• Journal of Biomedical Engineering Research
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• v.42 no.6
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• pp.295-303
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• 2021

Idiopathic normal-pressure hydrocephalus (INPH) is considered a potentially treatable neurological disorder by shunt surgery and characterized by a triad of symptoms including gait disturbance, cognitive impairment and urinary dysfunction. Although disorders of white matter are generally viewed as the principal pathological features of INPH, analysis of cortical features are important since the destruction of neural tracts could be associated with cortical structural changing. The aim of the study was to determine whether there was any relationship between gait parameter and structural features of cerebral cortex in INPH patients. Gait parameters were measured as follows: step width, toe in/out angle, coefficient of variation (CV) value of stride length, CV value of stride time. After obtaining individual brain MRI of patients with INPH and hemispheric cortical surfaces were automatically extracted from each MR volume, which reconstructed the inner and outer cortical surface. Then, cortical thickness, surface area, and volume were calculated from the cortical surface. As a result, step width was positively correlated with bilateral postcentral gyrus and left precentral gyrus, and toe in/out was positively correlated with left posterior parietal cortex and left insula. Also, the CV value of stride length showed positive correlation in the right superior frontal sulcus, left insula, and the CV value of stride time showed positive correlation in the right superior frontal sulcus. Unique parameter of cerebral cortical changes, as measured using MRI, might underline impairments in distinct gait parameters in patients with INPH.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.272-275
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• 2012

Objective : Choroid plexus papillomas (CPPs) are generally regarded as benign tumors with typical radiologic and pathologic findings. However, they sometimes have unusual findings. We have analyzed radiologic findings and pathologic growth patterns on CPPs. Methods : The study group included 5 male and 5 female patients (age range, 3 months to 58 years : median, 29 years). The study group included 3 pediatric and 7 adult patients. All patients underwent surgery; 9 patients had a gross total resection and 1 patient had a subtotal resection. We analyzed the radiologic findings (location, size, mottle-like appearance, enhancement, calcifications, and hydrocephalus) and pathologic growth patterns (typical papillary, papillary and solid, and papillary and tubular). Results : The median follow-up duration was 21.3 months (range, 4-47.8 months). There were no recurrences after initial treatment. All patients had benign CPPs. Pediatric CPPs were 3.2 cm masses (range, 2.7-4 cm) with homogeneous enhancement and a mottle-like appearance, which pathologically showed the papillary growth pattern. Hydrocephalus was present in all pediatric patients. Postoperatively, subdural hygroma had occurred in two patients. In adults, CPPs were located in the fourth ventricle in 6 patients and suprasellar area in 1 patient. The size varied from 0.5-4.2 cm. Hydrocephalus and calcifications occurred in 3 and 4 patients, respectively. Three patients showed the heterogeneous enhancement without a mottle-like appearance and pathologically showed combined papillary and solid growth in 2 patients and papillary and tubular growth in one. Postoperatively, two patients with large masses had injuries of the brainstem and underwent shunt procedures for aggravation of hydrocephalus. Conclusion : CPPs may show unusual radiologic findings, which preoperatively give the difficulty to be differentiated from other tumors. CPPs with unusual radiologic findings showed the combined pathologic growth patterns.

• Phonetics and Speech Sciences
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• v.16 no.1
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• pp.57-65
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• 2024

Normal pressure hydrocephalus (NPH) is a condition wherein the cerebrospinal pressure in the brain is within the normal range, but the cerebrospinal fluid increases above the normal level, causing ventriculomegaly. In patients with NPH, the articulatory system exhibits reduced mobility and range, which may affect diadochokinesis (DDK) and speech intelligibility. In this study, we investigated the characteristics of DDK, including accurate-token DDK and all-token DDK including inaccurate tokens, in patients with NPH and healthy elderly adults (HE). We also examined the classification accuracy of DDK between the two groups. Finally, we investigated whether there was a correlation between speech intelligibility and DDKs in the NPH group. The results showed that NPH and HE groups differed significantly in both accurate-token DDK and all-token DDK, and their classification accuracy was relatively high. However, there was no correlation between speech intelligibility and DDK. The findings suggest that the DDK is a useful method for sensitively assessing speech motor performance in patients with NPH.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.981-984
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• 2001

Object : To treat hydrocephalus by ventriculo-peritoneal shunt operation, the correct positioning of the proximal catheter in the ventricle is very important. The purpose of this study was to develop the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle in the ventriculo-peritoneal shunt operation. Materials and Methods: The "shunt guiding kit" is made of tungsten alloy and it consists of one frame, two screws and one guider. Through the guider, the proximal shunt catheter operates by mechanically coupling the posterior burr hole to the anterior target point. Results: We have treated three hydrocephalus patients with use of the "shunt guiding kit", and achieved good location of proximal shunt catheters. Conclusion: We developed the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle, and this would be very useful for preventing ventriculo-peritoneal shunt malfunction and preventing possible brain injury during the procedures.

• Journal of Korean Neurosurgical Society
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• v.29 no.7
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• pp.968-972
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• 2000

Post-shunting subdural hemorrhages are usually small and self-limited, and they can be recognized on the routine post-operative CT examinations. However, delayed subdural bleeding may occur without any clinical symptoms or signs. Thus the hematoma remains undetected, and it can be increased in size and sometimes become calcified with time. We experienced a case of 15-year-old male with a large calcified subdural hematoma who had undergone shunt operation 10 years previously. With pertinent review of the literatures, we discuss the possible mechanism of calcification and the proper way of treatment in calcified chronic subdural hematoma.

• Clinical and Experimental Pediatrics
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• v.53 no.5
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• pp.653-656
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• 2010

$Listeria$ $monocytogenes$ is a facultative anaerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria occurs predominantly in the elderly, immunocompromised patients, pregnant women and newborns. Infections by this microorganism are rare in healthy infants and children. $L.$ $monocytogenes$ may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscesses in children. The course of meningoencephalitis by listeria is often severe and even fatal. Acute hydrocephalus can develop as a complication and the mortality associated with listeriosis is significantly high. We present a case of meningoencephalitis caused by $L.$ $monocytogenes$ in a previously healthy 7-year-old girl.

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.375-379
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• 2010

The Chiari 1.5 malformation is defined as a tonsillar hemiation within a Chiari I malformation with additional caudal descent of the brainstem through the foramen magnum. We describe a patient with Chiari I malformation who evolved to Chiari 1.5 malformation during longitudinal follow-up. A 15-year-old girl presented with neck pain during exercise for two years. She had been diagnosed with Chiari I malformation with mild hydrocephalus after minor cervical trauma at the age of six years. At that time, she was asymptomatic. After she complained of aggravated neck pain, neuroimaging (nine years after first imaging) revealed caudal descent of the brainstem and syringomyelia in addition to progression of tonsillar hemiation. Posterior fossa decompressive surgery resulted in complete resolution of neck pain. Based on neuroimaging and operative findings, she was diagnosed as Chiari 1.5 malformation. Neuroimaging performed seven months after surgery showed an increased anterior-posterior diameter of the medulla oblongata and markedly decreased syringomyelia. This case demonstrates progressive developmental process of the Chiari 1.5 malformation as an advanced form of the Chiari I malformation.

• Clinical and Experimental Pediatrics
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• v.57 no.6
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• pp.251-256
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• 2014

Severe intraventricular hemorrhaging (IVH) in premature infants and subsequent posthemorrhagic hydrocephalus (PHH) causes significant mortality and life-long neurological complications, including seizures, cerebral palsy, and developmental retardation. However, there are currently no effective therapies for neonatal IVH. The pathogenesis of PHH has been mainly explained by inflammation within the subarachnoid spaces due to the hemolysis of extravasated blood after IVH. Obliterative arachnoiditis, induced by inflammatory responses, impairs cerebrospinal fluid (CSF) resorption and subsequently leads to the development of PHH with ensuing brain damage. Increasing evidence has demonstrated potent immunomodulating abilities of mesenchymal stem cells (MSCs) in various brain injury models. Recent reports of MSC transplantation in an IVH model of newborn rats demonstrated that intraventricular transplantation of MSCs downregulated the inflammatory cytokines in CSF and attenuated progressive PHH. In addition, MSC transplantation mitigated the brain damages that ensue after IVH and PHH, including reactive gliosis, cell death, delayed myelination, and impaired behavioral functions. These findings suggest that MSCs are promising therapeutic agents for neuroprotection in preterm infants with severe IVH.

• Journal of Biomedical Engineering Research
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• v.26 no.4
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• pp.193-197
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• 2005

Shunt valves used to treat patients with hydrocephalus were tested to investigate influence of intracranial pressure pulsation on their flow control characteristics. Five commercial shunt valves were tested in the flow loop that simulates pulsed flow under pressure pulsation. As 20cc/hr of flow rate was adjusted at a constant pressure, application of $40mmH_2O$ of pressure pulse increased the flow rate by $67.9\%.$ As a 90cm length catheter was connected to the valve outlet, increase in the flow rate was substantially reduced to $17.5\%.$ As the flow rate was adjusted to 40cc/hr at a constant pressure, increase in the flow rate was $51.1\%$ with the same pressure pulsation of $40mmH_2O$. The results indicated that pressure-flow control characteristics of shunt valves implanted above human brain ventricle is quite different from those obtained by syringe pump test at constant pressures right after manufacture. The influence of pressure pulsation was observed to be more significant at low flow rate and the flexibility of the outlet silicone catheter was estimated to significantly reduce flow increase due to pressure pulsation.

• Molecules and Cells
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• v.38 no.5
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• pp.426-431
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• 2015

Odin has been implicated in the downstream signaling pathway of receptor tyrosine kinases, such as the epidermal growth factor and Eph receptors. However, the physiologically relevant function of Odin needs to be further determined. In this study, we used Odin heterozygous mice to analyze the Odin expression pattern; the targeted allele contained a ${\beta}$-geo gene trap vector inserted into the 14t intron of the Odin gene. Interestingly, we found that Odin was exclusively expressed in ependymal cells along the brain ventricles. In particular, Odin was highly expressed in the subcommissural organ, a small ependymal glandular tissue. However, we did not observe any morphological abnormalities in the brain ventricles or ependymal cells of Odin null-mutant mice. We also generated BAC transgenic mice that expressed the PTB-deleted Odin (dPTB) after a floxed GFP-STOP cassette was excised by tissue-specific Cre expression. Strikingly, Odin-dPTB expression played a causative role in the development of the hydrocephalic phenotype, primarily in the midbrain. In addition, Odin-dPTB expression disrupted proper development of the subcommissural organ and interfered with ependymal cell maturation in the cerebral aqueduct. Taken together, our findings strongly suggest that Odin plays a role in the differentiation of ependymal cells during early postnatal brain development.