• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.420-425
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• 2000

Epidural steroid injection(ESI) has been a commonly applied conservative therapy for the management of chronic low back pain and sciatica. However, there are many reports concerning various local, systemic and neurological complications related to ESI. We report two cases with fatal complications after ESI for low back pain and sciatica. In both patients, ventriculitis and meningitis were causative factors to be fatal. Aseptic procedures and careful post-procedure assessment are essential to avoid serious complications following ESI.

• Journal of Korean Neurosurgical Society
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• 제43권2호
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• pp.69-78
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• 2008

Recently, due to the evolution of technology, the field of neurosurgery is receiving spotlight. In particular endovascular neurosurgery has gained a great interest along with the advancement of the modern neurosurgery. The most remarkable advances were made in embolization of the cerebral aneurysms, arteriovenous malformations and intracranial stenosis during the past 10 years. These advances will further change the role of neurosurgeons in treating cerebrovascular disease. Because interventional neuroradiologists have performed most of procedures in the past, neurosurgeons have been deprived of chances to learn endovascular procedure. This article discusses the development of technological aspect of endovascular neurosurgery in chronological order. By understanding the history and current status of the endovascular surgery, the future of neurosurgery will be promising.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.281-283
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• 2014

McCune-Albright syndrome (MAS) is characterized by a triad of poly/monostotic fibrous dysplasia, caf$\acute{e}$-au-lait macules and hyperfunctioning endocrinopathies including human growth hormone excess. Acromegaly as a manifestation of endocrine hyperfunction with MAS is uncommon. Surgical excision may be challenging due to the associated severe fibrous dysplasia of the skull base. Through the endoscopic procedures, we treated a case of MAS presenting with compressive optic neuropathy due to fibrous dysplasia and acromegaly caused by growth hormone secreting pituitary adenoma. We reviewed the literature on GH excess in MAS to highlight its surgical and medical challenges.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.3-9
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• 2019

As more intracranial aneurysms and other cerebrovascular pathologies are treated with neurointervention procedure, thromboembolic events that frequently lead to serious neurological deficit or fatal outcomes are increasing. In order to prevent the thromboembolic events, antiplatelet therapy is used in most procedures including coil embolization, stenting, and flow diversion. However, because of variable individual pharmacodynamics responses to antiplatelet drugs, especially clopidogrel, it is difficult for clinicians to select the adequate antiplatelet regimen and its optimal dose. This article reviews the neurointervention literature related to antiplatelet therapy and suggests a strategy for tailoring antiplatelet therapy in individual patients undergoing neurointervention based on the results of platelet function testing.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.107-113
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• 2022

Objective : To describe the surgical management and postoperative outcomes in infants with metopic synostosis. Methods : We conducted a 5 years retrospective chart review of patients who underwent surgical correction of metopic synostosis at two university hospitals in Egypt during the period between June 2014 and June 2019. The study is conducted to 18 children. The type of surgical procedures and postoperative outcomes were assessed in all patients. Results : Five cases (27.8%) underwent endoscopic-assisted suturectomy, 10 cases (55.6%) underwent craniofacial reconstruction, and three cases (16.6%) underwent open burring of the metopic ridge. Fifteen patients underwent one surgery and three patients (16.6%) who need second operation. Ten patients (55.6%) had class I Whitaker classification. Conclusion : Regardless of type of surgery, the outcomes of surgical correction of metopic synostosis are excellent with only a few patients require revision or develop major complications.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.929-934
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• 2000

Objective : The results of secondary transsphenoidal surgery(TSS) for either residual or recurring pituitary adenomas have been reported to be unfavorable. To evaluate the effectiveness of secondary TSS, we analyzed the surgical results of residual or recurred pituitary adenomas in patients who underwent secondary TSS from 1992 to 1998. Material and Methods : Among the 95 patients who underwent TSS during this period, 14(15%) received repeated TSS. Two of the 14 patients underwent three TSS. Among the 11 patients with pituitary adenomas, three had nonfunctioning tumors ; six prolachnomas ; two GH-secreting adenomas. The remaining three patieats had craniopharyngioma, pituitary abscess and hemangioendothelioma respectively. The interval between the two surgical procedures ranged from one week to 33 months(mean ; 12 months). Causes of the secondary TSS were tumor recurrence in 11 patients, intentional staged operation in three, persistent disease despite medical therapy and CSF leak after initial operation in one respectively. Treatments prior to secondary TSS were medical treatment only in eight patients. Results : During the repeated operationtss some adhesion was noted in septal mucous membrane. The sphenoid cavity was filled with fibrous tissue which correlated with the methods of reconstruction of the sellar floor at the previous operation. There was no statistically significant difference in success rate of surgery between the initial and the second TSS(86% vs 81%). The complication rate was similar between the two procedures. There was no statistically significant factors affecting the results of second TSS. Conclusion : Transsphenoidal reoperation was regarded as a suitable approach for treating recurrent pituitary adenomas in spite of some degree of operative difficulties. In patients with transsphenoidally resectable tumor residuals or recurrences confirmed by magnetic resonance imaging, remissions can be obtained with high probability, especially in secondary surgery after an staged decompression.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1505-1513
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• 2000

Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.161-166
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• 2013

Objective : Neuroendoscopy is applied to various intracranial pathologic conditions. But this technique needs informations for the anatomy, critically. Neuronavigation makes the operation more safe, exact and lesser invasive procedures. But classical neuronavigation systems with rigid pinning fixations were difficult to apply to pediatric populations because of their thin and immature skull. Electromagnetic neuronavigation has used in the very young patients because it does not need rigid pinning fixations. The usefulness of electromagnetic neuronavigation is described through our experiences of neuroendoscopy for pediatric groups and reviews for several literatures. Methods : Between January 2007 and July 2011, nine pediatric patients were managed with endoscopic surgery using electromagnetic neuronavigation (AxiEM, Medtronics, USA). The patients were 4.0 years of mean age (4 months-12 years) and consisted of 8 boys and 1 girl. Totally, 11 endoscopic procedures were performed. The cases involving surgical outcomes were reviewed. Results : The goal of surgery was achieved successfully at the time of surgery, as confirmed by postoperative imaging. In 2 patients, each patient underwent re-operations due to the aggravation of the previous lesion. And one had transient mild third nerve palsy due to intraoperative manipulation and the others had no surgery related complication. Conclusion : By using electromagnetic neuronavigation, neuroendoscopy was found to be a safe and effective technique. In conclusion, electromagnetic neuronavigation is a useful adjunct to neuroendoscopy in very young pediatric patients and an alternative to classical optical neuronavigation.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1406-1416
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• 2001

Objective : The goal of this study was to evaluate the effect of Gamma Knife radiosurgery(GKS) on cerebral arteriovenous malformation(AVM) and the factors associated with complete occlusion. Patients and Methods : A total of 369 radiosurgical procedures for 336 patients with cerebral AVMs were performed between December 1988 and June 2001. Three hundreds and twenty-four cases of 293 patients who were treated with GKS procedures from May 1992 to December 2000 were analyzed. Various clinical and radiologic parameters were evaluated. Results : The total obliteration rate for the cases with satisfactory radiological follow-up(more than 2 years) after GKS was 79.3%. In multivariate analysis, maximal diameter, angiographic form of AVM nidus, and number of draining veins significantly influenced the result of radiosurgery. In addition, marginal radiation dose, Spetzler-Martin grade, and flow pattern of AVM nidi also partly influenced the radiosurgical outcome. Conclusion : GKS on cerebral AVM is considered as an effective treatment modality. The risk of hemorrhage seems to decrease within the latency interval between GKS and complete occlusion of nidus. Along with the size, topography, or radiosurgical parameters of AVMs, it is necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.5-10
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• 2009

Objective : Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms. Methods : From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively. Results : After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5. Conclusion : Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms.