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Journal of Korean Neurosurgical Society | 2008

Radiologic Assessment of Subsidence in Stand-Alone Cervical Polyetheretherketone (PEEK) Cage

Sung Kon Ha; Jung Yul Park; Se Hoon Kim; Dong Jun Lim; Sang Dae Kim; Sang Kook Lee

OBJECTIVE Aim of study was to find a proper method for assessing subsidence using a radiologic measurement following anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK), Solistrade mark cage. METHODS Forty-two patients who underwent ACDF with Solistrade mark cage were selected. With a minimum follow-up of 6 months, the retrospective investigation was conducted for 37 levels in 32 patients. Mean follow-up period was 18.9 months. Total intervertebral height (TIH) of two fused vertebral bodies was measured on digital radiographs with built-in software. Degree of subsidence (DeltaTIH) was reflected by the difference between the immediate postoperative and follow-up TIH. Change of postoperative disc space height (CT-MRDeltaTIH) was reflected by the difference between TIH of the preoperative mid-sagittal 2D CT and that of the preoperative mid-sagittal T1-weighted MRI. RESULTS Compared to preoperative findings, postoperative disc height was increased in all cases and subsidence was observed only in 3 cases. For comparison of subsidence and non-subsidence group, TIH and CT-MRDeltaTIH of each group were analyzed. There was no statistically significant difference in TIH and CT-MRDeltaTIH between each group at 4 and 8 weeks, but a difference was observed at the last follow-up TIH (p=0.0497). CONCLUSION ACDF with Solistrade mark cage was associated with relatively good radiologic long-term results. Fusion was achieved in 94.5% and subsidence occurred in 8.1% by the radiologic assessment. Statistical analysis reveals that the subsidence seen later than 8 weeks after surgery and the development of subsidence does not correlate statistically with the change of the postoperative disc space height.


Journal of Korean Neurosurgical Society | 2009

Biomechanical study of lumbar spinal arthroplasty with a semi-constrained artificial disc (activ L) in the human cadaveric spine.

Sung Kon Ha; Se Hoon Kim; Daniel H. Kim; Jung Yul Park; Dong Jun Lim; Sangkook Lee

OBJECTIVE The goal of this study was to evaluate the biomechanical features of human cadaveric spines implanted with the Activ L prosthesis. METHODS Five cadaveric human lumbosacral spines (L2-S2) were tested for different motion modes, i.e. extension and flexion, right and left lateral bending and rotation. Baseline measurements of the range of motion (ROM), disc pressure (DP), and facet strain (FS) were performed in six modes of motion by applying loads up to 8 Nm, with a loading rate of 0.3 Nm/second. A constant 400 N axial follower preload was applied throughout the loading. After the Activ L was implanted at the L4-L5 disc space, measurements were repeated in the same manner. RESULTS The Activ L arthroplasty showed statistically significant decrease of ROM during rotation, increase of ROM during flexion and lateral bending at the operative segment and increase of ROM at the inferior segment during flexion. The DP of the superior disc of the operative site was comparable to those of intact spine and the DP of the inferior disc decreased in all motion modes, but these were not statistically significant. For FS, statistically significant decrease was detected at the operative facet during flexion and at the inferior facet during rotation. CONCLUSION In vitro physiologic preload setting, the Activ L arthroplasty showed less restoration of ROM at the operative and adjacent levels as compared with intact spine. However, results of this study revealed that there are several possible theoretical useful results to reduce the incidence of adjacent segment disease.


Journal of Korean Neurosurgical Society | 2009

Risk of Stroke with Temporary Arterial Occlusion in Patients Undergoing Craniotomy for Cerebral Aneurysm

Sung Kon Ha; Dong Jun Lim; Bong Gil Seok; Se Hoon Kim; Jung Yul Park; Chung Yg

OBJECTIVE This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms. METHODS Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age, Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke. RESULTS In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p = 0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p = 0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p = 0.011). CONCLUSION Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patients age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.


Clinical Neurology and Neurosurgery | 2011

Analysis of multiple factors affecting surgical outcomes of proximal middle cerebral artery aneurysms.

Sung Kon Ha; Dong Jun Lim; Shin Hyuk Kang; Se Hoon Kim; Jung Yul Park; Chung Yg

OBJECTIVE We analyzed multiple factors including anatomical characteristics that influence the surgical outcomes of proximal middle cerebral artery (M1) aneurysms. METHODS Between January 1999 and February 2007, 189 patients had middle cerebral artery aneurysms and 60 had M1 aneurysms. Eleven patients were excluded from this study. The aneurysms were classified into two groups (superior- and inferior-wall type). Retrospectively, we evaluated characteristics of these patients and investigated factors affecting surgical outcomes. RESULTS Of the 49 patients, 28 had ruptured aneurysms and 43 had aneurysms sized less than 10mm in diameter. There were no giant aneurysms, the incidence of multiple aneurysms was high (22 patients, 45%), and intracerebral hematomas (ICH) were recognized in 13 patients (27%). The superior-wall group included 29 patients (59.2%) and the inferior-wall group had 20 (40.8%). Overall mortality and morbidity rates were 6.1% and 24.5%, respectively. Thirty-four patients (69%) showed good outcomes (GOS 4-5). Eleven and five patients showed unfavorable outcomes from the superior- and inferior-wall group, respectively. Of the four operation-related morbidity patients, three were from the superior-wall and one from the inferior-wall group. There were no statistically significant differences with respect to clinical outcome between the superior- and inferior-wall groups. Patients with poor Hunt-Hess (H-H) grades on admission showed worse outcomes than those with good H-H grades (p=0.002) and those patients without ICH revealed better outcomes than those with ICH (p=0.004). CONCLUSIONS In patients with M1 aneurysms, clinical status on admission and the presence of ICH were significant factors for surgical outcome. Surgical morbidity seems to be related to the direction of the aneurysm. It is critical to save the lenticulostriate arteries and their branches in patients with superior-wall type aneurysms. Thorough preoperative angiographic evaluation, careful brain retraction, and meticulous inspection for hidden small branches are crucial to successful outcomes.


Journal of Korean Neurosurgical Society | 2012

Fatal Case of Cerebral Aspergillosis : A Case Report and Literature Review

Jae Chang Lee; Dong Jun Lim; Sung Kon Ha; Sang Dae Kim; Se Hoon Kim

Cerebral aspergillosis is rare and usually misdiagnosed because its presentation is similar to that of a tumor. The correct diagnosis is usually made intra-operatively. Cerebral abscess with fungal infection is extremely rare and few cases have been reported, but it carries a poor prognosis. A 73 year-old man presented with decreased visual acuity and paresis of the right cranial nerve III. Magnetic resonance imaging (MRI) revealed a mass in the right cavernous sinus, extened to the anterior crainial fossa and the superior orbital fissure. During surgery, a well encapsulated pus pocket was found, and histopathological examination of the mass resulted in the diagnosis of aspergillosis. Despite appropriate anti-fungal treatment, the patient eventually died from fatal cerebral ischemic change and severe brain swelling. The correct diagnosis of cerebral aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific. Surgical intervention and antifungal therapy should be considered the optimal treatment. Early diagnosis and aggressive antifungal treatment provide good results.


Childs Nervous System | 2015

Differential clinical outcomes following encephaloduroarteriosynangiosis in pediatric moyamoya disease presenting with epilepsy or ischemia

Jong Il Choi; Sung Kon Ha; Dong Jun Lim; Sang Dae Kim

PurposeThe purpose of this study was to compare clinical outcomes and surgical results after encephaloduroarteriosynangiosis (EDAS) in pediatric patients with Moyamoya disease that manifested as either ischemia or epileptic seizures.MethodsWe treated 23 children who underwent EDAS; we divided the patients into either ischemic or epileptic groups according to the individuals’ clinical presentation. Group Ia included those who mainly presented with cerebral ischemia in the form of preoperative transient ischemic attacks (TIA), while Group Ib presented with ischemia in the form of irreversible neurologic deficits or proven cerebral infarcts. Group II included those who presented with epileptic seizures rather than cerebral ischemia. We compared the clinical outcomes and surgical results following EDAS in the three groups.ResultsWe grouped the patients into three groups according to their main preoperative clinical symptoms (Group Ia n = 10, Group Ib n = 6, and Group II n = 7). Group II, the epileptic manifestation group, tended to show more favorable clinical outcomes compared to the ischemic manifestation group, especially the severe ischemic group. However, there were no significant differences in postoperative neuroimaging and hemodynamic assessments between the groups.ConclusionsEDAS is a safe and effective surgical technique that prevents epileptic seizures and shows more favorable clinical outcomes when used in patients with Moyamoya disease presenting with epileptic seizures compared to cerebral ischemia.


Journal of Korean Neurosurgical Society | 2013

Rupture of de novo anterior communicating artery aneurysm 8 days after the clipping of ruptured middle cerebral artery aneurysm.

Sung Kon Ha; Dong Jun Lim; Sang Dae Kim; Se Hoon Kim

Rapidly developed de novo aneurysm is very rare. We present a rapidly developed and ruptured de novo anterior communicating aneurysm 8 days after the rupture of another aneurysm. This de novo aneurysm was not apparent in the initial 3-dimensional computed tomography and digital subtraction angiography. We reviewed the literature and discussed possible mechanisms for the development of this de novo aneurysm.


Journal of Korean Neurosurgical Society | 2018

The Potential of Diffusion-Weighted Magnetic Resonance Imaging for Predicting the Outcomes of Chronic Subdural Hematomas

Seung Hwan Lee; Jong Il Choi; Dong Jun Lim; Sung Kon Ha; Sang Dae Kim; Sehoon Kim

Objective Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH. Methods We studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density: 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect. Results Analysis showed statistically significant differences in surgical (A to B: p<0.001, A to C: p<0.001, B to C: p=0.129) and functional (A to B: p=0.039, A to C: p<0.001, B to C: p=0.108) outcomes and treatment failure rates (A to B: p=0.037, A to C: p=0.03, B to C: p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A. Conclusion CSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.


Journal of Korean Neurosurgical Society | 2003

Prognostic Factors of Percutaneous Radiofrequency Neurotomy on the Posterior Primary Ramus

Hoon Joy; Sung Kon Ha; Sehoon Kim; Dong Jun Lim; Jung Yul Park; J K Suh


Journal of Korean Neurosurgical Society | 2001

Surgical Anatomy of Lateral Extracavitary Approach to the Thoracolumar Spine: Cadaveric Study.

Sang Dae Kim; J K Suh; Sung Kon Ha; Kim Jh; Tai Hyoung Cho; Park Jy; Hyun-Jib Kim

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Dong Jun Lim

Catholic University of Korea

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Chung Yg

Korea University Medical Center

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Sehoon Kim

Korea Institute of Science and Technology

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