• Journal of Korean Neurosurgical Society
• /
• v.60 no.2
• /
• pp.257-261
• /
• 2017

Objective : This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique's usefulness and limitations. Methods : Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. Results : The mean follow-up period was 25 months (range, 3-58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. Conclusion : One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.4
• /
• pp.467-475
• /
• 2019

Objective : There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2. Methods : Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3-6 months of life expectancy, Tomita score ${\geq}5$, and Spinal Instability Neoplastic Score ${\geq}7$ were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009). Results : The MIS group had a significantly shorter operative time ($94.2{\pm}48.2minutes$ vs. $162.9{\pm}52.3minutes$, p=0.001), less blood loss ($140.0{\pm}182.9mL$ vs. $1534.4{\pm}1484.2mL$, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group ($3.0{\pm}1.2$ vs. $4.3{\pm}1.2$, p=0.042). The MIS group had longer ambulation time ($183{\pm}33days$ vs. $166{\pm}36days$) and survival time ($216{\pm}38days$ vs. $204{\pm}43days$) than the open surgery group without significant difference (p=0.814 and 0.959, respectively). Conclusion : MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.

• Journal of Korean Foot and Ankle Society
• /
• v.27 no.4
• /
• pp.137-143
• /
• 2023

Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.

• Journal of the Korean Society of Radiology
• /
• v.84 no.4
• /
• pp.809-823
• /
• 2023

Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes caused by forces acting from outside the body. The number of patients with trauma is increasing as our society becomes more sophisticated. The importance and demand of traumatology are growing due to the development and spread of treatment and diagnostic technologies. In particular, damage to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe; therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to nonaortic vessels of the thorax and aorta results in varying degrees of physical damage depending on the mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can often improve the prognosis. The treatment of trauma can be surgical or interventional, depending on the patient's condition. Among them, interventional procedures are increasingly gaining popularity owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries. These procedures have many advantages over surgical treatments, such as fewer internal or surgical side effects, and can be performed more quickly than surgical procedures, contributing to improved outcomes for patients with trauma.

• Korean Journal of Cleft Lip And Palate
• /
• v.2 no.1_2
• /
• pp.15-22
• /
• 1999

It is well known that the postoperative skeletal instability after Le Fort I osteotomy for advancement of maxilla in the cleft patients is one of the major surgical problems. So we had tried to compare the amount of relapse after Le Fort I advancement surgery in the horizontal and vertical positional change, angular change of reference points between cleft patients and non-cleft patients. Longitudinal records of 10 consecutive cleft patients (test group) and 20 non-cleft patients (control group) were analyzed. Lateral cephalograms were taken preoperatively, immediately postoperatively, and 2, 6, 12 months postoperatively. We measured horizontal and vertical changes (ANS, PNS, AI) and angular change (SNA) of the reference points and lines. In the test group, horizontal relapse of ANS, PNS, AI point are 36.4%, 37.5%, 32.0% respectively at 12 months postoperatively. The vertical relapse of ANS, PNS, AI are 25.3%, 32.3%, 39.1% respectively at 12 months postoperatively. The angular change of SNA is 33.6% at 12 months postoperatively. In the control group, horizontal relapse of ANS, PNS, AI point are 23.8%, 30.2%, 21.7% respectively at 12 months postoperatively. The vertical relapse of ANS, PNS, AI are 22.7%, 27.3%, 25.1% respectively at 12 months postoperatively. The angular change of SNA is 22.2% at 12 months postoperatively. The cleft patients have a larger tendency of skeletal and dental relapse compared with non-cleft patients after Le Fort I surgery. So the oral and maxillofacial surgeons must keep in mind these facts in order to minimize the relapse phenomenon from the beginning of surgical planning to postoperative care.

• Journal of Korean Neurosurgical Society
• /
• v.41 no.2
• /
• pp.111-117
• /
• 2007

Objective : The objective of this study was to validate the effects of a titanium mesh cage and dynamic plating in anterior cervical stabilization after corpectomy. Methods : A retrospective study was performed on 31 consecutive patients, who underwent anterior cervical reconstruction with a titanium mesh cage and dynamic plating, from March 2004 to February 2006. Twenty-four patients had 1-level and 7 had 2-level corpectomies. Ten patients underwent surgery with a cage of 10-mm diameter and 21 with 13-mm diameter. Neurological status and outcomes were assessed according to Odom's criteria. Sagittal angle, coronal angle, settling ratio, sagittal displacement, and cervical lordosis were used to evaluate the radiological outcomes. Results : In overall, 26 [83.9%] of 31 showed excellent or good outcomes. Thirteen percent [4 cases] of the patients developed surgical complications, such as hoarseness, transient dysphagia, or nerve root palsy. Seven [22.6%] patients had reconstruction failure:5 [20.8%] in the 1-level corpectomy group and 2 [28.5%] in the 2-level corpectomy group. Revisions were required in 2 patients with plate pullout due to significant instability. However, none of 5 patients who demonstrated cage displacement or screw pullout, underwent a revision. Radiographs revealed bony consolidation in 96.3% of the patients, including 6 patients with implantation failure during the follow-up period. Conclusion : Based on our preliminary results, the titanium mesh cage and dynamic plating was effective for cervical reconstruction after corpectomy. The anterior cervical reconstruction performed with dynamic plates is considered to reduce stress shielding and greater graft compression that is afforded by the unique plate design.

• Clinics in Shoulder and Elbow
• /
• v.20 no.4
• /
• pp.230-235
• /
• 2017

Background: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. Methods: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. Results: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. Conclusions: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.2
• /
• pp.108-113
• /
• 2014

Objective : Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods : Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. Results : A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. Conclusions : Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.5
• /
• pp.366-369
• /
• 2006

Objective : There are various surgical approaches to far-lateral lesions in the L5-S1 intervertebral space. Of these is the validity of a paramedian tangential approach is being investigated in this study. Methods : A retrospective study was conducted on 25 patients who had been diagnosed as having a far-lateral L5-S1 disc herniations, osteophyte, costal process hypertrophy, and had undergone a paramedian tangential approach from November 1999 through December 2003. The degree of symptoms and improvement were compared via the visual analog pain scale, before and after surgery. Results : This study included 4 males and 21 females with a mean age of $62{\pm}11.8$ years old. The average follow-up period after surgery was $8.2{\pm}2.7$ months. The visual analog pain scale taken before surgery was $6.7{\pm}1.1$ points, while the post-surgical scale was $2.4{\pm}0.9$ points showing a significant degrease [p < 005]. There were no complications that developed during surgery. Conclusion : A paramedian tangential approach is less invasive in the soft tissue than that of the median approach. This approach may effectively reduce nerve root compression and expand intervertebral foramens, and is devoid of the risk of spinal instability after surgery. The authors suppose that a paramedian tangential approach is quite an effective technique to relive compression in the far-lateral L5-S1 intervertebral space.

• Journal of Korean Neurosurgical Society
• /
• v.60 no.6
• /
• pp.738-748
• /
• 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.