• Journal of Korean Neurosurgical Society
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• 제64권3호
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• pp.427-436
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• 2021

Objective : The fate of partially thrombosed intracranial aneurysms (PTIAs) is not well known after endovascular treatment. The authors aimed to analyze the treatment outcomes of PTIAs. Methods : We retrospectively reviewed the medical records of 27 PTIAs treated with endovascular intervention between January 1999 and March 2018. Twenty-one aneurysms were treated with intraluminal embolization (ILE), and six were treated with parent artery occlusion (PAO) with or without bypass surgery. Radiological results, clinical outcomes and risk factors for major recurrence were assessed. Results : The initial clinical status was similar in both groups; however, the last status was better in the ILE group than in the PAO group (p=0.049). Neurological deterioration resulted from mass effect in one case and rupture in one after ILE, and mass effect in two and perforator infarction in one after PAO. Twenty cases (94.2%) in the ILE group initially achieved complete occlusion or residual neck status. However, 13 cases (61.9%) showed major recurrence, the major causes of which included coil migration or compaction. Seven cases (33.3%) ultimately achieved residual sac status after repeat treatment. In the PAO group, all initially showed complete occlusion or a residual neck, and just one case ultimately had a residual sac. Two cases showed major recurrence, the cause of which was incomplete PAO. Aneurysm wall calcification was the only significantly protective factor against major recurrence (odds ratio, 36.12; 95% confidence interval, 1.85 to 705.18; p=0.018). Conclusion : Complete PAO of PTIAs is the best option if treatment-related complications can be minimized. Simple fluoroscopy is a useful imaging modality because of the recurrence pattern.

• Journal of Korean Neurosurgical Society
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• 제62권3호
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• pp.353-360
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• 2019

Epilepsy surgery that eliminates the epileptogenic focus or disconnects the epileptic network has the potential to significantly improve seizure control in patients with medically intractable epilepsy. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been an established option for epilepsy surgery since the US Food and Drug Administration cleared the use of MRgLITT in neurosurgery in 2007. MRgLITT is an ablative stereotactic procedure utilizing heat that is converted from laser energy, and the temperature of the tissue is monitored in real-time by MR thermography. Real-time quantitative thermal monitoring enables titration of laser energy for cellular injury, and it also estimates the extent of tissue damage. MRgLITT is applicable for lesion ablation in cases that the epileptogenic foci are localized and/or deep-seated such as in the mesial temporal lobe epilepsy and hypothalamic hamartoma. Seizure-free outcomes after MRgLITT are comparable to those of open surgery in well-selected patients such as those with mesial temporal sclerosis. Particularly in patients with hypothalamic hamartoma. In addition, MRgLITT can also be applied to ablate multiple discrete lesions of focal cortical dysplasia and tuberous sclerosis complex without the need for multiple craniotomies, as well as disconnection surgery such as corpus callosotomy. Careful planning of the target, the optimal trajectory of the laser probe, and the appropriate parameters for energy delivery are paramount to improve the seizure outcome and to reduce the complication caused by the thermal damage to the surrounding critical structures.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.27-34
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• 2019

Objective : Stent-assisted coil embolization of intracranial wide-necked aneurysm requires long-term postoperative antiplatelet therapy to prevent in-stent thrombosis. This study aimed to demonstrate results of temporary stent placement for coiling wide necked small intracranial aneurysms, which eliminated need for antiplatelet agents, and to discuss its feasibility and safety. Methods : Data of 156 patients who underwent stent-assisted coil embolization between 2011 and 2014 were retrospectively analyzed. Thirteen cases of temporary stent-assisted coil embolization were included, and their clinical and radiological results were evaluated. Results : The aneurysms treated were all unruptured except one case. All of them had wide neck with mean dome-to-neck ratio of 0.96 and were small-sized aneurysms with mean maximal diameter of 4.2 mm. There was no technical failure in retrieval of stent after completion of embolization of the target aneurysm. Immediate angiography revealed 11 complete and two partial embolization (one residual neck and one residual aneurysm). Two cases encountered thrombosis complication, and they were managed without neurological sequelae. The mean follow-up period was 43 months, angiographic follow-up revealed two cases with minor recurrence, and clinical outcome was good with modified Rankin scale score of 0. Conclusion : Temporary stent-assisted coil embolization of small wide-necked intracranial aneurysm using fully retrievable stent appears safe and effective. Further application and evaluation of this technique in more cases with larger size aneurysm is warranted.

• 대한의료기공학회지
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• 제20권1호
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• pp.68-84
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• 2020

Objective : The purpose of this study is to suggest the evidence of traditional Korean medicine by analyzing the clinical research trends of the Korean Academy of Medical Gi-Gong and to use it as reference data for future clinical studies. Methods : The clinical studies published in the Journal of the Korean Academy of Medical Gi-Gong from 2011 to 2019 were reviewed and the study design, yearly trends, patient's disease, therapeutic intervention, and outcome measure were analyzed. Results : Of the 24 clinical studies, there are 13 Case Reports, 9 Case Series Researches, and 2 Case-Control Studies. In terms of disease group, Musculoskeletal Diseases and female Diseases were the most common, followed by neurological Diseases, dermatological Diseases, and rare Diseases. In terms of treatment methods, acupuncture, herbal medicine, and Sugi therapy were mainly used. And cupping, thermotherapy, and Korean medical exercise therapy were used as a supplement. As an evaluation tool, clinical symptom change was the most common, followed by DITI, VAS, survey, and X-ray. In most reports, Korean medical treatment has been effective in treating diseases. Conclusions : More clinical studies including controlled clinical trials should be conducted to provide a basis for verifying the effectiveness of Korean medicine.

• Journal of Korean Neurosurgical Society
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• 제65권3호
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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.

• PNF and Movement
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• 제21권3호
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• pp.387-401
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• 2023

Purpose: The purpose of this study was to develop a Korean version of the Falls Efficacy Scale (K-FES), which is used to measure the fear of falling, that is conceptually equivalent to the original and culturally adaptable to the Korean population. Methods: A five-step translation and adaptation process was employed to create the K-FES, adhering to the established guidelines for cross-cultural rehabilitation outcome measures. The content validity was then evaluated by 22 rehabilitation professionals (15 males and 7 females) with an average clinical experience of 201 months at neurological rehabilitation centers. The content validity ratio and index were used as a basis for judgment. Results: The translation process identified inconsistencies with the terms "objects" and "telephone" in the original Falls Efficacy Scale, which were subsequently resolved in the final K-FES version. The content validity ratios for the original, second, and third versions of the K-FES ranged from -0.27-0.91, -0.27-0.91, and -0.27-0.91, respectively. Correspondingly, the content validity index values for the original, second, and third versions of the K-FES ranged from 0.77-1.00, 0.68-1.00, and 0.63-1.00, respectively. Conclusions: The K-FES was rigorously developed through translation, adaptation, and validation processes, making it a reliable tool for Korean stroke rehabilitation professionals. It is expected to be instrumental in clinical and research settings to assess postural stability and fall risk in patients with strokes and brain injuries.

• Physical Therapy Rehabilitation Science
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• 제13권1호
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• pp.86-94
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• 2024

Objective: To evaluate the changes in bladder capacity and storage through non-invasive neuromodulation by application of repetitive Trans magnetic stimulation (rTMS) and genital nerve stimulation (GNS) in traumatic spinal cord survivors. Design: A Single Case Study. Method: The Patient was registered in trail with the clinical trial registry of India (CTRI/2022/05/042431). The Patient was interposed with rTMS on lumbar area, from T11-L4 vertebrae with 1 Hz and the intensity was 20% below that elicited local paraspinal muscular contraction for 13 minutes. GNS was placed over dorsum of the penis with the cathode at the base and anode 2 cm distally at 20 Hz, 200 microseconds, Continuous and biphasic current was delivered and amplitude of stimulation necessary to elicit the genito-anal reflex. For assessment, Neurological examination was done for peri-anal sensation (PAS), voluntary anal contraction (VAC) and bulbocavernous reflex (BCR), deep anal pressure (DAP), and American Spinal Injury Association Impairment Scale (ASIA scale). Outcome assessment was done using Urodynamics, Spinal Cord Independence Measure Scale Version-III (SCIM-III), American Spinal Injury Association Impairment Score (ASIA Score), Beck's Depression Inventory Scale (BDI). The baseline evaluation was taken on Day 0 and on Day 30. Results: The pre-and post-data were collected through ASIA score, SCIM-III, BDI and Urodynamics test which showed significant improvement in bladder capacity and storage outcomes in the urodynamics study across the span of 4 weeks. Conclusion: rTMS along with GNS showed improvement in bladder capacity & storage, on sensory-motor score, in functional independence of individual after SCI.

• Hip & pelvis
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• 제35권4호
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• pp.268-276
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• 2023

Purpose: Resection remains the most reliable treatment for established heterotopic ossification, despite questions regarding its effectiveness due to the potential for complications. This study evaluated the clinical outcomes and complications of neurogenic heterotopic ossification (NHO) resection in stroke patients' ankylosed hips. Materials and Methods: We retrospectively analyzed nine hip NHO resections performed on seven patients from 2010 to 2018. The pre- and postoperative range of motion of the operated hip were compared. Analysis of postoperative complications, including infection, recurrence, iatrogenic fracture, and neurovascular injury was performed. Results: The mean operative time was 132.78±21.08 minutes, with a mean hemoglobin drop of 3.06±0.82 g/dL within the first postoperative week. The mean duration of postoperative follow-up was 52.08±28.72 months for all patients. Postoperative range of motion showed improvement from preoperative. Flexion and external rotation (mean, 58.89±30.60° and 16.67±18.03°, respectively) showed the greatest gain of motion of the operated hip joint. Postoperative infections resolved in two cases through surgical debridement, and one case required conversion to total hip arthroplasty due to instability. There were no recurrences, iatrogenic fractures, or neurovascular injuries. Conclusion: Resection is a beneficial intervention for restoring the functional range of motion of the hip in order to improve the quality of life for patients with NHO and neurological disorders. We recommend performance of a minimal resection to achieve a targeted functional arc of motion in order to minimize the risk of postoperative complications.

• 한국간담췌외과학회지
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• 제26권3호
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• pp.270-276
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• 2022

Backgrounds/Aims: Thoracic epidural analgesia (TEA) is an established analgesic method in open Kausch-Whipple pancreaticoduodenectomy (KWPD). Although, it can cause hemodynamic instability and neurological complications. Inter pleural analgesia (IPA) is an alternative option. We aim to evaluate the effectiveness of IPA versus TEA after KWPD. Methods: We retrospectively studied the efficacy of IPA against TEA in patients, operated by a single surgeon. The primary outcome was the analgesic efficacy and secondary outcomes were analgesia-related complications, inotrope use, and duration. Results: Forty patients (TEA, 22; IPA, 18) were included. Both groups were well matched for patient characteristics, type, and duration of surgery. TEA was associated with higher analgesia-related complications (n = 8, 36.4% vs. n = 1, 5.6%; p = 0.027). TEA complications included analgesia not working (n = 4), leakage (n = 2), refractory hemodynamic instability (n = 1), and lower limb anaesthesia (n = 1). One patient in the IPA group encountered leakage. TEA was associated with longer inotrope requirement (35 vs. 18 hours; p = 0.047). There was no significant difference in intensive care unit (ITU) admission rate (81.8% vs. 77.8%; p > 0.999), median ITU stay (3 vs. 2 days, p = 0.385), or hospital stay (11 days in both groups). Conclusions: In open KWPD, IPA is not inferior to TEA in its efficacy of pain control. IPA was associated with less analgesia-related complications and shorter inotrope requirements. However, this was a small retrospective study. Larger randomized controlled trials are needed to study the effectiveness of IPA.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.420-428
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• 2023

Objective: Intraprocedural rupture (IPR) is a fatal complication of endovascular coiling for cerebral aneurysms. We hypothesized that contrast leakage period may be related to poor clinical outcomes. This study aimed to retrospectively evaluate the relationship between clinical outcomes and contrast leakage period. Methods: Data from patients with cerebral aneurysms treated via endovascular coiling between January 2010 and October 2018 were retrospectively assessed. The enrolled patient's demographic data, the aneurysm related findings, endovascular treatment and IPR related findings, rescue treatment, and clinical outcome were analyzed. Results: In total, 2,859 cerebral aneurysms were treated using endovascular coiling during the study period, with IPR occurring in 18 (0.63 %). IPR occurred during initial frame coiling (n=4), coil packing (n=5), stent deployment (n=7), ballooning (n=1), and microcatheter removal after coiling (n=1). Tear sites included the dome (n=14) and neck (n=4). All IPRs were controlled and treated with coil packing, with or without stenting. Flow arrest of the proximal balloon was not observed. Temporary focal neurological deficits developed in two patients (11.1%). At clinical follow-up, 14 patients were classified as modified Rankin Scale (mRS) 0, three as mRS 2, and one as mRS 4. The mean contrast leakage period of IPR was 11.2 min (range: 1-31 min). Cerebral aneurysms with IPR were divided into late (n=9, mean time: 17.11 min) and early (n=9, mean time: 5.22 min) control groups based on the criteria of 10 min of contrast leakage period. No significant between-group differences regarding clinical outcomes were observed after IPR (p=1). Conclusions: In our series, all patients with IPR were controlled with further coil packing or stenting without proximal balloon occlusion within 31 min of contrast leakage. There was no difference in clinical outcomes when the long contrast leakage period group and short contrast leakage period group were compared.