• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.340-345
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• 2009

Objective : We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. Methods : A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. Results : Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. Conclusion : The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.20 no.1
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• pp.9-14
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• 2014

Background: Cervical radiculopathy is the result of cervical nerve root pathology that may lead to chronic pain and disability. Although manual therapy interventions including cervical traction and neural mobilization have been advocated to decrease pain and disability caused by cervical radiculopathy, their analgesic effect has been questioned due to the low quality of research evidence. The purpose of this paper is to present the effect of manual therapy on pain, ROM, disability in a patient experiencing cervical radiculopathy. Methods: In this study, 30 participants who met the diagnostic criteria for cervical radiculopathy were randomized into two groups: group I (nerve mobilization group) & group II (Mckenzie exercise group). The experimental group was performed manual cervical traction and neural mobilization technique. The control group was performed manual cervical traction and cervical retraction, extension exercise. Assessments were performed to 30 participants before and after 4 weeks therapy. The components of assessments were pain intensity (PI), cervical rotation ROM (CR) and neck disability index (NDI). Results: After 4 weeks therapy, PI, CR and NDI were significantly reduced in both groups (p<.01). The PI, CR and NDI were no significantly reduced between group I and group II (p>.01). Conclusions: Manual therapy could reduce the symptoms of cervical radiculotpathy.

• 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.

• Journal of Yeungnam Medical Science
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• v.26 no.1
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• pp.74-77
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• 2009

There are debates about whether peripherally induced movement disorders exist. We report a case of upper limb tremor induced by peripheral nerve injury. A 20-year-old male patient presented with pain and tremor of the left upper extremity, 2 days after a car accident. Magnetic resonance images of the brain and cervical spine were normal. His past medical history was unremarkable and there were no family members with symptoms of movement disorders. He suffered from an aggravating tremor for about 10 minutes, four to six times a day. We treated the patient with medication, epidural infusion, cervical nerve root block and trigger point injection of the trapezius muscle. The pain subsided 50% and the incidence of tremor attacks was reduced to once or twice a day. The role of peripheral trauma in the genesis of movement disorders has not been generally accepted. It is unclear whether peripheral trauma can induce dystonia and other movement disorders. It has been proposed that peripheral trauma can alter sensory input and induce cortical and subcortical reorganization that generates a movement disorder. Some studies provide evidence for central reorganization following peripheral injury.

• The Journal of Korean Obstetrics and Gynecology
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• v.25 no.4
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• pp.56-65
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• 2012

Purpose: This study aims to analyze Heart Rate Variability(HRV) in women with fibroadenoma compared with non-fibroadenoma women. Methods: We studied 82 patients visiting Kang-Nam Kyung-Hee Korean Hospital Medical Examination Center from January, 2010 to November, 2011. The subjects were categorized in two groups, fibroadenoma group(n=16) and non-fibroadenoma group (n=66). We investigated the difference of HRV between two groups. Results: The square root of the mean squared difference of successive NNs (RMSSD) in fibroadenoma group is significantly lower than non-fibroadenoma group. LF/HF ratio in fibroadenoma group is significantly higher than non-fibroadenoma group. There was no significant difference in low frequency(LF) and high frequency (HF). However, normalized LF in fibroadenoma group is significantly higher than non-fibroadenoma group. In addition, normalized HF in fibroadenoma group is significantly lower than non-fibroadenoma group. Conclusions: Fibroadenoma group is related to autonomic nerve imbalances that is assumed by psychological problems.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.479-488
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• 2022

Objective : The surgical management of trigeminal neuralgia (TN) caused by petrous apex meningioma (PAM) is still a challenge because of the lesion's deep location and the surrounding complex structures. The authors describe the intradural anterior transpetrosal approach (ATPA) and its effect on the treatment of TN secondary to PAM. Methods : A retrospective analysis of 15 patients with TN secondary to PAM who underwent surgery via the intradural ATPA was conducted. The key techniques, which included drilling off the petrosal apex (PA) and opening the upper wall of Meckel's cave (MC), are described in detail. Results : Total removal of the tumor and complete pain relief (Barrow Neurological Institute I) were achieved in all 15 patients without significant morbidity. Five patients developed new facial numbness postoperatively, which disappeared within three months after surgery. The postoperative magnetic resonance imaging showed temporal lobe swelling in three patients, but no clinical symptoms. One patient had cerebrospinal fluid leakage and was managed with bed rest and temporary lumbar drainage. One patient had an intracranial infection and was treated with antibiotics. By the last follow up, no patients had pain relapse or/and tumor recurrence. It is worth noting that the vascular compression at the root of the trigeminal nerve was found in one patient during the operation. Conclusion : Our experience suggests that drilling off the PA and opening the upper wall of the MC are key elements for a good outcome of the treatment of TN secondary to PAM. The intradural ATPA has the advantages for both tumor resection and pain relief.

• The Korean Journal of Pain
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• v.37 no.4
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• pp.320-331
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• 2024

Background: MicroRNA (miRNA) plays a crucial role in neuropathic pain (NP) by targeting mRNAs. This study aims to analyze the regulatory function and mechanism of miR-382-5p/dual specificity phosphatase-1 (DUSP1) axis in NP. Methods: We utilized rats with chronic constriction injury (CCI) of the sciatic nerve as the NP model. The levels of miR-382-5p and DUSP1 were reduced by intrathecal injection of lentiviral interference vectors targeting miR-382-5p and DUSP1. The mRNA levels of miR-382-5p and DUSP1 in the dorsal root ganglions (DRGs) were measured by RT-qPCR assay. The pain behavior was evaluated by mechanical nociceptive sensitivity and thermal nociceptive sensitivity. The expression levels of interleukin-6 (IL)-6, IL-1β, and tumor necrosis factor-α in the DRGs were analyzed by ELISA assay. The targeting relationship between miR-382-5p and DUSP1 was verified by DLR assay and RIP assay. Results: Compared to the Sham group, the CCI rats exhibited higher levels of miR-382-5p and lower levels of DUSP1. Overexpression of miR-382-5p significantly decreased DUSP1 levels. Reducing miR-382-5p levels can lower the mechanical nociceptive sensitivity and thermal nociceptive sensitivity of CCI rats and inhibit the over-activation of pro-inflammatory factors. Reduced miR-382-5p levels decreased NP in CCI rats. DUSP1 is the target of miR-382-5p, and down-regulation of DUSP1 reverses the inhibitory effect of reduced miR-382-5p levels on NP. Conclusions: Down-regulation of miR-382-5p inhibits the over-activation of pro-inflammatory factors by targeting and regulating the expression of DUPS1, thereby alleviating NP.

• The Korean Journal of Pain
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• v.27 no.4
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• pp.353-359
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• 2014

Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.180-184
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• 2018

Study Design: Case report Objectives: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). Summary of Literature Review: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. Materials and Methods: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. Results: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. Conclusions: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

• Imaging Science in Dentistry
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• v.38 no.3
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• pp.169-176
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• 2008

Purpose : To assess the diagnostic accuracy and value in an imaging technique field through the comparison of cone beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Materials and Methods : Participants consisted of 100 patients offered the images through cone beam computed tomography and panoramic radiography. PSR-$9000^{TM}$ Dental CT system (Asahi Roentgen Ind. Co., Ltd, Japan) was used as the unit of cone beam computed tomography. CE-II (Asahi Roentgen Ind. Co., Ltd, Japan) and Pro Max (Planmeca Oy, Finland) were used as the unit of panoramic radiography. The images obtained through panoramic radiography were classified into 3 types according to the distance between mandibular canal and root of mandibular third molar. And they were classified into 4 types according to the proximity of radiographic feature. The images obtained through cone beam computed tomography based on the classification above were classified into 4 types according to the location between the mandibular canal and the root and were analyzed. And they were classified into buccal, inferior, lingual, and between roots, according to the location between mandibular canal and root. The data were statistically analyzed and estimated by $X^2$-test. Results : 1. There was no statistical significance according to 3 types (type I, type II, type III) through CBCT. 2. The results of 4 types (type A, type B, type C, type D) through CBCT were as high prevalence of CBCT 1 in type A, CBCT 2 in type B, CBCT 3 in type C, and CBCT1 in type D and those of which showed statistical significance (P value=0.03). 3. The results according to location between mandibular canal and root through CBCT recorded each 49, 25, 17, 9 as buccal, inferior, lingual, between roots. Conclusion : When estimating the mandibular canal and the roots through the panoramic radiography, it could be difficult to drive the views of which this estimation was considerable. Thus it is required to have an accurate diagnostic approaching through CBCT that could estimate the location between mandibular canal and roots.