation and brachial plexus injury was recovered 2months after discharge.Brachial plexus injury after axillary thoracotomy is caused by stretching around the clavicle and tendon of pectoralis minor by fixation of the abducted arm to the frame. Thus, when we perform wedge resection by axillary thoracotomy, we must avoid over-stretching of the brachial plexus in positioning. If brachial plexus injury develops, immediate attention and management with close rapport are important to avoid possible medicolegal problems.

• The Korean Journal of Pain
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• 제33권2호
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• pp.144-152
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• 2020

Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

• The Korean Journal of Pain
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• 제25권1호
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• pp.38-42
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• 2012

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.

• Journal of Korean Neurosurgical Society
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• 제67권3호
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• pp.376-381
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• 2024

Choroid plexus hyperplasia (CPH), also known as diffuse villous hyperplasia of choroid plexus, is a rare condition characterized by excessive production of cerebrospinal fluid (CSF), resulting in hydrocephalus. Diagnosing CPH can be challenging due to the absence of clear imaging criteria for choroid plexus hypertrophy and the inability to assess CSF production non-invasively. As a result, many CPH patients are initially treated with a ventriculoperitoneal (VP) shunt, but subsequently require additional surgical intervention due to intractable ascites. In our study, we encountered two CPH patients who presented with significantly enlarged subarachnoid spaces, reduced parenchymal volume, and prominent choroid plexus. Initially, we treated these patients with a VP shunt, but eventually opted for endoscopic choroid plexus cauterization (CPC) to address the intractable ascites. Following the treatment with endoscopic CPC, we observed a gradual reduction in subarachnoid spaces and an increase in parenchymal volume. In cases where bilateral prominent choroid plexus, markedly enlarged subarachnoid spaces, and cortical atrophy are present, CPH should be suspected. In these cases, considering initial treatment with combined endoscopic CPC and shunt may help minimize the need for multiple surgical interventions.

• Journal of Korean Neurosurgical Society
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• 제46권1호
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• pp.74-76
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• 2009

We present an extremely rare case of the atypical choroid plexus papilloma in an adult which developed at the trigone of right lateral ventricle. A 62-year-old woman presented with the history of intermittent and gradually progressive headache and left side hemiparesis for 6 months. The brain magnetic resonance image showed highly enhanced and well demarcated mass at the trigone of lateral ventricle attached to the choroid plexus. Gross total resection was performed by transcortical approach via the middle temporal gyrus. The tumor was diagnosed as an atypical choroid plexus papilloma. She had no neurologic deficit after the surgery. We report a case of atypical choroid plexus papilloma in adult and introduce newly classified pathologic characteristics of this tumor.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.396-399
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• 2006

Brachial plexus schwannoma is rare. A case of a 28-year old woman who complained of a palpable mass in the right axilla is presented. She had previous incisional biopsy on the axillary mass. Brachial plexus magnetic resonance imaging revealed a well circumscribed contrast enhancing mass on the right distal cord of the brachial plexus. EMG revealed normal. Tumor resection was performed with the transaxillary approach. Though dense granulation tissue obscured normal brachial plexus nerve anatomy, using the surgical microscope and nerve stimulator, grossly total tumor resection was performed. She is free of any neurologic symptom at three months postoperatively.

• The Korean Journal of Pain
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• 제1권1호
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• pp.28-33
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• 1988

1986년 3월 통증치료실을 개설한 이래 상복부의 불인통을 호소하는 12명의 암환자에서 복강신경총 차단을 시행하였다. 처음 5예는 fluoroscopy의 도움만으로, 나머지 7예는 CT를 이용하여 피부에 천자부위를 정하고 재차 수술실로 옮겨서 시행한 결과 다음과 같은 결론을 얻었다. 1) CT를 이용한 복강신경총 차단을 시행할 경우, 평균 시술시간을 훨씬 단축시킬 뿐 아니라(약 1시간) 초보자에게는 시술이 훨씬 용이하다. 2) Fluoroscopy만 이용한 5예 중 3예에서, CT 및 fluoroscopy틀 동시에 이용한 경우는 7예중 5예에서 양호한 결과를 얻었다. 3) 정확한 위치에서 천자하면 신경파괴제의 양을 줄 일 수 있다. 4) 거대 간장, 심한 복수 등에서는 그 효과가 의문시 된다.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1278-1281
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• 1992

We have experienced two cases of traumatic subclavian artery rupture at the department of thoracic and cardiovascular surgery, Youngdong Severance hospital, Yonsei University college of medicine. One was combined with brachial plexus injury and the other was combined with brachial plexus injury and subclavian vein rupture. They were treated with graft interposition after segmental resection of ruptured subclavian artery and neurorrhaphy for brachial plexus injury. Post operative courses were not eventful.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.138-143
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• 2012

Objective : This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. Methods : Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. Results : Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. Conclusion : Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.625-632
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• 2018

Objective : Because the anatomical structure of the brachial plexus is very complex, surgical treatment of tumors in this region is challenging. Therefore, a lot of clinical and surgical experience is required for successful treatment; however, many neurosurgeons have difficulty accumulating this experience owing to the rarity of brachial plexus tumors. The purpose of this report is to share our surgical experience with brachial plexus tumor with other neurosurgeons. Methods : The records of 18 consecutive patients with brachial plexus tumors who underwent surgical treatment between January 2010 and December 2017 in a single institution were retrospectively reviewed. The surgical approach was determined according to the tumor location and size, and intraoperative neurophysiological monitoring (IONM) was used in most of cases to prevent iatrogenic nerve injury during surgery. In addition, to evaluate the differences in tumor characteristics according to pathologic diagnosis, the tumors were divided twice into two groups, based on two separate classifications, and statistical analysis was performed. Results : The 18 brachial plexus tumors comprised 15 (83.3%) benign peripheral nerve sheath tumors including schwannoma and neurofibroma, one (5.6%) malignant peripheral nerve sheath tumor, one (5.6%) benign tumor of non-neural sheath origin (neurogenic cyst), and one (5.6%) metastatic tumor (papillary carcinoma). The authors analyzed relationship between tumor size/location and tumor characteristic parameters such as age, size, right-left, and pathology. There were no statistically significant differences except a tendency of bigger tumor size in young age. Conclusion : For a successful surgical outcome, an appropriate surgical approach is essential, and the appropriate surgical approach is determined by the location and size of the tumor. Furthermore, applying IONM may prevent postoperative complications and it is favorable option for brachial plexus tumors surgery.