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Featured researches published by Hwang Sk.


Journal of Clinical Neuroscience | 2008

Chronic subdural hematoma preceded by traumatic subdural hygroma.

Seong-Hyun Park; Sun-Ho Lee; Jaechan Park; Jeong-Hyun Hwang; Hwang Sk; In-Suk Hamm

Patients with traumatic subdural hygroma (SDG) are at an increased risk of developing chronic subdural hematoma (CSDH). However, the mechanism by which this occurs is still not fully understood. The purpose of this paper is to investigate the clinical characteristics and pathogenesis of CSDH, as well as the relationship between CSDH and SDG. We review the pertinent literature and retrospectively examine a series of cases in which CSDH had been preceded by SDG to understand the natural history and developmental mechanisms of these lesions. We discuss the cases of 24 patients in whom CSDH developed from traumatic SDG between 2001 and 2005. Headache was the most common symptom, and the mean Glasgow Coma Scale score was 14.1. Increases in SDG volume were observed in CT scans of 17 patients, and increased density and volume was observed in five patients. The mean interval between the two diseases was 57.6 days, and 13 patients developed new symptoms after the development of CSDH. The most common symptoms at that time were headache and hemiparesis. All patients underwent an operation, which resulted in good recovery in all but one case. The cycle of persistent SDG, rebleeding, coagulation and fibrinolysis contributes to the development of CSDH from SDG. It is important to understand the natural history of CSDH and carefully follow up patients with head injury, especially if it is associated with SDG, and the potential for the development of CSDH should be considered.


Journal of Clinical Neuroscience | 2011

Outcomes of gamma knife radiosurgery for trigeminal neuralgia after a minimum 3-year follow-up

Seong-Hyun Park; Hwang Sk

We conducted a retrospective study of the outcomes of 17 patients who underwent gamma knife radiosurgery (GKRS) for idiopathic trigeminal neuralgia (TN) with a minimum 3-year follow-up. The median interval from GKRS to pain improvement was 4 weeks (range, 1-16 weeks). At the last follow-up, a good treatment outcome was verified in 16 (94.1%) patients (Barrow Neurologic Index pain score, I-IIIb). One patient (5.9%) had treatment failure. On follow up, six patients (35.3%) had a recurrence of pain following some initial relief. Mean time to pain recurrence was 20 months (range, 3-36 months). Four patients (23.5%) experienced treatment-related complications. Three patients reported some degree of post-treatment facial numbness. One patient reported decreased corneal sensation (dry eye syndrome). GKRS is a safe and effective long-term treatment method for TN and should be considered as an alternative option for medically intractable TN.


Journal of Clinical Neuroscience | 2009

Gamma knife radiosurgery for multiple brain metastases from lung cancer

Seong-Hyun Park; Hwang Sk; Dong-Hun Kang; Sun-Ho Lee; Jaechan Park; Jeong-Hyun Hwang; In-Suk Hamm; Yeun-Mook Park

The aim of this study was to compare the effectiveness of gamma knife radiosurgery (GKS) for the treatment of multiple brain metastases from lung cancer with that of whole brain radiation therapy (WBRT). Patients with multiple (2-20) brain metastases were divided into two groups for initial brain tumor management: a GKS group (14 patients) and a WBRT group (19 patients). The patients were stratified by gender, age, initial Karnofsky performance status score, control of the primary site, known extracranial metastases, number of brain metastases, diameter of the maximal lesion, chemotherapy, and recursive partitioning analysis (RPA) Class. The 6-month and 1-year overall survival rates were 64.3% and 47.7%, respectively, in the GKS group, and 42.1% and 10.5%, respectively, in the WBRT group. The median survival time was 32 weeks in the GKS group and 24 weeks in the WBRT group. The overall survival time in the GKS group was significantly longer than in the WBRT group (p=0.04). The univariate analysis suggests that survival was increased in both patients with a controlled primary tumor site and in the GKS group (p=0.03, 0.04). The use of GKS in patients with multiple brain metastases significantly improved patient survival compared to the employment of WBRT. When we assessed the subgroups, systemic disease control and GKS were significant variables by univariate analysis.


World Neurosurgery | 2013

Gamma Knife Radiosurgery for Symptomatic Brainstem Intra-Axial Cavernous Malformations

Seong-Hyun Park; Hwang Sk

OBJECTIVE The purpose of this study was to evaluate the efficacy and safety of gamma knife radiosurgery (GKRS) for the treatment of symptomatic brainstem intra-axial cavernous malformations (CMs) associated with high surgical morbidity. METHODS Twenty-one patients with symptomatic brainstem intra-axial CMs were treated by GKRS between 2005 and 2010. One patient was lost to follow-up. The median age of the patients was 39.5 years (range, 24-69 years). All patients had experienced 1 or more symptomatic hemorrhages before GKRS (range, 1-3). The median marginal radiation dose was 13 Gy, and the median volume of the malformation was 0.56 mL. The median follow-up period after radiosurgery was 32 months (range, 12-82 months; mean, 38.9 months). RESULTS Before GKRS, 31 hemorrhages (1.55 per patient) were observed. The annual hemorrhage rate before GKRS was 39.5%, excluding the first hemorrhage. After GKRS, 1 hemorrhage (0.05 per patient) was identified. It occurred 6 months after radiosurgery. The patient showed complete recovery to a premorbid status with steroid medication. The annual hemorrhage rate after GKRS was 8.2% for the first 2 years. After the expected latency period, no hemorrhages were identified. One patient (5%) exhibited permanent paresthesia, which was a new neurologic symptom in absence of any hemorrhagic event, after the radiosurgery. CONCLUSIONS GKRS seems to be relatively effective and safe for reducing the rebleeding rate of brainstem intra-axial CMs that have high surgical risk. Careful selection of a low marginal dose and an optimal radiosurgical technique are helpful to achieve good outcomes.


Clinical Neurology and Neurosurgery | 2011

Fibrinogen and D-dimer analysis of chronic subdural hematomas and computed tomography findings: a prospective study.

Seong-Hyun Park; Dong-Hun Kang; Jaechan Park; Jeong-Hyun Hwang; Hwang Sk; Joo-Kyung Sung; In-Suk Hamm

OBJECTIVE We investigated the relationship between fibrinolytic factors and computed tomography (CT) findings in patients with chronic subdural hematomas (CSDHs). METHODS Thirty-one patients with CSDHs were divided on the basis of CT findings into heterogeneous and homogeneous groups. A sample from the subdural hematoma was obtained at surgery to measure the concentrations of fibrinogen and D-dimer. RESULTS The mean level of fibrinogen in the heterogeneous group, including the layering (n=4) and mixed (n=10) type, was 88.2±121.2 mg/dL, whereas in the homogeneous group, including high density (n=2), isodensity (n=9), and low density (n=6) types, it was <25 mg/dL. The concentration of fibrinogen was significantly higher in the heterogeneous group than in the homogeneous group (p=0.006). The mean level of D-dimer in the heterogeneous group was 35,407.9±16,325.5 μg/L, whereas for the homogeneous group it was 1476.4±2091.4 μg/L. The concentration of D-dimer was significantly higher in the heterogeneous group than in the homogeneous group (p<0.001). CONCLUSIONS The layering and mixed types of CSDH exhibited higher concentrations of fibrinogen and D-dimer in subdural hematoma than the homogeneous types. These fibrinolytic factors appear to be associated with evolution in CSDHs with heterogeneous density.


Journal of Clinical Neuroscience | 2009

Transcranial doppler study of cerebral arteriovenous malformations after gamma knife radiosurgery

Seong-Hyun Park; Hwang Sk

The aim of this study was to evaluate the clinical value of the Transcranial Doppler (TCD) in follow-up examinations after gamma knife radiosurgery (GKS) for arteriovenous malformations (AVM). We performed TCD after GKS in 18 patients who had cerebral AVMs to evaluate the hemodynamic effects of the procedure. Ten patients underwent TCD within 12 months after GKS, and eight between 12 and 24 months. The mean blood velocity (Vm) and pulsatility index (PI) were primarily analyzed in the feeding arteries (FAs) and non-FAs. Fifteen healthy volunteers served as control patients. The Vm values in the FAs after GKS ranged from 31 cm/s to 90 cm/s, with PI values ranging from 0.48 to 1.03. The Vm values in the comparable normal arteries ranged from 28 cm/s to 87 cm/s, and the PI values in these arteries ranged from 0.62 to 1.02. The Vm and PI values in every FA in all patients were normal compared to the values in the non-FAs (p=0.67 and 0.38, respectively). Our results suggest that AVM vessels with high Vm and low PI values return to normal as the nidus of the AVM is obliterated after GKS. Although there was a trend toward a reduction of the Vm values after obliteration, this trend was not significant, except when the < 12 month subgroup was compared to the 12-24 month subgroup. In our limited study, TDC proved to be a reliable, safe and non-invasive method to monitor the outcome of GKS for cerebral AVMs.


Pediatric Neurosurgery | 2006

Surgical Treatment of Subacute Epidural Hematoma Caused by a Vacuum Extraction with Skull Fracture and Cephalohematoma in a Neonate

Seong-Hyun Park; Hwang Sk

[1] . Cephalohematoma is an accumulation of blood between the periosteum and bone; therefore, cranial sutures limit its expansion ( fi g. 5 ). However, if a space-restricted cephalohematoma is combined with an EDH communicated through a skull fracture, this is potentially fatal. Rarely, the breakdown of hemoglobin retained in the tissues may result in hyperbilirubinemia and jaundice, or pallor may ensue from the anemia. The course of a cephalohematoma is variable. It may not be apparent for 24–72 h, it may enlarge over a few days, and it usually resorbs within 4 weeks, although it can take longer. Treatment of the cephalohematoma can begin with head wrapping, which may promote resorption. However, the careful follow up of neonates with cephalohematomas is important. If the neonatal head circumference enlarges, a CT or MR scan should be performed to fi nd another head injury or to make a decision regarding immediate surgical evacuation. Skull fractures of the parietal bones have been reported after the introduction of vacuum extraction [2] . Approximately 5.4–25% of linear skull fractures have an associated cephalohematoma [3] . In such patients, a CT or MR scan should be obtained to rule out an EDH. The signifi cance of skull fractures among newborns is often underestimated since the majority of these lesions demand no special treatment and heal spontaneously within weeks or months. Additional lesions causing neuroA male infant was born at 39 weeks to a 31-year-old multipara via vacuum extraction after an uncomplicated pregnancy. One week after delivery, the newborn developed an expanding fl uid collection within the right temporoparietal region on the scalp ( fi g. 1 a). The newborn became progressively lethargic and anemic. Plain skull X-rays showed a linear skull fracture in the right parietal area ( fi g. 1 b, c). Magnetic resonance (MR) imaging revealed a huge crescent-shaped cephalohematoma communicating to the massive epidural hematoma (EDH) through a fracture of the skull ( fi g. 2 ). Because of the radiographic feature of the increased intracranial pressure, the neurological defi cit, and the massive EDH with some coagulated blood, a decision was made to remove the hematoma immediately. Initially, percutaneous needle aspiration was performed, and about 100 ml of liquefi ed cephalohematoma was removed. At the same time, packed red blood cells were transfused. After an open craniotomy had been performed ( fi g. 3 ), the EDH was carefully removed. A follow-up computed tomography (CT) scan revealed no hematoma in the subperiosteal and epidural space ( fi g. 4 ). The postoperative course was uneventful, and the infant was discharged about 2 weeks after the operation. Cephalohematoma is a subperiosteal hemorrhage and occurs as a result of birth trauma in about 1% of live births Received: August 22, 2005 Accepted after revision: October 21, 2005


Journal of Korean Neurosurgical Society | 2011

The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Treatment of Brain Abscess

Seong-Hyun Park; Sang-Woo Lee; Dong-Hun Kang; Jeong-Hyun Hwang; Joo-Kyung Sung; Hwang Sk

OBJECTIVE The purpose of this study was to evaluate whether (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to assess the therapeutic response of brain abscess. METHODS A study was conducted on 10 consecutive patients with brain abscess. Magnetic resonance imaging (MRI) with diffuse-weighted imaging (DWI) was performed at 3 and 6 weeks after surgical treatment and intravenous antibiotics therapy and FDG-PET at 6 weeks after treatment. The extent of the abscess, signal changes on MRI, and FDG-PET standardized uptake values were analyzed and correlated with the response to therapy. RESULTS Aspiration or craniotomy with excision of the abscess followed by intravenous antibiotics for 6-8 weeks resulted in good recovery with no recurrence. In 10 patients, two had low signal intensity on the DWI; one had no uptake on FDG-PET imaging after 6 weeks antibiotics and discontinued intravenous treatment, but the other patient had diffuse, increased uptake on FDG-PET imaging after 6 weeks antibiotics and underwent an additional 2 weeks of intravenous antibiotics. The remaining eight patients had high signals on the DWI. Four had no uptake on FDG-PET imaging and the treatment period varied from 6 to 8 weeks (mean, 6.75 weeks). Among the other four patients, FDG was accumulated in a diffuse or local area corresponding to a high signal area within the DWI and 2 weeks of intravenous antibiotics was added. CONCLUSION MRI plus FDG-PET improved the accuracy of assessing therapeutic responses to antibiotics treatment of brain abscess and aided in optimizing therapy.


Brain Tumor Research and Treatment | 2015

Analysis of Circulating Endostatin and Vascular Endothelial Growth Factor in Patients with Pituitary Adenoma Treated by Stereotactic Radiosurgery: A Preliminary Study

Kyung-Min Lee; Seong-Hyun Park; Ki-Su Park; Jeong-Hyun Hwang; Hwang Sk

Background The purpose of this study was to investigate plasma levels of endostatin and vascular endothelial growth factor (VEGF) in normal subjects and in patients with pituitary adenoma and to evaluate change in these levels following stereotactic radiosurgery (SRS) for pituitary adenoma. Methods Peripheral venous blood was collected from five patients with pituitary adenoma before SRS using Gamma Knife and at the 1 week and 1 month follow-up visits. Plasma endostatin and VEGF levels were measured using commercially available enzyme-linked immunosorbent assay kits. Peripheral blood samples were obtained from 10 healthy volunteers as controls. Results Mean baseline plasma endostatin level (105.3 ng/mL, range, 97.0-120.2 ng/mL) in patients with pituitary adenoma was higher than that of the healthy controls (86.6 ng/mL, range, 71.3-98.2 ng/mL) (p=0.001). Mean plasma VEGF level was 89.5 pg/mL (range, 24.1-171.8 pg/mL) in patients with pituitary adenoma at baseline and 29.3 pg/mL (range, 9.2-64.3 pg/mL) in the control group (p=0.050). Plasma endostatin level changed to 106.6 ng/mL 1 week after SRS and decreased to 95.9 ng/mL after 1 month. Plasma VEGF level following SRS decreased to 74.1 pg/mL after 1 week and 79.0 pg/mL after 1 month. There was a trend toward decreased plasma endostatin and VEGF concentrations 1 month after SRS compared to baseline levels (p=0.195, p=0.812, respectively). Conclusion Plasma endostatin and VEGF levels in patients with pituitary adenoma were significantly elevated over controls at baseline, which decreased from baseline to 1 month after SRS for pituitary adenomas.


World Neurosurgery | 2018

Prognostic Value of Serum Levels of S100 Calcium-Binding Protein B, Neuron-Specific Enolase, and Interleukin-6 in Pediatric Patients with Traumatic Brain Injury

Seong-Hyun Park; Hwang Sk

OBJECTIVE To analyze serum levels of S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), and interleukin (IL)-6 in pediatric patients with traumatic brain injury (TBI) and to assess their relationship with clinical outcome. METHODS To measure biomarkers, peripheral venous blood was collected within 6 hours and 1 week after TBI. Initial Glasgow Coma Scale (GCS) scores and Glasgow Outcome Scale scores 6 months after the trauma were used to evaluate clinical outcome. RESULTS Median serum levels of S100B (178.12 pg/mL), NSE (16.54 ng/mL), and IL-6 (15.48 pg/mL) at admission decreased significantly 1 week after TBI to 40.86 pg/mL, 5.85 ng/mL, and 8.63 pg/mL. In the group with poor GCS scores, serum S100B and NSE levels both at admission and 1 week after TBI were significantly higher than levels in the group with good GCS scores. Serum S100B and NSE levels 1 week after injury in patients with unfavorable 6-month outcomes were significantly higher than levels 1 week after injury in patients with favorable outcomes. CONCLUSIONS Serum levels of S100B, NSE, and IL-6 decreased 1 week after injury. Serum levels of S100B and NSE at admission were related to initial GCS scores, and these levels 1 week after TBI were related to 6-month Glasgow Outcome Scale scores. Thus, serial measurements of serum S100B and NSE, but not IL-6, may help assess brain damage and clinical outcome of pediatric patients with TBI.

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Hamm Is

Kyungpook National University

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Jeong-Hyun Hwang

Kyungpook National University Hospital

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Park Ym

Kyungpook National University

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Seong-Hyun Park

Kyungpook National University

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Sung Jk

Kyungpook National University

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Dong-Hun Kang

Kyungpook National University Hospital

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Jaechan Park

Kyungpook National University Hospital

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Joo-Kyung Sung

Kyungpook National University Hospital

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In-Suk Hamm

Kyungpook National University Hospital

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Ki-Su Park

Kyungpook National University Hospital

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