• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.270-272
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• 2012

A 31-year-old man was admitted to our hospital due to hydrocephalus with neurosarcoidosis. Ventriculo-peritoneal shunting was performed in the right lateral ventricle with intravenous methylprednisolone. Subsequently, after 4 months, additional ventriculo-peritoneal shunting in the left lateral ventricle was performed due to the enlarged left lateral ventricle and slit-like right lateral ventricle. After 6 months, he was re-admitted due to upward gaze palsy, and magnetic resonance image showed an isolated fourth ventricle with both the inlet and outlet of fourth ventricle obstructed by recurrent neurosarcoidosis. Owing to the difficulty of using an endoscope, we performed neuronavigator-guided ventriculo-peritoneal shunting via the left lateral transcerebellar approach for the treatment of the isolated fourth ventricle with intravenous methyl prednisolone. The patient was discharged with improved neurological status.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.211-216
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• 2008

Objective : The cranioplasty and ventriculoperitoneal (VP) shunt operation have been used to treat a large cranial defect with posttraumatic hydrocephalus (PTH). The aim of this study was to evlauate the difference of outcomes between in the shunting after the cranioplasty (group 1) and the cranioplasty after the shunting (group 2) in a large flaccid cranial defect with PTH. Methods : In this study, a retrospective review was done on 23 patients undergoing the cranioplasty and VP shunt operation after the decompressive craniectomy for a refractory intracranial hypertension from 2002 to 2005. All of 23 cases had a large flaccid concave cranial defect and PTH. Ten cases belong to group 1 and 13 cases to group 2. The outcomes after operations were compared in two groups 6 months later. Results : The improvement of Glasgow outcome scale (GOS) was seen in 8 cases (80.0%) of total 10 cases in group 1, and 6 cases (46.2%) of 13 cases in group 2. Three (75.0%) of 4 cases with hemiparesis in group 1 and 3 of 6 cases (50.0%) in group 2 were improved. All cases (2 cases) with decrease of visual acuity were improved in each group. Dysphasia was improved in 3 of 5 cases (60%) in group 1 and 4 of 6 cases (66.6%) in group 2. Conclusion : These results suggest that outcomes in group 1 may be better than in group 2 for a large flaccid concave cranial defect with PTH.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1103-1106
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• 2000

We have recently experienced a third ventricular tumor from a 63-year old woman who presented with paraparesis, voiding difficulty and general weakness. Histopathologic study of the tumor was compatible with recently reported and newly termed chordoid glioma. Clinical behavior of the reported tumors were mostly benign but because of its very close proximity to the hypothalamus, some of the subtotally removed tumors recurred or some of the patients died of postoperative complications. The presenting patient regained normal leg power after removal of the tumor followed by ventriculoperitoneal shunt and discharged on her own feet.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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• pp.144-146
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• 2012

Parkinsonism secondary to intracranial mass lesions usually results from compression or distortion of the basal ganglia. Secondary parkinsonism due to midbrain infiltration or compression is rare and generally associated with other neurologic signs caused by pyramidal tract and/or cranial nerve involvement. We report a case of 30-year-old woman in whom mild parkinsonism was the major clinical manifestation of an astrocytoma in the anterior third ventricle and hypothalamus. She underwent surgical resection, ventriculoperitoneal shunt and radiation therapy. All symptoms of parkinsonism were completely recovered 3 months after the treatment. Brain tumors can be manifested only by the symptoms of parkinsonism. This case emphasizes the significance of neuroimaging in the evaluation of parkinsonism.

• Journal of Korean Neurosurgical Society
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• 제39권6호
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• pp.438-442
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• 2006

The sylvian aqueduct syndrome is a global rostral midbrain dysfunction induced by a transtentorial pressure gradient through the aquaeductus. Several months after ventriculoperitoneal shunt, a patient with hydrocephalus began experiencing a constellation of midbrain dysfunction symptoms, including bradykinesia, medial longitudinal fasciculus syndrome, third nerve palsy, and mutism. These were indicative of cerebral aqueduct syndrome. In addition, the patient showed posture-dependent underdrainage or overdrainage. All symptoms were resolved after distal catheter elongation and floating cranioplasty. We present a case of reversible parkinsonism, which developed in a patient with shunted hydrocephalus and aqueductal stenosis, and discuss the diagnosis and treatment of the sylvian aqueduct syndrome. We also review the literature to address problems of drainage and potential treatment modalities.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권3호
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• pp.273-278
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) is a safe method to feed patients with feeding difficulty. This study aimed to compare the outcomes of conventional PEG and laparoscopic-assisted PEG (L-PEG) placement in high-risk pediatric patients. Methods: In our tertiary pediatric department, 90 PEG insertions were performed between 2014 and 2019. Children with severe thoracoabdominal deformity (TAD), previous abdominal surgery, ventriculoperitoneal (VP) shunt, and abdominal tumors were considered as high-risk patients. Age, sex, diagnosis, operative time, complications, and mortality were compared among patients who underwent conventional PEG placement (first group) and those who underwent L-PEG placement (second group). Results: We analyzed the outcomes of conventional PEG placement (first group, n=15; patients with severe TAD [n=7], abdominal tumor [n=6], and VP shunts [n=2]) and L-PEG placement (second group, n=10; patients with VP shunts [n=5], previous abdominal surgery [n=4], and severe TAD [n=1]). Regarding minor complications, 1 (6.6%) patient in the first group underwent unplanned PEG removal and 1 (10%) patient in the second group had peristomal granuloma. We observed three major complications: colon perforation (6.6%) in a patient with VP shunt, gastrocolic fistula (6.6%) in a patient with Fallot-tetralogy and severe TAD, and pneumoperitoneum (6.6%) caused by early tube dislodgement in an autistic patient with severe TAD. All the three complications occurred in the first group (20%). No major complications occurred in the second group. Conclusion: In high-risk patients, L-PEG may be safer than conventional PEG. Thus, L-PEG is recommended for high-risk patients.

• Journal of Korean Neurosurgical Society
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• 제51권3호
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• pp.160-163
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• 2012

We report an unusual case of lateral medullary infarction after successful embolization of the vertebral artery dissecting aneurysm (VADA). A 49-year-old man who had no noteworthy previous medical history was admitted to our hospital with a severe headache. Computed tomography (CT) revealed a subarachnoid hemorrhage, located in the basal cistern and posterior fossa. Cerebral angiography showed a VADA, that did not involve the origin of the posterior inferior cerebellar artery (PICA). We treated this aneurysm via endovascular trapping of the vertebral artery distal to the PICA. After operation, CT revealed post-hemorrhagic hydrocephalus, which we resolved with a permanent ventriculoperitoneal shunt procedure. Postoperatively, the patient experienced transient mild hoarsness and dysphagia. Magnetic resonance image (MRI) showed a small infarction in the right side of the medulla. The patient recovered well, though he still had some residual symptom of dysphagia at discharge. Such an event is uncommon but can be a major clinical concern. Further investigation to reveal risk factors and/or causative mechanisms for the medullary infarction after successful endovascular trapping of the VADA are sorely needed, to minimize such a complication.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.645-652
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• 2018

Objective : This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system. Methods : This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed. Results : Of the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p<0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06). Conclusion : Surveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.125-127
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• 2013

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.

• Clinical and Experimental Pediatrics
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• 제50권7호
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• pp.698-701
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• 2007

Cryseobacterium meningosepticum은 흙, 병원, 수돗물을 포함한 물이 있는 환경에서 발견되는 그람 음성 막대균으로, 미숙아, 노인과 같이 면역성이 결여된 인체에 기회감염을 일으키고, 미숙아에서는 패혈증, 뇌수막염과 같은 중증 질환을 유발하여 사망률과 합병증 발생이 높다. 특히, 균주가 병원내 배수관, 기계장비등을 통해 오염되어 신생아실에서 폭발적 유행이 가능하다. 저자들은 미숙아에서 발생한 다항생제 내성 C. meningosepticum에 의한 패혈증, 뇌수막염을 ciprofloxacin으로 치료한 1례와 동기간에 무증상 보균상태를 보였던 1례와 성공적인 환경검사와 조절에 대해서 보고하는 바이다.