• 대한족부족관절학회지
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• 제8권1호
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• pp.52-57
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• 2004

Purpose: We evaluated the effect of nerve decompression for restoration of plantar sweating and sensation in diabetic neuropathic feet, and we selected diabetic neuropathic patients with the possibility of overlying entrapmental neuropathy. Materials and Methods: From June 2002 to May 2003, we have investigated and follow-up examed 10 patients with diabetic neuropathic feet, with decreased sensation in their lower limb, who underwent peripheral nerve decompression. The surgical procedure was multiple neurolysis of the common peroneal nerve, posterior tibial nerve and its three branches of one limb. We compared the operated limb with the opposite, unoperated limb. We performed history taking, physical examination, sweat secretion test, touch sensory test using Semmes-Weinstein monofilaments and electrodiagnostic study, pre-operatively and post-operatively. Results: On 6 months after the operation, the post-operative tests showed that there were noticeable improvements to sensation, statistically (P<0.05), but there was no change in the sweat secretion test. According to the Cseuz criteria, 7 patients out of the 10 patients who received the multiple neurolysis showed excellent or good results. Conclusion: We observed that the peripheral nerve neurolysis could be benefit for improving sensation and alleviating pain of the diabetic neuropathic feet with nerve entrapmental symptoms, but there was no change in the sweat secretion on short-term follow-up. To identify whether the effect will be continued or not, additional follow-up will be required.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1505-1513
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• 2000

Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.165-169
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• 2001

Apatient, 51 years old woman, had suffered form headache and decrease of visual acuity. She had $3{\times}3cm$ sized giant aneurysm originated in cavernous and clinoid portion of left ICA(C4,C5) in the cerebral angiography. Before craniotomy, left CCA was exposed and 6F double lumen catheter was inserted in left ICA through the sheath. Pre-operative angiography was done. balloon catheter was positioned at the petrous portion of ICA. Eyebrow approach was done and giant aneurysm was exposed. The proximal blood flow was controlled with balloon dilatation and suction and decompression was tried, then multiple clips were applied. The loss of distal blood flow under intra-operative angiography was notified after clipping. The position of clips were repositioned to preserve blood flow & the rich flow was confirmed at distal part of clipping. In the post-operative cerebral angiography, the same finding was shown.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.301-305
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• 2018

혈관종은 내피세포로부터 기원한 양성종양의 일종으로, 수부에서는 드물게 발생하는 것으로 알려져 있다. 62세 여자환자로 우측 2수지 요골측의 통증을 주소로 내원하였으며, 시행한 자기공명영상에서 수지신경을 압박하는 것으로 보이는 혈관종이 의심되었다. 수술을 시행하여 요골측 수지신경 및 수지혈관을 압박하고 있는 혈관종을 확인하였으며, 수지신경 및 혈관을 가능한 보존하기 위하여 미세수술을 통해 혈관종을 제거하였다. 공간점유성 병변에 의한 압박성 신경병증은 드문 일로, 정확한 진단에 어려움이 있으나, 본 증례와 같이 자기공명영상을 통한 술 전 평가와 및 미세수술을 이용한 병변 제거 및 신경 보존을 통하여 신경병성 통증을 성공적으로 호전시킬 수 있을 것으로 생각한다.

• Journal of Korean Neurosurgical Society
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• 제29권10호
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• pp.1365-1371
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• 2000

악성 임파종중에서 Non-Hodgkin 임파종이 척수 압박 증상을 일으키는 경우는 0.1~10.2%정도로 알려져 있으며, 이러한 척수 압박 증세가 임파종의 초기 증상으로 나타나는 경우는 특히 드문 것으로 알려져 있다. 척수 압박은 척추관내에 국한되어 있는 임파종에 의하거나 주변 임파절이나 척추로부터 전이된 경우에 발생하며, 다른 장기로의 침범 소견이 없는 원발성 척수 경막외 임파종의 경우, 조기에 외과적 감압이 이루어지고 보조요법으로 항암 치료 및 방사선 치료가 행해진다면 그 경과가 비교적 양호한 것으로 알려져 있다. 저자들은 요통을 전구 증상으로, 급성 하반신 부전마비 및 배뇨 장애 소견을 보여 본원에 내원후, 응급 감압술 및 조직병리검사 결과 B-세포성 Non-Hodgkin 임파종으로 확인된 두 명의 여자환자를 경험하였다. 수술후 두 환자의 증세는 모두 회복되었으며, 항암 치료 및 방사선 치료후 현재까지 추적 조사중이다. 이에 저자들은 초기 증상으로 경막외 척수 압박을 보인 원발성 Non-Hodgkin 임파종에 관해 문헌 고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.58-65
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• 2000

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

• 한국임상수의학회지
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• 제26권3호
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• pp.273-275
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• 2009

사지마비를 보이는 6년령 시쮸 숫컷이 내원하였다. 신경검사소견 및 영상진단소견에서 경추 4번과 5번 사이, 경추 5번과 6번 사이 및 경추 6번과 7번 사이의 디스크가 탈출되어 척수를 압박하고 있는 것으로 나타났다. 오존가스를 경추 4번과 5번 사이 디스크 및 경추 6번과 7번 사이 디스크에 주입하고 경추 5번과 6번 사이는 복측 감압술로 탈출된 디스크를 제거하였다. 환축은 수술후 목 통증이 사라지고 수술후 3주경 정상보행을 나타냈다. 수술후 2개월째 자기공명영상에서 경추 5번과 6번 사이 디스크와 경추 6번과 7번 사이 디스크의 탈출된 소견이 사라졌고 경추 4번과 5번 사이의 디스크는 탈출된 정도가 현저히 줄어든 소견을 보였다.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.278-283
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• 2001

Objective : Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. Method : We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : All 15 patients(five men, ten women ; mean age, 52.3 years ; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale : GOS I, II), unfavorable in 6 cases(Glasgow outcome scale : GOS III, IV) and dead in 4 cases. Conclusion : Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1179-1183
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• 2000

Objective : The treatment of malignant posttraumatic brain swelling remains a frustrating endeavor for neurosurgeon. Mortality and morbidity rates remain high depite advances in medical treatment of increased intracranial pressure. If conventional therapy fails in patients suffering from intracranial hypertension, there is only small number of second-tier option left including decompressive craniectomy. The role of decompressive craniectomy in posttraumatic brain swelling remains controversial. We assessed the efficacy and indications of decompressive craniectomy. Methods : The authors performed decompressive bifrontotemporal craniectomy in 22 patients with malignant posttraumatic brain swelling. Epidural pressure monotoring was performed in all patients. The clnical data and surgical outcomes were reviewed retrospectively. Result : The favorable outcome(GOS score 4-5) was 59%(13 of 22 patients), whereas the mortality rate was 32% (7 of 22 patients). Two patients(9%) remained in severely disabled state. Increased rate of favorable outcome was seen in the patients who had 8 or more of GCS score at admission and exhibited B wave in ICP monitoring and who showed steady state or slow deterioration in clinical course. Conclusion : If conservative therapy fails, decompressive bifrontotemporal craniectomy should be considered in the management of malignant posttraumatic brain swelling before irreversible ischemic brain damage occur.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.235-241
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• 2001

Objective : Controversy exists which surgical treatment better in lumbar grade I spondylolisthesis, decompressive laminectomy with or without lumbar instrumentation. Methods : Out of Sixty-four patients with lumbar spondylolisthesis underwent surgery, 18 patients operated with decompressive laminectomy alone and 44 patients with decompession and lumbar instrument, during recent 5-years between January, 1994 and December, 1998. The author studied a long term follow-up in the above two groups to analyzing the overall clinical outcomes in each group and to determining the incidence of pos-toperative radiologic instability. Results : 1) Overall postoperative symptoms improvement were not so different in both groups. 2) Postoperative progressive subluxation is more common after decompressive laminectomy without instrumentation than with instrumentation group. 3) Overall clinical outcomes were slightly better in decompressive laminectomy without instrumentation than with instrumentation group but there was no significant difference. 4) Postoperative radiologic changes did not seem to influence the patient-reported clinical outcomes. 5) Postoperative complications is more common in decompressive laminectomy with instrumentation group than without instrumentation group. Conclusion : In the surgical management of grade I spondylolisthesis, the efficiency and superiority of surgical treatments requires the cost effectiveness and risk/benefit analysis of decompressive laminectomy with or without instrumentation. Therefore, Further detailed studies of long term follow up in a large number of patients in each group are needed for choice of best treatment.