• Journal of Chest Surgery
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• 제33권8호
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• pp.630-637
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• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

• Journal of Chest Surgery
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• 제55권6호
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• pp.462-469
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• 2022

Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision. Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed. Results: The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21-28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03-1.12; p<0.01) were found to be risk factors for nerve injuries. Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.287-296
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• 2022

Objective : Although radiotherapy (RT) is recommended for multiple myeloma (MM) involving spine, the treatment of choice between reconstructive surgery with RT and RT alone for pathologic vertebral fractures (PVFs) associated with structural instability or neurologic compromises remains controversial. The purpose of this study was to evaluate the clinical efficacies of reconstructive surgery with adjuvant RT for treatment of MM with PVFs by comparing with matched cohorts treated with RT alone. Methods : Twenty-eight patients underwent reconstructive surgery followed by RT between 2008 and 2015 in a single institution, for management of PVFs associated with structural instability of the spine and/or neurologic compromises (group I). Twenty-eight patients were treated with RT alone (group II) after propensity score matching in a 1-to-1 format based on instability of the spine, as well as age and performance. Clinical outcomes including the overall survival rates, duration of independent ambulation, neurological status, and numeric rating scale (NRS) for back pain were compared. Results : Clinical and radiological features before treatment were similar in both groups. The median survival period was similar between the two groups. However, the mean duration of independent ambulation was significantly longer in group I (88.8 months; 95% confidence interval [CI], 66.0-111.5) than in group II (39.4 months; 95% CI, 25.2-53.6) (log rank test; p=0.022). Deterioration of Frankel grade (21.4% vs. 60.7%, p=0.024) and NRS for back pain (2.7±2.2 vs. 5.0±2.7, p=0.000) at the last follow-up were higher in the group II. Treatment-related complications were similar in both groups. Conclusion : In patients with unstable PVFs due to MM, reconstructive surgery may yield superior clinical outcomes compared with RT alone in maintaining independent ambulation and neurological status, as well as pain control despite similar median survival and complications.

• Pediatric Infection and Vaccine
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• 제29권3호
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• pp.147-154
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• 2022

코로나바이러스-19 (COVID-19)는 일반적으로 성인에 비해 소아에서 임상적으로 경한 양상을 보이며, 대부분의 소아에서 약 7일간의 격리가 끝나면 증상이 호전되어 특별한 이벤트 없이 퇴원하게 된다. 우리는 통상적인 임상경과와는 다르게, 격리 해제시점 또는 퇴원을 고려하고 있는 시점에 갑자기 악화된 임상증상을 보이는 3명의 청소년 환아들을 경험하였다. 세 명의 아이들은 공통적으로 신경학적 질환을 기저질환으로 가지고 있었다. Case 1은 울리히 선천성 근디스트로피로 진단받고 밤에만 이중양압기로 호흡보조를 받던 17세 남환의 경우로, 첫 COVID-19 증상 이후 9일이 지나고 증상 호전되어 퇴원을 준비하던 중 심폐정지가 발생하였다. Case 2는 뇌출혈 및 뇌경색 이후 병상에 누워 지내며 기관절개관 삽입 후 가정용 인공호흡기로 호흡보조를 받던 12세 여자 환아로, 증상이 호전되어 퇴원하였으나 첫 COVID-19 증상 이후 11일이 지난 후 심폐정지가 발생하였다. Case 3의 경우 조산아로 출생하여 뇌실출혈 및 수두증 진단받고 병상에 누워 지내나 호흡보조는 받지 않았던 12세 남자 환아로, 첫 증상 이후 호전추세였으나 10일 후 다기관 기능부전 확인되어 입원 진행하였다. 항바이러스제, 스테로이드제, 경험적 항생제가 투여되었고 중환자실 치료를 시행하였다. 세 환아들 중 2명 (case 1, 3)은 치료를 통해 호전되었으나, 1명 (case 2)는 심부전 진행하여 사망하였다. 이러한 경험에 비추어 볼 때, COVID-19 격리 기간이 끝나고 퇴원 가능한 시점이라도 갑작스러운 증상 악화를 보일 가능성이 있기에, 긴장을 놓지 않고 임상 증상의 변화를 확인하고 필요시 빠른 조치를 취해야 할 것으로 생각된다. 특히 신경학적 또는 호흡기적 만성 질환을 갖는 아이들에게 주의가 더 필요할 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.316-320
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• 2015

Objective : The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. Methods : From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ${\geq}70%$ were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. Results : CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Conclusion : Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

• 대한한방내과학회지
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• 제35권1호
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• pp.1-11
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• 2014

Objectives : To investigate the effects of Sa-am acupuncture on muscle architecture and elastic properties of the spastic elbow flexor and to evaluate the correlation between clinical findings and parameters of real-time sonoelastography (RTS) in patients with chronic post-stroke hemiparesis. Materials and Methods : Seven patients (five males, two females) with chronic post-stroke hemiparesis were included. Sa-am acupuncture of Ganseunggyeok (肝勝格: LU8 LR4 補, HT8 LR2 瀉) was applied to the unaffected side 3 times a week for 4 weeks. During each acupuncture treatment period, patients were requested to exercise their affected arm, and spasticity and functional recovery outcomes of the affected arm were evaluated before and after Sa-am acupuncture treatment. Clinical outcomes were assessed using motricity index (MI), modified Ashworth scale (MAS), Fugl-Meyer assessment scale (FMA) and modified Barthel index (MBI) for elbow flexor spasticity. RTS images indicate the relative hardness of the examined muscles ranged from red (hard) to purple (soft) for color-scale, and from black (hard) to white (soft) for hue scale. Color and hue histograms of the biceps brachii and brachialis were analyzed using Image J software, and median red, blue, and hue pixel intensity were obtained. Results : MI and FMA score significantly increased and MAS score significantly decreased (p<0.05). F-wave maximal amplitude of affected abductor pollicis brevis significantly decreased (p<0.05). Muscle thickness of affected brachialis significantly increased (p<0.05). Red and green pixel intensity of affected brachialis significantly decreased (p<0.05). Conclusions : Our study revealed that Sa-am acupuncture is effective as a useful and safe treatment for spasticity in chronic post-stroke hemiparesis.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.249-255
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• 2006

Objective : This study is to evaluate the efficacy of dorsal short-segment fixation in unstable thoracolumbar junction fractures. Methods : The cases of 20 patients who underwent dorsal short-segment fixation were reviewed retrospectively. Clinical outcomes were analysed using Sonntag's pain level, work status, and neurological scale according to the modified Frankel classification. Radiological outcomes were analysed using Mumford's anterior body compression[%], canal compromise ratio, and Cobb's kyphotic angle. Results : At the latest clinical follow-up [average=14.6 months]. there were 19 [95.0%] in group I and 1 patient [5.0%] in II in pain level. The postoperative work status were 17 [85.0%] in group I, 2 patients [10.0%] in II, and 1 patient [5.0%] in V. Surgery brought to improve the neurologic status. In success group [19 cases, 95%], the average canal compromise ratio was reduced from 0.57 [${\pm}0.07$] to 0.05 [${\pm}0.08$] [P<005], the average anterior body compression [%] was reduced from 41% [${\pm}17$] to 18% [${\pm}14$] [P<0.05], and the average preoperative kyphotic angle was $20.0^{\circ}$ [${\pm}9.0$], and corrected to $5.7^{\circ}$ [${\pm}7.1$] postoperatively, and progressed to $7.8^{\circ}$ [${\pm}6.2$] at the latest follow-up. There was a case of implantation failure in an elderly osteoporotic patient. Conclusion : Although there are limitations in the patient number and follow-up period, the present study favors dorsal short-segment fixation for selective cases in unstable thoracolumbar junction fractures.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.248-260
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• 2020

Objective : To investigate the efficiency of diffusion tensor imaging (DTI) fiber-tracking based neuronavigation and assess its usefulness in the preoperative surgical planning, prognostic prediction, intraoperative course and outcome improvement. Methods : Seventeen patients with cerebral masses adjacent to corticospinal tract (CST) were given standard magnetic resonance imaging and DTI examination. By incorporation of DTI data, the relation between tumor and adjacent white matter tracts was reconstructed and assessed in the neuronavigation system. Distance from tumor border to CST was measured. Results : The sub-portion of CST in closest proximity to tumor was found displaced in all patients. The chief disruptive changes were classified as follows : complete interruption, partial interruption, or simple displacement. Partial interruption was evident in seven patients (41.2%) whose lesions were close to cortex. In the other 10 patients (58.8%), delineated CSTs were intact but distorted. No complete CST interruption was identified. Overall, the mean distance from resection border to CST was 6.12 mm (range, 0-21), as opposed to 8.18 mm (range, 2-21) with simple displacement and 2.33 mm (range, 0-5) with partial interruption. The clinical outcomes were analyzed in groups stratified by intervening distances (close, <5 mm; moderated, 5-10 mm; far, >10 mm). For the primary brain tumor patients, the proportion of completely resected tumors increased progressively from close to far grouping (42.9%, 50%, and 100%, respectively). Five patients out of seven (71.4%) experienced new neurologic deficits postoperatively in the close group. At meantime, motor deterioration was found in six cases in the close group. All patients in the far and moderate groups received excellent (modified Rankin Scale [mRS] score, 0-1) or good (mRS score, 2-3) rankings, but only 57.1% of patients in the close group earned good outcome scores. Conclusion : DTI fiber tracking based neuronavigation has merit in assessing the relation between lesions and adjacent white matter tracts, allowing prediction of patient outcomes based on lesion-CST distance. It has also proven beneficial in formulating surgical strategies.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3271-3276
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• 2016

Background: Intracranial nonvestibular schwannomas arising from various cranial nerves excluding CN VIII are uncommon. Recently, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have been widely reported as effective treatment modalities for nonvestibular schwannomas. The purpose of this study was to study the long term clinical outcome for nonvestibular schwannomas treated with both X-Knife and CyberKnife (CK) radiosurgery at one institution. Materials and Methods: From 2004 to 2013, fifty-two nonvestibular schwannoma patients were included in this study, 33 patients (63%) were treated with CK, and 19 (37%) were treated with X-Knife. The majority of the tumors were jugular foramen schwannomas (38%) and trigeminal schwannomas (27%). HSRT was given for 45 patients (86%), whereas CSRT was for 6 (12%) and SRS for 1 (2%). Results: The median pretreatment volume was $9.4cm^3$ (range, $0.57-52cm^3$). With the median follow up time of 36 months (range, 3-135), the 3 and 5 year progression free survival was 94 % and 88%, respectively. Tumor size was decreased in 13 (25%), stable in 29 (56%), and increased in 10 (19%). Among the latter, 3 (30%) required additional treatment because of neurologic deterioration. No patient was found to develop any new cranial nerve deficit after SRS/SRT. Conclusions: These data confirmed that SRS/SRT provide high tumor control rates with low complications. Large volume tumors and cystic expansion after radiation should be carefully followed up with neurological examination and MRI, because it may frequently cause neurological deterioration requiring further surgery.

• Clinical and Experimental Pediatrics
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• 제63권6호
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• pp.219-225
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• 2020

Background: There is increasing concern that moderate preterm (32-33 weeks' gestation) and late preterm (34-36 weeks' gestation) birth may be associated with minor neurodevelopmental problems affecting poor school performance. Purpose: We explored the cognitive function, cognitive visual function, executive function, and behavioral problems at school age in moderate to late preterm infants. Methods: Children aged 7-10 years who were born at 32⁺⁰ to 36⁺⁶ weeks of gestation and admitted to the neonatal intensive care unit from August 2006 to July 2011 at the National Health Insurance Service Ilsan Hospital were included. We excluded children with severe neurologic impairments, congenital malformations, or chromosomal abnormalities. Neuropsychological assessments consisted of 5 neuropsychological tests and 3 questionnaires. Results: A total of 37 children (mean age, 9.1±1.2 years) participated. The mean gestational age at birth was 34.6±7.5 weeks, while the mean birth weight was 2,229.2±472.8 g. The mean full-scale intelligence quotient was 92.89±11.90; 24.3% scored between 70 and 85 (borderline intelligence functioning). An abnormal score was noted for at least one of the variables on the attention deficit hyperactivity disorder diagnostic system for 65% of the children. Scores below borderline function for executive quotient and memory quotient were 32.4% and 24.3%, respectively. Borderline or clinically relevant internalizing problems were noted in 13.5% on the Child Behavior Check List. There were no significant associations between perinatal factors or socioeconomic status and cognitive, visual perception, executive function, or behavior outcomes. Conclusion: Moderate to late preterm infants are at risk of developing borderline intelligence functioning and attention problems at early school age. Cognitive and executive functions that are important for academic performance must be carefully monitored and continuously followed up in moderate to late preterm infants.