• Journal of Korean Neurosurgical Society
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• v.47 no.6
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• pp.454-457
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• 2010

Pure ventral midline giant schwannoma is an extremely rare entity. Spinal intradural extramedullary schwannomas commonly occur posterolateral or anterolateral to the spinal cord. A case of a pure midline ventrally situated giant pan cervical extramedullary schwannoma in an 18-year-old male patient with compressive myelopathy and sphincter involvement is presented. Spinal MR imaging showed a midline ventrally situated extramedullary tumor with severe spinal cord compression extending from clivus to C7 vertebra. It was resected through a posterolateral approach. Histology was consistent with a schwannoma. Post operative MR imaging showed no evidence of the tumor. The radiological features, pathogenesis and surgical strategies in management of these difficult tumors are discussed and the relevant literature is briefly reviewed.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.502-505
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• 1994

Neurogenic tumors of the mediastinum may have an intraspinal component connected by a narrowed segment of tumor in the intervertebral foramen,hence the descriptive term dumbbell.Recently we had an occasion to remove a dumbbell neurilemmoma in a 62 years old woman using an approach designed to allow wide posterolateral thoracotomy and concomitant laminectomy for a single stage removal of the entire tumor. The mass in the posterior mediastinum was discovered on routine chest roentgenography. CT scan demonstrated a dumbbell shaped soft tissue mass density compressing spinal canal but preserving spinal cord. There were no neurologic signs. A standard posterolateral thoracotomy incision was made to remove tumor mass and then T5 unilateral laminectomy has done by Neurosurgeon. 7 x 7 cm sized extrapleural neurilemmoma was round, cystic, soft mass which covered parietal pleural with invaded regional vertebrae. There was no postoperative neurological complication.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1677-1681
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• 2000

Microsurgical transthoracic extrapleural approach for thoracic discectomy in three cases were modified and simplified in order to achieve better exposure of ventral extradural space than posterolateral extrapleural(lateral extracavitary) approach and less pulmonary complications than transthoracic transpleural approach. These approaches were optimized by microscope and video-assistance. Surgery was followed by clinical improvement in all patients. The results of treatment seem to support the use of these modified techniques as adequate surgical treatment of thoracic disc herniations without any complications.

• Journal of Korean Neurosurgical Society
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• v.40 no.1
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• pp.58-62
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• 2006

Objective : Development of diagnostic tools has resulted in early detection of thoracic disc herniations[TDH] even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy[PETD] technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. Methods : Eight consecutive patients [range, 31 to 75 years] with soft lateral or central TDH [from T2-3 to T11-12] underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and flu oroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index[ODI]. Results : The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. Conclusion : The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.2
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• pp.91-96
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• 1998

Surgical resection of tumors in the maxillofacial region sometimes results in extended defects of soft and hard tissue that frequently causes aesthetic, functional and especially mental damages. It is essential for patients with such facial defects to reduce the scar and maxillofacial asymmetry. To attain esthetic facial appearance after hemimaxillectomy, we devise a new design, so called 'IOIO Incision' (InfraOrbital-IntraOral incision). The new approach is established on infraorbital region to expose maxillofacial skeleton in aspect of face. And the other incision is designed on intraoral region. The IOIO incision provide excellent aesthetic result after hemimaxillectomy, because of reduced minimal facial scar contraction. Maxillofacial surgeons are used to designing Weber-Fergusson incision in resection of maxillofacial tumors, but disadvantages of the incision were large scar and asymmetry of face. To improve theses problem, we attempted IOIO Incision.. For correct osteotomy of posterolateral wall of maxillary sinus, 1. Fenestra formation on zygomatic body for easily access of reciprocating saw to posterolateral wall of maxillary sinus. 2. To achieve better visual field in posterolateral aspect of maxilla, fat tissue is removed from infratemporal fossa. This new, versatile procedure can be used for benign and malignant lesions of the maxillary area. We introduce cases with review of literatures.

• Journal of Chest Surgery
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• v.28 no.8
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• pp.807-810
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• 1995

The recommended approach for dumbell trmor is a one-stage removal by a team work of both neurosurgeons & thoracic surgeons. Recently we removed a case of dumbell tumor in a 69 years old woman with standard posterolateral thoracotomy and concomitant laminectomy as single stage operation. Postoperative course was uneventful and there were no postoperative neurologic signs.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.193-196
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• 2005

A posterior 3-portal arthroscopic approach with the patient in the prone position provides a novel and optimal approach for isolated subtalar arthrodesis. This approach facilitates access to the posterior talocalcaneal facet and facilitates safe access with regard to the posteromedial neuromuscular bundle. The technique involves prone positioning, establishment of two posterolateral portals and one posteromedial portal, arthroscopic posterior talocalcaneal facet debridement, percutaneous morcellized bone grafting and internal screw fixation. Preliminary results have shown high patient satisfaction, an excellent fusion rate and less postoperative morbidity than open subtalar arthrodesis.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.59-64
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• 1969

Three cases of traumatic diaphragmatic hernia were repaired in this department from June 1967 to Nov.1968. The first case, a 14 year old girl, was diagnosed as diaphragmatic hernia during the operation of the diffuse peritonitis from jejunaI perforation 3 days after the traffic accident at local clinic and she was transfered to this hospital after the closure of the perforated jejunum. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture at the posterolateral portion of the left diaphragm was repaired with two layer sutures by transthoracic approach. The second case. a 26 year old man. was diagnosed immediately after the traffic accident at local clinic and transfered to this hospital 24 hours later. Herniated and distended stomach, transverse colon and jejunum were repositioned and the large diaphragmatic rupture, about 9 cm in length, from the posterolateral portion to the base of the pericardium was directly repaired with two layer sutures. The third case, a 26 year old man, who had a history of stab wound at left lower lateral chest two years ago,was admitted with the sudden onset of abdominal pain and vomiting. The diaphragmatic hernia was confirmed with barium enema. The herniated stomach and transverse colon through the defect, about 3.5 cm in diameter, at anterolateral portion of the left diaphragm, were repositioned and the defect was repaired with two layer sutures. All of the cases recovered uneventfully.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.55-58
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• 2008

Purpose: The purpose of this study is to find out the clinical results of excision of the Os trigonum through a posterolateral approach and to compare the surgical results of athletes with non-athletes. Materials and Methods: Within a five year and four month period, from July 2001 to October 2006, twenty patients underwent excision of symptomatic os trigonum, with a mean age of 22 years and 9 months at the time of the operation. There were fifteen female patients and five male patients. Eight were athletes and twelve were non-athletes. Results: The average duration of postoperative follow-up was thirty months. The postoperative AOFAS scored an average of 89 points compared to the preoperative AOFAS scored an average of 67 points. Sixteen patients (80%) who were operated, had good or excellent satisfactory results. The average preoperative AOFAS score of the athletes were 61 points, compared to the average postoperative AOFAS score of 90 points. For non-athletes, the average preoperative score was 71 points, compared to the average postoperative AOFAS score of 88 points. Seven athletes (87%) and nine non-athletes (75%) had good or excellent satisfaction results after surgery. The time until full recovery averaged 88 days for all the patients. 133 days for the athletes and 56 days for the non-athletes. There is no analytic difference between result in athletes and result in non-athletes. Conclusion: Open surgical treatment through posterolateral approach of os trigonum syndrome of the ankle may be effective modality regardless of the patient being an athlete or non-athlete.

• The Korean Journal of Pain
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• v.25 no.2
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• pp.81-88
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• 2012

Background: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. Methods: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. Results: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. Conclusions: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.