• Journal of Korean Neurosurgical Society
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• v.45 no.2
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• pp.90-95
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• 2009

Objective : We aimed to identify clinico-radiological risk factors that may predict unfavorable neurological outcomes in traumatic brain injury (TBI), and to establish a guideline for patient selection in clinical trials that would improve neurological outcome during the early post TBI period. Methods : Initial clinico-radiological data of 115 TBI patients were collected prospectively. Regular neurological assessment after standard treatment divided the above patients into 2 groups after 6 months : the Favorable neurological outcome group (GOS : good & moderate disability, DRS : 0-6, LCFS : 8-10) and the Unfavorable group (GOS : severe disability-death, DRS : 7-29 and death, LCFS : 1-7 and death). Results : There was a higher incidence of age $\geq$35 years, low initial GCS score, at least unilateral pupil dilatation, and neurological deficit in the Unfavorable group. The presence of bilateral parenchymal lesions or lesions involving the midline structures in the initial brain CT was observed to be a radiological risk factor for unfavorable outcome. Multivariate analysis demonstrated that age and initial GCS score were independent risk factors. The majority of the Favorable group patients with at least one or more risk factors showed improvement of GCS scores within 2 months after TBI. Conclusion : Patients with the above mentioned clinico-radiological risk factors who received standard treatment, but did not demonstrate neurological improvement within 2 months after TBI were deemed at risk for unfavorable outcome. These patients may be eligible candidates for clinical trials that would improve functional outcome after TBI.

• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.227-236
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• 2024

Objective : Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction. Methods : This analysis included 67 patients with major anterior circulation major infarction who underwent DC after IA-Tx, with or without intravenous tissue plasminogen activator. We retrospectively reviewed the medical records, radiological findings, and compared the neurological outcomes based on the "surgical time window" and neurological status at the time of surgery. Results : For patients treated with DC following IA-Tx, a Glasgow coma scale (GCS) score of 7 was the lowest score correlated with a favorable outcome (p=0.013). Favorable outcomes were significantly associated with successful recanalization after IA-Tx (p=0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p=0.007). However, the surgical time window (within 36 hours, p=0.389; within 48 hours, p=0.283) did not correlate with neurological outcomes. Conclusion : To date, early DC surgery after major infarction is crucial for patient outcomes. However, this study suggests that the indication for DC following IA-Tx should include neurological status (GCS ≤7), as some patients treated with early DC without considering the neurological status may undergo unnecessary surgery. Recanalization of the occluded vessel and P/D-mismatch are important for long-term neurological outcomes.

• Journal of The Korean Society of Clinical Toxicology
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• v.21 no.2
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• pp.135-142
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• 2023

Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status. Methods: This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027-1.844), 1.017 (95% CI, 1.002-1.032), and 0.196 (95% CI, 0.040-0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746-0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652-0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527-0.722). Conclusion: The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.

• The Korea Journal of Herbology
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• v.26 no.3
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• pp.7-14
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• 2011

Object : This study evaluated the effects of Daeseungkitang(DSK) on cerebral infarct of middle cerebral artery occlusion(MCAO). Method : Sprague-Dawley rats are used for observing to induce cerebral infraction closing its middle cerebral artery temporarily and take DSK by mouth the next 5 days, observe the amount of feces and urine. It is investigated the correlation between them after examining neurological score. Results : It is resulted the below. On the 2nd day of taking DSK, the total amount of feces of the cerebral infarct rats is increased significantly. After taking DSK, the urine volume of the cerebral infarct rats does not change at all. Taking DSK significantly improves neurological score of the cerebral infarct rats. There is a significant correlation between total amount of feces of the cerebral infarct rats and neurological score, otherwise there is no significant correlation between total amount of feces and neurological score which is taken DSK. By taking DSK, the volume of cerebral infarction does not decrease significantly. Taking DSK restrains the expression of iNOS in the cerebral cortex and striatum of the cerebral infarct rats. Taking DSK restrains the expression of MMP-9 in the cerebral cortex of the cerebral infarct rats. Taking DSK restrains the edema of astrocytes of the positive reaction of GFAP in the cerebral cortex of the cerebral infarct rats. Conclusion : According to above results, Daeseungkitang(DSK) is assumed that showing reaction of protecting neuron cell by restraint brain tissue edema thorough controlling water balance.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.382-386
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• 2007

Objective : Various techniques of cervical laminoplasty have been developed to decompress the spinal canal in patients with multilevel cervical spondylotic myelopathy. This study compared the early surgical outcomes between unilateral open-door laminoplasty and midline splitting cervical laminoplasty. Materials and Methods : From March 2004 to August 2005, we performed cervical laminoplasty in 34 patients with cervical myelopathy. Of these patients, 24 were treated by unilateral open-door laminoplasty [open-door group] and 10 by midline splitting cervical laminoplasty [splitting group]. The mean duration of follow up was 9.2 months in the open-door group and 15.8 months in the splitting group. We retrospectively analyzed neurological outcomes using the Japanese Orthopedic Association [JOA] score, and compared the radiological changes between the two groups. Results : Postoperative JOA score and recovery rate were $13.29{\pm}4.01$ and $56.28{\pm}44.91%$ in the open-door group and $15.75{\pm}0.88$ and $72.69{\pm}19.99%$ in the splitting group. There was no statistical difference between the two groups [p>0.05]. Regarding the radiological assessment, the increase of postoperative axial canal area was $63.23{\pm}23.24%$ in the open-door group and $42.30{\pm}14.96%$ in the splitting group [p<0,05]. Conclusion : There was no statistical difference in the neurological outcome when the early surgical outcomes of the open-door group and the splitting group were compared. However, the open-door group showed wider cervical spinal canal areas than the splitting group.

• 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.66 no.6
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• pp.664-671
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• 2023

Objective : The optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio is a more reliable marker of intracranial pressure than the ONSD alone. We aimed to investigate the predictive value of the ONSD/ETD ratio (OER) for neurological outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods : Adult patients with aSAH who visited the emergency department of a tertiary hospital connected to a South Korean university between January 2015 and December 2021 were included. Data on patient characteristics and brain computed tomography scan findings, including the ONSD and ETD, were collected using a predefined protocol. According to the neurological outcome at hospital discharge, the patients were divided into the unfavorable neurological outcome (UNO; cerebral performance category [CPC] score 3-5) and the favorable neurological outcome (FNO; CPC score 1-2) groups. The primary outcome was the association between the OER and neurological outcomes in patients with aSAH. Results : A total of 171 patients were included in the study, of whom 118 patients (69%) had UNO. Neither the ONSD (p=0.075) nor ETD (p=0.403) showed significant differences between the two groups. However, the OER was significantly higher in the UNO group in the univariate analysis (p=0.045). The area under the receiver operating characteristic curve of the OER for predicting UNO was 0.603 (p=0.031). There was no independent relationship between the OER and UNO in the multivariate logistic regression analysis (adjusted odds ratio, 0.010; p=0.576). Conclusion : The OER was significantly higher in patients with UNO than in those with FNO, and the OER was more reliable than the ONSD alone. However, the OER had limited utility in predicting UNO in patients with aSAH.

• The Journal of Internal Korean Medicine
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• v.42 no.6
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• pp.1356-1365
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• 2021

This study examined the effectiveness of Korean medical treatment in a patient with persistent drug-induced parkinsonism after drug discontinuation. The changes in symptoms were assessed using the unified parkinson's disease rating scale (UPDRS), postural instability-gait disturbance (PIGD) score, and the 20 m gait time and steps. After 22 days of hospitalization, the UPDRS, PIGD score, and 20 m gait time and steps showed clinically significant improvement. The improvement persisted after discharge. This study indicated that Korean medical treatment could be an effective alternative therapy for treating persistent drug-induced parkinsonism after drug discontinuation.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.971-977
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• 2015

Malignant glioblastoma multiforme (GBM) is the most malignant brain tumor and despite recent advances in diagnostics and treatment prognosis remains poor. In this retrospective study, we assessed the clinical and radiological parameters, as well as fluorescence in situ hybridization (FISH) of 1p19q deletion, in a series of cases. A total of 816 patients with GBM who received surgery and radiation between January 2010 and May 2014 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to find the factors independently influencing patient progression free survival (PFS) and overall survival (OS). Age at diagnosis, preoperative Karnofsky Performance Scale (KPS) score, KPS score change at 2 weeks after operation, neurological deficit symptoms, tumor resection extent, maximal tumor diameter, involvement of eloquent cortex or deep structure, involvement of brain lobe, Ki-67 and MMP9 expression level and adjuvant chemotherapy were statistically significant factors (p<0.05) for both PFS and OS in the univariate analysis. Cox proportional hazards modeling revealed that age ${\leq}50$ years, preoperative KPS score ${\geq}80$, KPS score change after operation ${\geq}0$, involvement of single frontal lobe, deep structure involvement, low Ki-67 and MMP9 expression and adjuvant chemotherapy were independent favorable factors (p<0.05) for patient clinical outcomes.

• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.259-264
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• 2008

Objective : Total laminectomy (TL) is an effective surgical technique for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) along multiple levels. However, kyphosis and probable neurological deterioration have been frequently reported after laminectomy. We analyzed the changes in the cervical curvature after TL and subsequent changes in neurological status. Methods : We retrospectively reviewed the records of 14 patients who underwent TL for the treatment of cervical OPLL between Jan. 1998 and Dec. 2003. TL was selected according to the previously determined criteria. The curvature of the cervical spine was visualized on a lateral cervical spine X-ray and measured using Ishihara's Curvature Index (CI) before the operation and at the last follow-up examination. Perioperative neurological status was estimated using the modified Japanese Orthopedic Association score and the Improvement Rate (IR) at the same time as the images were evaluated. Results : The mean age of the patients was 57 years, the male/female ratio was 10:4, and the mean follow-up period was 41 months. The mean number of OPLL was 4.9, and the mean number of operated levels was also 4.9. The CI decreased after TL (p=0002), which was indicative of a kyphotic change. However, this kyphotic change showed no correlation with the length of the follow-up period, number of operated levels and preoperative CI. Neurological examination at the last follow-up showed an improved neurological status in all patients (p=0.001). There was no neurological deterioration in any case during the follow-up period. Moreover, there was no correlation between IR and the degree of kyphotic change. Postoperative complications, such as C5 radiculopathy and epidural bleeding, resolved spontaneously without neurological sequelae. Conclusion : Kyphotic change was observed in all but one patient who underwent TL for the treatment of cervical OPLL. However, we did not find any contributing factors to kyphosis or evidence of postoperative neurological deterioration.