• Biomedical Science Letters
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• v.15 no.1
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• pp.31-35
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• 2009

High blood pressure (BP) is the most frequent risk factor among metabolic syndrome components. The control of hypertension is very important to prevent the cardiovascular risk in metabolic syndrome. The dysfunction of calcium channel is responsible in the regulation of the vascular muscle contribution to hypertension. Calcium channel, voltage-dependent, P/Q type, alpha-1A subunit (CACNA1A) gene is located in brain and known to control the intracranial hypertension. In this study, we investigate whether the polymorphisms of CACNA1A gene is associated with hypertension. The 49 CACNA1A genotypes were determined using the Affymetrix Genotyping chip array in 92 hypertension and 279 control individuals from a Korean population. Logistic and multiple regression models were employed to analyze the genetic contributions of polymorphisms. Out of 49 polymorphisms, six SNPs (rs12611029, rs16035, rs7259944, rs10419472, rs17777900, and rs4926294) showed a significant association with hypertension in three alternative models (codominant, dominant, and recessive models; P<0.05 after adjusting for age and sex). Our results suggest that the CACNA1A gene may be associated with hypertension in the Korean population.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.431-434
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• 2005

Objective : Subarachnoid hemorrhage[SAH] is commonly associated with polyuria [solute diuresis or water diuresis]. The authors investigate the incidence and clinical characteristics of polyuria with special reference to the administration of osmotic diuretics. Methods : One hundred and forty eight patients with high urine output [>200ml/hr] after ruptured cerebral aneurysm operated early from Jan 1998 to Jun 2003 were selected. Water diuresis [diabetes insipidus, DI] was differentiated from solute diuresis by lower urine specific gravity [<1.005] and higher plasma osmolality. The incidence and mode of onset of polyuria were compared between two types of diuresis. Additionally, the relationships between development of polyuria and clinical features including aneurysm location, clinical grade, Fisher grade, and outcome were analyzed. Osmotic diuretics were not routinely used in patients with Hunt-Hess grade I-III since July 2001. Results : Annual incidence of polyuria decreased markedly since July 2001 : 45.2% in 1998, 34.5% in 2001, 11.9% in 2003. Postoperative DI occurred in $2.4{\sim}11.1%$. DI developed mainly from ruptured anterior communicating artery aneurysm. The mean interval between the last SAH and the onset of DI was 7.1 days [range $1{\sim}27$ days] and lasted mean 4.6 days. When compared with solute diuresis, the development of DI was significantly delayed. Other clinical features were not closely related to polyuria. Conclusion : Uncontrolled polyuria may lead to cerebral ischemia and electrolyte imbalance because SAH patients are already predisposed to hypovolemia, and will risk precipitating the opposite situation with overhydration. We can decrease the development of polyuria without routine use of osmotic diuretics, by avoiding the increased intracranial pressure such as the intraoperative ventriculostomy and gentle brain retraction in good grade patients.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.391-396
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• 2007

Objective : This study was performed to review the clinical characteristics and operative results of brain abscess in order to define the therapeutic strategy for this disease. Methods : We reviewed the medical records and radiology images of brain abscess patients treated in our hospital during the last 16 years. A total of 35 cases included 23 males and 12 females, with the mean age of 48 years old. We excluded cases of postoperative, post traumatic, and fungal abscess. All patient underwent at least one surgical treatment such as stereotactic aspiration or craniotomy with excision. Results : Twenty seven [77.1%] patients presented with symptoms of increased intracranial pressure. The frontal lobe was the most common anatomical place, and streptococcal species were the most frequently encountered pathogens. The chronic pulmonary diseases and chronic otitis media are common underlying condition. Eighteen patients underwent stereotactic aspiration and 17 patients had excision of their abscess as an initial treatment. Seven patients had a repeated surgery, 6 of them had been treated with aspiration initially. At discharge, 60.0% patients showed a favorable outcome. Conclusion : The stereotactic drainage would be more suitable for the brain abscess located in deep and eloquent area. A large, solitary, and well-encapsulated lesion of superficial location could be best treated with complete excision, and this procedure was more definite because it is associated with less repeated surgery and showed more favorable outcome compared to aspiration surgery.

• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.631-643
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• 2021

Objective : Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict the treatment response or be prognostic for patient overall survival (OS) along with clinical factors. Methods : Paired 1) pretreatment lumbar, 2) pretreatment ventricular, and 3) posttreatment ventricular samples and their CSF profiles were collected retrospectively from 148 LMC patients who received Ommaya reservoir installation and intraventricular chemotherapy. CSF profile changes were assessed by calculating the differences between posttreatment and pretreatment samples from the same ventricular compartment. CSF cell counts were further differentiated into total and other based on clinical laboratory reports. Results : For the treatment response, a decreased CSF 'total' cell count tended to be associated with a 'controlled' increase in intracranial pressure (ICP) (p=0.059), but other profile changes were not associated with either the control of increased ICP or the cytology response. Among the pretreatment CSF profiles, lumbar protein level and ventricular cell count were significantly correlated with OS in univariable analysis, but they were not significant in multi-variable analysis. Among CSF profile changes, a decrease in 'other' cell count showed worse OS than 'no change' or increased groups (p=0.001). The cytological response was significant for OS, but the hazard ratio of partial remission was paradoxically higher than that of 'no response'. Conclusion : A decrease in other cell count of CSF after intraventricular chemotherapy was associated with poor OS in LMC patients. We suggest that more specific CSF biomarkers of cancer cell origin are needed.

• The Journal of the Society of Stroke on Korean Medicine
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• v.12 no.1
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• pp.1-7
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• 2011

Objectives : The purpose is to discuss the clinical applications of Orungsan(Goreisan: 五苓散) as an alternative management for increased intracranial pressure in the field of neurosurgery in Japan. Methods and Results : Attention has focused on Kampo medicine(traditional Japanese medicine) for some cerebral disease including chronic subdural hematoma(CSDH) and cerebral infarction in Japan. Orungsan and one of its classes, Sirungtang(Saireto: 柴苓湯) are well known their effects on brain edema. After some studies of Orungsan has the anti-edemic effects by the inhibition of aquaporin, this herbal medicine has been used widely in the neurosurgery field in Japan. It is high time to think about where we are and we go ahead for the progress and the integration in medicine. We have reviewed the studies using Orungsan or Sirungtang, that was reported at the 20th annual meeting of 'the Japan society for Kampo medicine and neurological surgery' was held on November 5, 2011 in Tokyo. Fifteen studies related with Orungsan or Sirungtang were reported among all 32 studies at the meeting. Orungsan in ten, and Sirungtang in five among 14 studies contained specific clinical case. In the aspects of disease, thirteen papers were related with SDH, including CSDH(11), SSDH(1), aneurism clipping for SDH prevention(1), and one was acute cerebral infarction and one was multiple metastatic brain tumor. In the report style, case control study was 7(mostly retrospective), and the case report was 8. Conclusions : Orungsan may be plausible to be an alternative method to reduce brain edema after SDH and other brain injury in the field of neurosurgery.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.664-671
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• 2023

Objective : The optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio is a more reliable marker of intracranial pressure than the ONSD alone. We aimed to investigate the predictive value of the ONSD/ETD ratio (OER) for neurological outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods : Adult patients with aSAH who visited the emergency department of a tertiary hospital connected to a South Korean university between January 2015 and December 2021 were included. Data on patient characteristics and brain computed tomography scan findings, including the ONSD and ETD, were collected using a predefined protocol. According to the neurological outcome at hospital discharge, the patients were divided into the unfavorable neurological outcome (UNO; cerebral performance category [CPC] score 3-5) and the favorable neurological outcome (FNO; CPC score 1-2) groups. The primary outcome was the association between the OER and neurological outcomes in patients with aSAH. Results : A total of 171 patients were included in the study, of whom 118 patients (69%) had UNO. Neither the ONSD (p=0.075) nor ETD (p=0.403) showed significant differences between the two groups. However, the OER was significantly higher in the UNO group in the univariate analysis (p=0.045). The area under the receiver operating characteristic curve of the OER for predicting UNO was 0.603 (p=0.031). There was no independent relationship between the OER and UNO in the multivariate logistic regression analysis (adjusted odds ratio, 0.010; p=0.576). Conclusion : The OER was significantly higher in patients with UNO than in those with FNO, and the OER was more reliable than the ONSD alone. However, the OER had limited utility in predicting UNO in patients with aSAH.

• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.227-236
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• 2024

Objective : Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction. Methods : This analysis included 67 patients with major anterior circulation major infarction who underwent DC after IA-Tx, with or without intravenous tissue plasminogen activator. We retrospectively reviewed the medical records, radiological findings, and compared the neurological outcomes based on the "surgical time window" and neurological status at the time of surgery. Results : For patients treated with DC following IA-Tx, a Glasgow coma scale (GCS) score of 7 was the lowest score correlated with a favorable outcome (p=0.013). Favorable outcomes were significantly associated with successful recanalization after IA-Tx (p=0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p=0.007). However, the surgical time window (within 36 hours, p=0.389; within 48 hours, p=0.283) did not correlate with neurological outcomes. Conclusion : To date, early DC surgery after major infarction is crucial for patient outcomes. However, this study suggests that the indication for DC following IA-Tx should include neurological status (GCS ≤7), as some patients treated with early DC without considering the neurological status may undergo unnecessary surgery. Recanalization of the occluded vessel and P/D-mismatch are important for long-term neurological outcomes.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.103-114
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• 2024

Objective : Decompressive craniectomy (DC) with duroplasty is one of the common surgical treatments for life-threatening increased intracranial pressure (ICP). Once ICP is controlled, cranioplasty (CP) with reinsertion of the cryopreserved autologous bone flap or a synthetic implant is considered for protection and esthetics. Although with the risk of autologous bone flap resorption (BFR), cryopreserved autologous bone flap for CP is one of the important material due to its cost effectiveness. In this article, we performed conventional statistical analysis and the machine learning technique understand the risk factors for BFR. Methods : Patients aged >18 years who underwent autologous bone CP between January 2015 and December 2021 were reviewed. Demographic data, medical records, and volumetric measurements of the autologous bone flap volume from 94 patients were collected. BFR was defined with absolute quantitative method (BFR-A) and relative quantitative method (BFR%). Conventional statistical analysis and random forest with hyper-ensemble approach (RF with HEA) was performed. And overlapped partial dependence plots (PDP) were generated. Results : Conventional statistical analysis showed that only the initial autologous bone flap volume was statistically significant on BFR-A. RF with HEA showed that the initial autologous bone flap volume, interval between DC and CP, and bone quality were the factors with most contribution to BFR-A, while, trauma, bone quality, and initial autologous bone flap volume were the factors with most contribution to BFR%. Overlapped PDPs of the initial autologous bone flap volume on the BRF-A crossed at approximately 60 mL, and a relatively clear separation was found between the non-BFR and BFR groups. Therefore, the initial autologous bone flap of over 60 mL could be a possible risk factor for BFR. Conclusion : From the present study, BFR in patients who underwent CP with autologous bone flap might be inevitable. However, the degree of BFR may differ from one to another. Therefore, considering artificial bone flaps as implants for patients with large DC could be reasonable. Still, the risk factors for BFR are not clearly understood. Therefore, chronological analysis and pathophysiologic studies are needed.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.5-14
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• 2000

Objective : Somatosensory evoked potential(SSEP) has been known to be a good method for evaluating brain stem function, but it is not sufficient to check the fine changes of cortical functions. A fine change of cortical function can be expressed with somatosensory evoked cortical field potential(SSEFP) rather than general SSEP. To confirm the usefulness of SSEFP for evaluating the cortical function, the authors simultaneously measured SSEFP and the intracranial pressure-volume index(PVI) in kaolin-induced hydrocephalic rats. Method : Hydrocephalus was induced with injection of 0.1ml kaolin-suspended solution into the cisterna magna in 60 Sprague-Dawley rats. The authors measured PVI and SSEFP 1 week after injection of kaolin-suspended solution. To evaluate the severity of induced hydrocephalus, we measured the transverse diameter of the lateral ventricle on the coronal slice of the rat brain 0.40mm posterior to the bregma. Result : The typical wave form of SSEFP in control rats showed a negative-positive complex wave at early latency. In SSEFP of normal rats, N0 is 10.0 msec, N1 15.3 msec, P1 31.2 msec and N1-P1 amplitude $15.4{\mu}V$. As hydrocephalus progressed, the peak latency of N1 and P1 were delayed. In mild hydrocephalus, negative peak waves were split. The N1-P1 amplitude was decreased only in severe hydrocephalus. The changes of the characteristics of SSEFP according to the severity of hydrocephalus were well correlated with the changes of PVI. Shunting normalized the characteristics of SSEFP in relation to ventricular sizes and PVI in hydrocephalic rats. Conclusion : SSEFP may be useful for evaluating the impairment of cortical function in hydrocephalus.

• Journal of Korean Neurosurgical Society
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• v.29 no.4
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• pp.536-542
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• 2000

Objective : This study was performed to evaluate the relationships among intracranial pressure(ICP), cerebral perfusion pressure(CPP), and cerebral arteriovenous oxygen difference($AVDO_2$) which were used as parameters of adequacy of cerebral blood flow to support cerebral metabolism after severe head injury and also to examine the association between delayed cerebral infarction and outcome. Material and Method : The authors studied the ICP, CPP and $AVDO_2$ before and after treatment on 34 head-injured patients from June 1996 to December 1997 and examined the association with the change of an ICP, CPP and $AVDO_2$ following treatment and the development of delayed cerebral infarction. Sixteen patients underwent craniotomy for hematoma evacuation and eighteen patients received mannitol to decrease ICP. Results : The development of delayed cerebral infarction was demonstrated in 3(42.9%) out of 7 patients in no improvement group and 13(48.1%) out of 27 patients in improvement group with an increased ICP following treatment. Also, the development of delayed cerebral infarction was demonstrated in 8(50%) out of 16 patients in no improvement group and 8(44.4%) out of 18 patients in improvement group with a decreased CPP following treatment. The association with changes of ICP and CPP following treatment and development of delayed cerebral infarction was not statistically significant(p>0.01). However, 11(78.6%) out of 14 patients who demonstrated an increase in $AVDO_2$ and 5(25%) out of 20 patients who demonstrated a decrease in $AVDO_2$ following treatment developed delayed cerebral infarction. No improvement(reduction) in $AVDO_2$ following treatment was significantly associated with the development of delayed cerebral infarction(p<0.01). All of 16 patients with delayed cerebral infarction showed poor prognosis. Conlcusion : The change of $AVDO_2$ rather than those of ICP and CPP was considered more important factor for the development of the delayed cerebral infarction and poor outcome.