Journal of Korean Neurosurgical Society最新文献

{"title":"Surgically Induced Subacute Antiepileptic Effect of Vagus Nerve Stimulation before Stimulation Onset.","authors":"Jong-Young Park, Kawngwoo Park, Jun Hyeok Jung, Hyo Jung Kim, Hyeon-Mi Park","doi":"10.3340/jkns.2025.0258","DOIUrl":"https://doi.org/10.3340/jkns.2025.0258","url":null,"abstract":"<p><strong>Objective: </strong>Vagus nerve stimulation (VNS) is an established adjunctive therapy for drug-resistant epilepsy (DRE). Although its long-term efficacy after electrical activation is well recognized, transient seizure reduction has occasionally been observed immediately after implantation, even before stimulation onset. This study aimed to investigate the early postoperative antiepileptic effect of VNS surgery itself during the stimulation-off period.</p><p><strong>Methods: </strong>We retrospectively analyzed 16 patients with DRE who underwent VNS implantation at a single institution between May 2019 and July 2024. Only patients whose stimulators remained off postoperatively were included. The latency to first postoperative seizure was compared with the expected interval estimated from preoperative seizure frequency using the Wilcoxon signed-rank test. Subgroup analysis was performed according to seizure type.</p><p><strong>Results: </strong>The median age was 43.0 years (interquartile range [IQR], 30.0-56.0), and the median latency to first seizure was 25.0 days (IQR, 18.0-48.5). The observed seizure-free interval was significantly longer than expected based on preoperative frequency (p=0.008), with no difference between patients with and without generalized tonic-clonic seizures (p=0.965). No serious postoperative complications were noted.</p><p><strong>Conclusion: </strong>VNS implantation was associated with a transient but significant postoperative seizure-free period even before stimulation onset, suggesting that surgery itself may induce short-term neuromodulatory modulation. This preliminary observation supports the presence of a surgically induced antiepileptic effect and warrants further prospective validation.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Vertebral Artery Injury Detected by Computed Tomography Angiography in Cervical Trauma : A Neurosurgical Perspective.","authors":"Yasin Taşkın, Özgür Demir, Veysel Kıyak, Fatma Zehra Polat, Şahin Azal, Övgü Can Ünal, Denizcan Özkan, Sinem Ülger Bulan, Yunus Emre Kuyucu","doi":"10.3340/jkns.2026.0084","DOIUrl":"https://doi.org/10.3340/jkns.2026.0084","url":null,"abstract":"<p><strong>Objectıve: </strong>To evaluate the incidence, radiological features, and clinical impact of vertebral artery injury (VAI) detected by computed tomography angiography in patients with cervical trauma, and to assess its association with neurological deficit and mortality.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 71 cervical trauma patients managed in our neurosurgery clinic between June 2024 to October 2025. After exclusions (age <18 years, malignancy, inadequate imaging, comorbid systemic pathology), 30 patients were included. Demographics, trauma mechanism, computed tomography angiography (CTA) findings, Biffl grading, neurological status and outcomes were compared. Statistical analysis was performed using non-parametric tests with p<0.05 as significance threshold.</p><p><strong>Results: </strong>VAI was detected in 13 patients (43.3%), predominantly Biffl grade 4 (23.3%) and grade 2 (13.3%). Neurological deficit was present in 43.3%, more common in VAI-positive cases, though not statistically significant (p=0.519). Mortality occurred exclusively in the VAI-positive group, demonstrating a significant association (p=0.026). Foramen transversum involvement (p=0.002) and facet joint injury (p=0.038) were significantly associated with vascular injury. No significant correlation was found with age, sex, trauma mechanism or other osseous structures.</p><p><strong>Conclusıon: </strong>The high VAI incidence detected via CTA highlights the importance of early vascular screening in cervical trauma. Biffl grade distribution and significant association with mortality underline the prognostic weight of high-grade lesions. Foramen transversum and facet involvement may serve as predictors of VAI, guiding clinicians on which patients require urgent CTA. Larger prospective studies are warranted. Early CTA screening may improve neurosurgical risk stratification and prevent missed vascular injuries in high-risk cervical trauma patients.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes of Mirogabalin in Patients with Postoperative Spinal Cord-Related Central Neuropathic Pain Inadequately Controlled with Conventional Gabapentinoids: A Retrospective Real-World Study.","authors":"Dong Wook Kim, Danbi Park, Sang Hoon Hwang, Jin Hoon Park","doi":"10.3340/jkns.2026.0149","DOIUrl":"https://doi.org/10.3340/jkns.2026.0149","url":null,"abstract":"<p><strong>Objective: </strong>This single-center, observational study investigated the effectiveness and safety of switching to mirogabalin in patients with residual spinal cord-related central neuropathic pain that persisted despite conventional gabapentinoid therapy (gabapentin or pregabalin).</p><p><strong>Methods: </strong>Electronic medical records of 41 patients who switched from pregabalin or gabapentin to mirogabalin between November 2023 and June 2024 were retrospectively analyzed. Analgesic effectiveness was primarily assessed using the patient-reported percentage of pain reduction. Clinically meaningful and substantial pain reduction were defined as ≥ 30% and ≥ 50%, respectively. Safety was evaluated by assessing the incidence and severity of adverse events (AEs).</p><p><strong>Results: </strong>The mean baseline numerical rating scale score was 3.93 ± 1.75. Among the 41 patients included in the study, the interval between surgery and the first switch to mirogabalin was available for 35 patients. The median interval between surgery and switching to mirogabalin was 411 days (IQR, 88-743; range, 27-2091 days). Overall, 53.7% and 46.3% of patients achieved clinically meaningful (≥ 30%) and substantial (≥ 50%) pain reduction, respectively, after switching to mirogabalin. AEs were reported in 31.7% of patients, with the most common being somnolence (12.2%), dizziness (7.3%), and weight gain (7.3%). All reported AEs were mild to moderate in severity. Consequently, 19.5% and 22.0% of patients discontinued mirogabalin and resumed their previous medication because of insufficient efficacy and AEs, respectively. For the secondary analysis, patients were divided according to disease etiology (spinal cord tumor vs. non-tumoral myelopathy). Clinically meaningful pain reduction was achieved in 60.0% and 47.6% of patients, respectively, with no significant difference in responder rates between the two groups.</p><p><strong>Conclusion: </strong>Although the findings may overestimate treatment effectiveness because of the retrospective design and reliance on subjective patient assessment, switching to mirogabalin provided additional clinically meaningful pain relief in approximately half of the patients with persistent postoperative spinal cord-related central neuropathic pain that was inadequately controlled with conventional gabapentinoids. These findings suggest that mirogabalin may represent a promising alternative treatment option for patients with residual spinal cord-related central neuropathic pain who have limited therapeutic options.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Feasibility of a Newly Designed Single-Port Trocar for Laparoscopy-Assisted Ventriculoperitoneal Shunt Surgery : A Prospective Pilot Study.","authors":"Jong Min Lee, Min Soo Kim, In Kyu Park, Eun Suk Park, Songsoo Yang","doi":"10.3340/jkns.2026.0068","DOIUrl":"https://doi.org/10.3340/jkns.2026.0068","url":null,"abstract":"<p><strong>Objective: </strong>This study was conducted to investigate the safety and feasibility of a newly designed single-port trocar that allows peritoneal catheter placement without the need for additional abdominal puncture during laparoscopy-assisted ventriculoperitoneal shunt surgery.</p><p><strong>Methods: </strong>This prospective, single-arm pilot study included patients who underwent ventriculoperitoneal shunt surgery using a newly designed trocar system between March and December 2024. The new trocar features a lateral opening, a transparent body, and builtin gas insufflation capability, enabling both laparoscopic visualization and final catheter placement through a single port. Its design allows the entire trocar to be removed along with the catheter without disrupting its position. Demographic and operative data of patients were collected, and the primary outcomes were procedural feasibility and intraoperative safety. Institutional review board approval was obtained before study initiation.</p><p><strong>Results: </strong>This study enrolled 16 patients (median age, 63.5 years [interquartile range (IQR), 58-72]; median body mass index, 23.6 kg/m2 [IQR, 21.8-25.1]). The most common diagnosis was posttraumatic hydrocephalus (87.5%), followed by posthemorrhagic hydrocephalus. The incision length for trocar insertion was a median of 1.2 cm (IQR, 0.95-1.5). The trocar insertion time varied (median, 40.5 seconds [IQR, 19.5-61]). The total operative time (from skin incision to closure) was a median of 52.5 minutes (IQR, 50-60). Importantly, there were no intraoperative technical difficulties or trocar-related adverse events. No early postoperative complications related to trocar insertion or distal catheter placement were observed. One patient was readmitted with fever, which was subsequently attributed to pneumonia and was not related to the surgical procedure.</p><p><strong>Conclusion: </strong>This pilot study demonstrates the safety and feasibility of the newly designed trocar system for laparoscopy-assisted ventriculoperitoneal shunt surgery.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow-Augmentation STA-MCA bypass for Acute Ischemic Stroke with Diffusion-Perfusion Mismatch: Clinical and Radiological Outcomes.","authors":"Seung-Il Jeong, Jae Hyung Choi, Yong-Hwan Cho","doi":"10.3340/jkns.2026.0151","DOIUrl":"https://doi.org/10.3340/jkns.2026.0151","url":null,"abstract":"<p><strong>Objective: </strong>While mechanical thrombectomy (EVT) is the established standard for acute ischemic stroke (AIS), a significant unmet clinical need remains for patients in whom EVT is unsuccessful, technically infeasible, or contraindicated. This study aimed to evaluate the safety and potential efficacy of increased flow augmentation via superficial temporal artery-middle cerebral artery (STA-MCA) bypass, primarily utilizing the double-barrel technique, as a rescue strategy for patients with AIS and significant diffusion-perfusion mismatch.</p><p><strong>Methods: </strong>We retrospectively analyzed 22 AIS patients with identifiable diffusion-perfusion mismatch who underwent emergency STA-MCA bypass between June 2020 and November 2023. The majority of patients underwent surgery within 24 hours of symptom onset or early neurological deterioration (END). Outcomes were assessed through radiological stabilization (reduction in Tmax > 6s volume), neurological improvement (National Institutes of Health Stroke Scale [NIHSS] score), and functional recovery (modified Rankin Scale [mRS] score at 3 months).</p><p><strong>Results: </strong>Graft patency was achieved in 100% of cases, with double-barrel bypass performed in 19 patients (86.4%) to increase flow augmentation. Postoperatively, the median hypoperfusion volume (Tmax > 6s) decreased significantly from 116 mL to 6 mL (p < 0.001), suggesting attenuation of infarct progression. The median NIHSS score improved from 9 at baseline to 5 at 14 days post-surgery (p < 0.001). At 3 months, 15 patients (68.2%) achieved a favorable functional outcome (mRS 0-2). No symptomatic or radiologically evident intracranial hemorrhage or procedure-related hematoma occurred despite the high rate (77.3%) of perioperative antithrombotic therapy.</p><p><strong>Conclusion: </strong>STA-MCA bypass may be a feasible rescue strategy and appears safe in carefully selected AIS patients lacking other reperfusion options. With physiology-driven, imaging-based selection and timely surgical intervention, this approach may be associated with meaningful hemodynamic restoration, early perfusion improvement, and subsequent clinical stabilization in the acute phase. In this context, the double-barrel technique may represent a feasible flow-augmentation strategy in selected patients with substantial hemodynamic compromise.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of the Need for Ventriculoperitoneal Shunt in Adults with Post-Hemorrhagic Hydrocephalus : A Single-Center Retrospective Cohort Study.","authors":"Yong Beom Lee, Solji Jung, Kwangho Lee, Kyeong-O Go","doi":"10.3340/jkns.2026.0204","DOIUrl":"https://doi.org/10.3340/jkns.2026.0204","url":null,"abstract":"<p><strong>Objective: </strong>The contemporary definition of hydrocephalus is a disorder of cerebrospinal fluid (CSF) physiology producing active ventricular distension and neurological dysfunction, which is distinct from radiological ventriculomegaly alone. Once post-hemorrhagic ventriculomegaly (PHV) is established, the clinically decisive question is whether the patient will progress to shunt-dependent post-hemorrhagic hydrocephalus (PHH) requiring permanent CSF diversion. We sought to identify independent predictors of ventriculoperitoneal shunt (VPS) placement among adults in whom PHV was already established, and to derive a simple bedside risk score for this specific decision point.</p><p><strong>Methods: </strong>We retrospectively studied 243 adults with radiologically established PHV (Evans index [EI] ≥0.30) after spontaneous or traumatic intracranial hemorrhage at a single tertiary center between December 2009 and May 2023 (176 shunted, 67 not shunted). The outcome was permanent VPS placement, used as the operational marker of shunt-dependent PHH. Predictors were examined by univariable and multivariable logistic regression. Cutoffs for continuous predictors were derived by receiver operating characteristic (ROC) analysis. The model was internally validated by bootstrap resampling and 10-fold cross-validation, and a simple additive score was constructed from the retained predictors (TRIPOD type 2a).</p><p><strong>Results: </strong>On multivariable analysis, predisposing subarachnoid hemorrhage (SAH), a history of hypertension, peak C-reactive protein (CRP) ≥24.4 mg/dL, and EI ≥0.315 were independently associated with VPS placement (all p <0.001; Nagelkerke R² = 0.408). A four-point score combining these variables separated shunt risk from 0% (score 0) to 100% (score 4), with an area under the curve (AUC) of 0.822 and good calibration (Hosmer-Lemeshow p = 0.906); The apparent and optimism-corrected AUCs of the full model were 0.832 and 0.828. The VPS rate did not change significantly across treatment eras (2009- 2015, 63.0%; 2016-2019, 78.8%; 2020-2023, 75.0%; trend p = 0.086). 3.</p><p><strong>Conclusion: </strong>In adults with established PHV, SAH, hypertension, elevated CRP, and greater ventricular size were independently associated with progression to shunt-dependent PHH. CRP is a nonspecific systemic inflammatory marker and should be interpreted as an associated, not causal, factor. The four-point score is an exploratory, hypothesis-generating tool derived and internally validated in a single-center retrospective cohort; external validation is required before any clinical application.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment with Neuronal-Induced Human Mesenchymal Stem Cells Improves Functional Recovery of Acute Spinal Cord Injury through Attenuating Astrogliosis and Neurotoxic Astrocyte Activation.","authors":"Sungjoon Lee, Jinsu Hwang, Han-Seong Jeong, Chi-Heon Kim, Choonghyo Kim, Sujeong Jang","doi":"10.3340/jkns.2025.0240","DOIUrl":"10.3340/jkns.2025.0240","url":null,"abstract":"<p><strong>Objective: </strong>Most of the preclinical studies have been focusing on inhibition of astrogliosis which is known as a major mechanism that inhibits recovery from spinal cord injury (SCI). Although mesenchymal stem cells (MSCs) have been widely studied as therapeutic candidates for SCI treatment, the role of MSCs on astrogliosis remains unclear. Furthermore, recent studies revealed that astrogliosis also has a protective role in SCI. The purpose of this study was to determine whether neural-induced human adipose tissue-derived MSCs (NIhADSCs) promote SCI repair through astrogliosis modulation.</p><p><strong>Methods: </strong>NI-hADSCs were transplanted into the perilesional spinal cord in an acute severe SCI rat model. Functional recovery was evaluated serially on postoperative day 1 and weekly thereafter for 6 weeks using the Basso-Beattie-Bresnahan (BBB) locomotor rating scale. Western blot analysis was performed to assess protein levels of gliosis markers and neuroinflammatory pathways at 6 weeks post-injury. Histopathological examination was conducted at 6 weeks post-injury to evaluate astrogliosis and astrocyte phenotypic changes.</p><p><strong>Results: </strong>NI-hADSC transplantation significantly improved functional recovery compared with the SCI group, as demonstrated by a greater cumulative BBB locomotor score over 6 weeks (area under the curve : 23.65 vs. 13.58; p=0.026). At 6 weeks post-injury, the levels of glial fibrillary acidic protein (0.52±0.11 vs. 1.00±0.12; p=0.012), vimentin (0.54±0.01 vs. 1.00±0.08; p=0.006), and complement component 3 (C3; 0.38±0.05 vs. 1.00±0.07; p<0.001) in the NI-hADSC-treated group were markedly decreased, whereas the levels of signal transducer and activator of transcription 3 (STAT3)/phosphorylated STAT3 proteins were markedly increased (1.51±0.18 vs. 1.00±0.14; p<0.05). The levels of S100 calcium-binding protein A10 and nuclear factor kappa B (NFκB)/phosphorylated NFκB expression showed no significant differences between groups. Immunohistochemistry confirmed reduced astrogliosis and fewer C3-expressing astrocytes in the NI-hADSC-treated group, predominantly in the dorsal perilesional spinal cord. Substantially increased B-cell lymphoma-2 (Bcl-2) expression (14.30±2.13 vs. 5.86±0.66; p<0.01) and decreased Bcl-2-associated X protein expression (58.64%±2.82% vs. 69.46%±1.81%; p<0.01) indicated that NI-hADSC treatment reduced neuronal apoptosis.</p><p><strong>Conclusion: </strong>NI-hADSC transplantation improved functional recovery in SCI by modulating astrogliosis. The modulation of astrogliosis was likely to be achieved through selective suppression of detrimental A1 astrocytes, potentially via STAT3 signaling. However, the protective effect of NI-hADSCs on astrogliosis diminished during the subacute SCI period and was spatially restricted to the perilesional area.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"704-716"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of Korean Triage and Acuity Scale for Predicting In-Hospital Mortality in Patients with Acute Traumatic Brain Injury : A Nationwide Population-Based Study of 2018-2020.","authors":"Byul Hee Yoon, Cheolsu Jwa, Yung Ki Park, Deok Ryeong Kim, Hyoung-Joon Chun, Jae Hoon Kim, Hee In Kang, In-Suk Bae","doi":"10.3340/jkns.2026.0006","DOIUrl":"10.3340/jkns.2026.0006","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the clinical validity of the Korean triage and acuity scale (KTAS) in predicting in-hospital mortality and surgical intervention in patients with acute traumatic brain injury (TBI).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the National Emergency Department Information System (NEDIS) collected between January 2018 and December 2020. Patients aged ≥20 years with acute TBI (International Classification of Diseases, 10th revision [ICD-10] S06.1-S06.9) admitted through the emergency department (ED) within 24 hours of injury were included. Initial KTAS classification and modified KTAS after physician evaluation were analyzed. The primary endpoint was in-hospital mortality, and the secondary endpoint was the need for craniotomy or craniectomy. Predictive performance was assessed using logistic regression and receiver operating characteristic analysis.</p><p><strong>Results: </strong>A total of 37450 patients were analyzed, with an overall in-hospital mortality of 11.5%. Craniotomy or craniectomy were performed in 9.8% of the TBI patients. Patients classified as initial KTAS level 1 had a 10.33-fold higher risk of in-hospital mortality (95% confidence interval [CI], 5.96-17.88) compared to those in level 5, while modified KTAS level 1 patients showed a 25.96-fold increased risk (95% CI, 6.37-105.76). The area under the curve (AUC) for in-hospital mortality was 0.750 for initial KTAS and 0.751 for modified KTAS, while the AUC for predicting surgical intervention was 0.666 for initial KTAS and 0.669 for modified KTAS. Retriage demonstrated the accuracy of the predictive validity of initial KTAS for in-hospital mortality.</p><p><strong>Conclusion: </strong>KTAS is an effective tool for early risk stratification in acute TBI, particularly for identifying critically ill patients. Retriage supplements the predictive validity of initial KTAS, supporting its role in guiding clinical decision-making. Further research is warranted to validate KTAS in broader TBI populations and refine its utility for surgical decision-making.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"757-769"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ERAS-Based Same-Day and Non-Same-Day Protocols in IDEM Spinal Cord Tumor Surgeries : A Propensity Score-Matched Analysis.","authors":"Sang Hoon Hwang, Subum Lee, Seung Jun Ryu, Min Han Kim, Sun Woo Jang, Danbi Park, Chong Man Kim, Jin Hoon Park","doi":"10.3340/jkns.2025.0269","DOIUrl":"10.3340/jkns.2025.0269","url":null,"abstract":"<p><strong>Objective: </strong>We developed enhanced recovery after surgery (ERAS)-based same-day surgery (SDS) and non-SDS protocols for intradural extramedullary (IDEM) spinal cord tumor surgeries, which were implemented in 2022. This study compared healthcare costs, and clinical and surgical outcomes between SDS and non-SDS protocols and describes how they are applied in practice.</p><p><strong>Methods: </strong>This retrospective study included 173 patients who underwent surgery for IDEM spinal cord tumors performed by a single neurosurgeon at single institution between 2022 and 2024. All patients were managed under an ERAS-based protocol : 58 receiving the SDS protocol and 115 managed under the non-SDS protocol. Propensity score matching was performed using six variables, resulting in 48 matched pairs. Surgical outcomes included operative time, estimated blood loss, the presence of residual tumor on postoperative imaging, and postoperative complications. Clinical outcomes were assessed using the Visual analog scale for pain, modified McCormick scale, the American Spinal Injury Association impairment scale, Karnofsky performance status scale, Eastern Cooperative Oncology Group performance status, a 5-point Likert scale for surgical satisfaction, and 30-day readmission rates. Healthcare costs were analyzed using a detailed itemized statement of medical expenses.</p><p><strong>Results: </strong>There were no significant differences in surgical or clinical outcomes between the groups. The SDS group had a shorter length of stay (LOS; 4.1 vs. 5.6 days) and lower total hospital costs, with an average cost reduction of approximately 1200 US dollars (USD). Facility costs showed the largest difference (600 USD) between the groups.</p><p><strong>Conclusion: </strong>ERAS-based SDS and non-SDS protocols for IDEM spinal cord tumor surgery show similar surgical and clinical outcomes. However, ERAS-based SDS protocols significantly reduce LOS and total hospital costs. Therefore, this protocol-driven SDS approach can be considered a feasible and cost-effective strategy for carefully selected patients with IDEM spinal cord tumors.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"734-743"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretation Challenges of Intraoperative Neurophysiological Monitoring Waveforms : A Technical Note.","authors":"Byeong Ho Oh, Hyeong Cheol Moon, Jae Hoon Woo, Jong Beom Lee","doi":"10.3340/jkns.2026.0082","DOIUrl":"10.3340/jkns.2026.0082","url":null,"abstract":"<p><p>Intraoperative neurophysiological monitoring (IONM) using motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is widely used during neurosurgical procedures to reduce the risk of postoperative neurological deficits. However, interpretation of intraoperative waveforms is often challenging because signal changes do not always clearly meet established alarm criteria. In this technical note, we present representative patterns of normal, uncertain, and abnormal IONM waveforms and discuss interpretative challenges associated with ambiguous recordings. A retrospective descriptive review was performed on seven adult patients who underwent neurosurgical procedures with intraoperative MEP and SEP monitoring. Waveforms were qualitatively categorized based on morphology, amplitude, latency, and reproducibility across repeated stimulations. Normal waveforms demonstrated stable morphology, reproducible amplitudes, and physiologic latency ranges. Abnormal waveforms showed marked signal attenuation or complete loss of reproducible responses. In contrast, uncertain waveforms exhibited partial amplitude reduction, fluctuating morphology, limited reproducibility, or latency values overlapping normal ranges despite qualitative instability. These equivocal patterns could not be reliably classified using conventional binary alarm criteria alone. Our observations suggest that intraoperative MEP and SEP interpretation cannot always be reduced to a binary normal-versus-abnormal framework. Recognition of an intermediate \"uncertain\" waveform category may improve contextual intraoperative assessment, prompt careful reassessment of reversible factors, and better reflect the dynamic complexity of neuromonitoring.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"815-821"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}