• 한국간담췌외과학회지
• /
• 제27권4호
• /
• pp.366-371
• /
• 2023

Backgrounds/Aims: Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression. Methods: Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed. Results: Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20-400 mL), 105 min (60-220 min), and 2 days (1-7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time. Conclusions: In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.

• Journal of Korean Neurosurgical Society
• /
• 제37권3호
• /
• pp.187-192
• /
• 2005

Objective: Spinal myeloma has been treated with radiation therapy and chemotherapy. However, the role of surgery was not fully evaluated. This study is performed to evaluate the efficacy of surgery in the treatment of spinal myeloma. Methods: 22 patients who were treated with surgery for spinal myeloma from August 1999 to April 2003 were analyzed. Radiological finding, surgical methods and result were reviewed in retrospective study. For compression fracture due to myeloma infiltration, percutaneous vertebroplasy(PVP) was done. Decompression surgery with or without fixation was performed for patients with neurologic deficit. The modalities of surgery consist of PVP (14 cases), corpectomy and fixation (7 cases), and laminectomy and epidural mass removal (3 cases). To evaluate clinical outcome, visual analogue pain score and Frankel neurological scale were used. Results: In 14 cases of PVP, total 57 vertebral segments were treated including 21 thoracic vertebral bodies and 36 lumbar vertebral bodies. Pain relief was achieved in all cases. The pain score changed from 7.7 (preoperatively) to 2.5 (postoperatively). And pain relief effect was maintained over than one year. Frankel grade improved in decompression cases. Conclusion: Surgical treatment can alleviate pain and improve neurologic deficit immediately in spinal myeloma patients.

• Journal of Korean Neurosurgical Society
• /
• 제41권6호
• /
• pp.359-366
• /
• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

• The Korean Journal of Pain
• /
• 제27권2호
• /
• pp.178-185
• /
• 2014

Epidural adhesions cause pain by interfering with the free movement of the spinal nerves and increasing neural sensitivity as a consequence of neural compression. To remove adhesions and deliver injected drugs to target sites, percutaneous epidural adhesiolysis (PEA) is performed in patients who are unresponsive to conservative treatments. We describe four patients who were treated with a newly developed inflatable balloon catheter for more effective PEA and relief of stenosis. In the present patients, treatments with repetitive epidural steroid injection and/or PEA with the Racz catheter or the NaviCath did not yield long-lasting effects or functional improvements. However, PEA and decompression with the inflatable balloon catheter led to maintenance of pain relief for more than seven months and improvements in the functional status with increases in the walking distance. The present case series suggests that the inflatable balloon catheter may be an effective alternative to performing PEA when conventional methods fail to remove adhesions or sufficiently relieve stenosis.

• The Korean Journal of Pain
• /
• 제18권2호
• /
• pp.246-250
• /
• 2005

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

• 한국콘텐츠학회논문지
• /
• 제22권9호
• /
• pp.570-582
• /
• 2022

수핵성형술은 경피적 디스크 감압술의 한 종류로 디스크 탈출증의 치료를 위해 개발된 시술법이다. 현재 몇몇 임상 현장에선 이 기술을 원래의 적응증인 디스크 탈출증을 지닌 환자들에 대해서 뿐 아니라, 디스크 내장증을 지닌 환자들에게도 사용하고 있다. 이 연구의 목적은 이와 같은 임상 현장에서의 수핵성형술의 적응증의 확대가 타당한 의학적 논리 위에서 수행된 것인지 평가하는 것이다. 그것을 위해 논자는 수핵성형술을 디스크 내장증 환자들에게 적용한 논문들을 분석하였다. 분석의 요점은 첫째, 연구자들이 제시하는 치료 근거의 타당성과 둘째, 환자 선별 기준의 적절성이다. 그 결과 수핵성형술을 디스크 내장증의 치료에 적용한 기존 논문들이 제시하는 치료 근거는 불분명하거나 일반적인 의학의 논리에 부합하지 않는 측면이 있는 것으로 판단되며, 환자 선별의 과정에선 경피적 감압술이 기능을 발휘할 수 있는 조건을 지닌 디스크를 찾기 위한 절차를 엄밀히 수행하지 않거나 경피적 감압술에 부적합한 것으로 판단될 수 있는 디스크도 시술 대상에 포함시킨 것으로 평가된다. 따라서 논자는 수핵성형술을 디스크 내장증 치료에 적용한 기존 연구들은 불필요하거나 잠재적 부작용을 발생시킬 수 있는 다소 모험적인 실험의 성격을 갖고 있다고 판단한다. 이 주제에 대한 연구과정에서 환자의 권익을 지키고 연구의 완성도를 높이기 위해선 현재의 이해 수준보다 선명한 치료적 근거의 확립과 이에 기반한 정교한 환자 선별 과정이 필수적으로 갖추어져야 할 것이라 생각한다.

• Journal of Korean Neurosurgical Society
• /
• 제38권5호
• /
• pp.384-386
• /
• 2005

There have been several reports about abdominal pain due to discitis in children or thoracic disc herniation. However, none of them could verify causal relationship between disc disease and abdominal pain clearly. The authors report a patient with discogenic abdominal pain who had disc degeneration at lower lumbar level without definite protrusion or any evidence of inflammation. We could reproduce the abdominal pain by using discography. The patient was treated by percutaneous disc decompression successfully.

• The Korean Journal of Pain
• /
• 제33권1호
• /
• pp.66-72
• /
• 2020

Background: Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel^®). We are introducing the first study on patient-reported outcomes of DiscoGel^® vs. PLDD for radiculopathy. Methods: Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel^®, which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. Results: The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel^® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel^® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel^® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. Conclusions: Both techniques were equivalent in pain reduction but DiscoGel^® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.

• 대한기계학회:학술대회논문집
• /
• 대한기계학회 2007년도 춘계학술대회A
• /
• pp.378-383
• /
• 2007

As the Minimally Invasive Surgery (MIS) is developed, an interventional procedure becomes the major of the spine surgery in the world. Despite of the use of the expensive medical equipments, the success chance of the nucleoplasty is about 30%. The reason is that the shape of the cannular needle is similar to that of the conventional injector and looks like the straight. Because the tip of these straight needles is not able to reach in the vicinity of the disc bulging or the protrusion, which are the cause of the low back pain and because the far indirect plasma discharge results in the decompression, the nucleoplasty has the limit. Many incurable diseases has not been solved due to the unexistence of the advanced technique for the MIS human body cannula device. If 3-D direction controllable cannular catheter (whose direction is accurately controlled after inserting into the bodies to cure the lesion) is developed, it is expected that new devised cannular catheter can cure many incurable diseases simultaneously. Therefore, the aims of this research are to develop the new devised cannular catheter of SMA direction controller for the medical situation, which has been produced through many previous trial-error procedures, and to produce the commercial medical device.

• The Korean Journal of Pain
• /
• 제9권1호
• /
• pp.183-186
• /
• 1996

When medical therapy fail to relieve pain at tolerable level for patients confirmed with trigeminal neuralgia, presence of mass lesion excluded, surgery is indicated. Innumerable surgical strategies have been attempted for the treatment of trigeminal neuralgia but only four have proven appropriate: (1)stereotactic radiofrequency gasserian ganglionotomy, (2) percutaneous glycerol gangliolysis, (3) percutaneous microcompression, (4) microvascular decompression. Radiofrequency thermocoagulation of the gasserian ganglion stems from the efforts of Sweet. This technique is the surgical treatment of choice around the world for surgical treatment for trigeminal neuralgia. Since 1986, over 14,000 cases have been reported utilizing this technique. To improve the treatment method further, an electrode with a flexible curved tip has been developed for easier and more precise electrode placement and lesion production during the thermocoagulation of gasserian ganglion. This operation was performed recently on three patients at Hallym University Hospital. using a curved tip electrode. Complete relief of pain was achieved for all patient. However, some complications were noted.