• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.99-102
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• 2006

Objective : To document surgical mortality and morbidity for the treatment of unruptured intracranial aneurysms, and to identify optimal treatment modalities, the authors reviewed and analyzed the surgical results. Methods : The authors reviewed 49 cases of unruptured intracranial aneurysm without a previous history of subarachnoid hemorrhage from March 1984 through December 2003. Unruptured intracranial aneurysms were categorized as asymptomatic and symptomatic, and operative results were assessed using the Karnofsky scale at 3 months postoperatively. Outcomes were defined as 'excellent' for a Karnofsky scale score of 100, 'good' for a score of $80{\sim}90$, 'fair' for $50{\sim}70$, 'poor' for $10{\sim}40$, or as 'death'. Excellent and good results were defined as a 'favorable' outcome and others as 'unfavorable' outcome. Results : Of the 49 study subjects, 45 had a favorable outcome and 4 an unfavorable outcome. Surgical mortality was 6.1% and surgical morbidity was 2.0% for all subjects. And the symptomatic group had more complications. Conclusion : There were no significant relationships between aneurysmal size, location, and preoperative symptoms with surgical results. And we believe that the reasons for morbidity and mortality are attributable to strokes, thus more attention should be paid to peri- and post-operative patients care with a focus on strokes prevention in the symptomatic group.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.220-224
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• 2017

Objective : This study aimed to unravel the putative mechanism underlying the neurologic deficits contralateral to the side with lumbar disc herniation (LDH) and to elucidate the treatment for this condition. Methods : From January 2009 to June 2015, 8 patients with LDH with predominantly contralateral neurologic deficits underwent surgical treatment on the side with LDH with or without decompressing the symptomatic side. A retrospective review of charts and radiological records of these 8 patients was performed. The putative mechanisms underlying the associated contralateral neurological deficits, magnetic resonance imaging (MRI), electromyography (EMG), and the adequate surgical approach are discussed here. Results : MRI revealed a similar laterally skewed paramedian disc herniation, with the apex deviated from the symptomatic side rather than directly compressing the nerve root; this condition may generate a contralateral traction force. EMG revealed radiculopathies in both sides of 6 patients and in the herniated side of 2 patients. Based on EMG findings and the existence of suspicious lateral recess stenosis of the symptomatic side, 6 patients underwent bilateral decompression of nerve roots and 2 were subjected to a microscopic discectomy to treat the asymptomatic disc herniation. No specific conditions such as venous congestion, nerve root anomaly or epidural lipomatosis were observed, which may be considered the putative pathomechanism causing the contralateral neurological deficits. The symptoms resolved significantly after surgery. Conclusion : The traction force generated on the contralateral side and lateral recess stenosis, rather than direct compression, may cause the contralateral neurologic deficits observed in LDH.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.767-776
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• 2020

Objective : The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated. Methods : Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom's criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2-7 sagittal vertical axis, cervical cobb angle, and facet violation. Results : Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p<0.05). The proportion of calcified disc and facet violations was significantly larger in group F (p<0.05). The minimal disc height decrease with mild improvement on sagittal alignment and cervical lordosis was radiologically measured without statistical significance in both groups (p>0.05). Conclusion : PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.

• The Korean Journal of Pain
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• v.30 no.1
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• pp.44-50
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• 2017

Background: Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. Methods: This retrospective cohort was carried out in the neurosurgery departments of hospitals in KahramanmaraŞ city and 23 patients diagnosed with LDH at the levels of L3-L4, L4-L5 or L5-S1 were enrolled. Results: The average age was $38.4{\pm}8.0$ and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. $Las{\grave{e}}gue$ tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3-L4, L4-L5, and L5-S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was $13.6{\pm}5.4$ months (range: 5-22). Conclusions: It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery.

• Clinical and Experimental Pediatrics
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• v.60 no.6
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• pp.175-180
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• 2017

Purpose: Plasma level of B-type natriuretic peptide (BNP), an emerging, sensitive, and specific biomarker of hemodynamically significant patent ductus arteriosus (PDA), rapidly decreases in infants receiving cyclooxygenase inhibitors for ductal closure. We investigated the usefulness of serial BNP measurement as a guide for individual identification of early constrictive responses to ibuprofen in preterm infants with symptomatic PDA (sPDA). Methods: Before March 2010, the standard course of pharmacological treatment was initiated with indomethacin (or ibuprofen) and routinely followed by 2 additional doses at intervals of 24 hours. After April 2010, individualized pharmacological treatment was used, starting with the first dose of ibuprofen and withholding additional ibuprofen doses if the BNP concentration was <600 pg/mL and clinical symptoms of PDA improved. Results: The BNP-guided group received significantly fewer doses of ibuprofen than the standard group did during the first course of treatment and the entire study period. The need for further doses of cyclooxygenase inhibitors and for surgical ligation was not significantly different between the 2 groups. No significant differences were seen in clinical outcomes and/or complications related to sPDA and/or pharmacological treatment. Conclusion: Individualized BNP-guided pharmacological treatment may be used clinically to avoid unnecessary doses of cyclooxygenase inhibitors without increasing the ductal closure failure and the short-term morbidity related to sPDA.

• Proceedings of the PSK Conference
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• 2002.10a
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• pp.220-222
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• 2002

The concentration effect relationship (pharmacokinetic pharmacodynamic model, PKPD) of drugs used for Parkinson's disease is complex. The benefits and adverse effects of drug treatment have to be considered in terms of short term and long term effects. Acute effects, observed over hours and days, reflect symptomatic benefit while chronic effects, observed over months and years, also reveal influences on the progress of the disease. (omitted)

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.184-190
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• 2007

Objective : The authors retrospectively analyzed clinical and radiographic features of patients who developed symptomatic adjacent segment degeneration (ASD) that required re-operation. Methods : From 1995 to 2004, among 412 patients who underwent posterior lumbar fusion surgery, the authors experienced twenty-six patients who presented symptomatic ASD. Records of these patients were reviewed to collect clinical data at the first and second operations. Results : The patients were 9 males and 17 females whose mean age was $63.5{\pm}8.7$ years. Among 319 one segment and 102 multi-segment fusions, 16 and 10 patients presented ASD, respectively. Seventeen ASDs were noticed at the cephalad to fusion (65%), eight at the caudad (31%), and one at the cephalad and caudad, simultaneously (4%). All patients underwent decompression surgery. Nine patients underwent additional fusion surgeries to adjacent degenerated segments. In 17 patients who underwent only decompression surgery without fusion, the success rate was 82.4%. In fusion cases. the success rate was observed as 55.5%. There were no statistically significant factors to be related to development of ASD. However, in cases of multi-level fusion surgery, there was a tendency toward increasing ASD. Conclusion : Multi-segment fusion surgery could be associated with a development of ASD. In surgical treatment of symptomatic ASD, selective decompression without fusion may need to be considered as a primary procedure, which could reduce the potential risk of later occurrence of the other adjacent segment disease.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.133-137
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• 2012

Objective : Twist-drill craniostomy (TDC) with closed-system drainage and burr-hole drainage (BHD) with a closed system are effective treatment options for chronic subdural hematoma (CSDH). The aim of this study was to analyze clinical data and surgical results from symptomatic CSDH patients who underwent TDC with closed-system drainage at the pre-coronal point (PCP). Methods : We analyzed data for 134 symptomatic CSDH patients who underwent TDC at the PCP with closed-system drainage. We defined the PCP for TDC to be 1 cm anterior to the coronal suture at the level of superior temporal line. TDC at the PCP with closed-system drainage was selected in patients with CSDH that extended beyond the coronal suture, confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed retrospectively. Results : Of the 134 CSDH patients, 114 (85.1%) showed improved clinical performance and imaging findings after surgery. Catheter failures were seen in two cases (1.4%); the catheters were inserted in the epidural space. Recurrent cases were seen in eight patients (5.6%), and they were improved with a second BHD with a closed-system operation. Conclusion : TDC at the PCP with closed-system drainage is safe and effective for patients with symptomatic CSDH whose hematomas extend beyond the coronal suture.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.193-197
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• 2006

Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was $21.9kg/m^2$ and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI > 25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI > 25).

• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.243-247
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• 2014

Objective : To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. Methods : We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. Results : Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. Conclusion : Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.