• Journal of Korean Neurosurgical Society
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• 제66권6호
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• pp.632-641
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• 2023

Central nervous system tumors are identified as tumors of the brain and spinal cord. The associated morbidity and mortality of cerebrospinal tumors are disproportionately high compared to other malignancies. While minimally invasive techniques have initiated a revolution in neurosurgery, artificial intelligence (AI) is expediting it. Our study aims to analyze AI's role in the neurosurgical management of cerebrospinal tumors. We conducted a scoping review using the Arksey and O'Malley framework. Upon screening, data extraction and analysis were focused on exploring all potential implications of AI, classification of these implications in the management of cerebrospinal tumors. AI has enhanced the precision of diagnosis of these tumors, enables surgeons to excise the tumor margins completely, thereby reducing the risk of recurrence, and helps to make a more accurate prediction of the patient's prognosis than the conventional methods. AI also offers real-time training to neurosurgeons using virtual and 3D simulation, thereby increasing their confidence and skills during procedures. In addition, robotics is integrated into neurosurgery and identified to increase patient outcomes by making surgery less invasive. AI, including machine learning, is rigorously considered for its applications in the neurosurgical management of cerebrospinal tumors. This field requires further research focused on areas clinically essential in improving the outcome that is also economically feasible for clinical use. The authors suggest that data analysts and neurosurgeons collaborate to explore the full potential of AI.

• Journal of Korean Neurosurgical Society
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• 제47권5호
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• pp.377-380
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• 2010

The abducens nerve usually travels from the brainstem to the lateral rectus muscle as a single trunk. However, it has been reported that this nerve could split into branches occasionally. We attempted to show the aberrant course of abducens nerve in a specimen with unilateral duplicated abducens nerve and review relevant literatures. The micro-dissections were performed in a head specimen injected with colored latex under the microscope. The abducens nerve was duplicated unilaterally. This nerve emerged from the pontomedullary sulcus as a single trunk and splitted into two branches in the prepontine cistern. These two separate branches were piercing the cerebral dura of the petroclival region respectively. The slender lower branch passed between the petroclinoid and petrosphenoid ligaments and the thick lower one passed under the petrosphenoid ligament. These two branches united just lateral to the ascending segment of internal carotid artery in the cavernous sinus. The fact that there are several types of aberrant abducens nerve is helpful to perform numerous neurosurgical procedures in the petroclival region and cavernous sinus without inadvertent neurovascular injuries.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.263-267
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• 2005

Objective: Middle cerebral artery(MCA) anomalies are found incidentally on conventional cerebral angiography and magnetic resonance angiography(MRA). Our goal is to examine the incidence and types of MCA anomalies. Methods: Cerebral angiography was performed in 448 patients and MRA in 743; the patients had or were suspected to have cerebrovascular disease. The images were retrospectively evaluated for arterial anatomic anomalies. We use Teal's classification for definition of accessory and duplicated MCAs. Results: On cerebral angiography, the following anomalies of the MCA were found in seven patients: fenestration (n = 2, incidence = 0.45%); duplication (n = 2, incidence = 0.45%); accessory MCA (n = 2, incidence = 0.45%); aplasia (n = 1, incidence = 0.22%). On MRA, eight patients had anomalous MCAs : fenestration (n = 1, incidence = 0.14%); duplication (n= 6, incidence = 0.81%); accessory (n = 1, incidence = 0.14%). Conclusion: Although the clinical significance is not great, we find a relatively high incidence of anomalous MCAs. Knowledge and recognition of these MCA anomalies are useful and important in the interpretation of cerebral images and during neurosurgical procedures.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.379-385
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• 2015

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

• 대한두개안면성형외과학회지
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• 제21권1호
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• pp.45-48
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• 2020

In neurosurgical cases, problems related to wound healing can vary from simple wound dehiscence to multilayer defects. This study demonstrates an effective method to prevent persistent cerebrospinal fluid (CSF) leakage using reinforcing acellular dermal matrix in neurosurgical patients with wound dehiscence. A 52-year-old woman was admitted for management of recurrent glioblastoma. After tumor removal surgery, the patient experienced sustained CSF leakage from the wound despite reparative attempts. The plastic surgery team performed wound repair procedure after remnant tumor removal by the neurosurgery team. Acellular dermal matrix was applied over the mesh plate to prevent CSF leakage and the postoperative status of the patient was evaluated. No sign of CSF leakage was found in the immediate postoperative period. After 3 years, there were no complications including CSF leakage, wound dehiscence, and infection. We hereby propose this method as a feasible therapeutic alternative for preventing CSF leakage in patients experiencing wound problem after neurosurgical procedures.

• Journal of Korean Medical Science
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• 제33권44호
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• pp.279.1-279.16
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• 2018

Magnetic resonance-guided focused ultrasound (MRgFUS) is a new emerging neurosurgical procedure applied in a wide range of clinical fields. It can generate high-intensity energy at the focal zone in deep body areas without requiring incision of soft tissues. Although the effectiveness of the focused ultrasound technique had not been recognized because of the skull being a main barrier in the transmission of acoustic energy, the development of hemispheric distribution of ultrasound transducer phased arrays has solved this issue and enabled the performance of true transcranial procedures. Advanced imaging technologies such as magnetic resonance thermometry could enhance the safety of MRgFUS. The current clinical applications of MRgFUS in neurosurgery involve stereotactic ablative treatments for patients with essential tremor, Parkinson's disease, obsessive-compulsive disorder, major depressive disorder, or neuropathic pain. Other potential treatment candidates being examined in ongoing clinical trials include brain tumors, Alzheimer's disease, and epilepsy, based on MRgFUS abilities of thermal ablation and opening the blood-brain barrier. With the development of ultrasound technology to overcome the limitations, MRgFUS is gradually expanding the therapeutic field for intractable neurological disorders and serving as a trail for a promising future in noninvasive and safe neurosurgical care.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.610-617
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• 2019

Objective : This study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve. Methods : The authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications. Results : Simpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6-66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation. Conclusion : PAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.490-495
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• 2010

Objective : Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. Methods : Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. Results : The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from $21.2{\pm}4.9^{\circ}$ before surgery to $10.4{\pm}3.8^{\circ}$ after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. Conclusion : In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.

• Journal of Korean Neurosurgical Society
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• 제51권5호
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• pp.292-295
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• 2012

Many reports have been published on complications related to middle cerebral artery (MCA) aneurysm surgical clipping procedures. We report an emergency intracranial in situ bypass surgery case which was performed as a rescue procedure after aneurysmal neck laceration during clipping of an MCA large aneurysm. In this case, we performed in situ M3-superficial temporal artery (STA) interposition graft-M3 bypass procedure. If a STA-MCA anastomosis is not available under MCA flow obstruction, we can consider an emergency in situ MCA-MCA bypass procedure with or without an STA interposition graft.

• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.311-313
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• 2015

Chiari type I malformation is a tonsillar herniation more than 3 mm from the level of foramen magnum, with or without concurrent syringomyelia. Different surgical treatments have been developed for syringomyelia secondary to Chiari's malformations: craniovertebral decompression with or without plugging of the obex, syringo-subarachnoid, syringo-peritoneal, and theco-peritoneal shunt placement. Shunt placement procedures are useful for neurologically symptomatic large-sized syrinx. In this paper, authors define the first successful treatment of a patient with syringomyelia due to Chiari type I malformation using a pre-defined new technique of syringo-subarachnoid-peritoneal shunt with T-tube system.