• Journal of Korean Neurosurgical Society
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• 제55권1호
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• pp.43-47
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• 2014

Patients with neurofibromatosis 1 (NF1) are predisposed to develop central nervous system tumors, due to the loss of neurofibromin, an inactivator of proto-oncogene Ras. However, to our knowledge, only three cases of ependymomas with NF1 have been reported in the literature. The authors present a case of NF1 patient with a spinal cord ependymoma. She was referred for about half a year history of increasing numbness that progressed from her fingers to her entire body above the bellybutton. Magnetic resonance imaging revealed a relative-demarcated, heterogeneously enhanced mass lesion accompanied by perifocal edema in C5-7 level, a left-sided T11 spinous process heterogeneously enhanced mass in soft tissue, intervertebral disk hernia in L2-5 level, and widespread punctum enhancing lesion in her scalp and in T11-L5 level. The patient underwent C5-7 laminectomies and total excision of the tumor under operative microscope, and intraoperative ultrasonography and physiological monitoring were used during the surgery. Histopathologically, her tumor was found to be a ependymoma without malignant features (grade II in the World Health Organization classification). Therefore, no adjuvant therapy was applied. Following the operation, the patient showed an uneventful clinical recovery with no evidence of tumor recurrence after one year of follow-up.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.625-632
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• 2018

Objective : Because the anatomical structure of the brachial plexus is very complex, surgical treatment of tumors in this region is challenging. Therefore, a lot of clinical and surgical experience is required for successful treatment; however, many neurosurgeons have difficulty accumulating this experience owing to the rarity of brachial plexus tumors. The purpose of this report is to share our surgical experience with brachial plexus tumor with other neurosurgeons. Methods : The records of 18 consecutive patients with brachial plexus tumors who underwent surgical treatment between January 2010 and December 2017 in a single institution were retrospectively reviewed. The surgical approach was determined according to the tumor location and size, and intraoperative neurophysiological monitoring (IONM) was used in most of cases to prevent iatrogenic nerve injury during surgery. In addition, to evaluate the differences in tumor characteristics according to pathologic diagnosis, the tumors were divided twice into two groups, based on two separate classifications, and statistical analysis was performed. Results : The 18 brachial plexus tumors comprised 15 (83.3%) benign peripheral nerve sheath tumors including schwannoma and neurofibroma, one (5.6%) malignant peripheral nerve sheath tumor, one (5.6%) benign tumor of non-neural sheath origin (neurogenic cyst), and one (5.6%) metastatic tumor (papillary carcinoma). The authors analyzed relationship between tumor size/location and tumor characteristic parameters such as age, size, right-left, and pathology. There were no statistically significant differences except a tendency of bigger tumor size in young age. Conclusion : For a successful surgical outcome, an appropriate surgical approach is essential, and the appropriate surgical approach is determined by the location and size of the tumor. Furthermore, applying IONM may prevent postoperative complications and it is favorable option for brachial plexus tumors surgery.

• Archives of Hand and Microsurgery
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• 제22권3호
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• pp.137-146
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• 2017

상완 신경총 손상은 상지의 가장 심각한 손상으로 정확한 진단을 내리는 것이 성공적인 결과를 얻는 데에 있어 중요하다. 기본적인 수술 전 평가에는 단순방사선 촬영, 경부 척수조영, 자기공명영상, 혈관조영술, 전기생리학적 검사 및 수술시의 평가가 있다. 또한, 적절한 수술 시기와 적응증, 수술계획과 환자의 예후에 대한 충분한 예후가 만족스러운 결과를 얻기 위한 필수적 조건이다. 저자들은 상완 신경총 손상의 진단, 수술 시의 관찰과 외상 후 상완신경총 손상 치료의 적절한 수술 계획에 대해 기술하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.635-639
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• 2000

Objective : Surgery for the microvascular decompression is mostly concerned with injury to the cranial nerves or brain stem by cerebellar retraction. Intraopeartive brain stem auditory evoked potentials(BAEPs) has been continuously monitored on surgery to evaluate the extent of injury, recovery of the nerves and prognosis. Methods : Of the 161 cases of CP angle surgery from Feb. 1996 to Apr. 1998, 103 cases were monitored during operation. Thirty five patients who had undergone similar surgery were selected and evaluated ; 23 patients were monitored and 12 were not during surgery. If monitor showed more than 0.5 mSec delay of latency, surgeon was given a warning not to retract brain any more. If more than 1mSec delay, surgeon was informed to stop surgery and wait for the returning of evoked potentials. The level of amplitudes and delay of latencies during the initial stage of operation, opening the dura, insertion of teflon patches, and closing the dura and recovery were then compared. Resuls : Twenty patients were male and 15 were female. Their average age was 50.26 years. Mean amplitude during the initial stage of operation was $0.60{\pm}0.25mV$, at opening the dura $0.56{\pm}0.26$, after teflon patches insertion $0.49{\pm}0.20$, and after closure of dura $0.47{\pm}0.28mV$. Mean latency during the early stage of operation was $6.08{\pm}0.67mSec$, at opening of dura $6.38{\pm}0.55$, insertion of teflon $6.97{\pm}0.59$, and closing the dura $6.17{\pm}0.54$. There was statistical significance in the difference of amplitudes between each procedures, and in the difference of latencies. For the complete recovery of amplitude and latency, it usually took average 5.65 minutes(0-20 min). In monitored group, only one patient required more than 20 minutes to recover and suffered from hearing disturbance after surgery. Others were recovered within 10 minutes without complications. However, 4 out of 12 patients who were not monitored showed hearing disturbance, and 1 patient had temporary facial palsy and dizziness(p＝0.000). Conclusion : The results indicate that continuous intraoperative monitoring of BAEPs during CP angle surgery is seen mandatory procedure to prevent operative complications.

• 대한근전도전기진단의학회지
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• 제20권2호
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• pp.98-105
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• 2018

Objective: To evaluate whether the increase of the amplitude of motor evoked potentials (MEPs) during surgery can imply favorable prognosis postoperatively in spinal cord tumor surgery. Method: MEPs were monitored in patients who underwent spinal cord tumor surgery between March 2016 and March 2018. Amplitude changes at the end of monitoring compared to the baselines in limb muscle were analyzed. Minimum and maximum changes were set to $MEP_{min}$ (%) and $MEP_{max}$ (%). Strengths of bilateral 10 key muscles which were documented a day before ($Motor_{pre}$), 48 h ($Motor_{48h}$) and 4 weeks ($Motor_{4wk}$) after the surgery were reviewed. Results: Difference of $Motor_{48h}$ from $Motor_{pre}$ ($Motor_{48h-pre}$) and $Motor_{4wk}$ from $Motor_{pre}$ ($Motor_{4wk-pre}$) positively correlated with $MEP_{min}$, suggesting that smaller the difference of MEPs amplitude, less recovery of muscle strength. There was a negative correlation between the amount of bleeding and $MEP_{min}$, indicating that the greater the amount of bleeding, the smaller the $MEP_{min}$, implying that MEPs amplitude is less likely to improve when the amount of bleeding is large. It also showed significant difference between patients with improved or no change of motor status and patients with motor deterioration after surgery according to anatomical tumor types. Conclusion: Improve of muscle strength was less when the increase of MEPs amplitude was small, and improvement of MEPs amplitude was less when the amount of bleeding was large. Correlation between changes of status of muscle strength after surgery and tumor types was observed. With amplitude increase in MEPs monitoring, restoration of muscle strength can be expected.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.425-429
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• 2001

Objective : Patients with poor grade aneurysm usually present with increased intracranial pressure(ICP), even those without an intracranial clot. Based on this fact, the present study investigated a significance of intracranial pressure monitoring in those patients. Patients and Methods : A total of 60 patients with Hunt and Hess Grade IV(50 patients) or V(10 patients) were treated for aneurysmal subarachnoid hemorrhage(SAH) during a 3-year-period, and intraparenchymal ICP was measured in the majority, immediately after arrival to the emergency room. Early surgery including intraoperative ventriculostomy was undertaken within 3 days after SAH. An ultraearly surgery was performed without preceding angiogram or ICP monitoring in patients with large sylvian hematomas, highly suggestive of middle cerebral artery aneurysm. Outcomes were assessed by the Glasgow Outcome Scale(GOS) at 6 months. Results : In overall, favorable outcome(GOS scores 1-2) was seen in 27(54.0%) of admission Grade IV and 1(10.0%) of admission Grade V patients. Of the 38 surgical patients with preoperative ICP monitorings, 25 patients (80.6%) exhibiting ICP values of less than 40mmHg showed favorable outcome, however, no patients with ICP values above 40mmHg recovered(Fisher's exact test, p=0.0001). Conclusion : It is concluded that a preoperative ICP above 40mmHg before ventriculostomy indicate significant vital brain destruction as intractable intracranial hypertension, and Grade IV patients at admission with an ICP below 40mmHg can be of benefit from early surgical intervention while Grade V patients still remains unfavorable.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.78-87
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• 2021

Objective : Intraoperative neurophysiological monitoring (IONM) has been widely used during spine surgery to reduce or prevent neurologic deficits, however, its application to the surgical management for cervical myelopathy remains controversial. This study aimed to assess the success rate of IONM in patients with cervical myelopathy and to investigate the factors associated with successful baseline monitoring and the effect of increasing the stimulation intensity by focusing on motor evoked potentials (MEPs). Methods : The data of 88 patients who underwent surgery for cervical myelopathy with IONM between January 2016 and June 2018 were retrospectively reviewed. The success rate of baseline MEP monitoring at the initial stimulation of 400 V was investigated. In unmonitorable cases, the stimulation intensity was increased to 999 V, and the success rate final MEP monitoring was reinvestigated. In addition, factors related to the success rate of baseline MEP monitoring were investigated using independent t-test, Wilcoxon rank-sum test, chi-squared test, and Fisher's exact probability test for statistical analysis. The factors included age, sex, body mass index, diabetes mellitus, smoking history, symptom duration, Torg-Pavlov ratio, space available for the cord (SAC), cord compression ratio (CCR), intramedullary increased signal intensity (SI) on magnetic resonance imaging, SI length, SI ratio, the Medical Research Council (MRC) grade, the preoperative modified Nurick grade and Japanese Orthopedic Association (JOA) score. Results : The overall success rate for reliable MEP response was 52.3% after increasing the stimulation intensity. No complications were observed to be associated with increased intensity. The factors related to the success rate of final MEP monitoring were found to be SAC (p<0.001), CCR (p<0.001), MRC grade (p<0.001), preoperative modified Nurick grade (p<0.001), and JOA score (p<0.001). The cut-off score for successful MEP monitoring was 5.67 mm for SAC, 47.33% for the CCR, 3 points for MRC grade, 2 points for the modified Nurick grade, and 12 points for the JOA score. Conclusion : Increasing the stimulation intensity could significantly improve the success rate of baseline MEP monitoring for unmonitorable cases at the initial stimulation in cervical myelopathy. In particular, the SAC, CCR, MRC grade, preoperative Nurick grade and JOA score may be considered as the more important related factors associated with the success rate of MEP monitoring. Therefore, the degree of preoperative neurological functional deficits and the presence of spinal cord compression on imaging could be used as new detailed criteria for the application of IONM in patients with cervical myelopathy.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1205-1213
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• 1997

가톨릭대학교 의과대학 부속 성바오로 병원에서 1996년 1월부터 7월까지 개심술시 경식도심초음파를 이용하여 수술 중 관찰한 61명의 증례를 분석하여 다음과 같은 결과를 얻었다. 61명의 환자 중 질병 분류는 심장 판막 질환 25명, 관상동맥 질환 22명, 선천성 심질환 13명, 심장 판막 질환과 관상동맥 질환이 병발한 경우가 1명 이었다. 1. 경식도심초음파를 이용하여 선천성 심질환 1예(심실중격결손증 재수술)와 대동맥 판막 치환술을 시행한 환자 1예에서 일차 심정지에 의한 수술 후 잔존 단락과 판막 주위 누출이 확인되어 재심정지를 유도하여 수술을 완료하였다 2. 공기색전증의 발생을 전 예에서 방지할 수 있었다. 3. 경식도심초음파로 측정한 심박출량과 온도희석법으로 측정한 심박출량은 통계학적으로 의미있는 상관관계를 보여 경식도 초음파를 이용한 심박출량 감시가 의미 있음을 시사하였다(Linear regression analysis, p<0.001). 4. 관상동맥우회로술을 시행한 23명의 환자에서 수술 중 경식도 초음파도상 이상 벽운동을 보이는 분절의 도부타민 투여 전후와 관상동맥우회로술 후의 반응을 비교 관찰하였다. 저 용량 도부타민 검사는 통계적으 \ulcorner유의하였다(민감도 76%, 특이도 94.7%, 양성 예측율 95%, 음성 예측율 75%).

• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.292-294
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• 2015

Vestibular schwannoma (VS) usually present the widening of internal auditory canal (IAC), and these bony changes are typically limited to IAC, not extend to temporal bone. Temporal bone invasion by VS is extremely rare. We report 51-year-old man who revealed temporal bone destruction beyond IAC by unilateral VS. The bony destruction extended anteriorly to the carotid canal and inferiorly to the jugular foramen. On histopathologic examination, the tumor showed typical benign schwannoma and did not show any unusual vascularity or malignant feature. Facial nerve was severely compressed and distorted by tumor, which unevenly eroded temporal bone in surgical field. Vestibular schwannoma with atypical invasion of temporal bone can be successfully treated with combined translabyrinthine and lateral suboccipiral approach without facial nerve dysfunction. Early detection and careful dissection of facial nerve with intraoperative monitoring should be considered during operation due to severe adhesion and distortion of facial nerve by tumor and eroded temporal bone.

• Journal of Korean Neurosurgical Society
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• 제63권3호
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• pp.342-345
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• 2020

Some types of spinal dysraphism can be accompanied by extraspinal cysts, including myelomeningocele, myelocystocele, myelocele, meningocele, limited dorsal myeloschisis, lipomyelomeningocele, and terminal myelocystocele. Each disease is classified according to the developmental mechanism, embryologic process, site of occurrence, or internal structure of the extraspinal cyst. In most cystic spinal dysraphisms except meningocele, part of the spinal cord is attached to the cyst dome. Most open spinal dysraphisms pose a risk of infection and require urgent surgical intervention, but when the cyst is accompanied by closed spinal dysraphism, the timing of surgery may vary. However, if the extraspinal cyst grows, it aggravates tethering by pulling the tip of the cord, which is attached to the dome of the cyst. This causes neurological deficits, so urgent surgery is required to release the tethered cord.