• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.221-227
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• 2001

Objective : The therapeutic impact of tumor resection in glioblastomas is poorly defined and still questionable. Therefore, we conducted the current study to verify the role of tumor resection in the treatment of these highly malignant tumors. Methods : A retrospective study was performed(1990-1999) to compare the treatment results of surgical resection plus radiotherapy(130 patients) with those of stereotactic biopsy plus radiotherapy(19 patients) in glioblastomas. Only adult patients with supratentorial, de novo glioblastoma located in one lobe were included. Survival time/rate was analysed with Kaplan-Meier method, and prognostic variables were obtained from the univariate log-rank test and the multivariate Cox's proportional hazards model. Results : The resection group and the biopsy group did not differ in terms of age, gender, duration of symptoms, presenting symptoms, tumor location, tumor side, tumor size, and the frequency of midline shift. Patients in the biopsy group more often were found to have worse preoperative Karnofsky performance status(KPS)(p=0.001). On univariate analysis, age, KPS, and tumor side were associated with survival(p=0.0053, 0.0001, and 0.0331 respectively). Median survival time and 1-year survival rate were also statistically improved by tumor resection ; resection group - 13 months and 61.2%, and biopsy group - 8 months and 19.7%, respectively(p=0.0001). In patients with midline shift of the tumor, resection was highly effective comparing to biopsy(p=0.0001), but in patients without midline shift, external beam radiation alone was as effective as tumor resection(p=0.0605). Other prognostic variables did not affect survival. On multivariate analysis after variable selection, survival was independently associated with KPS(p=0.001), but not the surgical resection(p=0.2837). Even in biopsy group with midline shift of the tumor, survival rate was not different from that seen after tumor resection(p=0.3505). Conclusions : Radiotherapy alone was as effective as tumor resection plus radiotherapy in patients without midline shift of the tumor. Although there was not statistically significant, tumor resection looked like effective in patients with midline shift. For supratentorial, lobar glioblastoma patients without mass effect of the tumor, biopsy with radiotherapy is one of rational treatment strategies. We consider that tumor resection should be performed in patients with pretreatment midline shift.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.14.3-15
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• 1981

Midline Granulcma(Malignant midline reticulosis) of upper respiratory tract was known as one of the fatal diseases that involve the nasal cavity, paranasal sinuses, pharynx and larynx, with progressive localized necrotizing inflammation and granuloma formation. The disease was first described in 1897 by McBride and after Stewart many clinical and histological studies have been done in 1933. But its etiology is still unclear and therapeutic methods are still under development. The authors carried out a clinical study of 15 cases which were diagnosed and treated as midline granuloma, including 7 cases which received combination radiation and steroid therapy from January 1964 to December 1980. The results are as follows: 1) Age and Sex distribution: 6 cases fell into the ages from 30 to 39 years: 13 cases (87%) were male and 2 cases (13%) were female. 2) Primary lesion sites were nasal cavity and paranasal sinuses area (8 cases: 53%), palatine tonsil (3 cases: 20%) and pharynx (2 cases: 13%) in order. 3) Common symptoms were nasal stuffiness and sore throat (6 cases: 40%), headache (5 cases: 33%), nasal discharge and facial edema (3 cases: 20%) in order. 4) Microorganisms were identified in 4 cases: staphylococcus in 2 cases, pseudomonas in 1 case and streptococcus in 1 case. 5) All 7 cases who received combination radiation and steroid therapy revealed complete regression and no recurrence. 6) Among the 5 cases, who received steroid and antibiotic therapy, 2 cases died and other 3 cases improved temporarily and then developed aggrevation of symptoms.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.266-270
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• 2015

Objective : Chronic subdural hematoma (CSDH) is one of the most frequent problems encountered in neurosurgery. Although burr-hole trephination is widely performed to treat CSDH, the incidence rate of recurrent CSDH is still 2-37%. The goal of this study is to determine the risk factors that affect recurrent CSDH. Methods : A total of 182 patients were included in this study who underwent burr-hole trephination. The clinical factors and radiographic features between the recurrence and the no recurrence groups were analyzed to find the parameters related to the postoperative recurrence of CSDH. Results : For the recurrence of CSDH that occurred in 25 patients (13.7%), among various risk factors, pre and postoperative midline displacements, which are more than 10 mm (p=0.000), and preoperative hemiparesis (p=0.026) had contributed to recurrent CSDH with statistical significance by univariate analysis. Unilateral CSDH were more frequently related to recurrent CSDH (16.3%), although it was not a statistical significant result (p=0.052). Furthermore, preoperative midline displacement only had statistical meaning for the recurrence of CSDH by multivariate analysis. Conclusion : This study indicates that the midline displacement on the preoperative computed tomography scan is the only independent predictor for the recurrence of CSDH.

• Korean Journal of Head & Neck Oncology
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• v.6 no.2
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• pp.85-90
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• 1990

Midline neck masses have numerous origin and it is important to diagnose correctly for management. A clinical analysis of 29 cases of midline neck masses confirmed by histopathological examination was done retrospectively during the last 5 years. The results were followings; 1) Of 29 cases, thyroglossal duct cyst was most frequent(17 cases, 58.6%) and non-specific lymphadenopathy was the next(4 cases, 13.8%). 2) Midline neck masses were most frequent on the suprahyoid area(12 cases, 41.4%) and hyoid area was the next(7 cases, 24.1%). 3) Two thyroglossal duct carcinoma was included in 17 thyroglossal duct cyst. 4) Seventy percent of thyroglossal duct cyst was present on hyoid and infrahyoid area.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.111-115
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• 2005

Objective : Upper lumbar disc herniation is rare disease, compared with lower. The lamina of this high level lumbar vertebra is narrower than that of low level, and this have taken surgeon into important consideration for surgical methods because partial removal of lamina for discectomy weakens the base of the articular process and may result in fracture. The authors an accurate preoperative diagnosis that enables the surgeon to operative approach for preserving the facet joint. Methods : Thirteen patients with upper lumbar disc herniation have underone surgical procedure by midline approach for removal of ruptured disc fragment and paraspinal approach for removal of residual disc materials simultaneously without instrumentation. All patients who underwent surgery were analyzed and long-term follow-up was conducted. Results : At a mean follow-up of 24months, there were complete resolution of presenting radiating leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. The follow-up radiologic findings of all patients shows that lamina and facet joint have preserved safely and no instability. Conclusion : Simultaneously, paraspinal with midline approach provides highly satisfactory operating methods by simplifying exposure and greatly limiting the risk of complications. This provides the basis for a planned surgical approach in which destruction of the facet joint can be avoided.

• Journal of the korean academy of Pediatric Dentistry
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• v.5 no.1
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• pp.27-32
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• 1978

To corroborate that the width of attached gingiva should be changed according to ages, and what relationships between the changes and the results of Glickman's clinical tension test would be, The author measured the width of attached gingiva of 85 Korean children in male, 94 Korean children in female from 8 to 11 ages and performed clinical tension test. The results were as followings; 1) At midline region of each evaluated teeth, Width of attached gingiva was the narrowest at midline region of deciduous canine, and nearly same at midline region of central incisor and lateral incisor. 2) At interproximal region of each evaluated teeth, Width of attached gingiva between left and right central incisors was the narrowest, that of between deciduous canine and lateral incisor, and between lateral incisor and cental incisor were the widest at maxilla and All were nearly same at mandible. 3) In general, width of attached gingiva of interproximal region was wider than that of midline region. 4) In this study, width of attached gingiva tended to be increasing according to ages both at maxilla and at mandible. 5) Compared maxilla with mandible, Width of attached gingiva of maxilla was wider than that of mandible. 6) The results of tension test were it that Over-all incidence was the highest in 8 year old children who had the narrowest width of attached gingiva at frenum attached region and tended to be decreasing according to ages from 8 to 11 years.

• Molecules and Cells
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• v.37 no.1
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• pp.59-65
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• 2014

Eph receptors and their ligands ephrins have been implicated in guiding the directed migration of neural crest cells (NCCs). In this study, we found that Wnt1-Cre-mediated expression of ephrinA5-Fc along the dorsal midline of the dien- and mesencephalon resulted in severe craniofacial malformation of mouse embryo. Interestingly, expression of cephalic NCC markers decreased significantly in the frontonasal process and branchial arches 1 and 2, which are target areas for the migratory cephalic NCCs originating in the dien- and mesencephalon. In addition, these craniofacial tissues were much smaller in mutant embryos expressing ephrinA5-Fc. Importantly, EphA7-positive cephalic NCCs were absent along the dorsal dien- and mesencephalon of mutant embryos expressing ephrinA5-Fc, suggesting that the generation of cephalic NCCs is disrupted due to ephrinA5-Fc expression. NCC explant experiments suggested that ephrinA5-Fc perturbed survival of cephalic NCC precursors in the dorsal midline tissue rather than affecting their migratory capacity, which was consistent with our previous report that expression of ephrinA5-Fc in the dorsal midline is responsible for severe neuroepithelial cell apoptotic death. Taken together, our findings strongly suggest that expression of ephrinA5-Fc decreases a population of cephalic NCC precursors in the dorsal midline of the dien- and mesencephalon, thereby disrupting craniofacial development in the mouse embryos.

• Clinical and Experimental Pediatrics
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• v.62 no.2
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• pp.68-74
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• 2019

Purpose: To investigate the prevalence of occult spinal dysraphism (OSD) and subsequent neurosurgery in pediatric patients with isolated or combined dorsal midline cutaneous stigmata with or without other congenital malformations. Methods: We carried out a retrospective review of patients who underwent sonography or magnetic resonance imaging (MRI) for OSD because of suspicion of dorsal midline cutaneous stigmata (presumed to be a marker for OSD) between January 2012 and June 2017. Information about patient characteristics, physical examination findings, spinal ultrasound and MRI results, neurosurgical notes, and accompanying congenital anomalies was collected. Results: Totally 250 patients (249 ultrasound and one MRI screening) were enrolled for analysis. Eleven patients underwent secondary MRI examinations. The prevalence of OSD confirmed by an MRI was 2.4% (6 patients including one MRI screening). Five patients (2%) had tethered cord and underwent prophylactic neurosurgery, 3 of whom had a sacrococcygeal dimple and a fibrofatty mass. Prevalence of tethered cord increased as markers associated with a sacrococcygeal dimple increased (0.5% of the isolated marker group, 8.1% of the 2-marker group, and 50% of the 3-marker group). Incidence of OSD with surgical detethering in 17 other congenital anomaly patients was 11.8%, which was higher than the 1.3% in 233 patients without other congenital anomalies. Conclusion: Our results suggest that the presence of dorsal midline cutaneous stigmata, particularly fibrofatty masses, along with a sacrococcygeal dimple is associated with OSD or cord tethering requiring surgery. OSD should be suspected in patients with concurrent occurrence of other congenital anomalies.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.48.1-48.7
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• 2019

Background: Soft tissue asymmetry such as lip canting or deviation of the philtrum is an important influencing factor for unbalanced facial appearance. Lip canting could be improved by the correction of the occlusal canting or positional change of the mentum. Although there are many studies about changes of lip canting, however, postoperative changes of philtrum deviation have not been yet reported. In this study, we investigate the positional change of the philtrum after orthognathic surgery and influencing factors. Methods: Positional change of the philtrum was evaluated in 41 patients with facial asymmetry who underwent bimaxillary surgery, in relation to other anatomical soft tissue landmarks using a frontal clinical photo. The surgical movement of the maxillary and mandibular dental midline and canting were measured in postero-anterior cephalogram before and 1 day after surgery. The same procedure was repeated in patients with more than 1.5 mm perioperative change of the mandibular dental midline after bimaxillary surgery. Results: Maxillary dental midline shifting and canting correction did not have a significant correlation with lateral movement of the philtrum midline. However, the mandibular shift had a statistically significant correlation with a lateral movement of the philtrum (p < 0.05) as well as other linear parameters and angle values. Conclusion: The horizontal change of the philtrum is influenced by lateral mandibular movement in patients with facial asymmetry, rather than maxillary lateral movement.

• Restorative Dentistry and Endodontics
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• v.37 no.3
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• pp.165-169
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• 2012

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.