Journal of Korean Society of Geriatric Neurosurgery最新文献

{"title":"A novel technique for surgical excision of a symptomatic lumbar spine facet joint synovial cyst using a cyst dyeing method: a report of two cases and a literature review","authors":"Ji Soo Moon, M. Kang, S. H. Lee, Chan Hong Park","doi":"10.51638/jksgn.2021.00136","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00136","url":null,"abstract":"of facet joint cysts in 2","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116956660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual collateral channel of ruptured vertebral artery fusiform aneurysm involving the posterior inferior cerebellar artery: a case report","authors":"Kyung Hoon Kim, D. Kim, S. Jang","doi":"10.51638/jksgn.2021.00115","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00115","url":null,"abstract":"Approximately 10% of vertebral artery (VA) aneurysms are fusiform and originate from the posterior inferior cerebellar artery (PICA) [1,2]. The ideal treatment for fusiform aneurysms is completely isolating them from the circulation while preserving flow to parent vessel branches. Fusiform aneurysms are treated surgically (proximal clip ligation, trapping, and microvascular bypass) or endovascularly (coil embolization, stenting, stent-assisted coiling, and flow diversion) [3–7]. The patient in this study was diagnosed with subarachnoid hemorrhage due to a ruptured right VA fusiform aneurysm originating from the PICA. Digital subtraction angiography (DSA) was performed after confirming subarachnoid hemorrhage using brain computed tomography (CT). We confirmed a preexisting collateral channel between the PICA and posterior meningeal artery A 60-year-old female patient presented to the emergency department with comatose mentation. Brain computed tomography angiography revealed subarachnoid hemorrhage due to a ruptured right vertebral artery (VA) fusiform aneurysm originating from the posterior inferior cerebellar artery (PICA). Subsequent digital subtraction angiography confirmed that the PICA was supplied by collateral circulation via the ipsilateral posterior meningeal artery. Coil embolization of the ruptured VA fusiform aneurysm was performed. Generally, the PICA is involved in dissecting VA aneurysms, and a therapeutic strategy without reconstructive therapy could pose a significant risk of morbidity. However, this case, we could perform parent artery occlusion without bypass surgery or stenting because of the unusual collateral channel.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133278060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-arterial thrombectomy in elderly patients: assessment of arterial tortuosity in determining successful procedure","authors":"S. Kye, Junhyoung Ahn, I. Chang, Joon-Ho Song, Ji Hee Kim, Heui Seung Lee, J. Oh","doi":"10.51638/jksgn.2021.00108","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00108","url":null,"abstract":"Intra-arterial thrombectomy (IAT) has become the mainstay of treatment for ischemic stroke caused by large artery occlusion [1,2]. However, IAT in older patients should be carefully considered due to uncertain clinical outcomes despite the risk of procedure-related complications [3,4]. Vascular tortuosity and longer procedure time have been suggested as factors associated with Objective: Intra-arterial thrombectomy (IAT) is the mainstay of initial treatment for intracranial large-vessel occlusion. However, arterial tortuosity is associated with procedural failure and unfavorable outcomes in older patients. Methods: We reviewed patients with ischemic stroke (>75 years) treated with IAT and analyzed procedure-related complications and arterial tortuosity based on pre-procedural computed tomography angiography. Results: Of the 29 patients, 7 had distal internal carotid artery (ICA) occlusion, 18 had middle cerebral artery (MCA) occlusion, 3 had anterior cerebral artery and MCA occlusion, and one had distal ICA and MCA occlusion. Significant arterial tortuosity was observed in 9 patients (31.0%). The degree of recanalization, as assessed by the modified thrombolysis in cerebral infarction grade, did not differ according to significant arterial tortuosity (P=0.55). Post-procedural subarachnoid hemorrhage was observed in 17 of 29 patients (58.6%) and there was no significant association with significant arterial tortuosity. The puncture to recanalization time was not significantly different according to the presence of significant arterial tortuosity (51.6±22 minutes vs. 53±43.9 minutes; P=0.93). Additionally, the number of thrombus retrieval trials during the procedure did not show a significant relationship with arterial tortuosity (2.4±1.2 times vs. 2.6±2.5 times; P=0.86). Conclusion: IAT can be performed in patients aged >75 years. Arterial tortuosity was not significantly associated with successful recanalization or post-procedural complications. Therefore, whether to perform IAT in older patients should not be determined only by arterial tortuosity.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132299506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of surgical outcomes between early decompressive craniectomy with clipping and coil embolization followed by decompressive craniectomy","authors":"Jessie Choi, I. Park","doi":"10.51638/jksgn.2021.00129","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00129","url":null,"abstract":"Aneurysmal subarachnoid hemorrhage (aSAH) is caused by rupture of an intracranial aneurysm and has high morbidity and mortality. Cases of poor grade aSAH have even higher morbidity and mortality [1–3]. Poor grade aSAH refers to modified Fisher grade 3 or higher and Hunt and Hess (H-H) grade 4 or higher aSAH. In Objective: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality, even when emergency treatment such as decompressive craniectomy (DC), coil embolization, or clipping is performed. The best treatment for acute aSAH, especially in poor-grade aSAH patients, has not been determined. The purpose of this study was to evaluate treatment methods in these patients in order to suggest the best treatment method. Methods: We compared 130 patients with poor-grade aSAH who underwent DC with clipping or coiling (clipping, 102 patients; coiling, 28 patients). We compared functional outcome, mortality, and the time interval between admission and DC surgery between the clipping and coiling groups. Results: There was a significant difference in functional outcomes (modified Rankin score [mRS]) between the clipping and coiling groups. The mean mRS at discharge in the clipping and coil groups was 4.824 and 5.214, respectively (P=0.049). The time interval until DC surgery was also significantly different (161 and 481 minutes in the clipping and coiling groups, respectively; P=0.003). No significant difference was found in mortality between the 2 groups (P=0.301). Conclusion: DC might be helpful for severe brain edema and intracranial pressure control. This procedure was more effective when performed with clipping than with coil embolization. DC with clipping showed better functional outcomes, lower mortality, and more favorable outcomes than DC with coil embolization. This demonstrates that aggressive surgical treatment can be helpful for poorgrade aSAH patients.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123684326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for disc height loss in conservatively treated symptomatic lumbar disc herniation in elderly patients","authors":"Dongwoo Seo, Yongjae Cho","doi":"10.51638/jksgn.2021.00094","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00094","url":null,"abstract":"Lumbar disc herniation, which causes low back pain and radiating pain in the lower extremities, is a common disease that occurs in 20% to 30% of the population [1]. Since Mixter and Barr introduced surgical treatment for lumbar disc herniation in 1934, discectomy has been performed as standard treatment for this disease [2]. However, it has been reported that the lumbar disc herniation-induced low back pain and radiating pain in the lower extremObjective: The purpose of this study was to evaluate the clinical and radiologic factors associated with disc height loss in patients with spontaneous resolution of lumbar disc herniation. Methods: In total, 56 symptomatic herniated lumbar disc patients above 65 years old (36 male and 20 female patients) who received conservative treatment from January 2017 to December 2018 were retrospectively investigated. Clinical findings including age, sex, pain, and smoking history were examined in each group (group A, patients with unchanged disc height; group B, patients with decreased disc height). As radiologic findings, the level, severity, laterality, Modic changes, and disc degeneration of lumbar disc herniation were investigated and compared between groups. Results: Group A contained 30 patients and group B comprised 26 patients. No statistically significant differences were found in age, sex, visual analogue scale scores, level of disc herniation, and laterality of disc herniation between groups. Group A had more protrusion cases (14/30 cases) and group B had more sequestration (11/26 cases). Group B had more cases of Modic changes and more disc degeneration cases than group A. Conclusion: In patients who receive conservative treatment for symptomatic lumbar disc herniation, disc height loss may occur later, especially in cases of extrusionand sequestration-type herniation. This disc height decrease after lumbar disc herniation without surgical removal of the disc may occur due to disc degeneration and disc herniation itself. Patients who are treated conservatively should receive an explanation that disc height may be reduced later.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"162 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123725623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Annuloplasty as a method to prevent recurrent herniation of lumbar intervertebral discs","authors":"T. Choi, H. Choi, Dae-Jean Jo","doi":"10.51638/jksgn.2021.00122","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00122","url":null,"abstract":"Among patients with herniation of the intervertebral disc (HIVD), surgical treatment is recommended for patients with failure of conservative treatment or severe muscle weakness [1,2]. During surgical treatment, the herniated disc is removed to relieve the compressed cauda equina or nerve roots. Although surgical treatment is performed successfully, the risk of recurrence is reported to be up to 15% [3–5]. Objective: Recurrent disc herniation occurs frequently after discectomy and is associated with annulus fibrosus defects. This study evaluated the effectiveness of annuloplasty in preventing recurrent intervertebral disc herniation following microscopic discectomy. Methods: We analyzed 102 patients (56 males, 46 females) who underwent discectomy between December 2019 and February 2021. Twenty-two patients received annuloplasty using sutures and 80 did not. Surgical and clinical outcomes and the herniation recurrence rate were compared between the groups. Results: The mean age was significantly lower in the suture group than in the non-suture group (54.55±10.12 years vs. 60.60±12.20 years; P=0.021). There were no significant between-group differences in sex, body mass index, or length of follow-up. The surgical outcomes, such as operation time (66.82±13.01 minutes vs. 63.14±20.54 minutes; P=0.305) and estimated blood loss (54.55±14.71 mL vs. 59.77±19.59 mL; P=0.175), did not differ significantly between the groups. No significant between-group difference was found in the proportion of patients with lower extremity weakness preoperatively (63.6% vs. 48.8%; P=0.155), and at 1 (36.4% vs. 25.0%; P=0.275) and 6 months (13.6% vs. 11.3%; P=0.707) postoperatively. There were no cases of recurrent herniation in the suture group, whereas the recurrence rate was 5.0% in the non-suture group. Conclusion: Despite the non-statistically significant results, annuloplasty may serve as a simple method to prevent recurrent intervertebral disc herniation.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125343618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple recurrent arachnoid cysts with adhesive arachnoiditis following a spontaneous spinal subdural hematoma in an elderly patient: a case report with a literature review","authors":"Junhyeok Yang, Hong Yoon, S. Yoon, D. Ryu","doi":"10.51638/jksgn.2021.00101","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00101","url":null,"abstract":"Adhesive arachnoiditis in addition to spinal arachnoid cysts is extremely uncommon [1]. It is known to be associated with devastating clinical outcomes. Although the exact pathophysiology associated with an arachnoid cyst remains unclear, congenital, inflammatory, iatrogenic, and post-traumatic factors might play roles in its pathophysiology [2]. Severe diffuse inflammatory reaction along the whole spinal cord can occur rarely after hemorrhage [3]. Adhesion forms tethering of neural component including spinal cord and nerve roots. Subsequently, cerebrospinal fluid (CSF) location due to the disruption of flow is generated. It can compress the spinal cord with a clinical manifestation as progressive motor weakness. Previous reported cases were adhesive arachnoiditis following aneurysmal or spontaneous subarachnoid hemorrhage. In this article, we report a case of a recurrent spinal arachnoid cyst Although arachnoid cysts associated with adhesive arachnoiditis are extremely rare, they can have devastating clinical outcomes. This severe form of arachnoiditis develops from fibrosis of the arachnoid membrane with subsequent adhesion of the arachnoid space. An arachnoid cyst with adhesive arachnoiditis can compress the spinal cord. Surgical decompression can be considered in case of neurologic deficits. However, surgery should be chosen carefully because it does not always guarantee favorable clinical outcomes. We present a case of recurrent arachnoid cysts with adhesive arachnoiditis following a spontaneous spinal hematoma in an elderly woman who suffered from progressive myelopathy despite 2 adhesiolysis treatments.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"461 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125810364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversible cerebral vasoconstriction syndrome presenting with intracranial hemorrhage: a case report and literature review","authors":"Tae Won Choi, H. Shin, S. Lee, J. Koh, Hak-Cheol Ko","doi":"10.51638/jksgn.2021.00087","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00087","url":null,"abstract":"Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches with segmental vasoconstriction of the intracranial arteries. RCVS may result in ischemic stroke or intracranial hemorrhage (ICH), but the pathophysiology and data of RCVS-related ICH are not well known [1]. The purpose of this case report is to discuss the process of diagnosis of RCVS when ICH is accompanied by severe headache on patients without a specific medical history.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117208485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological outcomes of denosumab and teriparatide treatment in elderly patients with osteoporotic spinal compression fracture without vertebroplasty","authors":"J. Jung, Byoung Hun Lee, Jong Young Lee, H. Jeon, B. Cho, S. Y. Kim, Se Hyuck Park","doi":"10.51638/jksgn.2021.00073","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00073","url":null,"abstract":"fore, we investigated the clinical and radiological outcomes of conservative treatment using a combination of denosumab and teriparatide. Methods: This study included 86 patients aged 75 or older who were diagnosed with osteoporotic spinal compression fracture from January 2011 to April 2021. The patients were then categorized into those who received denosumab and teriparatide combination treatment without vertebroplasty(group A) and those who received bisphosphonate treatment and underwent vertebroplasty(group B). Several parameters were analyzed: age, sex, underlying diseases, BMI, hospital stay, the time of ambulation start, BMD, VAS score, compression ratio, regional Cobb angle, and local kyphotic angle. Results: As compared to group A, group B showed a relatively shorter hospital stay and time until starting ambulation, but without statistical significance. The VAS scores measured at the time of injury, post-treatment, 3months post-injury, and 1year post-injury did not show statistically significant differences between the groups. In contrast, the mean BMD measured at the time of injury and 1year post-injury demonstrated statistically significant improvements in group A compared to group B. The differences in the compression ratio, regional Cobb angle, and local kyphotic angle measured at the time of injury and 1year post-injury were not statistically significant. Conclusion: Combination treatment without vertebroplasty did not show significant differences in either clinical or radiologic results compared to vertebroplasty cases. Therefore, denosumab and teriparatide combination treatment could be considered as an alternative option for osteoporotic spinal compression fracture patients.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"552 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123103363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and surgical treatment of arachnoid web","authors":"Ga-On Park, Do-Yeon Kim, H. Jang, K. Kim, Jeong-Yoon Park, D. Chin, Keun-Su Kim, Y. Cho","doi":"10.51638/jksgn.2021.00052","DOIUrl":"https://doi.org/10.51638/jksgn.2021.00052","url":null,"abstract":"The term “arachnoid web” was first mentioned by Mallucci et al. [1] in 1997 as one of the possible causes of idiopathic syringomyelia. They reported that arachnoid webs or pouches create syringomyelia by partially blocking the flow of cerebrospinal fluid (CSF) and can originate from the septum posticum. Then, the disease entity of arachnoid web was verified by Paramore [2] in 2000. He reported two cases of arachnoid web characterized by focal indentation of the dorsal thoracic cord that was not true arachnoid cyst but blocking CSF flow in magnetic resonance imaging (MRI) and computed tomography (CT) myelogram. Both patients presented with weakness of lower extremities and were treated with surgical resection, which produced improvement clinically and radiologically. Since then, a few case reports and studies have been pubArachnoid web is a rare disease entity that can cause progressive myelopathy and most often develops at the upper thoracic level. Its pathophysiology is unclear, but may be associated with degeneration of the septum posticum in the dorsal subarachnoid space, which alters the flow of cerebrospinal fluid (CSF) and subsequently leads to cord compression and syringomyelia. It often presents with pain, paresthesia, and extremity weakness. Arachnoid web is diagnosed by a typical pattern of displacement of the spinal cord, known as the scalpel sign, with intact ventral dura mater and disturbed but conserved CSF flow. Arachnoid web should be differentiated from other disease entities sharing the feature of ventral displacement of the dorsal spinal cord, such as arachnoid cyst or spinal cord herniation. The treatment for arachnoid web is surgical resection. We report a 66-year-old female who was diagnosed with arachnoid web in the dorsum of the spinal cord at the T3 level. She had suffered from weakness of both legs for 3 months. She underwent laminectomy of T3 and T4 and the dura was opened. The web was resected and the displacement of the spinal cord then improved.","PeriodicalId":161607,"journal":{"name":"Journal of Korean Society of Geriatric Neurosurgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124094959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}