Jung Yt

Gamma knife surgery for intracranial cavernous hemangioma

OBJECT The purpose of this study was to assess the benefits of radiosurgery for cavernous hemangioma. METHODS Sixty-five cavernous hemangiomas were treated with gamma knife surgery (GKS) between October 1994 and December 2002. Forty-two patients attended follow up. The mean patient age was 37.6 years (range 7-60 years). The lesions were located in the frontal lobe in 12 cases, deep in the parietal lobe in five, in the basal ganglia in five, in the temporal in three, in the cerebellum in three, in the pons/midbrain in six, and in multiple locations in eight cases. The presenting symptoms were seizure in 12, hemorrhage in 11, and other in 19. The maximum dose was 26.78 Gy, and the mean margin dose was 14.55 Gy. The mean follow-up period after radiosurgery was 29.6 months (range 5-93 months). The tumor decreased in size in 29 cases, was unchanged in 12, and increased in size in one. In the seizure group, seizures were controlled without anticonvulsant medication in nine cases (81.8%) after 31.3 months (range 12-80 months). After 93 months, one patient developed a cyst, which was resected. Rebleeding occurred in one case (2.3%). On T2-weighted imaging changes were seen in 11 cases (26.2%), in three (7.1%) of which neurological deterioration was correlated with imaging changes. In other cases these deficits were temporary. CONCLUSIONS The authors found that GKS was an effective treatment modality for cavernous hemangiomas, especially for those located within the brainstem, basal ganglia, or deep portions of the brain. It can reduce seizure frequency significantly although this takes time. In the group receiving a marginal dose below 15 Gy the patients fared better than when the dose exceeded 15 Gy.

Microelectrode recording: lead point in STN-DBS surgery

BACKGROUND Microelectrode recording is an integral part of many surgical procedures for movement disorders. We evaluate the Lead point compared to the NeuroTrek system. We used NeuroTrek in 18 Parkinsonian patients, Lead point-4 in 12 patients, during STN-DBS surgery. We compared MR-Stir image with Microelectrode recording. METHOD The MicroGuide system with its integrated screen display provides the user with all the information needed during the surgery on its screen. Microelectrode recordings showed characteristic neuronal discharges on a long trajectory (5-6 mm), intraoperative stimulation induces dramatic improvement of Parkinsonian motor symptoms. FINDINGS Microrecording data of the Leadpoint showed high background activity, and firing rate of 14-50 Hz. The discharge pattern is typically chaotic, with frequent irregular bursts and pauses. DISCUSSION The microelectrode recording of the neuroTrek and Lead point-4 showed unique results of the typical STN spike. The DBS effect is maximized associated by MER mapping.

The Effectiveness of Early Tracheostomy (within at least 10 Days) in Cervical Spinal Cord Injury Patients

Objective This study aimed to determine the optimal time for tracheostomy by evaluating the benefits and safety of early versus late tracheostomy in spinal cord injury (SCI) patients. Methods We retrospectively reviewed a total of 254 patients with spinal cord injury. Of them, we selected 21 spinal cord injury patients who required tracheostomy due to long-term mechanical ventilation and analyzed their medical records. The patients were categorized into two groups. Early tracheostomy was performed day 1-10 from intubation in 10 patients and the late tracheostomy was performed after day 10 in 11 cases. We also evaluated the duration of mechanical ventilation, stay in the ICU and complications related to tracheostomy, the injury level of and clinical severity. All data was analyzed using SPSS 18.0/WIN. Results The early tracheostomy offered clear advantages for shortening the total ICU stay (20.8 day vs. 38.0 day, p=0.010). There was also statistically significant reduction in the total length of time on mechanical ventilation (5.2 day vs. 29.2 day, p=0.009). However, the reductions in the incidence of pneumonia (40% vs. 82%) and the length of ICU stay post to tracheostomy (6 day vs. 15 day) were found to be statistically not significant. There were also no statistically significant differences in the injury level and clinical severity between the groups. Conclusion We concluded that the early tracheostomy (at least 10 days) is beneficial for SCI patients who are likely to require prolonged mechanical ventilation.

Hybrid Surgery for Multilevel Cervical Radiculopathies

Introduction Conventional anterior cervical discectomy and fusion (ACDF) operation is the treatment of choice for cervical radiculopathies caused by herniated cervical disc (HCD) or foraminal stenosis (FS) when surgery is indicated. But neck motion limitation and axial neck pain after multilevel ACDF and/or corpectomy and reconstruction would be considerable. For preserving the motion of spinal motion segment, artificial disc transplantation was revolutionary developed, but all of these prosthesis still did not reach to normal angular and sliding range of motion segment, and cause many complications such as prosthesis loosening and migration, subsidence, postoperative kyphosis, progression of facet arthrosis (PFA), heterotopic ossification (HO), and not so much as spontaneous fusion. These device-related failures are still of concern for motion-sparing devices, and moreover, the benefit of these devices in preventing adjacent level degeneration still requires further confirmation. Then anterior cervical microforaminotomy (ACM) which is one of nonfusion surgical technique is applicable method in combination with fusion surgery in other levels for decreasing the numbers of fusion levels on multilevel cervical radiculopathy. The purpose of this study is to introduce alternative surgical technique for minimizing fusion surgery on cases of multilevel cervical radiculopathies as possible. Patients and Methods Patients with bilateral or unilaterally dominant upper extremity radiculopathies, who was defined multilevel pathologies such as HCD or FS on image studies, and underwent ACM combined with ACDF or corpectomy and reconstruction in other levels between December 2010 and May 2012 were included. There were two females and eight males with mean age of 56.86 years. Total number of fusions were15 disc levels including ACDF (13 disc levels) and corpectomy and reconstruction (two disc levels) and total number of ACM were 11 disc levels. Combination surgical techniques were1 level ACDF and 1 level ACM is six cases, 2 level ACDF and 1 level ACM is one case, 3 level ACDF and 1 level ACM is one case, 2 level ACDF and 2 level ACM in one case, and 1 level corpectomy and 1 level ACM is one case. Pre- and postoperative arm, shoulder, and neck pain were evaluated by Visual Analogue Scale (VAS). Functional outcomes were evaluated using Neck Disability Index (NDI). Results Arm and shoulder pain relief was assessed by VAS postoperative immediately and 2, 4, 6 months after procedure. Early postoperatively, there was significant improvement in VAS arm pain (p < 0.0001). After 1 year, there was also significant improvement in VAS neck pain (p = 0.001), and VAS arm pain (p < 0.0001, p = 0.001, respectively). The functional outcome was measured by NDI and relatively good in almost. Major complications such as recurrence of HCD, instrumental failure, or fusion failure were not found and related reoperations were absent in all the cases at this study periods. Conclusion Anterior cervical microforaminotomies are an effective technique for treatment of radiculopathies because of the multilevel degenerative pathologies to minimize the need for fusion.

Recurrent spinal meningioma: a case report.

Meningiomas are the second most common intradural spinal tumors accounting for 25% of all spinal tumors. Being a slow growing and invariably benign tumor, it responds favorably to surgical excision. In addition, spinal meningioma has low recurrence rates. However, we experienced a case of intradural extramedullary spinal meningioma which recurred 16 years after the initial surgery on a 64-year-old woman. She presented with progressive neurological symptoms and had a surgical history of removal of thoracic spinal meningioma 16 years ago due to bilateral low leg weakness. She underwent a second operation at the same site and a pale yellowish tumor was excised, which was histopathologically confirmed as meningothelial meningioma, compared with previously transitional type. she showed neurological recovery after the operation. We, therefore, report the good results of this recurrent intradural spinal meningioma case developed after 16 years with literature review.