• Title/Summary/Keyword: Root entry zone

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Linear Accelerator Radiosurgery for Trigeminal Neuralgia: Case Report (선형가속기를 이용한 삼차신경통의 정위적 방사선수술: 증례보고)

  • Yun Hyong-Geun
    • Radiation Oncology Journal
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    • v.24 no.2
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    • pp.144-148
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    • 2006
  • Trigeminal neuralgia is defined as an episodic electrical shock-like sensation in a dermatomal distribution of the trigeminal nerve. When medications fail to control pain, various procedures are used to attempt to control refractory pain. Of available procedures, stereotactic radiosurgery is the least invasive procedure and has been demonstrated to produce significant pain relief with minimal side effects. Recently, linear accelerators were introduced as a tool for radiosurgery of trigeminal neuralgia beneath the already accepted gamma unit. Author have experienced one case with trigeminal neuralgia treated with linear accelerator. The patient was treated with 85 Gy by means of 5 mm collimator directed to trigeminal nerve root entry zone. The patient obtained pain free without medication at 20 days after the procedure and remain pain free at 6 months after the procedure. He didn't experience facial numbness or other side effects.

Anatomical Considerations in Gamma Knife Radiosurgery for Idiopathic Trigeminal Neuralgia

  • Kim, Young-Hoon;Park, Chul-Kee;Chung, Hyun-Tai;Paek, Sun-Ha;Kim, Dong-Gyu
    • Journal of Korean Neurosurgical Society
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    • v.40 no.3
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    • pp.148-153
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    • 2006
  • Objective : The authors conducted this study to present the long-term treatment outcomes [minimum 2 years] of Gamma knife radiosurgery[GKS] for trigeminal neuralgia[TN] and to demonstrate the correlation of treatment outcomes and the anatomical characteristics of TN. Methods : From 1997 to 2003, 44 consecutive patients suffering from medically intractable pain underwent GKS for TN. A single 4mm collimator was used with a median maximum dose of 80Gy [range $75{\sim}80Gy$] prescribed to the root entry zone of the trigeminal nerve. Median follow up duration was 30 months [range $24{\sim}78\;months$]. Anatomical measurements of trigeminal nerve in magnetic resonance images during GKS planning were correlated with clinical outcome. Results : Twenty-two patients [50%] achieved an excellent outcome [BNI grade I & II], 20 patients [45.5%] a good outcome [grade IIIa & IIIb], and only 2 patients [4.5%] a poor outcome [grade IV & V]. Eleven patients [25.0%] experienced pain recurrence after initial pain relief. Smaller volume of trigeminal nerve area irradiated more than 40Gy was significantly correlated with excellent outcome in both univariate and multivariate analyses respectively [P=0.033 and 0.040]. Conclusion : Anatomical considerations during the planning of GKS would be helpful for predicting clinical outcome in TN.

Microvascular Decompression for Glossopharyngeal Neuralgia : Clinical Analyses of 30 Cases

  • Kim, Mi Kyung;Park, Jae Sung;Ahn, Young Hwan
    • Journal of Korean Neurosurgical Society
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    • v.60 no.6
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    • pp.738-748
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    • 2017
  • Objective : We present our experience of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) and evaluate the postoperative outcomes in accordance with four different operative techniques during MVD. Methods : In total, 30 patients with intractable primary typical GPN who underwent MVD without rhizotomy and were followed for more than 2 years were included in the analysis. Each MVD was performed using one of four different surgical techniques : interposition of Teflon pieces, transposition of offending vessels using Teflon pieces, transposition of offending vessels using a fibrin-glue-coated Teflon sling, and removal of offending veins. Results : The posterior inferior cerebellar artery was responsible for neurovascular compression in 27 of 30 (90%) patients, either by itself or in combination with other vessels. The location of compression on the glossopharyngeal nerve varied; the root entry zone (REZ) only (63.3%) was most common, followed by both the REZ and distal portion (26.7%) and the distal portion alone (10.0%). In terms of detailed surgical techniques during MVD, the offending vessels were transposed in 24 (80%) patients, either using additional insulation, offered by Teflon pieces (15 patients), or using a fibrin glue-coated Teflon sling (9 patients). Simple insertion of Teflon pieces and removal of a small vein were also performed in five and one patient, respectively. During the 2 years following MVD, 29 of 30 (96.7%) patients were asymptomatic or experienced only occasional pain that did not require medication. Temporary hemodynamic instability occurred in two patients during MVD, and seven patients experienced transient postoperative complications. Neither persistent morbidity nor mortality was reported. Conclusion : This study demonstrates that MVD without rhizotomy is a safe and effective treatment option for GPN.

A Study on the Variation of Physical Properties of Line-heated for Type-B LNG Fuel Tank with 9% Nickel Steel Plate (9% Nickel강이 적용된 Type-B LNG 연료탱크 선상가열의 물성 변화에 관한 연구)

  • Choi, Kyung-Shin;Lee, Ji-Han;Hong, Ji-Ung;Chung, Won-Jee
    • Journal of the Korean Society of Manufacturing Process Engineers
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    • v.19 no.7
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    • pp.89-97
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    • 2020
  • Container vessels continue to grow in size, led by global shipowner. Large ships can be loaded more cargo at a time, reducing the cost of transportation per teu. this eventually leads to economies of sale, in which the production cost per unit decreases with increasing output. in accordance with the 70th Convention of the Marine Environment Protection Committee of the International Maritime Organization, as of January 1, 2020, MARPOL Annex VI Regulation 14.1.3 will be effective. All vessels must be meet these criteria to reduce Sox emissions and reduce NOx emissions by reducing the content of manned sulfur oxides from 3.5% to less than 0.5%, otherwise IACS Member States Entry to the port is denied. in order to do that need to LNG storage tank. in this study characteristic of the material after line heating (600℃,700℃,800℃,900℃) of 9% Ni steel used in the manufacture of LNG fuel tank of ship were verified using by mechanical test. In the heating method by line heating. The initial properties of steel are changed by variables such as temperature, time, speed. The experimental data of line heating presented in this paper confirmed that the initial change of 9% Ni steel could be minimized.

Head Thrust Test (두부충동 검사)

  • Choi, Kwang-Dong;Oh, Sun-Young;Kim, Ji Soo
    • Annals of Clinical Neurophysiology
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    • v.8 no.1
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    • pp.1-5
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    • 2006
  • The head thrust maneuver is a simple bedside test of the higher frequency vestibulo-ocular reflex, which is based on Ewald's second law. It is performed by grasping the patient's head and applying a brief, small-amplitude, high-acceleration head turn, first to one side and then to the other. The patient fixates on the examiner's nose and the examiner watches for corrective rapid eye movements (saccades), which are a sign of decreased vestibular response. The "catch-up" saccades after a head thrust in one direction indicate a peripheral vestibular lesion on that side (in the labyrinth or the $8^{th}$ nerve including the root's entry zone in the brain stem). An individual pair of vertical semicircular canals can also be stimulated by turning the head to the right or left by $45^{\circ}$ and then by rotating the head in the pitch plane relative to the body. Recent studies have suggested that assessment of individual semicircular canal function by head thrust test may provide useful information for anatomical and functional details of a variety of peripheral vestibulopathies and for predicting the prognosis of vestibular neuritis. In central vestibulopathy, the head thrust test may also be valuable sign to determine dysfunction of the central pathways from individual semicircular canals and its role for the development of diverse central nystagmus.

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Involvement of Crosstalk Between cAMP and cGMP in Synaptic Plasticity in the Substantia Gelatinosa Neurons

  • Kim, Tae-Hyung;Chung, Ge-Hoon;Park, Seok-Beom;Chey, Won-Young;Jun, Sung-Jun;Kim, Joong-Soo;Oh, Seog-Bae
    • International Journal of Oral Biology
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    • v.36 no.2
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    • pp.83-89
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    • 2011
  • Substantia gelatinosa (SG) neurons receive synaptic inputs from primary afferent $A{\delta}$- and C-fibers, where nociceptive information is integrated and modulated by numerous neurotransmitters or neuromodulators. A number of studies were dedicated to the molecular mechanism underlying the modulation of excitability or synaptic plasticity in SG neurons and revealed that second messengers, such as cAMP and cGMP, play an important role. Recently, cAMP and cGMP were shown to downregulate each other in heart muscle cells. However, involvement of the crosstalk between cAMP and cGMP in neurons is yet to be addressed. Therefore, we investigated whether interaction between cAMP and cGMP modulates synaptic plasticity in SG neurons using slice patchclamp recording from rats. Synaptic activity was measured by excitatory post-synaptic currents (EPSCs) elicited by stimulation onto dorsal root entry zone. Application of 1 mM of 8-bromoadenosine 3,5-cyclic monophosphate (8-Br-cAMP) or 8-bromoguanosine 3,5-cyclic monophosphate (8-Br-cGMP) for 15 minutes increased EPSCs, which were maintained for 30 minutes. However, simultaneous application of 8-BrcAMP and 8-Br-cGMP failed to increase EPSCs, which suggested antagonistic cross-talk between two second messengers. Application of 3-isobutyl-1-methylxanthine (IBMX) that prevents degradation of cAMP and cGMP by blocking phosphodiesterase (PDE) increased EPSCs. Co-application of cAMP/cGMP along with IBMX induced additional increase in EPSCs. These results suggest that second messengers, cAMP and cGMP, might contribute to development of chronic pain through the mutual regulation of the signal transduction.

Diagnostic Usefulness of CISS Image in Preoperative Evaluation of Trigeminal Neuralgia and Hemifacial Spasm (삼차신경통과 반측안면경련에서 CISS 영상의 진단적 유용성)

  • Lee, Dong Hoon;Lee, Sang Weon;Choi, Chang Hwa
    • Journal of Korean Neurosurgical Society
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    • v.30 no.2
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    • pp.186-193
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    • 2001
  • Objectives : Trigeminal neuralgia and hemifacial spasm are caused by vascular compression of the REZ(root entry or exit zone) of the 5th and the 7th cranial nerve. Preoperative detection of neurovascular compression is essential for accurate diagnosis, appropriate treatment, and the good operative results. Three dimensional Fourier Transformation-Constructive Interference in Steady State(3DFT-CISS) images are known to give good contrast between CSF, nerve, and vessels. We applied a 3DFT-CISS imaging technique for the preoperative evaluation of patients with these diseases and estimated the diagnostic accuracy and usefulness of this study. Methods : A series of 71 patients with trigeminal neuralgia and hemifacial spasm were treated by microvascular decompression. Among them 34 patients with trigeminal neuralgia and 24 patients with hemifacial spasm had preoperative CISS images. We compared the radiologic finding with the operative finding, and analysed the diagnostic usefulness of 3DFT-CISS imaging. Results : The sensitivity of CISS images of detecting the neurovascular compression was 90.3% in trigeminal neuralgia and 100% in hemifacial spasm. There were one false-positive and three false-negative cases in trigeminal neuralgia, and one false-positive case in hemifacial spasm. The accuracy in diagnosing the causative vessel was 73.5% in trigeminal neuralgia and 83.3% in hemifacial spasm. Conclusion : CISS image is very useful diagnostic tool for preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia and hemifacial spasm. No additional neuroradiologic examination other than CISS image and MRA is needed for preoperative evaluation of patients with trigeminal neuralgia and hemifacial spasm.

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Surgical Management Options for Trigeminal Neuralgia

  • Lunsford, L. Dade;Niranjan, Ajay;Kondziolka, Douglas
    • Journal of Korean Neurosurgical Society
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    • v.41 no.6
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    • pp.359-366
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    • 2007
  • Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

Decision of Available Soil Depth Based on Physical and Hydraulic Properties of Soils for Landscape Vegetation in Incheon International Airport

  • Jung, Yeong-Sang;Lee, Hyun-Il;Jung, Mun-Ho;Lee, Jeong-Ho;Kim, Jeong-Tae;Yang, Jae E
    • Korean Journal of Soil Science and Fertilizer
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    • v.48 no.5
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    • pp.522-527
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    • 2015
  • Decision of available soil depth based on soil physical and hydraulic properties for the $3^{rd}$ Landscape Vegetation Project in the Incheon International Airport was attempted. The soil samples were collected from the 8 sites at different depths, 0-20 and 20-60cm, for the three project fields, A, B, and C area. Physical and chemical properties including particle size distribution, organic matter content and electrical conductivity were analyzed. Hydrological properties including bulk density and water holding capacity at different water potential, -6 kPa, -10 kPa, -33 kPa, and -1500 kPa were calculated by SPAW model of Saxton and Rawls (2006), and air entry value was calculated by Campbell model (1985). Based on physical and hydrological limitation, feasibility and design criteria of soil depth for vegetation and landfill were recommended. Since the soil salinity of the soil in area A area was $19.18dS\;m^{-1}$ in top soil and $22.27dS\;m^{-1}$ in deep soil, respectively, landscape vegetation without amendment would not be possible on this area. Available soil depth required for vegetation was 2.51 m that would secure root zone water holding capacity, capillary fringe, and porosity. Available soil depth required for landscape vegetation of the B area soil was 1.51 m including capillary fringe 0.14 m and available depth for 10% porosity 1.35 m. The soils in this area were feasible for landscape vegetation. The soil in area C was feasible for bottom fill purpose only due to low water holding capacity.

Early Therapeutic Effects of Cyberknife Radiosurgery on Trigeminal Neuralgia (삼차신경통에 대한 사이버나이프 방사선수술의 조기 치료 효과)

  • Mun Seong-Kwon;Choi Ihl-Bohng;Kang Young-Nam;Jang Ji-Sun;Kang Ki-Mun;Choi Byung-Ock
    • Radiation Oncology Journal
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    • v.24 no.2
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    • pp.88-95
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    • 2006
  • Purpose: We evaluated whether Cyberknife radiosurgery is an effective and safe method of therapy for medically intractable trigeminal neuralgia (TN). Materials and Methods: We retrospectively analyzed the outcome of 26 patients, who failed to surgery or were not suitable candidates for invasive intervention and were treated by Cyberknife radiosurgery between March 2004 and May 2005. Radiosurgery doses of $60{\sim}64 Gy$ were delivered to the 80% isodose line prescribed to an 6 mm length of the nerve, sparing the most proximal 3 mm away from the trigeminal nerve root entry zone (median dose: 64 Gy). Results: Follow-up period was $3{\sim}15$ months (median follow-up period: 9 months) Preliminary results from a cohort of 26 patients undergoing Cyberknife radiosurgery for TN showed that pain relief was achieved in 50% (13/26) of patients within the first 24 hrs after treatment. At last follow-up, 96.2% (25/26) of patients reported early pain relief within 7 days. Treatment failure developed in 2 of 26. Poor response occurred in one patient and relapse was observed in the other patient. 3 patients had hypoesthesia (11.5%), which was the only complication observed with any of our patients. Conclusion: With these results, authors assumed that Cyberknife radiosurgery for TN could be one of safe and effective therapeutic methods.