• Journal of Korean Neurosurgical Society
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• v.66 no.2
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• pp.162-171
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• 2023

Objective : The goal of this study was to analyze the clinical outcomes of endoscopic third ventriculostomy (ETV) and endoscopic septostomy when shunt malfunction occurs in a patient who has previously undergone placement of a ventriculoperitoneal shunt. Methods : From 2001 to 2020 at Seoul National University Children's Hospital, patients who underwent ETV or endoscopic septostomy for shunt malfunction were retrospectively analyzed. Initial diagnosis (etiology of hydrocephalus), age at first shunt insertion, age at endoscopic procedure, magnetic resonance or computed tomography image, subsequent shunting data, and follow-up period were included. Results : Thirty-six patients were included in this retrospective study. Twenty-nine patients, 18 males and 11 females, with shunt malfunction underwent ETV. At the time of shunting, the age ranged from 1 day to 15.4 years (mean, 2.4 years). The mean age at the time of ETV was 13.1 years (range, 0.7 to 29.6 years). Nineteen patients remained shunt revision free. The 5-year shunt revision-free survival rate was 69% (95% confidence interval [CI], 0.54-0.88). Seven patients, three males and four females, with shunt malfunction underwent endoscopic septostomy. At the time of shunting, the age ranged from 0.2 to 12 years (mean, 3.9 years). The mean age at the time of endoscopic septostomy was 11.9 years (range, 0.5 to 29.5 years). Four patients remained free of shunt revision or addition. The 5-year shunt revision-free survival rate was 57% (95% CI, 0.3-1.0). There were no complications associated with the endoscopic procedures. Conclusion : The results of our study demonstrate that ETV or endoscopic septostomy can be effective and safe in patients with shunt malfunction.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.457-468
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• 2022

Objective : The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. Methods : We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. Results : Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. Conclusion : The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.577-583
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• 2016

Objective : The inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas. Methods : From November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Two neurosurgeons and a neuroradiologist independently measured the degree of parasellar extension on the preoperative sellar MRI according to the modified Knosp's classification. Inter-rater reliability was statistically assessed by measuring the intraclass correlation coefficient. The extents of resection were evaluated by comparison of the pre- and post-operative MR images; the neurovascular complications were assessed by reviewing the patients' medical records. The extent of resection was measured in each parasellar extension grade; thereafter, their statistical differences were calculated. Results : The intraclass correlation coefficient value of reliability across the three raters amounted to 0.862. The gross total removal (GTR) rates achieved in each grade were 70.0, 69.8, 62.9, 21.4, 37.5, and 4.3% in Grades 0, 1, 2, 3A, 3B, and 4, respectively. A significant difference in the extent of resection was observed only between Grades 2 and 3A. In addition, significantly higher complication rates were observed in the groups above Grade 3A. Conclusion : Although the modified Knosp's classification system appears to be complex, its inter-rater reliability proves to be excellent. Regarding the clinical validity of the parasellar extension grading system, Grades 3A, 3B, and 4 have a negative predictive value for the GTR rate, with higher complication rates.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.137-142
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• 2005

Purpose: To evaluate the safety, efficacy and technical problems of the endoscopic balloon dilatation of esophageal anomalies in children. Methods: The medical records of 8 children treated by endoscopic balloon dilatation for esophageal anomalies over a 10-year period at Pusan National University Hospital were reviewed retrospectively. The balloon catheter (Maxforce TTS or CRE, Boston Scientific Co., USA) was positioned across the area of narrowing by direct visualization. The balloon was slowly inflated with normal saline to specified pressures for each balloon and maintained for 60 seconds and then deflated. After 60 seconds pause, the procedure was repeated with a larger sized balloon (increments of 1 mm for each subsequent dilation) till effective dilatation was confirmed by direct visualization without complications. Results: Three male and five female were included and their mean age was 4.2 years. A total of 27 (average of 3.2 per patient) dilatation were performed. Underlying diseases of patients are postoperative stricture of esophageal atresia in 3 cases, esophageal ring in 2 cases, achalasia, corrosive esophagitis and hypertensive LES in one case respectively. The size of initial dilating balloon was chosen on the basis of the diameter of the narrowing determined by endoscopy. The first dilation in patients with severe esophageal stricture was made with a 6 mm sized balloon. Complications observed were esophageal perforation and respiratory holding during the procedure in one case respectively. Successful outcome was seen in 6 patients (75%). Conclusion: Endoscopic balloon dilatation can provide a safe and effective mean of treating esophageal anomalies in children and should be considered the treatment of choice in the initial management of those cases.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1983.05a
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• pp.13.3-14
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• 1983

A clinical study was done on 24 cases with foreign body in the air passage, who were treated at the department of otolaryngology of Kyung Hee university hospital during the period from Apr. 1973 to Feb. 1983. The obtained results were as follows : 1) The incidence of sex was much higher in male than female and children under 4 years old were predominant. 2) Almost of all patients came in the hospital within 3 days after onset. However one patient came in hospital 5 months later. 3) The variety of foreign body was numerous, among which vegetables and plastic materials were most frequently found. 4) The most common sites of lodgement were trachea and right main bronchus. 5) The common clinical manifestations were dyspnea, decreasing breathing sound and cough. Negative X-ray findings did not exclude a foreign body in the air passage. 6) The important pulmonary complications due to foreign body were atelectasis, emphysema and pneumonia. 7) Foreign body was successfully removed by use of peroral or inferior endoscopy in all cases except one case, on whom thorachotomy was done. 8) The important complications due to the surgical procedure were decannulation difficulty and pneumothorax.

• The Korean Journal of Gastroenterology
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• v.72 no.6
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• pp.308-312
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• 2018

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.4
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• pp.350-365
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• 2023

Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically. Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome. Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome. Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.136-142
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• 2002

Purpose: Foreign body swallowing is common in children. Most of foreign bodies passed upper esophagus are removed spontaneously. But recently, therapeutic endoscopy in children is widely used. In this study, we reviewed gastric foreign bodies regarding types, location, interval from swallowing, complications, and treatment or method of removal. Methods: We reviewed medical records of 96 cases with foreign bodies in gastrointestinal tract at Department of Pediatrics in Gyeongsang National University Hospital (GNUH) from Feb 1987 to Feb 2002. Results: The peak age of patients (male=60, female=36) with foreign bodies in gastrointestinal tract was 2 to 5 years of age. Sixty two patients (64.5%) were asymptomatic. The location of foreign bodies in gastrointestinal tract were detected by simple X-ray in eighty one patients (86.0%), barium study (1 case), and gastroduodenoscopy in 37 cases. The most common location was stomach (63.5%). The most common foreign body was coin (41.7%). In thirty seven cases (38.5%), foreign bodies were removed with flexible gastroduodenoscopy. Fifty four patients (56.3%) visited GNUH in 24 hours after swallowing foreign bodies. The long interval (over 24 hours) of swallowing of foreign bodies is related with high frequency of endoscopic removal. Conclusion: The flexible gastroduodenoscopy was effective in diagnosis and removal of foreign bodies. Further studies for indication and validity of endoscopic removal of foreign bodies in upper gastrointestinal tract are needed.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.75-84
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• 2001

Background: The accidental swallowing of foreign body is a common problem in the children. Ingested foreign bodies may be managed by endoscopy, observation, or surgery. So we analyzed the methods of removal, type, location and complications of foreign bodies. Materials and Methods: This report reviewed 37 cases of ingested foreign body in the gastrointestinal tract at the Department of Pediatrics, Yeungnam University Hospital between January 1997 and April 2001. Results: The age ranged from 8 months to 8 years. The most prevalent age group was between 1 year and 2 years of age(19%). The male to female ratio was 2.1:1 with 25 male and 12 female patients. The type of foreign bodies were coins in 20 cases(54%), nail in 4 cases(11%), key in 4 cases(11%), pin in 2 cases(5.5%), necklace in 2 cases(5.5%) and others. The locations of foreign bodies were upper esophagus in 12 cases(32.5%), lower esophagus in 4 cases(10.8%), stomach in 16 cases(43.2%), small bowel in 5 cases(13.5%). 4. Presenting symptoms were variable with asymptomatic(59.4%), vomiting(19.0%), epigastric pain(8.1%), dysphagia(5.4%) and others. The methods for removal of foreign bodies included 20 cases of endoscopic removal(54.0%). 3 cases of spontaneous removal(8.1%) and there was no surgical removal. 14 cases(37.9%) did not confirmed removal of foreign body because of no revisit of our hospital. Endoscopic finding of patients were normal(15 cases), ulceration(2 cases), erosion(1 case), inflammation(1 case), mucosal scratch(1 case). Conclusion: It appears that the endoscopic approach is the preferable method for the removal of upper gastrointestinal foreign bodies in the children.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.575-580
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• 2001

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.