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ABSTRACT: The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events.
A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group.
Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS.
In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.
Journal of Korean Neurosurgical Society 03/2013; 53(3):155-60. · 0.60 Impact Factor
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ABSTRACT: The sinking skin flap syndrome is a rare complication after a large craniectomy. It consists of a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. In patient with sinking skin flap syndrome, cerebral blood flow and cerebral metabolism are decreased by sinking skin flap syndrome, and it may cause the deterioration of autoregulation of brain. We report a case of a patient with sinking skin flap syndrome who suffered from reperfusion injury after cranioplasty with review of pertinent literature.
Journal of Korean Neurosurgical Society 02/2012; 51(2):117-9. · 0.60 Impact Factor
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ABSTRACT: Lhermitte-Duclos disease (LDD) is a rare cerebellar disorder characterized by diffuse or focal enlargement of cerebellar folia. Clinical manifestations are usually related to a mass effect and secondary obstructive hydrocephalus. Increased intracranial pressure symptoms and cerebellar symptoms are the most frequent patient complaints. We describe the case of a patient with LDD who developed secondary obstructive hydrocephalus. A 68-year-old woman was brought to the emergency room for sudden vertigo following several bouts of vomiting and headache. There were no external signs of trauma, serious illness or infection. On admission, the patient was alert and had no neurological deficits. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed hydrocephalus and a cerebellar mass in the right cerebellar hemisphere compressing the fourth ventricle. Suboccipital craniotomy and subtotal removal of the mass was performed. Pathological study of the surgical specimen showed abnormal ganglionic neurons and an enlarged molecular layer compatible with dysplastic gangliocytoma. Cytoreduction can achieve improvement in symptoms caused by mass effect, but postoperative swelling may aggravate obstructive hydrocephalus. Therefore, if symptoms still remain after removal of the mass, an additional shunting procedure may be needed as a further management option.
Acta neurochirurgica. Supplement 01/2012; 113:161-5.
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ABSTRACT: Colpocephaly is an abnormal enlargement of the occipital horns, i.e., the posterior or rear portions of the lateral ventricles of the brain, and is associated with several other brain abnormalities. Colpocephaly is occasionally misdiagnosed as hydrocephalus, and various etiologies have been postulated, including genetic disorders and errors of morphogenesis. Meanwhile, chromosomal losses including 22q and rarely 21q are observed in malignant and atypical meningiomas. We report an uncommon case of a 67-year-old woman with colpocephaly and an atypical meningioma in the posterior fossa. There were no neurological deficits or family history of hereditary neuropsychiatric disorders. Brain magnetic resonance (MR) images showed bilateral enlarged occipital horns, agenesis of corpus callosum, and a cerebellar mass in the right cerebellar hemisphere. Right suboccipital craniotomy was performed, and the tumor was resected totally. Pathological study of the surgical specimen showed findings of atypical meningioma, and the postoperative course was uneventful until hydrocephalus developed. At 36th day after tumor removal, the patient undertook an external ventricular drainage followed by replacement of the ventriculoperitoneal shunt. We discuss the importance of colpocephaly in terms of the differential diagnosis for hydrocephalus and review the pertinent literature.
Acta neurochirurgica. Supplement 01/2012; 113:167-71.
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ABSTRACT: Although pituitary adenoma is a primary brain tumor that occasionally accompanies intratumoral hemorrhage, there are little reports about the molecular mechanism of intratumoral bleeding in pituitary adenoma. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis and vascular permeability of various brain tumors. The authors studied the relationship between intratumoral hemorrhage and the expression of VEGF in human pituitary adenomas.
VEGF expression was assessed by reverse transcriptase polymerase chain reaction (RT-PCR) in 71 pituitary adenomas. Clinical factors to investigate were age, gender, hormonal functioning, and radiological findings of pituitary adenomas. Radiological findings which were investigated by magnetic resonance (MR) images were intratumoral hemorrhage, cystic change, tumor size, and cavernous sinus invasion. The relationship between these factors and VEGF expression was statistically analyzed.
VEGF was expressed in 25 cases (35.2%). Functioning tumors, hemorrhage, cystic change, and cavernous sinus invasion were 32 (45.1%), 18 (25.4%), 12 (16.9%), and 21 (29.6%) respectively. The expression of VEGF showed a significant relationship with the intratumoral hemorrhage of the adenomas (P <0.001). However, age, gender, tumor size, hormonal functioning, cyst formation, and cavernous sinus invasion had no relationship with VEGF expression (P >0.05).
This study suggests that VEGF expression may be responsible for intratumoral hemorrhage of pituitary adenomas. Therefore, VEGF can be a novel target to prevent a catastrophic apoplexy in pituitary adenomas and to establish roles in angiogenesis-based therapeutics of pituitary adenomas.
Tumori. 09/2011; 97(5):639-46.
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ABSTRACT: Herein, we demonstrate the adsorption process system with the diethylenetriamne coupled polyacrylonitrile fiber for the removal of Cu(II) and Cr(VI) ions in the aqueous solution. The synthesized chelating fiber showed a high adsorption capacity of 11.4 mequiv/g. Interestingly, the crystal growth of copper ions on the chelating fiber was observed during the adsorption process. The chelating fiber packed column showed the high performance of the removal of Cu(II) in the aqueous solution due to the distinct characteristic of the crystal growth of metal ions on the chelating fiber. After Cu(II) adsorption on the chelating fiber, the color of the fiber changed to light blue from yellow. The isotherm parameter n of 1.991 was obtained with Freundlich isotherm model for the adsorption equilibrium study which indicates that Cu(II) adsorption on the chelating fiber is very favorable due to n>1. The pseudo-first-order and pseudo-second-order model equations were used for the kinetic study.
Journal of hazardous materials 08/2011; 194:92-9. · 4.14 Impact Factor
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ABSTRACT: Pituitary apoplexy is one of the most serious life-threatening complications of pituitary adenoma. The purpose of this study is to investigate the visual outcome after early transsphenoidal surgery for the patients with pituitary apoplexy.
We retrospectively reviewed the 31 patients with pituitary apoplexy who were admitted due to acute visual acuity or field impairment and treated by transsphenoidal surgery. Five patients were excluded because of the decreased conscious level. The visual acuity of each individual eye was evaluated by Snellen's chart. Visual fields were also checked using automated perimetry. To compare the visual outcome according to the surgical timing, we divided the patients into 2 groups. The first group, 21 of the patients have been undertaken transsphenoidal approach (TSA) within at least 48 hours after admission. The second group included 8 patients who have been undertaken TSA beyond 48 hours. All patients were monitored at least 12 months after surgery.
Patients were 21 males and 8 females (M : F=2.6 : 1) with the mean age of 42.4 years. Among the enrolled 29 patients, 26 patients presented with decreased visual acuity and 23 patients revealed the defective visual field respectively. Postoperatively, improvement in the visual acuity was seen in 15 patients (83.3%) who underwent surgery within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=5; 62.5%) (p=0.014). Improvement in the visual field deficits was observed in 15 (88.2%) of patients who had been operated on within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=3; 50.0%) (p=0.037).
This study suggests that rapid transsphenoidal surgery is effective to recover the visual impairment in patients with pituitary apoplexy. If there are associated abnormalities of visual acuity or visual fields in patients with hemorrhagic pituitary apoplexy, early neurosurgical intervention within 48 hours should be also required to recover visual impairment.
Journal of Korean Neurosurgical Society 06/2011; 49(6):339-44. · 0.60 Impact Factor
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ABSTRACT: Isolated hypoglossal nerve paresis due to mechanical compression from a vascular lesion is very rare. We present a case of a 32-year-old man who presented with spontaneous abrupt-onset dysarthria, swallowing difficulty and left-sided tongue atrophy. Brain computed tomographic angiography and magnetic resonance imaging of the brainstem demonstrated an abnormal course of the left vertebral artery compressing the medulla oblongata at the exit zone of the hypoglossal rootlets that was relieved by microvascular decompression of the offending intracranial vertebral artery. This case supports the hypothesis that hypoglossal nerve palsy can be due to nerve stretching and compression by a pulsating normal vertebral artery. Microvascular decompression of the intracranial nerve and careful evaluation of the imaging studies can resolve unexpected isolated hypoglossal nerve palsy.
Journal of Korean Neurosurgical Society 03/2011; 49(3):167-70. · 0.60 Impact Factor
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ABSTRACT: Minocycline, a second-generation tetracycline-class antibiotic, has been well established to exert a neuroprotective effect in animal models and neurodegenerative disease through the inhibition of microglia. Here, we investigated the effects of minocycline on motor recovery and neuropathic pain in a rat model of spinal cord injury.
To simulate spinal cord injury, the rats' spinal cords were hemisected at the 10th thoracic level (T10). Minocycline was injected intraperitoneally, and was administered 30 minutes prior surgery and every second postoperative day until sacrifice 28 days after surgery. Motor recovery was assessed via the Basso-Beattie-Bresnahan test. Mechanical hyperalgesia was measured throughout the 28-day post-operative course via the von Frey test. Microglial and astrocyte activation was assessed by immunohistochemical staining for ionized calcium binding adaptor molecule 1 (Iba1) and glial fibrillary acidic protein (GFAP) at two sites: at the level of hemisection and at the 5th lumbar level (L5).
In rats, spinal cord hemisection reduced locomotor function and induced a mechanical hyperalgesia of the ipsilateral hind limb. The expression of Iba1 and GFAP was also increased in the dorsal and ventral horns of the spinal cord at the site of hemisection and at the L5 level. Intraperitoneal injection of minocycline facilitated overall motor recovery and attenuated mechanical hyperalgesia. The expression of Iba1 and GFAP in the spinal cord was also reduced in rats treated with minocycline.
By inhibiting microglia and astrocyte activation, minocycline may facilitate motor recovery and attenuate mechanical hyperalgesia in individuals with spinal cord injuries.
Journal of Korean Neurosurgical Society 02/2011; 49(2):83-91. · 0.60 Impact Factor
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ABSTRACT: Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.
Journal of Korean Neurosurgical Society 01/2011; 49(1):49-52. · 0.60 Impact Factor
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ABSTRACT: Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system. Most cases of NCC are to related and/or associated with inflammation within the cerebral parenchyma. A 71-year-old woman presented with a 4-year history of visual disturbance. This symptom had become aggravated 4 weeks earlier. Her visual acuity gradually decreased and superior hemianopsia was noted. Magnetic resonance imaging (MRI) revealed an enhanced and thickened pituitary stalk accompanying a suspicious mass. The provisional diagnoses were lymphoma, glioma, or other inflammatory conditions. Laboratory studies, including blood and hormonal studies, showed normal findings. Surgical resection was performed. In the pathological examination, degenerated parasitic wall structure was seen and its contents were composed of completely degenerated focal globular structures suggesting the scolex of cysticercus. We report an unusual case of NCC involving the pituitary stalk which was presented with a juxtasellar tumor. The possible underlying mechanisms are discussed with a review of pertinent literature.
Journal of Korean Neurosurgical Society 07/2010; 48(1):91-3. · 0.60 Impact Factor
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ABSTRACT: Gliosarcoma is an uncommon malignant brain tumor composed of distinct sarcomatous and malignant glial cell elements. These tumors are defined as a variant of glioblastoma, and it can be developed by progression of the malignant glial cell tumors or primary tumors. We report a rare case with gliosarcomatous recurrence of anaplastic astrocytoma with neurofibromatosis type 1 (NF-1) followed by chemoradiation therapy. A 26-year-old male patient was presented with headache. Five years before admission, he had been diagnosed with NF-1. Magnetic resonance imaging (MRI) showed a well-demarcated, enhanced lesion in the right frontal lobe and multiple enhanced lesions in the scalp, lower cervical, thoracic, and upper lumbar regions. He underwent an osteoplastic craniotomy with total tumor resection. Histopathology of the tumor showed findings corresponding with anaplastic astrocytoma. He was followed by radiotherapy and chemotherapy postoperatively. A month later, his spinal lesion was also resected and confirmed pathologically as plexiform neurofibroma. The subsequent follow-up period of 27 months was uneventful until he developed a generalized tonic-clonic seizure. MRI showed tumor recurrence in the original site of the tumor. Re-exploration was carried out. Pathological examination displayed a biphasic pattern of the glial and sarcomatous components suggesting gliosarcoma.
Clinical neurology and neurosurgery 05/2010; 112(8):701-6. · 1.30 Impact Factor
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ABSTRACT: The granulins, a novel class of peptides from leukocytes, are growth factors that mediate cycle progression and the motility of epithelial and mesenchymal cells. They are also involved in tissue repair and tumorigenesis. We investigated granulin expression in intracranial meningiomas by reverse transcription-polymerase chain reaction and correlated its expression to clinical parameters. Seventy-nine patients who underwent tumor removal for intracranial meningiomas were included in this study. Granulin expression was analyzed in respect to clinical parameters including age, gender, tumor size and peritumoral brain edema (PTBE). Granulin was expressed in the tumors of 29 of 79 (36.7%) patients with intracranial meningiomas, and its presence or absence was correlated to tumor size and PTBE volume. However, granulin expression did not vary significantly according to patient age or gender. Our data provide improved understanding about the clinical implications of granulin expression in intracranial meningiomas. Additionally, our information suggests a potential role for granulin as a molecular target in the management of meningiomas.
Experimental and therapeutic medicine 01/2010; 1(3):493-496.
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ABSTRACT: Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.
Journal of Korean Neurosurgical Society 04/2009; 45(3):176-8. · 0.60 Impact Factor
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Choong Hyun Kim
Surgical Neurology 04/2009; 72(5):554-5; discussion 555. · 1.67 Impact Factor
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ABSTRACT: Ventriculoperitoneal (VP) shunt is commonly and effectively used to treat hydrocephalus. Intracardiac migration of the shunt catheter is a rare complication. A 68-year-old woman underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to anterior communicating artery aneurysm rupture. Two weeks after the shunt surgery, she had suffered from the abdominal pain. Plain chest x-rays, computed tomography, and echocardiography revealed the distal catheter which was in the right ventricle of the heart. We tried to remove the catheter through the internal jugular vein by fluoroscopic guidance. But, the distal catheter was kinked and knotted; therefore, we failed to withdraw the catheter. After then, we punctured the right femoral vein and pulled down the multi-knotted shunt catheter to the femoral vein using the snare catheter. Finally, we removed the knotted distal catheter via the femoral vein and a new distal catheter was placed into the peritoneal cavity. We report a case in which the distal catheter of the VP shunt migrated into the heart via the internal jugular vein. We emphasize the importance of careful and proper placement of the distal catheter during the tunneling procedure to prevent life-threatening complications.
Journal of Korean Neurosurgical Society 10/2008; 44(3):170-3. · 0.60 Impact Factor
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ABSTRACT: We investigate cases of low-lying IC-PC artery aneurysms with the aim to demonstrate an easy and less laborious technique of APF resection in lieu of AC in cases involving difficult aneurysmal neck clipping.
Among a total 117 IC-PC artery aneurysms, 15 low-lying IC-PC artery aneurysms (13 ruptured and 2 unruptured) were obliterated between January 1996 and December 2006. We retrospectively investigated patients who have been treated by simple resection of APF (APF group) compared with patients treated by AC (AC group) in the surgery of the communicating segment of the ICA aneurysms. Clinical, radiological, and operative data were analyzed; and the 2 groups were compared.
Among 15 cases, 7 cases were included in the AC group and 8 cases were included in the APF group. One case was treated by a combination of AC and APF resection simultaneously. There was no difference in the clinical outcome between the 2 groups. No operative complications were encountered in any patients treated by the simple APF resection.
Simple APF resections improve the visualization of the proximal neck of aneurysms, allowing for accurate clip placement and also facilitating the use of proximal vascular control as an adjunct to low-lying IC-PC artery aneurysms surgery.
Surgical Neurology 10/2008; 72(2):142-5. · 1.67 Impact Factor
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ABSTRACT: Aneurysmal subarachnoid hemorrhage is uncommon in young adults. The aim of this study was to compare clinical characteristics of ruptured aneurysms between males and females in the third or fourth decade of life. We retrospectively investigated 301 patients who underwent surgery for ruptured cerebral aneurysms over 6 years. Among them, 53 patients were aged between 20-39 years. Clinical characteristics and related variables were compared between genders. In general, there was a favorable outcome in either gender (84.9%). There was a higher incidence of multiplicity and intraoperative rupture in females, as well as a significant difference in aneurysm location between genders (p=0.030, p=0.014, and p=0.027 respectively). Overall outcome was not different between the two groups. These results suggest that aneurysm formation may differ between genders.
Journal of Clinical Neuroscience 05/2008; 15(4):389-92. · 1.25 Impact Factor
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ABSTRACT: This retrospective study was performed to relate tunnel position as measured by plain radiographs and magnetic resonance imaging (MRI) to residual pivot shift and to determine its clinical relevance after anterior cruciate ligament reconstruction via central quadriceps tendon autograft.
We reviewed 137 arthroscopic anterior cruciate ligament reconstructions via quadriceps tendon autograft with a minimum of 2 years' follow-up. Clinical results were evaluated by use of the Lachman test, pivot-shift test, Lysholm score, and Cybex dynamometer (Lumex, Ronkonkoma, NY). Anterior tibial translation was measured with the KT-1000 arthrometer (MEDmetric, San Diego, CA). Patients were classified into 3 groups based on postoperative pivot-shift and Lachman test findings: group I, both negative; group II, negative Lachman test and positive pivot shift; and group III, both positive. The radiographic analysis was performed via the angle between the tibial and femoral tunnels on plain anteroposterior radiographs, the angle between the tibial tunnel and anterior tibial cortex on the lateral view, and the femoral and tibial tunnel location by use of the ratio method. Postoperative knee MRI was performed, and the angle between the intercondylar anteroposterior axis and femoral tunnel on the axial view and the angle between the joint line and the graft on the oblique coronal and sagittal views were measured.
There were 100 patients in group I, 13 in group II, and 24 in group III. Patients in group I showed the greatest improvement in Lysholm score among the groups, and patients in group III had the greatest side-to-side difference by KT-1000 arthrometer. Tunnel obliquity as measured by the angle between the anteroposterior axis of the femur and the femoral tunnel in the axial view on MRI was greater (P < .05) and the angle between the joint line and the graft on the oblique coronal view was less in group I.
This study showed a significantly lower Lysholm score and more vertical orientation of the femoral tunnel in the group with residual pivot shift than in the group without pivot shift. Vertical orientation of the femoral tunnel in the axial plane is closely related to residual pivot shift without definite anteroposterior laxity. More oblique positioning of the graft may have advantages in rotational stability, which in turn increase subjective patient satisfaction.
Level III, diagnostic study of nonconsecutive patients without consistently applied reference gold standard.
Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2007; 23(7):771-8. · 3.02 Impact Factor
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ABSTRACT: CT angiography has been widely used for the detection of cerebral aneurysm. However, there are still limitations despite improving CT angiographic techniques. We describe the unusual case of the detection of a false-positive aneurysm on CT angiography.
A 64-year-old man presented with a 14-day history of severe headache and nuchal rigidity. Brain CT demonstrated no subarachnoid hemorrhage, but cerebrospinal fluid appeared xanthochromic in 3 successive tubes after lumbar puncture. Subsequent CT angiography suggested an aneurysm at the bifurcation of the left MCA. However, at operation, prominent sylvian vein superimposed on the bifurcation of the left MCA, and there was no aneurysm. Follow-up monitoring with conventional angiography at 2 weeks showed no abnormal findings. The patient recovered uneventfully.
The case demonstrates that although CT angiography has a reportedly high specificity and sensitivity for the detection of intracranial aneurysm, careful interpretation is required to diagnose intracranial aneurysms.
Surgical Neurology 12/2006; 66(5):524-6. · 1.67 Impact Factor
