PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-13 (13)
 

Clipboard (0)
None
Journals
Authors
more »
Year of Publication
Document Types
1.  Evaluation of the Department of Neurosurgery of the Seoul National University Hospital 
The Department of Neurosurgery (DNS) of the Seoul National University Hospital (SNUH), belongs to the largest and oldest such institutions in Korea. Because of its growing reputation it is hardly surprising that the DNS draws visitor and scholars for clinical education and academic exchange from far beyond Korea. I myself visited the SNUH in February and March 2013. During this time I composed this evaluation in which I compare the DNS to my home Department at the Johannes Gutenberg-University in Mainz/Germany, as well as the situation of Neurosurgery in Korea and Germany in general. In the first part this evaluation summarizes data concerning equipment, staff and organizational structure, as well as educational and scientific issues of the DNS. In the second part some issues of interest are discussed in special regard to the corresponding practices in Germany.
doi:10.3340/jkns.2013.53.5.261
PMCID: PMC3730026  PMID: 23908698
Neurosurgical unit; Departmental evaluation; International standard
2.  The Role of Stereotactic Radiosurgery in Metastasis to the Spine 
Objective
The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis.
Methods
A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets.
Results
Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild.
Conclusion
In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.
doi:10.3340/jkns.2012.51.1.1
PMCID: PMC3291699  PMID: 22396835
Radiosurgery; Spinal metastasis; Spine surgery; Radiation therapy; Local control; Spine tumors
3.  Strategies of Spinal Fusion on Osteoporotic Spine 
The prevalence of osteoporosis has been increasing globally. Recently surgical indications for elderly patients with osteoporosis have been increasing. However, only few strategies are available for osteoporotic patients who need spinal fusion. Osteoporosis is a result of negative bone remodeling from enhanced function of the osteoclasts. Because bone formation is the result of coupling between osteoblasts and osteoclasts, anti-resorptive agents that induce osteoclast apoptosis may not be effective in spinal fusion surgery, necessitating new bone formation. Therefore, anabolic agents may be more suitable for osteoporotic patients who undergo spinal fusion surgery. The instrumentations and techniques with increased pullout strength may increase fusion rate through rigid fixation. Studies on new osteoinductive materials, methods to increase osteogenic cells, strengthened and biocompatible osteoconductive scaffolds are necessary to enable osteoporotic patients to undergo spinal fusion. When osteoporotic patients undergo spinal fusion, surgeons should consider appropriate osteoporosis medication, instrumentation and technique.
doi:10.3340/jkns.2011.49.6.317
PMCID: PMC3158472  PMID: 21887387
Osteoporosis; Spine; Fusion; Osteoblast; Osteoclast
4.  Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment 
A cervical radiculopathy is the most common symptom of cervical degenerative disease and its natural course is generally favorable. With a precise diagnosis using appropriate tools, the majority of patients will respond well to conservative treatment. Cervical radiculopathy with persistent radicular pain after conservative treatment and progressive or profound motor weakness may require surgery. Options for surgical management are extensive. Each technique has strengths and weaknesses, so the choice will depend on the patient's clinical profile and the surgeon's judgment.
doi:10.3340/jkns.2010.48.6.473
PMCID: PMC3053539  PMID: 21430971
Cervical radiculopathy; Diagnosis; Surgery
5.  Unsuspected Plasticity of Single Neurons after Connection of the Corticospinal Tract with Peripheral Nerves in Spinal Cord Lesions 
Objective
To report an unsuspected adaptive plasticity of single upper motor neurons and of primary motor cortex found after microsurgical connection of the spinal cord with peripheral nerve via grafts in paraplegics and focussed discussion of the reviewed literature.
Methods
The research aimed at making paraplegics walk again, after 20 years of experimental surgery in animals. Amongst other things, animal experiments demonstrated the alteration of the motor endplates receptors from cholinergic to glutamatergic induced by connection with upper motor neurons. The same paradigm was successfully performed in paraplegic humans. The nerve grafts were put into the ventral-lateral spinal tract randomly, without possibility of choosing the axons coming from different areas of the motor cortex.
Results
The patient became able to selectively activate the re-innervated muscles she wanted without concurrent activities of other muscles connected with the same cortical areas.
Conclusion
Authors believe that unlike in nerve or tendon transfers, where the whole cortical area corresponding to the transfer changes its function a phenomenon that we call "brain plasticity by areas", in our paradigm due to the direct connection of upper motor neurons with different peripheral nerves and muscles via nerve grafts motor learning occurs based on adaptive neuronal plasticity so that simultaneous contractions of other muscles are prevented. We propose to call it adaptive functional "plasticity by single neurons". We speculate that this phenomenon is due to the simultaneous activation of neurons spread in different cortical areas for a given specific movement, whilst the other neurons of the same areas connected with peripheral nerves of different muscles are not activated at the same time. Why different neurons of the same area fire at different times according to different voluntary demands remains to be discovered. We are committed to solve this enigma hereafter.
doi:10.3340/jkns.2009.46.1.1
PMCID: PMC2729817  PMID: 19707486
Paraplegia; Adaptive neuronal plasticity; Compensation; Nerve graft; Neural connection; Restoration of ambulation
6.  Surgical Management of Intracranial Aneurysms in the Endovascular Era : Review Article 
The advent of endovascular therapy for intracranial aneurysms and the rapid advances in that field have supplanted microsurgical treatment for many intracranial aneurysms. Applying current outcome data and other parameters, nuances of selecting the modality of treatment for intracranial aneurysms are reviewed. Patient factors, such a age, co-morbidities, vasospasm and other medical conditions, are addressed. A custom-tailored multimodality treatment paradigm for the management of ruptured and unruptured aneurysms will maximize the favorable results seen in this difficult patient population.
doi:10.3340/jkns.2009.45.3.133
PMCID: PMC2666114  PMID: 19352474
Aneurysm; Subarachnoid hemorrhage; Aneurysm clip; Endovascular treatment
7.  The Jugular Foramen Schwannomas: Review of the Large Surgical Series 
Objective
Jugular foramen schwannomas are uncommon pathological conditions. This article is constituted for screening these tumors in a wide perspective.
Materials
One-hundred-and-ninty-nine patients published in 19 articles between 1984 to 2007 years was collected from Medline/Index Medicus.
Results
The series consist of 83 male and 98 female. The mean age of 199 operated patients was 40.4 years. The lesion located on the right side in 32 patients and on the left side in 60 patients. The most common presenting clinical symptoms were hearing loss, tinnitus, disphagia, ataxia, and hoarseness. Complete tumor removal was achieved in 159 patients. In fourteen patients tumor reappeared unexpectedly. The tumor was thought to originate from the glossopharyngeal nerve in forty seven cases; vagal nerve in twenty six cases; and cranial accessory nerve in eleven cases. The most common postoperative complications were lower cranial nerve palsy and facial nerve palsy. Cerebrospinal fluid leakage, meningitis, aspiration pneumonia and mastoiditis were seen as other complications.
Conclusion
This review shows that jugular foramen schwannomas still have prominently high morbidity and those complications caused by postoperative lower cranial nerve injury are life threat.
doi:10.3340/jkns.2008.44.5.285
PMCID: PMC2612565  PMID: 19119464
Cranial nerve; Schwannoma; Skull base tumors; Surgery; Jugular foramen
8.  Vertebral Artery Dissection: Natural History, Clinical Features and Therapeutic Considerations 
When a tear occurs in one of the major cervicocerebral arteries and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. Vertebral artery dissection (VAD) is an infrequent occurrence but is a leading cause of stroke in young and otherwise healthy patients. This article discusses recent developments in understanding of the epidemiology and pathogenesis of VAD and the various clinical manifestations, methods of diagnosis, and approaches to treatment.
doi:10.3340/jkns.2008.44.3.109
PMCID: PMC2588305  PMID: 19096659
Stenosis; Aneurysmal dilatation; Vertebral artery dissection; Diagnosis; Treatment
9.  Current Status and Future Prospect of Endovascular Neurosurgery 
Recently, due to the evolution of technology, the field of neurosurgery is receiving spotlight. In particular endovascular neurosurgery has gained a great interest along with the advancement of the modern neurosurgery. The most remarkable advances were made in embolization of the cerebral aneurysms, arteriovenous malformations and intracranial stenosis during the past 10 years. These advances will further change the role of neurosurgeons in treating cerebrovascular disease. Because interventional neuroradiologists have performed most of procedures in the past, neurosurgeons have been deprived of chances to learn endovascular procedure. This article discusses the development of technological aspect of endovascular neurosurgery in chronological order. By understanding the history and current status of the endovascular surgery, the future of neurosurgery will be promising.
doi:10.3340/jkns.2008.43.2.69
PMCID: PMC2588227  PMID: 19096608
Endovascular surgery; Embolization; Aneurysm; Arteriovenous malformation; Intracranial stenosis
10.  Proposal for the Promotion of Korean Neurosurgery 
The author conducted a survey on the current status of neurosurgery around the world in preparation for Presidential Address at the International Society for Pediatric Neurosurgery (ISPN). The addresses and findings from the survey were presented at ISPN in 2006 and Child's Nervous System in 2007. After reviewing the current status of neurosurgery of various countries, the author would like to share this information with members of the Korean Neurosurgical Society, as well as offer a proposal to promote Korean neurosurgery around the world.
doi:10.3340/jkns.2008.43.1.1
PMCID: PMC2588160  PMID: 19096536
Neurosurgery; World Federation of Neurological Surgeons; Korean Neurosurgical Society; Neurosurgical Society
11.  Intracranial Atherosclerotic Disease; Current Options for Surgical or Medical Treatment 
Recently, intracranial atherosclerosis has become a major cause of ischemic stroke, appearing more frequently in Koreans than Caucasians. Symptomatic or asymptomatic intracranial atherosclerosis is a disease that could recur readily even during the treatment with anti-platelet agents. When the symptoms develop, ischemic stroke can not be recovered readily. Therefore, aggressive treatments such as endovascular therapy and bypass surgery are required in addition to medical treatment for the intracranial artery stenosis. Recent intracranial stenting and drug eluting stenting have shown as very advanced effective therapeutic modalities. Nevertheless, until now, a randomized controlled study has not been conducted. Regarding bypass surgery, since the failed EC-IC bypass surgery study performed 20 years ago, extensive studies on its efficacy has not been conducted yet, and thus it has to be performed strictly only in hemodynamically compromised patients. Unless breakthrough drugs that suppress the progression of intracranial atherosclerosis and the formation of thrombi, and facilitate the regression of the arterial stenosis, the treatment concept of the recovery of the blood flow of stenotic arterial territory by mechanical recanalization or bypass surgery would be remained for the prevention as well as treatment of ischemic stroke caused by intracranial atherosclerosis.
doi:10.3340/jkns.2007.42.6.427
PMCID: PMC2588182  PMID: 19096584
Angioplasty and stenting; Bypass surgery; Intracranial atherosclerosis
12.  Hemifacial Spasm: A Neurosurgical Perspective 
Hemifacial spasm (HFS) is characterized by tonic clonic contractions of the muscles innervated by the ipsilateral facial nerve. Compression of the facial nerve by an ectatic vessel is widely recognized as the most common underlying etiology. HFS needs to be differentiated from other causes of facial spasms, such as facial tic, ocular myokymia, and blepharospasm. To understand the overall craniofacial abnormalities and to perform the optimal surgical procedures for HFS, we are to review the prevalence, pathophysiology, differential diagnosis, details of each treatment modality, usefulness of brainstem auditory evoked potentials monitoring, debates on the facial EMG, clinical course, and complications from the literature published from 1995 to the present time.
doi:10.3340/jkns.2007.42.5.355
PMCID: PMC2588188  PMID: 19096569
Hemifacial spasm; Microvascular decompression; Craniofacial abnormalities
13.  Clinical Applications of the Tubular Retractor on Spinal Disorders 
Tubular retractor system as a minimally invasive surgery (MIS) technique has many advantages over other conventional MIS techniques. It offers direct visualization of the operative field, anatomical familiarity to spine surgeons, and minimizing tissue trauma. With technical advancement, many spinal pathologies are being treated using this system. Namely, herniated discs, lumbar and cervical stenosis, synovial cysts, lumbar instability, trauma, and even some intraspinal tumors have all been treated through tubular retractor system. Flexible arm and easy change of the tube direction are particularly useful in contralateral spinal decompression from an ipsilateral approach. Careful attention to surgical technique through narrow space will ensure that complications are minimized and will provide improved outcomes. However, understanding detailed anatomies and keeping precise surgical orientation are essential for this technique. Authors present the technical feasibility and initial results of use a tubular retractor system as a minimally invasive technique for variaties of spinal disorders with a review of literature.
doi:10.3340/jkns.2007.42.4.245
PMCID: PMC2588212  PMID: 19096551
Tubular retractor; Minimally invasive surgery; Spinal disorders; Microendoscopic discectomy

Results 1-13 (13)