• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.197-202
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• 2001

Objective : The purpose of this study is to evaluate and compare surgical results of pterional(fronto-temporal) approach and interhemispheric approach for the high positioned anterior communicating artery aneurysm with our surgical experience. Methods : During the period between May 1990 and May 2001, 263 anterior communicating aneurysms were treated at the department of neurosurgery of Dong-A university hospital. Among them, 175 patients were operated by same operator. Thirty six out of the 175 cases were high positioned anterior communicating artery aneurysms located more than 15mm above the anterior clinoid process. Results : Pterional approaches were applied in 32 cases and interhemispheric approaches were applied in 4 cases of total 36 cases of the high positioned anterior communicating artery aneurysms. The 32 cases of pterional approach resulted in Good Recovery 20/32(63%), Moderate Disability 6/32(19%), Severe Disability 4/32(12%) and Dead 2/32(6%), and 4 cases of interhemispheric approach resulted in GR 3/4(75%) and MD 1/4(25%). Relatively, pterional approach showed poorer result on high positioned anterior communicating artery aneurysm located more than 19mm above the anterior clinoid process with GR 5/13(39%), MD 3/13(23%), SD 3/13(23%) and Dead 2/13(15%). Conclusion : Interhemispheric approach is preferable to pterional approach for certain cases of high positioned anterior communicating artery aneurysm located more than 19 mm above the anterior clinoid process because it provides adequate orientation to the regional anatomy, less retraction of frontal lobe and preservation of the olfactory tract and gyrus rectus without any surgical complications.

• Journal of Korean Neurosurgical Society
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• 제38권5호
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• pp.399-402
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• 2005

Direct anterior approach for lesions located anterior to the thecal sac is definitely superior to lateral or posterior approach in many respects. However, various anatomical obstacles and technical difficulties often hinder direct anterior approach. Thanks to ripe experience of retroperitoneal approach to the lumbar spine for anterior lumbar interbody fusion and total disc replacement, the authors could perform lumbar corpectomy and reconstruction by using midline retroperitoneal approach recently. During this approach, we repaired anterior longitudinal ligament also to reduce the risk of graft extrusion and to prevent erosion of vascular wall due to direct contact between metallic hardware, which was used for reconstruction of vertebral body, and major vessels.

• 대한족부족관절학회지
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• 제18권4호
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• pp.189-194
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• 2014

Purpose: The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis. Materials and Methods: There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively. Results: Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case. Conclusion: After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.

• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.524-533
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• 2021

Objective : When treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. Methods : Twenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. Results : The pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. Conclusion : For high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.

• 대한족부족관절학회지
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• 제27권4호
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• pp.131-136
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• 2023

Purpose: This study compared the clinical and radiology results of arthrodesis between the anterior and transfibular approaches with a lateral malleolar-saving procedure in ankle arthritis. Materials and Methods: This study was a retrospective study of 31 cases who underwent ankle arthrodesis with the anterior approach (14 cases) and trans-fibular approach (17 cases). The remnant lateral malleolus was fixed during the trans-fibular procedure. The patients included 17 females and 14 males with a mean age of 57.2 (range 41~73) years; the mean follow-up was 30.4 (range 15~68) months. The clinical and radiology outcomes, including the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and union time, were recorded. The complications and subjective satisfaction degrees were also recorded and compared between the two groups. Results: Clinically, the preoperative mean AOFAS score and VAS in the anterior approach group were 39.3 and 7.4, respectively, which changed to 61.9 and 3.1 postoperatively. In the trans-fibular approach group, the mean AOFAS score and VAS increased from 36.6 to 64.2 and 7.1 to 2.4, respectively. On the other hand, no significant differences in the clinical results were observed between the two groups. The time to achieve union was 9.2 and 11.6 weeks in the anterior and transfibular approach groups, respectively. Three patients (21%) complained of tenderness and discomfort around the fibular tip in the anterior approach group, and seven patients (41%) showed a gap between the talus and remnant lateral malleolus in the trans-fibular approach group. Conclusion: There was no difference in the clinical and radiological results between the anterior and transfibular approaches with a lateral malleolar saving procedure in ankle arthrodesis. Careful selection of the approach method according to the patient's preoperative condition is needed to prevent remnant discomfort or nonunion around the lateral malleolus.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1055-1062
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• 2000

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1258-1261
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• 2000

Intraspinal neurenteric cyst is rare congenital lesion derived from disorder of notochord formation. Most of these are located ventral to the spinal cord and conventional posterior approach is considered to be effective method as initial treatment modality. This cyst can recur, but the risk of reccurence after partial removal through long term follow-up has not been determined. We experienced one case of cervical neurenteric cyst which recurred after partial removal through laminectomy. The magnetic resonance imaging and postmyelography computerized tomography revealed an intradural extramedullary cystic lesion anterior to the cervical cord at the fifth cervical vertebra level. We performed anterior cervical corpectomy and cyst was totally removed. The patient's neurological symptom was improved postoperatively. Neurenteric cyst located ventrally to the cervical spinal cord should be removed through anterior route for direct visualization of the relationship between the cyst wall and the spinal cord.

• Journal of Korean Neurosurgical Society
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• 제39권3호
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• pp.188-191
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• 2006

Objective : The purpose of this study is to evaluate the efficacy and necessity of combined anterior approach [discectomy and fusion] and posterior approach[open-door laminoplasty] in the treatment of cervical spondylotic myelopathy. Methods : The authors reviewed 14 cases in whom combined anterior and posterior approach performed for cervical myelopathy due to simultaneous anterior and posterior pathology such as huge central disc herniation with narrow spinal canal between January 2000 and December 2002. Clinical symptoms were evaluated by Japanese Orthopaedic Association [JOA] score and then the cervical curvature, change of spinal canal to vertebral body[SC/VB] ratio and canal widening were measured and compared to the clinical symptoms. Results : The mean JOA score increased from $10.4{\pm}3.1$ preoperatively to $14.8{\pm}1.2$ at the final follow up with a mean recovery rate 66.4%. In all cases, there were not neurologic deterioration. Mild postoperative complications developed in two cases. One patient had a limitation of range of neck motion and the other one showed kyphotic change. Postoperative radiography showed an improvement of body to canal ratios [average $0.70{\pm}0.08$ before surgery to $1.05{\pm}0.12$ after surgery and mainte nance or recovery of cervical lordosis. Canal widening of antero-posterior diameter and dimension after operation is 6.8mm. $116.61mm^2$. Conclusion : Combined anterior and posterior procedure could be helpful in decompression of the spinal cord and good functional recovery in spondylotic myelopathy patients with combined anterior and posterior pathology such as huge disc herniation accompanying narrow spinal canal.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.202-209
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• 2020

Objective : The purpose of this study was to evaluate the efficacy of the anterior approach following intraoperative reduction under general anesthesia in patients with cervical facet fracture and dislocation. Methods : Twenty-three patients with single level cervical facet fracture and dislocation who were subjected to the anterior approach alone following immediate intraoperative reduction under general anesthesia from March 2013 to December 2017 were enrolled in this study. Neurological status, clinical outcome, and radiological studies were evaluated preoperatively, postoperatively, and during the follow-up period. Results : The cohort comprised 15 men and eight women with a mean age of 57 years (from 24 to 81). All patients were operated on within the first 8 hours following the injury. After gentle manual reduction or closed reduction with Gardner-Wells traction, under general anesthesia monitored by somatosensory-evoked potentials, all operations were successfully completed using the anterior approach alone except in two patients, who had a risk of over-distraction. In them, a satisfactory gentle manual reduction or closed reduction was not possible, and required open posterior reduction of the locked facets followed by anterior cervical discectomy and fusion. In one patient, screw retropulsion was observed in 1 month after surgery. There were no reduction-related complications or neurological aggravations after surgery. All patients showed evidence of stability at the instrumented level at the final follow-up (mean follow-up, 12 months). Conclusion : Anterior approach following intraoperative reduction monitored by somatosensory-evoked potentials under general anesthesia for cervical dislocation and locked facets is a relatively safe and effective alternative when cervical alignment is achieved by intraoperative reduction.

• 대한두개안면성형외과학회지
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• 제17권4호
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• pp.186-189
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• 2016

Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are controversial. The subbrow approach enables accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by allowing direct visualization of the fracture. Given the surgical success in reduction and rigid fixation, patient satisfaction, and aesthetic benefits, the transcutaneous approach through a subbrow incision is superior to other reduction techniques used in the management of an anterior table frontal sinus fracture.