• Journal of Yeungnam Medical Science
• /
• 제7권2호
• /
• pp.173-179
• /
• 1990

외상성 뇌경막의 혈종의 비수술적 치료에 대한 기준은 보고자에 따라 상이하고 비수술적 요법시 환자를 집중관찰해야 되고, 입원기간이 길며 여러번 CT 촬영을 해야 하는 위험성이 있으나 상시정맥동 주위의 경미한 뇌경막외 혈종의 경우 시도해 볼 수 있는 한 방법으로 판단된다. 저자들은 다른 부위의 뇌경막외 혈종과는 달리 임상증상 및 국소증후가 적고 단순 뇌압상승증세가 주 증상인 상시정맥동 주위의 뇌경막외 혈종 환자에서 집중적인 관찰과 추적 및 고식요법으로 좋은 결과를 얻었기에 비수술적 치료의 대상, 방법등에 관하여 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
• /
• 제30권sup1호
• /
• pp.170-173
• /
• 2001

Germinoma associated with chronic granulomatous inflammation of pineal gland has been rarely reported in the literature. The mechanism of chronic granulomatous inflammation is not understood well. We report a case of chronic granulomatous inflammation in pineal germinoma. In a 17 year-old male who suffered from headache and diplopia for six months, the mass of pineal gland was detected by brain MRI and removed through occipital transtentorial approach. The pathological specimen revealed the mass was predominantly composed of chronic granulomatous inflammation associated with small portion of germ cell tumor nests In the pathological interpretation of chronic granulomatous inflammation of pineal mass, it would be obliged to search for the presence of germ cell component.

• Journal of Korean Neurosurgical Society
• /
• 제55권3호
• /
• pp.117-124
• /
• 2014

The need for standard endovascular neurosurgical (ENS) training programs and certification in Korea cannot be overlooked due to the increasing number of ENS specialists and the expanding ENS field. The Society of Korean Endovascular Neurosurgeons (SKEN) Certification Committee has prepared training programs and certification since 2010, and the first certificates were issued in 2013. A task force team (TFT) was organized in August 2010 to develop training programs and certification. TFT members researched programs and systems in other countries to develop a program that best suited Korea. After 2 years, a rough draft of the ENS training and certification regulations were prepared, and the standard training program title was decided. The SKEN Certification Committee made an official announcement about the certification program in March 2013. The final certification regulations comprised three major parts: certified endovascular neurosurgeons (EN), certified ENS institutions, and certified ENS training institutions. Applications have been evaluated and the results were announced in June 2013 as follows: 126 members received EN certification and 55 hospitals became ENS-certified institutions. The SKEN has established standard ENS training programs together with a certification system, and it is expected that they will advance the field of ENS to enhance public health and safety in Korea.

• Journal of Korean Neurosurgical Society
• /
• 제64권4호
• /
• pp.608-618
• /
• 2021

Objective : The endoscopic endonasal transsphenoidal approach is a widely-used method for the surgical treatment of pituitary adenomas. We aimed to evaluate the results of endoscopic surgery by comparing preoperative classification methods and investigating their relationship with postoperative resection and remission rates and complications. Methods : We retrospectively reviewed the medical records of 236 patients (118 males) who underwent surgery for pituitary adenomas. Preoperative Knosp classification, tumor size (TS), suprasellar extension (SSE), postoperative resection and remission rates, and complications were evaluated. Results : The follow-up period was 3 months to 6 years. The patients' ages ranged between 16 and 84 years. Endocrinologically, 114 patients (48.3%) had functional adenoma (FA), and 122 patients (51.7%) had non-functional adenoma (NFA). Among the FA group, 92 (80.7%) showed remission. A statistically significant difference was found between patients with and without remission in terms of the Knosp, TS, and SSE classifications (p<0.01). Knosp, TS, and SSE classification grades were found to be correlated with the resection rates (p<0.01). Meningitis was seen in seven patients (3.0%), diabetes insipidus in 16 (6.9%; permanently in two [0.9%]), and rhinorrhea in 19 (8.1%). Thirty-six patients (15.3%) developed pituitary insufficiency and received hormone replacement therapy. Conclusion : The resection categories and remission rates of FAs were directly proportional to the adenoma sizes and Knosp grades, while the degree of suprasellar growth further complicated resection and remission rates. Adenoma sizes less than 2 cm and SSEs less than 1 cm are associated with favorable remission and resection rates.

• Journal of Korean Neurosurgical Society
• /
• 제66권5호
• /
• pp.488-493
• /
• 2023

We aimed to develop a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local hospitals in rural and underserved areas in Gangwon-do using artificial intelligence and non-face-to-face collaboration treatment technology. This is a prospective and multi-center development project in which neurosurgeons from four university hospitals in Gangwon-do will participate. Information technology experts will verify and improve the performance of the cloud-based telemedicine collaboration platform while treating ICH patients in the actual medical field. Problems identified will be resolved, and the function, performance, security, and safety of the telemedicine platform will be checked through an accredited certification authority. The project will be carried out over 4 years and consists of two phases. The first phase will be from April 2022 to December 2023, and the second phase will be from April 2024 to December 2025. The platform will be developed by dividing the work of the neurosurgeons and information technology experts by setting the order of items through mutual feedback. This article provides information on a project to develop a cloud-based telemedicine platform for acute ICH patients in Gangwon-do.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• 제25권1호
• /
• pp.62-68
• /
• 2023

The treatment of complicated anterior cerebral artery aneurysms remains challenging. Here, the authors describe a case of ruptured complicated A3 aneurysm, which was treated with trapping and in-situ bypass. A 47-year-old man presented to the emergency department with severe headache and vomiting. Computed tomography illustrated acute intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) confirmed a ruptured fusiform A3 aneurysm with lobulation and a daughter sac. Trapping of the ruptured fusiform A3 aneurysm and distal end-to-side A4 anastomosis was performed. DSA on postoperative day 7 showed mild vasospasm to the afferent artery. However, 2 months later, DSA demonstrated that the antegrade flow through the anastomosis site had recovered. Thus, surgeons should be aware of the possibility of postsurgical vasospasm of anastomosed arteries, especially in cases of ruptured aneurysms.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• 제26권2호
• /
• pp.223-226
• /
• 2024

Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• 제26권2호
• /
• pp.187-195
• /
• 2024

Perianeurysmal cysts are a rare and poorly understood finding in patients both with treated and untreated aneurysms. While the prior literature suggests that a minority of perianeurysmal cysts develop 1-4 years following endovascular aneurysm treatment, this updated review demonstrates that nearly half of perianeurysmal cysts were diagnosed following aneurysm coiling, with the other half diagnosed concurrently with an associated aneurysm prior to treatment. 64% of perianeurysmal cysts were surgically decompressed, with a 39% rate of recurrence requiring re-operation. We report a case of a 71-year-old woman who presented with vertigo and nausea and was found to have a 3.4 cm perianeurysmal cyst 20 years after initial endovascular coiling of a ruptured giant ophthalmic aneurysm. The cyst was treated with endoscopic fenestration followed by open fenestration upon recurrence. The case represents the longest latency from initial aneurysm treatment to cyst diagnosis reported in the literature and indicates that the diagnosis of perianeurysmal cyst should remain on the differential even decades after treatment. Based on a case discussion and updated literature review, this report highlights proposed etiologies of development and management strategies for a challenging lesion.

• Journal of Korean Neurosurgical Society
• /
• 제63권4호
• /
• pp.519-531
• /
• 2020

Objective : The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010. Method : This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010. Results : Seventy seven hospitals (87.5%) participated in the survey. Nineteen hospitals (24.7%) employed a neurointensivist or faculty member; Thirty seven hospitals (48.1%) reported high demand for neurointensivists, and 62 hospitals (80.5%) stated that the mandatory deployment of a neurointensivist improved the quality of patient care. Forty four hospitals (57.1%) believed that hiring neurointensivist would increase hospital costs, and in response to a question on potential earnings declines. In terms of potential solutions to these problems, 70 respondents (90.9%) maintained that additional fees were necessary for neurointensivists' work, and 64 (83.1%) answered that direct support was needed of the personnel expenses for neurointensivists. Conclusion : We hope the results of this survey will guide successful implementation of neurointensivist systems across Korea.

• Journal of Yeungnam Medical Science
• /
• 제14권1호
• /
• pp.237-244
• /
• 1997

A 14-year old boy was admitted with stuporous mentality. CT scan, MRI and cerebral angiogram revealed SAH and a giant aneurysm of right middle cerebral artery($4{\times}5{\times}5.3cm$). To minimize surgical risk, endovascular treatment was done with MDS(mechanical detachable system)-spiral coil. Follow up MRI showed intraluminal thrombus formation of the aneurysm.