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1.  Surgical Management of Massive Cerebral Infarction 
Objective
The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy.
Methods
From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale.
Results
All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases.
Conclusion
We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.
doi:10.3340/jkns.2007.42.4.331
PMCID: PMC2588216  PMID: 19096565
Acute cerebral infarction; Brain edema; Brain herniation; Decompressive craniectomy; Intracranial pressure
2.  Effective D-A-D type chromophore of fumaronitrile-core and terminal alkylated bithiophene for solution-processed small molecule organic solar cells 
Scientific Reports  2015;5:11143.
A new and novel organic π-conjugated chromophore (named as RCNR) based on fumaronitrile-core acceptor and terminal alkylated bithiophene was designed, synthesized and utilized as an electron-donor material for the solution-processed fabrication of bulk-heterojunction (BHJ) small molecule organic solar cells (SMOSCs). The synthesized organic chromophore exhibited a broad absorption peak near green region and strong emission peak due to the presence of strong electron-withdrawing nature of two nitrile (–CN) groups of fumaronitrile acceptor. The highest occupied molecular orbital (HOMO) energy level of –5.82 eV and the lowest unoccupied molecular orbital (LUMO) energy level of –3.54 eV were estimated for RCNR due to the strong electron-accepting tendency of –CN groups. The fabricated SMOSC devices with RCNR:PC60BM (1:3, w/w) active layer exhibited the reasonable power conversion efficiency (PCE) of ~2.69% with high short-circuit current density (JSC) of ~9.68 mA/cm2 and open circuit voltage (VOC) of ~0.79 V.
doi:10.1038/srep11143
PMCID: PMC4464324  PMID: 26066557
3.  Combination Treatment for Rapid Growth of a Saccular Aneurysm on the Internal Carotid Artery Dorsal Wall: Case Report 
Aneurysms arising from non-branching sites of the supraclinoid internal carotid artery (ICA) are considered rare, accounting for only 0.9-6.5% of all ICA aneurysms. They are thin-walled, broad-based, can easily rupture during surgery, and are referred to as dorsal, superior, anterior, or ventral wall ICA aneurysms, as well as blister-like aneurysms. Various treatment modalities are available for blister-like aneurysms, but with varying success. Here, we report on two cases of saccular shaped dorsal wall aneurysms. Both patients were transferred to the emergency department with subarachnoid hemorrhage because of an aneurysmal rupture. Computed tomography angiography and transfemoral cerebral angiography (TFCA) showed a dorsal wall aneurysm in the distal ICA. We performed clipping on the wrapping material (Lyodura®, temporal fascia). Follow-up TFCA showed rapid configuration changes of the right distal ICA. Coil embolization was also performed as a booster treatment to prevent aneurysm regrowth. Both patients were discharged without neurologic deficit. No evidence of aneurysm regrowth was observed on follow-up TFCA at two years. Dorsal wall ICA aneurysms can change in size over a short period; therefore, follow-up angiography should be performed within the short-term. In cases of regrowth, coil embolization should be considered as a booster treatment.
doi:10.7461/jcen.2014.16.3.303
PMCID: PMC4205260  PMID: 25340036
Dorsal wall aneurysm; Subarachnoid hemorrhage; Wrapping; Coiling
4.  Does Intramedullary Signal Intensity on MRI Affect the Surgical Outcomes of Patients with Ossification of Posterior Longitudinal Ligament? 
Objectives
Patients with cervical ossification of posterior longitudinal ligament (OPLL) are susceptible to cord injury, which often develops into myelopathic symptoms. However, little is known regarding the prognostic factors that are involved in minor trauma. We evaluated the relationship between minor trauma and neurological outcome of OPLL and investigated the prognostic factors with a focus on compressive factors and intramedullary signal intensity (SI).
Methods
A total of 74 patients with cervical myelopathy caused by OPLL at more than three-levels were treated with posterior decompression surgeries. We surveyed the space available for spinal cord (SAC), the severity of SI change on T2-weighted image, and diabetes mellitus (DM). The neurological outcome using Japanese Orthopedic Association (JOA) scale was assessed at admission and at 12-month follow-up.
Results
Among the variables tested, preoperative JOA score, severity of intramedullary SI, SAC, and DM were significantly related to neurological outcome. The mean preoperative JOA were 11.3±1.9 for the 41 patients who did not have histories of trauma and 8.0±3.1 for the 33 patients who had suffered minor traumas (p<0.05). However, there were no significant differences in the recovery ratios between those two groups.
Conclusions
Initial neurological status and high intramedullary SI in the preoperative phase were related to poorer postoperative outcomes. Moreover, the patients with no histories of DM and larger SACs exhibited better improvement than did the patients with DM and smaller SACs. Although the initial JOA scores were worse for the minor trauma patients than did those who had no trauma prior to surgery, minor trauma exerted no direct effects on the surgical outcomes.
doi:10.3340/jkns.2014.56.2.121
PMCID: PMC4200359  PMID: 25328649
Ossification of the posterior longitudinal ligament; Spinal cord injury; Surgical treatment; Magnetic resonance imaging
5.  Prognostic Factors and Clinical Outcomes of Acute Intracerebral Hemorrhage in Patients with Chronic Kidney Disease 
Objective
We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis.
Methods
From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis.
Results
The mean GCS score on admission was 9.4±4.4 and the mean mRS was 4.3±1.8. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome.
Conclusion
Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.
doi:10.3340/jkns.2013.54.4.296
PMCID: PMC3841271  PMID: 24294452
Intracerebral hemorrhage; Chronic kidney disease; Renal failure; Modified Rankin Scale; Prognosis; Mortality
6.  Acute Spontaneous Cervical Epidural Hematoma Mimicking Cerebral Stroke: A Case Report and Literature Review 
Korean Journal of Spine  2013;10(3):170-173.
Spontaneous cervical epidural hematoma (SCEDH) is a rare disease, but can cause severe neurologic impairment. We report a case of a 68-year-old female who presented with sudden onset, posterior neck pain, right shoulder pain, and progressive right hemiparesis mimicking stroke with no trauma history. Initial brain CT and diffusion MRI performed to rule out brain lesion did not show any positive findings. Laboratory examination presented only severe thrombocytopenia (45,000/mm3). Subsequent cervical MRI revealed a cervical epidural mass lesion. We confirmed that it was pure hematoma through C5 unilateral total laminectomy and C6 partial hemilaminectomy. She achieved complete neurologic recovery with active rehabilitation. Early surgical decompression for SCEDH with neurologic impairment should be recommended for better outcome.
doi:10.14245/kjs.2013.10.3.170
PMCID: PMC3941760  PMID: 24757481
Spontaneous cervical epidural hematoma (SCEDH); Stroke; Liver cirrhosis
7.  The Clinical Efficacy of Decompressive Craniectomy in Patients with an Internal Carotid Artery Territory Infarction 
Objective
To evaluate the surgical efficacy of and factors associated with decompressive craniectomy in patients with an internal carotid artery (ICA) territory infarction.
Methods
Seventeen patients (8 men and 9 women, average age 61.53 years, range 53-77 years) were treated by decompressive craniectomy for an ICA territory infarction at our institute. We retrospectively reviewed medical records, radiological findings, and National Institutes of Health Stroke Scale (NIHSS) at presentation and before surgery. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS).
Results
Of the 17 patients, 15 (88.24%) achieved a poor outcome (Group A, GOS 1-3) and 2 (11.76%) a good outcome (Group B, GOS 4-5). The mortality rate at one month after surgery was 52.9%. Average preoperative NIHSS was 27.6±10.88% in group A and 10±4.24% in group B. Mean cerebral infarction fraction at the septum pellucidum level before surgery in group A and B were 33.67% and 23.72%, respectively. Mean preoperative NIHSS (p=0.019) and cerebral infarction fraction at the septum pellucidum level (p=0.017) were found to be significantly associated with a better outcome. However, no preexisting prognostic factor was found to be of statistical significance.
Conclusion
The rate of mortality after ICA territory infarction treatment is relatively high, despite positive evidence for surgical decompression, and most survivors experience severe disabilities. Our findings caution that careful consideration of prognostic factors is required when considering surgical treatment.
doi:10.3340/jkns.2012.52.4.293
PMCID: PMC3488635  PMID: 23133715
Cerebral infarction; Decompressive craniectomy; Surgical efficacy
8.  Clinical Outcomes of Halo-Vest Immobilization and Surgical Fusion of Odontoid Fractures 
Objective
In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation.
Methods
From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation.
Results
There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 type III fractures). Nine (60%) out of 15 patients who underwent HVI experienced successful healing of odontoid fractures. The mean period for bone healing was 20.2 weeks. Sixteen patients underwent surgery including anterior screw fixation (6 cases), posterior C1-2 screw fixation (8), and transarticular screw fixation (2) for healing the odontoid fractures (11 type II fractures, 5 type III fractures). Fifteen (93.8%) out of 16 patients who underwent surgery achieved healing of cervical fractures. The average bone healing time was 17.6 weeks.
Conclusion
The overall healing rate was 60% after HVI and 93.8% with surgical management. Patients treated with surgery showed a higher fusion rate and shorter bony healing time than patients who received HVI. However, prospective studies are needed in the future to define better optimal treatment and cost-effective perspective for the treatment of odontoid fractures.
doi:10.3340/jkns.2011.50.1.17
PMCID: PMC3159875  PMID: 21892399
Cervical fracture; Odontoid fracture; Operation; Halovest; Bony healing
9.  Optimal Use of the Halo-Vest Orthosis for Upper Cervical Spine Injuries 
Yonsei Medical Journal  2010;51(5):648-652.
Purpose
Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI.
Materials and Methods
From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire.
Results
The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%.
Conclusion
The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.
doi:10.3349/ymj.2010.51.5.648
PMCID: PMC2908866  PMID: 20635437
Halo-vest; cervical trauma; bony healing; complication
10.  Formation of ZnO Micro-Flowers Prepared via Solution Process and their Antibacterial Activity 
Nanoscale Research Letters  2010;5(10):1675-1681.
This paper presents the fabrication and characterization of zinc oxide micro-flowers and their antibacterial activity. The micro-flowers of zinc oxide composed of hexagonal nanorods have been prepared via solution process using precursor zinc acetate di-hydrate and sodium hydroxide in 3 h of refluxing time at ~90°C. The antibacterial activities of grown micro-flowers were investigated against four pathogenic bacteria namely S. aureus, E. coli, S. typhimurium and K. pneumoniae by taking five different concentrations (5–45 μg/ml) of ZnO micro-flowers (ZnO-MFs). Our investigation reveals that at lowest concentration of ZnO-MFs solution inhibiting the growth of microbial strain which was found to be 5 μg/ml for all the tested pathogens. Additionally, on the basis of morphological and chemical observations, a chemical reaction mechanism of ZnO-MFs composed of hexagonal nanorods was also proposed.
doi:10.1007/s11671-010-9694-y
PMCID: PMC2956051  PMID: 21076675
E. coli; S. aureus; X-ray diffraction pattern; ZnO micro-flowers and antibacterial activity
11.  Formation of ZnO Micro-Flowers Prepared via Solution Process and their Antibacterial Activity 
Nanoscale Research Letters  2010;5(10):1675-1681.
This paper presents the fabrication and characterization of zinc oxide micro-flowers and their antibacterial activity. The micro-flowers of zinc oxide composed of hexagonal nanorods have been prepared via solution process using precursor zinc acetate di-hydrate and sodium hydroxide in 3 h of refluxing time at ~90°C. The antibacterial activities of grown micro-flowers were investigated against four pathogenic bacteria namely S. aureus, E. coli, S. typhimurium and K. pneumoniae by taking five different concentrations (5–45 μg/ml) of ZnO micro-flowers (ZnO-MFs). Our investigation reveals that at lowest concentration of ZnO-MFs solution inhibiting the growth of microbial strain which was found to be 5 μg/ml for all the tested pathogens. Additionally, on the basis of morphological and chemical observations, a chemical reaction mechanism of ZnO-MFs composed of hexagonal nanorods was also proposed.
doi:10.1007/s11671-010-9694-y
PMCID: PMC2956051  PMID: 21076675
E. coli; S. aureus; X-ray diffraction pattern; ZnO micro-flowers and antibacterial activity
12.  Anterior Communicating Artery Aneurysm Related to Visual Symptoms 
Objective
Intracranial aneurysms are sometimes presented with visual symptoms by their rupture or direct compression of the optic nerve. It is because their prevalent sites are anatomically located close to the optic pathway. Anterior communicating artery is especially located in close proximity to optic nerve. Aneurysm arising in this area can produce visual symptoms according to their direction while the size is small. Clinical importance of visual symptoms presented by aneurysmal optic nerve compression is stressed in this study.
Methods
Retrospective analysis of ruptured anterior communicating artery aneurysms compressing optic apparatus were carried out. Total 33 cases were enrolled in this study. Optic nerve compression of the aneurysms was confirmed by the surgical fields.
Results
In 33 cases among 351 cases of ruptured anterior communicating artery aneurysms treated surgically, from 1991 to 2000, the dome of aneurysm was compressed in optic pathway. In some cases, aneurysm impacted into the optic nerve that deep hollowness was found when the aneurysm sac was removed during operation. Among 33 cases, 10 cases presented with preoperative visual symptoms, such as visual dimness (5), unilateral visual field defect (2) or unilateral visual loss (3), 20 cases had no visual symptoms. Visual symptoms could not be checked in 3 cases due to the poor mental state. In 6 cases among 20 cases having no visual symptoms, optic nerve was deeply compressed by the dome of aneurysm which was seen in the surgical field. Of 10 patients who had visual symptoms, 8 showed improvement in visual symptoms within 6 months after clipping of aneurysms. In 2 cases, the visual symptoms did not recover.
Conclusion
Anterior communicating artery aneurysm can cause visual symptoms by compressing the optic nerve or direct rupture to the optic nerve with focal hematoma formation. We emphasize that cerebral vascular study is highly recommended to detect intracranial aneurysm before its rupture in the case of normal CT findings with visual symptoms and frequent headache.
doi:10.3340/jkns.2009.46.3.232
PMCID: PMC2764022  PMID: 19844624
Anterior communicating artery; Intracranial aneurysm; Optic pathway; Visual Symptoms
13.  Surgical Complications of Epilepsy Surgery Procedures : Experience of 179 Procedures in a Single Institute 
Objective
There are a few reports on the complications of surgery for epilepsy. We surveyed our data to present complications of epilepsy surgeries from the neurosurgeon's point of view and compare our results with other previous reports.
Methods
A total of 179 surgical procedures for intractable epilepsy (41 diagnostic, 138 therapeutic) were performed in 92 consecutive patients (10 adults, 82 children) during the last 9.2 years (February. 1997-April. 2006). Their medical records and radiological findings were reviewed to identify and analyze the surgical complications.
Results
The diagnostic procedures encompassed various combinations of subdural grid, subdural strips, and depth electrodes. Four minor transient complications developed in 41 diagnostic procedures (4/41=9.8%). A total of 138 therapeutic procedures included 28 anterior temporal lobectomies, 21 other lobectomies, 6 lesionectomies, 21 topectomies, 13 callosotomies, 20 vagus nerve stimulations, 13 multiple subpial transections, and 16 hemispherectomies. Twenty-six complications developed in therapeutic procedures (26/138=18.8%). Out of the 26 complications, 21 complications were transient and reversible (minor; 21/138=15.2%), and 5 were serious complications (major; 5/138=3.6%). Five major complications were one visual field defect, two mortality cases and two vegetative states. There were 2 additional mortality cases which were not related to the surgery itself.
Conclusion
Our results indicate that complication rate was higher than previous other reports in minor complications and was comparable in major complications. However, our results show relatively high frequency of mortality cases and severe morbidity case compared to other previous reports. The authors would like to emphasize the importance of acute postoperative care in young pediatric patients as well as meticulous surgical techniques to reduce morbidity and mortality in epilepsy surgery.
doi:10.3340/jkns.2008.44.4.234
PMCID: PMC2588306  PMID: 19096683
Epilepsy; Surgery; Intraoperative complication; Morbidity; Mortality

Results 1-13 (13)