• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.479-488
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• 2022

Objective : The surgical management of trigeminal neuralgia (TN) caused by petrous apex meningioma (PAM) is still a challenge because of the lesion's deep location and the surrounding complex structures. The authors describe the intradural anterior transpetrosal approach (ATPA) and its effect on the treatment of TN secondary to PAM. Methods : A retrospective analysis of 15 patients with TN secondary to PAM who underwent surgery via the intradural ATPA was conducted. The key techniques, which included drilling off the petrosal apex (PA) and opening the upper wall of Meckel's cave (MC), are described in detail. Results : Total removal of the tumor and complete pain relief (Barrow Neurological Institute I) were achieved in all 15 patients without significant morbidity. Five patients developed new facial numbness postoperatively, which disappeared within three months after surgery. The postoperative magnetic resonance imaging showed temporal lobe swelling in three patients, but no clinical symptoms. One patient had cerebrospinal fluid leakage and was managed with bed rest and temporary lumbar drainage. One patient had an intracranial infection and was treated with antibiotics. By the last follow up, no patients had pain relapse or/and tumor recurrence. It is worth noting that the vascular compression at the root of the trigeminal nerve was found in one patient during the operation. Conclusion : Our experience suggests that drilling off the PA and opening the upper wall of the MC are key elements for a good outcome of the treatment of TN secondary to PAM. The intradural ATPA has the advantages for both tumor resection and pain relief.

• The Journal of Korean Academy of Prosthodontics
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• v.62 no.1
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• pp.28-37
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• 2024

Severe cases of mandibular prognathism can be treated with orthodontic therapy or surgical correction, but there are situations where only prosthetic improvement is possible. An understanding of class III patients is needed, including a vertical chewing pattern and the absence of anterior guidance. Additionally, it is relatively easy to increase occlusal vertical dimension to correct the anterior crossbite, but this approach can sometimes lead to unfavorable results, necessitating careful diagnosis and treatment planning. In this case report, oral rehabilitation was conducted in a patient with mandibular prognathism and asymmetry, utilizing implants and fixed dental prosthesis. Through a step-by-step treatment approach, the existing occlusal vertical dimension was maintained, and the final fixed dental prosthesis restoration was completed. Accordingly, it shows functional and aesthetically appropriate results, and reports on the patient's diagnosis and treatment process.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.249-254
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• 2017

Background: Lower eyelid incisions are widely used for the orbital approach in periorbital trauma and aesthetic surgery. In general, the subciliary approach is known to cause disposition of the lower eyelid by scarring the anterior lamella in some cases. On the other hand, many surgeons believe that a transconjunctival approach usually does not result in such complications and is a reliable method. We measured positional changes in the lower eyelid in blowout fracture repair since entropion is one of the most serious complications of the transconjunctival orbital approach. Methods: To measure the positional changes in the lower eyelids, we analyzed preoperative and postoperative photographs over various time intervals. In the analysis of the photographs, marginal reflex distance 2 ($MRD_2$) and eyelash angle were used as an index of eyelid position. Statistical analyses were performed to identify the significance in the positional changes. All patients underwent orbital reconstruction through a transconjunctival incision by a single plastic surgeon. Results: In 42 blowout fracture patients, there was no statistical significant difference in the MRD2 and eyelash angle. Furthermore, there were no clinical complications, such as infection, hematoma, bleeding, or implant protrusion, during the follow-up periods. Conclusion: The advantages of the transconjunctival approach for orbital access include minimal scarring and a lower risk of eyelid displacement compared with other approaches. Based on these results, we recommend the transconjunctival approach for orbital exposure as a safe and reliable method.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1555-1562
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• 2000

Objects : Surgical management of the distal anterior cerebral artery(DACA) aneurysms presents several unique problems to surgeons, such as difficulty in early identification of parent arteries, high incidence of rebleeding and premature rupture, and requirement of unfamiliar approach other than conventional frontotemporal craniotomy. Therefore, preoperative anatomical knowledge of anterior interhemispheric fissure and entry point of dissection is prerequisite. Authors utilized a frontobasal approach for DACA aneurysms by using consistent external landmark for guidance to the deep structure. Materials and Methods : From Nov. 1995 to Jun. 1999, a surgical clipping of DACA aneurysms was carried out in 9 patients among a total 131 patients with intracranial aneurysms. In each case, the clinical and aneurysmal features were carefully reviewed through the angiograms, medical records, and intraoperative findings. Results : The incidence of DACA aneurysms was 6.9% from our series. All cases were arisen from juxtacallosal por-tion ; 6 cases from pericallosal-callosomarginal(PC-CM) junction and 3 from pericallosal-frontopolar(PC-FP) junction. Associated vascular anomalies were noted in 3 cases and multiple aneurysms in 3 cases, respectively. The preoperative clinical grades were generally poor. An early surgery was performed in 7 cases and frontobasal interhemispheric approaches in 7 cases. Postoperatively, two patients died of complications ; one delayed ischemic vasospasm and one aspiration pneumonia but remaining patients recovered well. Conclusion : The frontobasal interhemispheric approach was useful for DACA aneurysms in early surgery. Division of superior sagittal sinus(SSS) enabled a minimal retraction of brain on both sides, and prevention of intraoperative rupture was possible. Authors suggest the frontopolar(first frontal bridging) vein as a constant external landmark for approaching the genu of the corpus callosum and juxtacallosal DACA aneurysms.

• Restorative Dentistry and Endodontics
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• v.36 no.6
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• pp.515-520
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• 2011

One of the most challenging task in closing anterior diastema is avoiding "black triangle" between the teeth. This paper reports a case that the closure of diastema in anterior teeth could be successfully accomplished using direct adhesive restorations and gingival recontouring. The traditional technique using Mylar strip was modified to increase the emergence profile with natural contours at the gingival-tooth interface. Mylar strip was extended out of the sulcus by approximately 1 mm high from the gingival margin, and a small cotton pellet was used to provide the emergence contour. This modified approach is acceptable for the clinical situation.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.46-46
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• 2003

Several MRI studies have reported reductions in temporal lobe volumes in Alzheimer´s disease (AD). Measures have been usually obtained with regions of interest (ROI) drawn manually on selected medial and lateral portions of the temporal lobes, with variable choices of anatomical borders across different studies. We used the automated voxel based morphometry (VBM) approach to investigate gray matter abnormalities over the entire extension of the temporal lobe in 11 AD patients (MMSE 14 - 25) and 11 healthy controls. Foci of significantly reduced gray matter volume in AD patients were detected in both medial and lateral temporal regions, most significantly in the right and left posterior parahippocampal gyri. At a more flexible statistical threshold (P<0.001, uncorrected for multiple comparisons), circumscribed foci of significant gray matter reduction were also detected in the right amygdala/enthorinal cortex, the anterior and posterior borders of the superior temporal gyrus bilaterally, and the anterior portion of the left middle temporal gyrus. These VBM results confirm previous findings of temporal lobe atrophic changes in AD, and suggest that these abnormalities may be confined to specific sites within that lobe, rather than showing a widespread distribution.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.702-704
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• 2010

Purpose: Chordoma is a rare primary osseous tumor arising from the remnants of the primitive notochord. It occurs once in 2,000,000. It is characterized by its slow growth, high frequency to invade destroy bone by direct extension. We experienced giant sacral chordoma and reconstructed with gluteal advancement flap. Methods: A 52-year-old woman presented with a 2-years history of gluteal pain. In the biopsy study revealed sacral chordoma. MRI study showed $13{\times}12{\times}10\;cm$ sized m0cs. We approached anterior and posterior resection and reconstructed with bilateral gluteus maximus advancement flap. Results: After the operation, blader and anal function were slightly decreased. But, 4 months later those were almost fully recovered. There was no significant complication and recurrence after 2-years follow-up. Conclusion: Chordoma is characterized by its slow growth, high frequency to invade and destroy bone by direct extension. Wide surgical resection is the only curative procedure. We report a ase of giant sacral chordoma which was successfully treated by anterior and posterior approach and reconstructed with bilateral gluteal advancement flap.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.264-266
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• 2012

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.

• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.289-292
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• 2014

A case of total spondyloptosis of the cervical spine at C6-7 level with cord compression is described in a 51-year-old male. Because the bodies of C6 and 7 were tightly locked together, cervical traction failed. Then the patient was operated on by a posterior approach. Posterior stabilization and fusion were performed by C4-5 lateral mass and C7-T1 pedicle screw fixation and rod instrumentation with bridging both C4-5's rods to the C7-T1's extended ones. After C6 total laminectomy and foraminotomy, the C6 body was returned to its proper position. Secondly, anterior stabilization and fusion were performed by C6-7 discectomy with a screw-plate system. A postoperative lateral plain radiograph showed good realignment. In this case, we report the clinical presentation and discuss the surgical modalities of C6-7 total spondyloptosis and the failed close reduction.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.178-181
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• 2011

Congenital anomalies in arches of the atlas are rare, and are usually discovered incidentally. However, a very rare subgroup of patients with unique radiographic features is predisposed to transient quadriparesis after minor cervical or head trauma, A 46-year-old male presented with a 2-month history of tremor and hyperesthesia of the lower extremities after experiencing a minor head trauma. He said that he had been quadriplegic for about 2 weeks after that trauma. Radiographs of his cervical spine revealed bilateral bony defects of the lateral aspects of the posterior arch of C1 and a midline cleft within the anterior arch of the atlas. A magnetic resonance imaging revealed an increased cord signal at the C2 level on the T2-weighted sagittal image. A posterior, suboccipital midline approach for excision of the remnant posterior tubercle was performed. The patient showed significant improvement of his motor and sensory functions. Since major neurologic deficits can be produced by a minor trauma, it is crucial to recognize this anomaly.