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Lee HS, Song SW, Chun YI, Choe WJ, Cho J, Moon CT, Koh YC. Complications Following Burr Hole Craniostomy and Closed-System Drainage for Subdural Lesions. Korean J Neurotrauma 2018; 14:68-75. [PMID: 30402421 PMCID: PMC6218354 DOI: 10.13004/kjnt.2018.14.2.68] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Burr hole craniostomy and closed-system drainage (BCD) is a common surgical procedure in the field of neurosurgery. However, complications following BCD have seldom been reported. The purpose of this study was to report our experiences regarding complications following BCD for subdural lesions. Methods A retrospective study of all consecutive patients who underwent BCD for presumed subdural lesions at one institute since the opening of the hospital was performed. Results Of the 395 patients who underwent BCD for presumed subdural lesions, 117 experienced surgical or nonsurgical complications. Acute intracranial hemorrhagic complications developed in 14 patients (3.5%). Among these, 1 patient died and 5 patients had major morbidities. Malposition of the drainage catheter in the brain parenchyma occurred in 4 patients, and opposite-side surgery occurred in 2 patients. Newly developed seizures after BCD occurred in 8 patients (2.0%), five of whom developed the seizures in relation to new brain lesions. Eighty-eight patients (22.3%) suffered from nonsurgical complications after BCD. Pulmonary problems (7.3%) were the most common nonsurgical complications, followed by urinary problems (5.8%), psychologic problems (4.3%), and cognitive impairments (3.8%). Conclusion The incidence of complications after BCD for subdural lesions is higher than previously believed. In particular, catastrophic complications such as acute intracranial hematomas and surgical or management errors occur at rates that cannot be ignored, possibly causing medico-legal problems. Great caution must be taken during surgery and the postoperative period, and these complications should be listed on the informed consent form before surgery.
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Affiliation(s)
- Hyun Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Woo Song
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young Il Chun
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Joon Cho
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Chang Taek Moon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young-Cho Koh
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Affiliation(s)
- Dae-Hyun Kim
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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3
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Kim KW, Kim JH, Choe WJ, Kim JY, Lee SI, Kim KT, Park JS, Kim JW, Lee Y, Lee JH, Park J. Effectiveness of 100 Beats per Minute Music on Cardiopulmonary Resuscitation Compression Rate Education: A Manikin Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Recent cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compression. The aim of this study is to determine the effect of education using music on the chest compression rate. Methods This randomised, open-labeled study enrolled 81 medical students. They were randomly divided into three groups. After they were educated in CPR according to the American Heart Association 2010 guidelines, they performed 100 chest compressions using a mannequin capable of collecting each compression depth and speed. After that, the control group received a verbal feedback about their own results. The metronome group was also notified of their own results, and listened to the metronome sound at 100 beats per minute (bpm). The music group listened to the music (about 100 bpm). Twenty-four hours after their CPR education, chest compressions were performed again with the method identical to the first evaluation. The results were compared using multivariate analysis of variances. Result Compression rate (bpm): There was a significant difference between the control (mean, 110.4; 95% CI: 104.4, 116.5) and metronome group (mean, 98.5; 95% CI: 91.6, 105.4) after education (p=0.01). There was a significant difference between control and music group (mean, 98.2; 95% CI: 94.6, 101.8) after education (p<0.001) There were no differences between the music and metronome group before or after education (p=0.50, p=0.94). However, the variance of music group was significantly less than the metronome group (p=0.01). Compression depth (inches): there was no difference between the groups according to the CPR education method. (Control: 1.8±0.3; Metronome group: 1.6±0.2; Music group: 1.7±0.3 p=0.09) Conclusion Both education method of using music and metronome are more effective than conventional method. However the effect of using music may be better than using metronome.
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Affiliation(s)
- KW Kim
- Inje University Seoul Paik Hospital, Department of Anesthesiology and Pain Medicine, 9 Marunnai-ro, Jung-gu, Seoul, Korea
| | - JH Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - WJ Choe
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - JY Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - SI Lee
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - KT Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - JS Park
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - JW Kim
- Inje University Ilsan Paik Hospital, Department of Anesthesiology and Pain Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
| | - Y Lee
- Dongguk University Medical Center Ilsan Hospital, Department of Anesthesiology/Statistic Institute, 27 Dongguk-ro IlsanDong-gu, Goyang-si, Gyeonggi-do, Korea
| | - JH Lee
- Dongguk University Medical Center Ilsan Hospital, Department of Anesthesiology/Statistic Institute, 27 Dongguk-ro IlsanDong-gu, Goyang-si, Gyeonggi-do, Korea
| | - J Park
- Inje University Ilsan Paik Hospital, Department of Emergency Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Korea
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Abstract
Presacral ganglioneuromas are extremely rare benign tumors and fewer than 20 cases have been reported in the literature. Ganglioneuromas are difficult to be differentiated preoperatively from tumors such as schwannomas, meningiomas, and neurofibromas with imaging modalities. The retroperitoneal approach for resection of presacral ganglioneuroma was performed for gross total resection of the tumor. Recurrence and malignant transformation of these tumors is rare. Adjuvant chemotherapy or radiation therapy is not indicated because of their benign nature. We report a case of a 47-year-old woman with a presacral ganglioneuroma.
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Affiliation(s)
- Donguk Lee
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - So Dug Lim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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5
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Abstract
BACKGROUND Chronic facial paralysis induces degenerative facial muscle changes on the involved side, thus, making the individual seem as older than their actual age. Furthermore, contralateral facial hypertrophy aggravates facial asymmetry. A thread-lifting procedure has been used widely for correction of a drooping or wrinkled face due to the aging process. In addition, botulinum toxin injection can be used to reduce facial hypertrophy. The aim of study was to evaluate the effectiveness of thread lifting with botulinum toxin injection for chronic facial paralysis. METHODS A total 34 of patients with chronic facial paralysis were enrolled from March to October 2014. Thread lifting for elevating loose facial muscles on the ipsilateral side and botulinum toxin A for controlling the facial muscle hypertrophy on the contralateral side were conducted. Facial function was evaluated using the Sunnybrook grading system and dynamic facial asymmetry ratios 1 year after treatment. RESULTS All 34 patients displayed improved facial symmetry and showed improvement in Sunnybrook scores (37.4 vs. 83.3) and dynamic facial asymmetry ratios (0.58 vs 0.92). Of the 34 patients, 28 (82.4%) reported being satisfied with treatment. CONCLUSION The application of subdermal suspension with a reabsorbable thread in conjunction with botulinum toxin A to optimize facial rejuvenation of the contralateral side constitutes an effective and safe procedure for face lifting and rejuvenation of a drooping face as a result of long-lasting facial paralysis.
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Affiliation(s)
- W J Choe
- Department of Anaesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Korea (Republic of)
| | - H D Kim
- Department of Otorhinolaryngology, Head & Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Korea (Republic of)
| | - B H Han
- Department of Otorhinolaryngology, Head & Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Korea (Republic of)
| | - J Kim
- Department of Otorhinolaryngology, Head & Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-do, Korea (Republic of).
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Jeon YS, Lee JG, Chun YI, Cho J, Choe WJ. Traumatic Pseudoaneurysm Related to Calcified Nodules of Cerebral Convexity Dura Mater in an American College Football Player. J Cerebrovasc Endovasc Neurosurg 2016; 18:322-326. [PMID: 27847782 PMCID: PMC5104863 DOI: 10.7461/jcen.2016.18.3.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 12/05/2022] Open
Abstract
Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.
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Affiliation(s)
- Yoo Sung Jeon
- Department of Neurosurgery Konkuk University College of Medicine, Seoul, Korea
| | - Jong Gon Lee
- Department of Neurosurgery Konkuk University College of Medicine, Seoul, Korea
| | - Young Il Chun
- Department of Neurosurgery Konkuk University College of Medicine, Seoul, Korea
| | - Joon Cho
- Department of Neurosurgery Konkuk University College of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery Konkuk University College of Medicine, Seoul, Korea
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Lee C, Choe WJ, Kim N. Epithelioid Sarcoma in the Cervical Spine: A Case Report. Korean J Spine 2015; 12:165-8. [PMID: 26512275 PMCID: PMC4623175 DOI: 10.14245/kjs.2015.12.3.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022]
Abstract
Epithelioid sarcoma is a rare and highly malignant soft tissue neoplasm that most commonly occurs in the long bones. This uncommon tumor has a poor clinical outcome, and the modality of its treatment has not yet been fully established. The authors report an extremely rare presentation of epithelioid sarcoma in the cervical spine, along with its clinical progression, imaging, and pathology. The patient underwent three surgical procedures and adjuvant radiochemical management. He survived for 25 months with a good general condition and adapted well to his social activity. Systemic metastasis was not found, but the patient died of respiratory failure due to direct tracheal invasion of the tumor.
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Affiliation(s)
- Chungnam Lee
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Nara Kim
- Department of Radiology, Konkuk University College of Medicine, Seoul, Korea
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8
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Song SH, Roh HG, Kim HY, Choi JW, Moon WJ, Choe WJ, Jung I. Recurrent posterior circulation infarction caused by anomalous occipital bony process in a young patient. BMC Neurol 2014; 14:252. [PMID: 25519166 PMCID: PMC4302142 DOI: 10.1186/s12883-014-0252-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Structural anomaly of the cervical spine or craniocervical junction has been reported as one of the rare causes of ischemic stroke. We report a case of a young patient with recurrent posterior circulation infarction that may have been associated with an anomalous occipital bony process compressing the vertebral artery. Case presentation A 23-year-old man experienced recurrent posterior circulation infarction 5 times over a period of 5 years. He had no conventional vascular risk factors. Young age stroke work-up including thorough cardiac, intra- and extracranial vascular evaluation and laboratory tests for the hypercoagulable state or connective tissue disease yielded unremarkable results. An anomalous bony process from the occipital base compressing the left vertebral artery was observed on brain CT. All the recurrent strokes were explainable by the arterial thromboembolism originating from the compressed left vertebral artery. Therefore, the left vertebral artery compressed by the anomalous occipital bony process may have been the culprit behind the recurrent thromboembolic strokes in our patient. Intractable recurrent strokes even under optimal medical treatment led us to make a decision for the intervention. Instead of surgical removal of the anomalous occipital bony process, the left vertebral artery was occluded permanently by endovascular coiling after confirming that this would cause no neurological deficits or flow disturbance in the posterior circulation. There was no recurrence of stroke for 2 years after permanent occlusion of the left vertebral artery. Conclusion Arterial thromboembolism originating from the left vertebral artery compressed by the anomalous occipital bony process is a rare but not to be overlooked cause of posterior circulation infarction. When intractable to medical treatment, endovascular occlusion of the vertebral artery without flow disturbance to the posterior circulation may be a useful treatment option when surgical removal is not feasible.
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Affiliation(s)
- Seung-Hoon Song
- Department of Neurology, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
| | - Hong Gee Roh
- Department of Radiology, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
| | - Jin Woo Choi
- Department of Radiology, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
| | - Won-Jin Moon
- Department of Radiology, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
| | - Ileok Jung
- Department of Neurology, Konkuk University School of Medicine, Neungdong-ro 120-1, Gwangjin-gu, Seoul, Republic of Korea.
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9
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Park HK, Choe WJ, Koh YC, Park SW. Endovascular management of great vessel injury following lumbar microdiscectomy. Korean J Spine 2014; 10:264-7. [PMID: 24891863 PMCID: PMC4040641 DOI: 10.14245/kjs.2013.10.4.264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 11/19/2022]
Abstract
Great vessel injury is a rare but well-known complication of lumbar disc surgery, which may result in acute or fatal outcomes of delayed diagnosis. Thus, early detection and proper management is vital. The authors report a case of retroperitoneal hemorrhage with arteriovenous fistula and pseudoaneurysm after lumbar microdiscectomy. The patient was successfully managed by endovascular intervention using a stent graft. Endovascular repair is a minimally invasive and efficient treatment modality with considerably low morbidity and mortality.
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Affiliation(s)
- Hee-Kwon Park
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Young-Cho Koh
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University College of Medicine, Seoul, Korea
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10
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Hong S, Choe WJ, Moon CT. Multiple spinal cord recurrences of an intracranial ependymoma after 14 years. J Korean Neurosurg Soc 2014; 54:521-4. [PMID: 24527198 PMCID: PMC3921283 DOI: 10.3340/jkns.2013.54.6.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/26/2013] [Accepted: 12/13/2013] [Indexed: 12/03/2022] Open
Abstract
Ependymoma can spread via cerebrospinal fluid, but late spinal recurrences of intracranial tumor are very rare. We describe a case of a 33-year-old male who presented with multiple, delayed, recurrent lesions in the spinal cord from an intracranial ependymoma. The patient underwent gross total resection and postoperative radiation therapy 14 years prior to visit for a low grade ependymoma in the 4th ventricle. The large thoraco-lumbar intradural-extramedullary spinal cord tumor was surgically removed and the pathologic diagnosis was an anaplastic ependymoma. An adjuvant whole-spine radiation therapy for residual spine lesions was performed. After completion of radiation therapy, a MRI showed a near complete response and the disease was stable for three years.
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Affiliation(s)
- Semie Hong
- Department of Radiation Oncology, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Korea
| | - Chang Taek Moon
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Korea
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11
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Abstract
The glomus tumor of the peripheral nerve is one of the mesenchymal tumors originating in the epineurium, and is extremely rare. A 56-year-old man presented complaining of lancinating pain on the left thigh, which was provoked by pressure or exercise. Subsequent image study revealed a mass in the femoral nerve. Total surgical excision with the aid of intraoperative ultrasonography was performed and the pain was successfully controlled. The authors report an unusual case of a patient diagnosed with glomus tumor in peripheral nerve, with a review of the clinical features, imaging, and pathological findings.
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Affiliation(s)
- Dong Sun Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Young Il Chun
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Chang-Taek Moon
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
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12
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Park CW, Choe WJ, Chun YI. Eosinophilic myelitis in the cervical cord mimicking intramedullary cord tumor. J Korean Neurosurg Soc 2012; 52:410-3. [PMID: 23133734 PMCID: PMC3488654 DOI: 10.3340/jkns.2012.52.4.410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 09/27/2012] [Accepted: 10/10/2012] [Indexed: 11/30/2022] Open
Abstract
Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.
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Affiliation(s)
- Cheon Wook Park
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Korea
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13
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Abstract
Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.
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Affiliation(s)
- Joon Cho
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Chang Taek Moon
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Hyun Seung Kang
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Sang Keun Chang
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Young Cho Koh
- Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Hospital, Seoul, Korea
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14
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Abstract
BACKGROUND AND AIM The authors present a retrospective analysis of 14 patients treated for spinal cord hemangioblastoma (SCH). This study was conducted to evaluate and compare the difference of functional outcomes associated with the extent of surgical removal of the tumor. METHODS Eleven patients were male and three were female, with a mean age of 37.2 years (19-62 years). Pre- and postoperative magnetic resonance imaging was performed in all cases. Preoperative angiography was performed in 11 cases and preoperative embolization in four. The follow-up period ranged from 15 to 161 months (median, 47 months). RESULTS Thirteen patients had intramedullary tumor, and the remaining one had an extradural lesion. All patients underwent surgical removal, and total removal (TR) was achieved in 10 cases. In four patients with preoperative embolization, intraoperative bleeding was minimal and TR was possible. In three of four patients without TR, their functional outcomes were aggravated postoperatively. At the last follow-up (15-161 months), eight patients were improved, three were stationary, and three deteriorated. All patients who showed improvements underwent TR. The statistical analysis showed that TR produced a significantly better outcome than incomplete removal (p = 0.015). CONCLUSION TR resulted in a better outcome for SCH. Preoperative embolization could be effective in the reduction of intraoperative bleeding and facilitate TR with an improved surgical outcome.
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Affiliation(s)
- Dae Kyu Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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15
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Abstract
BACKGROUND The efficacy of radiosurgery in cases of surgically high risk symptomatic cavernous malformations (CMs) for reducing haemorrhagic risk and for seizure control has not been clearly documented and the radiation-induced complications of radiosurgery remain problematic. The authors present a retrospective clinical analysis of 22 cases of CMs treated by radiosurgery. METHODS Twenty-two patients with symptomatic CMs were treated by linear accelerator (LINAC) radiosurgery or Gamma knife (GK) between 1995 and 1998. Medical records including radiological investigations were carefully reviewed to the last follow-up. The mean age of the patients was 34.1 years (12-56) and the male to female ratio was 12:10. Twenty patients reported at least one episode of bleeding and four had undergone microsurgery before radiosurgery. The remaining two patients presented with seizure without evidence of recent haemorrhage. In 16 cases, the CMs were deep-seated, and the others were located in the cerebral hemispheres; four were located at an eloquent area. LINAC radiosurgery using computed tomography scan was performed in 11 cases until May 1997, after which GK radiosurgery using magnetic resonance (MR) image was performed in 11 cases. The volume of the lesion ranged from 0.09 cc to 4.8 cc (mean 1.42 cc) and the mean marginal dose was 16.1 Gy (8-24). The median follow-up period after radiosurgery was 38.3 months (21-67). The rate of haemorrhage, seizure, and neurological deterioration following radiosurgery was analyzed, and the rate of haemorrhage was compared to that seen in natural course reports. FINDINGS There was one case of haemorrhage during the follow-up period and the seizure was well controlled with anticonvulsants. In the group with prior haemorrhage, the bleeding rate of cavernous malformation after radiosurgery (1.55%/year) was lower than that of pre-radiosurgical period (35.5%/year, t=1.296, P=0.04). Six patients showed neurological deterioration following radiosurgery, however, the neurological deficits persisted in only two of the patients with LINAC. The radiosurgical modality (LINAC vs. GK) showed a possible correlation to radiation induced neurological deficits (P=0.06). On the MR images at the last follow-up, the lesion was decreased in eleven patients, increased in one, and no change was found in 10 cases. The T2 weighted MR images revealed a perilesional high signal change in nine patients. This signal change was not statistically related to lesion size (P=0.236), location (P=0.658), nor radiation dose (P=0.363), but was dependent on the treatment modality (P=0.02). New-enhancing lesion and a new cyst were each found in one case, respectively, during the follow-up. INTERPRETATION Radiosurgery may be a good alternative option for treatment of surgically high risk CMs. However, the optimal radiosurgical technique, dose adjustment, and proper delineation of the mass are prerequisites. Radiosurgery induced complications are still problematic and post-radiosurgery MR image changes need to be further elucidated.
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Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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16
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Abstract
The goal of treatment for spinal ependymoma is complete removal with minimal postoperative neurological deficit. The authors correlated the results of surgical management for spinal cord ependymoma with the rate of postoperative disease progression and the prognostic factors. Thirty-one cases of spinal ependymomas, surgically treated between 1979 and 1998, were retrospectively analyzed. The authors reviewed clinical features, radiological characteristics and operative findings for the surgical outcome analysis. Thirty-five percent of patients with preoperative Nurick's grade better than grade 4 showed improvement in functional status, whereas no improvement was observed in patients with preoperatively poorer functional status (P = 0.05). The proportion of complete surgical removals was influenced by tumor location (40% in cases around the conus versus 97% in other regions, P = 0.003) and histology (42% in the myxopapillary subtype versus 97% in the non-myxopapillary subtype, P = 0.001). Disease progression was observed in six cases, the mean progression free interval after surgical removal was 83 months and the 5-year progression free rate was 70%. Disease progression was found in two out of 23 cases from the complete removal group and in four out of eight cases from the incomplete removal group (P = 0.008). In the aspect of disease progression, the only statistically significant factor by multivariate analysis was the surgical extent of removal (P = 0.010). Of those patients where there was incomplete removal, radiation therapy lead to improved clinical results, which were not statistically significant (P = 0.27). In the surgical treatment of spinal cord ependymoma, preoperative functional status and the extent of removal were the significant prognostic factors influencing postoperative outcome. Early diagnosis is vital and complete removal of the tumor should be attempted in all surgical treatment of spinal ependymoma.
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Affiliation(s)
- Ung Kyu Chang
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
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17
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Abstract
OBJECTIVES To describe the underlying causes, surgical results and prognostic factors in thoracic stenosis causing myelopathy. METHODS The underlying causes and surgical results were analyzed retrospectively in 28 cases of thoracic spinal stenosis which caused myelopathy. Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was performed in 24 cases, anterior decompression in five cases, and combined decompression in one case. Ossification of ligamentum flavum was found in 18 cases, facet hypertrophy in 13, ossification of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively 16 patients improved and four patients worsened. Follow-up ranged from 2 months to 5 years and 8 months). Statistical analysis was performed using a chi(2) test to investigate the relationship between subjects. Multivariant analysis (general linear model) was used to determine the factors which influence surgical outcome. RESULTS There were neurological improvements in 16 patients, in whom Nurick grade changed from 3.3 preoperatively to 1.8 postoperatively. Eight patients showed no significant change in functional grade and four patients deteriorated after decompressive laminectomy. The group of which initial symptom duration was less than 2 years showed better results (P=0.006). The group with sufficient decompression and no additional proximal stenosis had better treatment outcome (P=0.005, P=0.002). CONCLUSION Chronic severe myelopathy caused by thoracic spinal stenosis can be reversible with appropriate decompression. Surgical outcome was dependent on initial symptom duration, sufficient decompression and presence of additional proximal stenosis. SPONSORSHIP This study was supported by a grant No. 02-1997-071-0 from the Seoul National University Hospital Research Fund.
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Affiliation(s)
- U K Chang
- Department of Neurosurgery, Neuroscience Research Institute, Seoul National University College of Medicine Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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18
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Abstract
OBJECTIVE The authors report on the metabolic features of central neurocytomas observed during in vivo single-voxel proton magnetic resonance spectroscopy. METHODS Volume-selective single-voxel proton magnetic resonance spectroscopy was performed with a 1.5-T unit using a point-resolved spectroscopy sequence (TR/TE = 2000 ms/135 and 270 ms) to obtain spectra of a single 8-cc voxel. The subjects were five patients in the Department of Neurosurgery of Seoul National University Hospital whose central neurocytomas had been diagnosed histologically. The peak intensities of compounds containing choline (Cho), N-acetylaspartate, creatine/phosphocreatine, and lactate were analyzed. RESULTS The ratios of Cho to creatine/phosphocreatine and Cho to N-acetylaspartate were significantly higher than ratios in normal brains. A lactate signal was present, and an unidentified signal was also observed at 3.55 ppm, which might have been produced by inositol or glycine. CONCLUSION A combination of the signal at 3.55 ppm and a prominent Cho peak seems to be a characteristic feature of central neurocytomas. Volume-selective single-voxel proton magnetic resonance spectroscopy could provide additional information to aid in diagnosing this condition.
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Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
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19
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Choe WJ, Cho BK, Kim IO, Shin HY, Wang KC. Extrapontine myelinolysis caused by electrolyte imbalance during the management of suprasellar germ cell tumors. Report of two cases. Childs Nerv Syst 1998; 14:155-8. [PMID: 9660114 DOI: 10.1007/s003810050202] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Extrapontine myelinolysis (EPM) is caused by marked fluctuation of the serum electrolyte level. Patients with suprasellar germ cell tumors frequently present with diabetes insipidus, which is often aggravated by administration of steroid hormone. In addition, cisplatin-based chemotherapy is sometimes accompanied by marked serum electrolyte fluctuation because it needs massive hydration to prevent renal damage. Two children with suprasellar germ cell tumors in whom EPM developed secondary to profound hyponatremia and was rapidly corrected are described. The central pons was spared in both cases. Clinically the children showed transient neurological deficits including confusion, pseudobulbar palsy, and deterioration of consciousness. MRI demonstrated bilateral symmetrical, high-signal-intensity (HSI) lesions on T2-weighted images (T2WI) at the basal ganglia and adjacent cerebral cortex. Follow-up T1WI a few months later revealed newly developed HSI lesions in the basal ganglia. The patients gradually improved, but the neurological deficits did not completely disappear. During the perioperative management of suprasellar germ cell tumors, EPM should be considered when a patient has a significant electrolyte imbalance and neurological deficits, especially confusion and pseudobulbar palsy.
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Affiliation(s)
- W J Choe
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Korea
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