• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.354-360
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• 2022

Traumatic brain injury (TBI) is the leading cause of death and disability in children. Survivors of severe TBI are more susceptible to functional deficits, resulting in disability, poor quality of life, cognitive decline, and mental health problems. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Internationally, efforts are being made to expand knowledge of pathophysiology and develop practical clinical treatment recommendations to improve outcomes. Here we discuss recently updated evidence and management of severe pediatric TBI.

• The Korean Journal of Pain
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• 제11권2호
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• pp.338-342
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• 1998

Postural headache due to spontaneous intracranial hypotension occurs without any diagnostic lumbar puncture, myelography, cranial or spinal injury, or spinal anesthesia. The clinical characteristics of the syndrome are disappearance of the headache or a notable decrease in its severity with recumbency, the finding of meningeal enhancement and subdural fluid collection on brain MRI, the pleocytosis and the increased CSF protein concentration. We report a case of a 40-year-old woman who exhibited the signs and symptoms of postural headache due to low CSF pressure. Her headache started suddenly at the occiput and radiated to frontal head. Magnetic resonance imaging (MRI) of her brain showed enhancement of the meninges and subdural fluid collection. Intrathecal radionuclide cisternography showed the delayed appearance of the isotope in the cranium and the minimal CSF leak at the left upper thoracic region. Her headache was relieved completely after a lumbar (L2-L3) epidural injection of 12 ml of autologous blood and remained asymptomatic.

• Journal of Korean Neurosurgical Society
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• 제67권4호
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• pp.467-476
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• 2024

Objective : To evaluate the usefulness of a cranial implantable chemoport, the H-port, as an alternative to the Ommaya reservoir for intraventricular chemotherapy/cerebrospinal fluid (CSF) access in patients with leptomeningeal metastasis (LM). Methods : One hundred fifty-two consecutive patients with a diagnosis of LM and who underwent H-port installation between 2015 and 2021 were evaluated. Adverse events associated with installation and intraventricular chemotherapy, and the rate of increased intracranial pressure (ICP) control via the port were evaluated for safety and efficacy. These indices were compared with published data of Ommaya (n=89), from our institution. Results : Time-to-install and installation-related complications of intracranial hemorrhage (n=2) and catheter malposition (n=5) were not significantly different between the two groups. Intraventricular chemotherapy-related complications of CSF leakage occurred more frequently in the Ommaya than in the H-port group (13/89 vs. 3/152, respectively, p<0.001). Intracranial hemorrhage during chemotherapy occurred only in the Ommaya group (n=4). The CSF infection rate was not statistically different between groups (14/152 vs. 12/89, respectively). The ICP control rate according to reservoir type revealed a significantly higher ICP control rate with the H-port (40/67), compared with the Ommaya result (12/58, p<0.001). Analyzing the ICP control rate based on the CSF drainage method, continuous extraventricular drainage (implemented only with the H-port), found a significantly higher ICP control rate than with intermittent CSF drainage (33/40 vs. 6/56, respectively, p<0.0001). Conclusion : The H-port for intraventricular chemotherapy in patients with LM was superior for ICP control; it had equal or lower complication rates than the Ommaya reservoir.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.386-389
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• 2009

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

• Journal of Korean Neurosurgical Society
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• 제54권5호
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• pp.444-447
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• 2013

In most intracranial surgery cases, a drain catheter is inserted to prevent the collection of the wound hematoma or seroma. A drain catheter is also inserted to drain the hematoma or the cerebrospinal fluid. The drain catheter itself does not cause complications; but many complications occur during its removal, such as hematoma, seroma, air collection and pseudomeningocele formation. To prevent these complications, neurosurgeons perform a suture on the catheter to remove the site. In this study, an additional horizontal mattress suture and an anchoring suture to the drainage catheter are proposed. This method maintains negative pressure in the catheter insertion site during the catheter removal, compresses the catheter tunnel site and attaches the external wounds strongly. The technique is easy and safe to perform, and does not require an additional suture to remove the catheter.

• Korean Journal of Acupuncture
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• 제33권1호
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• pp.37-45
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• 2016

Objectives : To understand spatial cause hypothesis of idiopathic trigeminal neuralgia, the body truncus area was divided into intracranial, thoracic and pelvic cavity and was illustrated, the subjective pain degrees of idiopathic trigeminal neuralgia were compared with the illustraion of three cavity. Methods : The frontal view of pictures of idiopathic trigeminal neuralgia subject truncus area were illustrated into three circles which was treated with conservative methods like the pelvic correction, cervical correction, FCST, posture training without drugs and acupuncture. The spatial analysis of three circle vertical centerlines were compared with the pain degrees. Results : The vertical centerlines of three circles were agreed with the body gravity centerline depending on the treatment progresses. namely, as the parts of truncus were matched to the body gravity centerline, the degrees of pain were decreased. Conclusions : The vascular pressure on the trigeminal nerve which was causing the idiopathic trigeminal neuralgia might be induced by the spatial misalignment of truncus area because the spatial misalignment of it can press to move vascular into trigeminal nerve partially. Further study will be progressed.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.363-367
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• 2015

Objective : The purpose of this study was to evaluate the clinical utility and validity of using a pupillometer to assess patients with acute brain lesions. Methods : Pupillary examinations using an automated pupillometer ($NeurOptics^{(R)}NPi^{TM}$-100 Pupillometer) were performed every 4 hours and were simultaneously assessed using the Glasgow Coma Scale (GCS) and for intracranial pressure (ICP), from admission to discharge or expire in neuro-intensive care unit (NICU). Manual pupillary examinations were also recorded for comparison. By comparing these data, we evaluated the validity of using automated pupillometers to predict clinical outcomes. Results : The mean values of the Neurologic Pupillary index (NPi) were different in the groups examined manually. The GCS correlated well with NPi values, especially in severe brain injury patients (GCS below 9). However, the NPi values were weakly correlated with intracranial pressure (ICP) when the ICP was lower than 30 cm $H_2O$. The NPi value was not affected by age or intensity of illumination. In patients with a "poor" prognosis who had a Glasgow Outcome Scale (GOS) of 1 or 2, the mean initial NPi score was $0.88{\pm}1.68$, whereas the value was $3.89{\pm}0.97$ in patients with a "favorable" prognosis who had a GOS greater than 2 (p<0.001). For predicting clinical outcomes, the initial NPi value of 3.4 had the highest sensitivity and specificity. Conclusion : An automated pupillometer can serve as a simple and useful tool for the accurate measurement of pupillary reactivity in patients with acute brain lesions.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.240-244
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• 2008

Objective : Sotos Syndrome is characterized by macrocephaly, overgrowth, and developmental delay, and more than 300 patients have been reported worldwide to date. The authors reviewed the clinical characteristics of 8 patients with Sotos Syndrome in Korea for a new understanding and treatment strategies. Methods : The medical records of a total of eight Korean children with Sotos Syndrome were reviewed. All patients underwent developmental checkup, lumbar punctures for measurement of intracranial pressure (ICP), brain and spine magnetic resonance imaging and computerized tomography. Results : All 8 patients showed macrocephaly and the characteristic craniofacial features of Sotos Syndrome. Other clinical characteristics shown were overgrowth (7/8), developmental delay (7/8), congenital heart defect (3/8), flat foot (8/8), scoliosis (4/8), spina bifida (8/8), hydrocephalus (4/8), cavum vergae (3/8), and increased subdural fluid collection (5/8). Mean ICP measured via lumbar puncture was $27.35{\pm}6.25\;cm$ $H_2O$ (range 20 to 36 cm $H_2O$). Two patients received ventriculo-peritoneal shunt, and 1 patient underwent subduro-peritoneal shunt with improvement. Spinal orthosis was applied to 4/5 patients with scoliosis and 4/8 children with flat foot were provided with foot orthosis. Conclusion : In this first Korean study of 8 Sotos Syndrome patients we demonstrated the presence of spina bifida and increased ICP, which had not been previously described. The authors therefore suggest that all patients with Sotos Syndrome should undergo examination for the presence of spina bifida, and that shunt procedures would improve development and alleviate clinical symptoms.

• 대한약리학회지
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• 제15권1_2호
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• pp.7-12
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• 1979

1. 두개내압상승(頭蓋內壓上昇)에 혈압상승(血壓上昇)이 중추(中樞)의 교감신경기능(交感神經機能)과의 관계(關係)가 있음을 확인(確認)하기 위하여, clonidine, phenoxybenzamine 및 phentolamine을 사용(使用)하여 이들 약물(藥物)이 두 개내압상승(頭蓋內壓上昇)에 따른 협압상승(血壓上昇)에 미치는 영향(影響)을 조사(調査)하였다. 2. 정맥내(靜脈內) clonidine은 측뇌실내(側腦室內) 주입시(注入時)와 같이 두개내압상승(頭蓋內壓上昇)에 따른 혈압상승(血壓上昇)을 억제(抑制)하였다. 3. Phenoxybenzamine 및 phentolamine의 정맥내주입후(靜脈內注後)에 두 개내압상승(頭蓋內壓上昇)에 따른 혈압상승(血壓上昇)은 현저히 약화(弱化)되었다. 4. 측뇌실내주입(側腦室內注入) phenoxybenzamine은 두개내압상승(頭蓋內壓上昇)에 따른 혈압상승(血壓上昇)에 영향(影響)을 미치지 않았다. 5. 측뇌실내(側腦室內)에 phenoxybenzamine을 주입후(注入後)에는 clonidine의 측뇌실내주입(側腦室內注入)이 두개내압상승(頭蓋內壓上昇)에 따른 혈압상승(血壓上昇)을 억제(抑制)치 못하였다. 6. 두개내압상승(頭蓋內壓上昇)에 따른 혈압상승(血壓上昇)에는 중추(中樞) 및 말초(末梢)의 교감신경기능(交感神經機能)이 관여(關與)함을 확인(確認)하였다.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.355-359
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• 2009

Objective : The definition of empty sella syndrome is 'an anatomical entity in which the pituitary fossa is partially or completely filled with cerebrospinal fluid, while the pituitary gland is compressed against the posterior rim of the fossa'. Reports of this entities relating to the brain tumors not situated in the pituitary fossa, have rarely been reported. Methods : In order to analyze the incidence and relationship of empty sella in patients having brain tumors, the authors reviewed preoperative magnetic resonance imaging (MRI) of 72 patients with brain tumor regardless of pathology except the pituitary tumors. The patients were operated in single institute by one surgeon. There were 25 males and 47 females and mean patient age was 53 years old (range from 5 years to 84 years). Tumor volume was ranged from 2 cc to 238 cc. Results : The overall incidence of empty sella was positive in 57/72 cases (79.2%). Sorted by the pathology, empty sella was highest in meningioma (88.9%, p=0.042). The empty sella was correlated with patient's increasing age (p=0.003) and increasing tumor volume (p=0.016). Conclusion : Careful review of brain MRI with periodic follow up is necessary for the detection of secondary empty sella in patients with brain tumors. In patients with confirmed empty sella, follow up is mandatory for the management of hypopituitarism, cerebrospinal fluid (CSF) rhinorrhea, visual disturbance and increased intracranial pressure.