• Title/Summary/Keyword: Neurosurgery

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Telemedicine Protocols for the Management of Patients with Acute Spontaneous Intracerebral Hemorrhage in Rural and Medically Underserved Areas in Gangwon State : Recommendations for Doctors with Less Expertise at Local Emergency Rooms

  • Hyo Sub Jun;Kuhyun Yang;Jongyeon Kim;Jin Pyeong Jeon;Sun Jeong Kim;Jun Hyong Ahn;Seung Jin Lee;Hyuk Jai Choi;In Bok Chang;Jeong Jin Park;Jong-Kook Rhim;Sung-Chul Jin;Sung Min Cho;Sung-Pil Joo;Seung Hun Sheen;Sang Hyung Lee
    • Journal of Korean Neurosurgical Society
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    • v.67 no.4
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    • pp.385-396
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    • 2024
  • Previously, we reported the concept of a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local emergency rooms in rural and medically underserved areas in Gangwon state by combining artificial intelligence and remote consultation with a neurosurgeon. Developing a telemedicine ICH treatment protocol exclusively for doctors with less ICH expertise working in emergency rooms should be part of establishing this system. Difficulties arise in providing appropriate early treatment for ICH in rural and underserved areas before the patient is transferred to a nearby hub hospital with stroke specialists. This has been an unmet medical need for decades. The available reporting ICH guidelines are realistically applicable in university hospitals with a well-equipped infrastructure. However, it is very difficult for doctors inexperienced with ICH treatment to appropriately select and deliver ICH treatment based on the guidelines. To address these issues, we developed an ICH telemedicine protocol. Neurosurgeons from four university hospitals in Gangwon state first wrote the guidelines, and professors with extensive ICH expertise across the country revised them. Guidelines and recommendations for ICH management were described as simply as possible to allow more doctors to use them easily. We hope that our effort in developing the telemedicine protocols will ultimately improve the quality of ICH treatment in local emergency rooms in rural and underserved areas in Gangwon state.

Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations

  • Yong-Hwan Cho;Jaehyung Choi;Chae-Wook Huh;Chang Hyeun Kim;Chul Hoon Chang;Soon Chan KWON;Young Woo Kim;Seung Hun Sheen;Sukh Que Park;Jun Kyeung Ko;Sung-kon Ha;Hae Woong Jeong;Hyen Seung Kang;Clinical Practice Guideline Committee of the Korean Neuroendovascular Society
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • v.26 no.1
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    • pp.1-10
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    • 2024
  • Objective: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. Methods: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. Results: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3-5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. Conclusions: The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.

Intraabdominal Aortic Obstruction with Severe Low Back Pain and Acute Paraplegia - Case Report - (심한 요통과 급성 양하지 마비증상으로 나타난 복부 대동맥 폐쇄증 - 증 례 보 고 -)

  • Kim, Rae Sang;Han, Ki Soo;Lee, Uhn;Park, Chol Wan;Kim, Young Bo;Lee, Sang Gu;Kim, Woo Kyung;Yoo, Chan Jong
    • Journal of Korean Neurosurgical Society
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    • v.30 no.1
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    • pp.95-98
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    • 2001
  • Acute intraabdominal aortic obstruction ends in progressive fatal course or severe permanent disability unless it is diagnosed and treated promptly. However, the incidence of such disease is very rare, so there is very little chance for a neurosurgeon to encounter a patient with acute intraabdominal aortic obstruction. The authors present a case of 62-year-old man with severe low back pain and acute paraplegia caused by acute intraabdominal aortic obstruction.

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A Giant Unruptured Aneurysm of Middle Cerebral Artery Bifurcation Solely Presenting with Seizure - A Case Report - (경련만으로 발현된 중대뇌동맥 분지부의 미파열성 거대 동맥류 - 증례보고 -)

  • Kim, Jae Hoon;Yi, Hyeong Joong;Kim, Kwang Myung;Kim, Jae Min;Kim, Young Soo;Ko, Yong;Oh, Seong Hoon;Oh, Suck Jun
    • Journal of Korean Neurosurgical Society
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    • v.30 no.5
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    • pp.657-661
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    • 2001
  • Intracranial giant aneurysms have been known to cause clinical signs and symptoms, either by rupture, compression of surrounding structures, repeated minor leakage, or cerebral ischemia due to thromboembolism. A giant aneurysm which manifests only a seizure disorder comprises relatively few contributions. The authors present a case of a giant, unruptured aneurysm solely presenting with generalized tonic-clonic type seizure in a 43-year-old man. Brain computed tomogram(CT) and 3-D CT angiogram demonstrated a huge calcified aneurysm at the bifurcation of right middle cerebral artery. Complete neck clipping and aneurysmectomy followed by uneventful neurologic recovery.

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Intradural Extramedullary Spinal Metastasis - A Case Report - (경막하 수외로 전이된 척수암 1례 - 증 례 보 고 -)

  • Shin, Il-Young;Doh, Jae-Won;Yoon, Seok-Mann;Lee, Kyeong-Seok;Bae, Hack-Gun;Yun, Il-Gyu;Choi, Soon-Kwan;Byun, Bark-Jang
    • Journal of Korean Neurosurgical Society
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    • v.29 no.8
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    • pp.1085-1088
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    • 2000
  • Spinal intradural extramedullary metastasis are very rare. The authors report a case of spinal metastasis at the T5 level in the intradural extramedullary space in a 76-year-old man who presented with paraparesis and sciatica. Preoper-ative neuroradiologic imaging studies were highly suggestive of intradural mass lesion with compressive myelopathy. Pathology revealed metastatic squamous cell carcinoma. We describle the mechanism of tumor spread in intradural spinal metastasis.

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The Application and Effect of the Brown-Roberts-Wells Stereotactic System in the Management of Intracranial Lesions (두개강내 질환에서 BRW 콤퓨터 정위수술장치의 적용과 효과에 관한 연구)

  • Moon, Choong-Bae;Kim, Wan-Shup;Ko, Sam-Kyu;Ihm, Jowa-Hyuk;Baek, Seung-Chan;Chi, Yung-Chul;Choi, Byung-Yearn;Cho, Soo-Ho
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.53-62
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    • 1986
  • In the past 10 years, modern technology has made deep seated obscure lesions visible. With development of computer technology and various stereotaxic techniques, many new procedures. refinement of old procedures, and development of new applications are possible. The authors are intended to provide a detailed description of our experience with the Brown-Roberts-Wells(BRW) stereotactic system in the evaluation and management of 90 patients with intracranial lesions, and to provide cases presentation of various inaccessible intracranial lesions.

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Subependymal Giant Cell Astrocytoma in the Tuberous Sclerosis (결정성 경화증에서의 상의하 거대 성상세포종)

  • Park, Jin-Han;Kim, Seong-Ho;Han, Dong-Ro;Bae, Jang-Ho;Ko, Sam-Kyu;Kim, Oh-Lyung;Chok, Byung-Yeam;Cho, Soo-He
    • Journal of Yeungnam Medical Science
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    • v.11 no.2
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    • pp.221-229
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    • 1994
  • Tuberous sclerosis is reported rarely and is associated with systemic lesions including central nervous system, skin, heart, eye and kidney. Approximately 5-15% of individuals with tuberous sclerosis will develope brain neoplasia, almost invariably subependymal giant-cell astrocytoma (SGCA). We experienced a case of SGCA with tuberous sclerosis operated by the transcallosal approach and report with literature review.

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Spontaneous Thoracic Spinal Cord Herniation - Case Report - (자발성 흉추부 척수 탈출증 - 증례보고 -)

  • Kim, Young Jin;Kim, Young Soo;Kim, Ju Hun;Yi, Hyeong Joong;Ko, Yong;Oh, Sung Hun;Kim, Kwang Myung;Oh, Suck Jun
    • Journal of Korean Neurosurgical Society
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    • v.30 no.10
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    • pp.1237-1240
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    • 2001
  • Spontaneous herniation of the spinal cord is a very rare. It's clinical symptom presents with progressive myelopathy. A 42-year old male patient who presented the progressive left leg weakness and Brown-Seqaurd syndrome is presented. MRI showed a typical finding of dural defect and herniation of the cord on the level of T3-4. Repair of dural defect using an artificial dura and reposition of cord herniation were undertaken after three level laminectomies with SSEP monitoring. Postoperatively, symptoms were improved rapidly. In our knowledgement, this is first case being reported in Korea. This entity, although rare, should be considered in the differential diagnosis of myelopathy in the absence of a mass lesion.

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