• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.41-46
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• 2001

Objective : The exact position of the lesion during the pallidotomy is critical to obtain the clinical improvement of parkinson's disease without damage to surrounding structure. Ventriculogrphy, CT(computed tomograpy) or MRI(magnetic resonance imaging) have been used to determine the initial coordinates of stereotactic target for pallidotomy. The goal of this study was to determine whether microelectrode recording significantly improves the neurophysiologic localization of the target obtained from MRI. Methods : Twenty patients were studied. They underwent a unilateral pallidotomy. Leksell frame was applied and T1 axial images parallel to the AC-PC(anterior commissure-posterior commissure) plane using a 1.5 Tesla MRI with 3mm slice thickness were obtained. Anteroposterior coordinate of target was chosen at 2mm in front of the midcommissural point and lateral coordinate between 19 and 22mm from the midline. The vertical coordinate was calculated on coronal slice using a fast spin echo inversion recovery sequence(FSEIR) related to the position of the choroidal fissure and ranged over 4-5mm below the AC-PC plane. Confirmation of the anatomical target was done on axial slices using the same FSEIR sequence . Microrecording was done at the pallidum contralateral to the symptomatic side using an electrode with a tip diameter of $1{{\mu}m}$ diameter tip and 1.1-1.4 mOhm impedance at 1000Hz. Electrophysiologic localization of the target was also confirmed intraoperatively by macrostimulation. Results : Microrecording techniques were reliable to define the transition from the base of the pallidum which was characterized by the disappearance of spike activity and by the change of the audible background activity. Signals from high amplitude neurons firing at 200-400Hz were recorded in the pallidal base. X, Y and Z coordinates of target obtained from the MRI were within 1mm from the X, Y, Z coordinates obtained with microrecording in 16 patients (80%), 15 patients(75%), 10 patients(50%) respectively. The difference of Y coordinate between on MRI and on microrecording was 4mm in only one patient. Conclusion : The MRI was accurate to localize the target within 1mm of the error from microrecording target in 70% of the patients. 4mm discrepancy was observed only once. We conclude that MRI alone can be used to determine the target for pallidotomy in most patients. However, microrecording technique can still be extremely valuable in patents with aberrant anatomy or unusual MRI coordinates. We also consider physiologic confirmation of the target using macrostimulation to be mandatory in all cases.

• Journal of Korean Neurosurgical Society
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• 제30권8호
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• pp.992-997
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• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.985-994
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• 2000

Objective : There are some advantages of trigeminal evoked potential(TEP) recording compared to other somatosensory evoked potential(SSEP) recordings. The trigeminal sensory pathway has a pure sensory nerve branch, a broader receptive field in cerebral cortex, and a shorter pathway. Despite these advantages, there is little agreement as to what constitutes a normal response and what wave forms truly characterize the intraoperative TEP. This study presents the normative data of TEP recorded on the epidural surface of the rat with a platinum ball electrode. Materials & Methods : Under general anesthesia with urethane, the adult Sprague-Dawley male rats(300-350g) were given electrical stimulation with two stainless steel electrodes which were inserted into the subcutaneous layer of the area around whiskers. A reference electrode was positioned in the temporalis muscle ipsilateral to the recording site. Results : TEPs were recorded in the Par I area of somatosensory cortex and recorded most apparently on the point of 2mm posterior from the bregma and 6mm lateral from the midline. The typical wave form consisted of 5 peaks (N1-P1-N2-P2-N3 according to emerging order, upward negativity). Each latency to corresponding peaks was not influenced by the different intensities of stimulation, especially from 1 to 5mA. Average latencies of 5 peaks were in the following order ; 7.7, 11.1, 15, 22.3, 29.4ms. There was also no significant difference between latencies before and after administration of muscle relaxant(pancuronium). For the electrophysiological localization of recorded waves, the action potential of a single unit was recorded with glass microelectrode(filled with 2M NaCl, $3-5M{\Omega}$) in the thalamus of rat. A sharp wave was recorded in the VPM nucleus, in which the latency was shorter than that of N1. This suggests that all 5 peaks were generated by neural activities in the suprathalamic pathway. Conclusion : In terms of recording near-field potentials, our data also suggests that TEP in the rat may be superior to other SSEPs. In overall, these results may afford normative data for the studies of supratentorial lesions such as hydrocephalus or cerebral ischemia which can have an influence on near-field potentials.

• Journal of Korean Neurosurgical Society
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• 제61권1호
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• pp.42-50
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• 2018

Objective : Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance. Methods : One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was $56.3{\pm}14.3$ (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality. Results : Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007). Conclusion : The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients' outcome and timely treatment decision.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.747-754
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• 2011

Purpose: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. Methods: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom-shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2 mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. Results: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. Conclusion: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

• 대한핵의학회지
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• 제16권2호
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• pp.25-28
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• 1982

Estimation of liver size is essential in the diagnosis of liver disease, Many approaches have been attempted in evaluation of liver size such as the measurement of length, area and volume. Among these, area and volume measurements are accurate but complicated, so we commonly use formerly introduced various linear measurements, but in scintigraphy one must calculate the actual liver size using rate of reduction, which is time consuming. Because of these reasons, we carried out present study to represent liver size by means of a simple liver measurement like we express the cardiac size by cardiothoracic ratio. Our cases consisted of 100 clinically normal subjects as the normal group and 50 patients suffering from liver disease and diagnosed to have hepatomegaly on abdominal palpation and scintigram at Dept, of Radiology of St. Mary's Hospital, Catholic Medical College during the period of 8 months from Jan. 1980. We measured the liver size using 4 linear diameters(Fig. 1). And as the reference measurement, the distance from the right margin of the liver to the left margin of the spleen was measured. We called this "abdominal transverse diameter(ATD)". The results were as follows; 1) The smallest value was recorded in the midline vertical diameter (MVD). It was $4.2{\pm}0.4cm$ in normal group and $5.0{\pm}0.6cm$ in the hepatomegaly group. 2) The diameter using other methods ranged from 5.6 to 7.2 cm in the normal group and from 6.3 to 7.5cm in the hepatomegaly group. 3) There was significant difference in the ratio of each diameter to ATD between the normal and hepatomegaly group (<0.01). We called this "hepato-abdominal ratio". 4) The "hepato-abdominal ratio" using MVD is $0.43{\pm}0.06$ in the normal group and $0.53{\pm}0.07$ in the hepatomegaly group. The "hepato-abdominal ratio" of MVD was most significantly different between normal and hepatomegaly group. 5) The tolerance limits(99%) of "hepato-abdominal ratio" using MVD is from 0.41 to 0.45 in the normal group and from 0.51 to 0.55 in the hepatomegaly group. Therefore, by reasons of error during measurement and convenience of memory, it was warranted to suggest hepatomegaly when "hepato-abdominal ratio" using MVD is more than 0.5 in the interpretation of hepatic scintigram.

• Journal of Animal Science and Technology
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• 제48권6호
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• pp.949-956
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• 2006

본 연구는 육경 조직판 이식이 사슴뿔의 성장에 미치는 영향을 구명하기 위하여 육경 조직판을 육경과 전두골 정중선 부위에 각각 이식 하였을 때 조직판의 발달, 조직판을 제공한 부위의 녹용 생산량 및 이식한 조직판의 발육성적을 조사하였으며, 그 결과를 요약하면 다음과 같다. 사슴뿔의 조직판 이식은 육경과 전두골 정중선 중앙과 좌우 양 뿔의 정수리에 이식 시 이식 성공률은 12두 중 5두로 42％이었다. 사슴뿔의 발생 정규부위가 아닌 사슴의 전두골에서 조직판 이식으로 추가적인 사슴뿔 발생을 유도할 수가 있었다. 레드디어의 경우 대조구와 조직판을 제공한 쪽의 녹용 총생산량은 각각 716, 1,071g으로 이식을 하기 위하여 절단된 쪽의 녹용 생산량이 더 많았으며, 가짓수도 조직판을 제공한 쪽이 2.3개로 대조구 1개보다 많았다. 엘크의 경우 1두에서 이마에 조직판이 이식된 뿔에서 길이 17cm, 무게 302g 녹용을 생산하였으며, 레드디어는 다음해 낙각 된 녹각에서 길이 26cm에 무게 122g을 생산하였다. 조직판 이식시 이식부위의 피부는 진피까지 제거하여야만 두개골에 이식한 조직판이 견고하게 부착되었다.이상의 결과에서 조직판 이식으로 사슴뿔 발생의 정규부위가 아닌 전두골에서 부가적인 사슴뿔을 생산할 수 있다고 사료된다.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.51-57
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• 2000

Objective : For relief of back pain related to spondylolisthesis, fusion with or without internal fixation may be necessary. Currently, bilateral wide posterior decompression and fusion with or without internal fixation are used for treatment of spondylolisthesis. In case of severe osteoporosis, discectomy may be done without fusion to decompress the nerve roots. However, the procedure may aggravate radicular symptom because slippage may increase and thus foramen may become narrower. In these settings, inferomedial partial pediculectomy has been done in our institution, The object of this study was to evaltuate such cases with regard to per- and postoperative clinical courses. Patients and Methods : Fifteen patients complaining radicular pain with mild or no back pain underwent inferomedial partial pediculectomy. It was done in lytic spondylolisthesis after extension of isthmic defect. In degenerative spondylolisthesis of L4-5 interspace, intertransverse pediculectomy was done via paraspinal approach not to injure the posterior segment with intact isthmus. But, in degenerative spondylolisthesis of L5-S1 interspace however, partial pediculectomy was done after making artificial isthmic defect via midline approach. Then, reconstructive laminoplasty of L5 was performed to avoid iatrogenic instability resulted from artificial isthmic defect. They were followed up for average 14.4 months(3-31 months). Results : Radiating pain was relieved in all cases(100%). Postoperative result was excellent in 7 cases(46.7%), good in 7(46.7%) and fair in 1(6.6%). Only 1 case(6.7%) showed increase in slippage during follow-up period. Conclusion : Inferomedial partial pediculectomy is considered as a useful procedure for severely osteoporotic patients with spondylolisthesis with regards to keeping stability and decompressing the nerve roots.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.723-729
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• 2017

Objective : Acute subdural hematoma (ASDH) is generally considered a condition that should be managed surgically. However, some patients initially receive conservative treatment, a subset of whom require surgical intervention later. This study aimed to evaluate the predictors of delayed surgical intervention in ASDH patients who are initially managed conservatively. Methods : From January 2007 to December 2015, 842 patients diagnosed with ASDH were treated at our institution. Among them, 158 patients with convexity ASDH were initially treated conservatively. Patients were divided into a delayed surgery group and a conservative group. Demographic characteristics, past medication and medical histories, and radiological and laboratory data were collected by retrospective chart review. Independent risk factors were identified with univariate and multivariate analyses. Results : Twenty-eight patients (17.7%) underwent delayed surgical intervention. Their mean age was 69.0 years, and 82.1% were male. Hypertension, diabetes mellitus, and heart disease prevalence and use of anti-platelet agents did not significantly differ from the conservative group. However, age (p=0.024), previous cerebral infarction history (p=0.026), increased maximal hematoma thickness (p<0.001), midline shifting (p=0.001) and accompanying subarachnoid hemorrhage (p=0.022) on initial brain computed tomography (CT) scan, low hemoglobin level (p<0.001), high leukocyte count (p=0.004), and low glucose level (p=0.002) were significantly associated with delayed surgical intervention. In multivariate analysis, increased maximal hematoma thickness (odds ratio [OR]=1.279, 95% confidence interval [CI] 1.075-1.521; p=0.006), low hemoglobin level (OR=0.673, 95% CI 0.467-0.970; p=0.034), and high leukocyte count (OR=1.142, 95% CI 1.024-1.272; p=0.017) were independent risk factors for delayed surgical intervention. Conclusion : Due to the high likelihood of delayed surgical intervention among minimal ASDH patients with a thicker hematoma on initial brain CT, lower hemoglobin level, and higher leukocyte count, these patients should receive more careful observation.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.157-165
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• 2011

Objective : We have introduced a method of characterization of invading glioma cells by using molecular analysis of marginal invading tumor cells and molecular profiles of glioma tumor margin. Methods : Each of tumor core and marginal tissues was obtained in 22 glioma patients. Tumor core cells and marginal cells from each glial tumor were collected by laser capture microdissection or intraoperative microdissection under the operating microscope. Expression of MMP-2, MMP-9, CD44 and RHAMM mRNA by invading glioma cells compared with tumor core was confirmed by realtime-PCR of twenty-four glioma specimens. Clinical data also were reviewed for invasion and recurrence pattern of the gliomas radiologically and invasive rim pattern microscopically. Results : Overall results of the molecular analysis showed that relative overexpression of MMP-2, MMP-9 and RHAMM were noted at the invasive edge of human glioma specimens comparing to the tumor core but CD44 was highly expressed in the tumor core comparing to the margin. High marginal expression of MMP-2 and MMP-9 were noted in poorly ill-defined margin on the pathological finding. High marginal expression of CD44 and MMP-2 were demonstrated in the midline cross group on the radiological review, and that of RHAMM and MMP-2 were showed in the aggressive recurrence group. High expression of MMP-2 seems to be involved in the various invasion-related phenomenons. Conclusion : Up-regulation of MMP-2, MMP-9, CD44 and RHAMM was noted in invasive edge of gliomas according to the various clinical situations.