Journal of Korean Neurosurgical Society最新文献

{"title":"Integration of Palliative Care in Neurosurgical Critical Care : Insights from a Single-Center Perspective.","authors":"Nam Hee Kim, Yejin Kim, Se Yeon Kim, Hyoung Suk Han, Hye Yoon Park, Eun Jin Ha, Shin Hye Yoo","doi":"10.3340/jkns.2024.0065","DOIUrl":"10.3340/jkns.2024.0065","url":null,"abstract":"<p><strong>Objective: </strong>Palliative care is a specialized approach designed to enhance the quality of life for both patients and their families, offering patient-centered care through comprehensive assessment and care planning. However, the integration of palliative care within neurocritical care settings has been relatively understudied. This descriptive study aims to identify the characteristics, palliative care needs, and outcomes of patients referred to palliative care services during admission to the neurosurgical intensive care unit (NS-ICU).</p><p><strong>Methods: </strong>A retrospective analysis of adults admitted to the NS-ICU at a referral hospital between December 2019 and December 2021 was conducted. The study focused on those referred to the inpatient palliative care team with diagnoses of non-traumatic brain hemorrhage, traumatic brain injury, or brain neoplasm. Excluded were patients who died before palliative care consultation or lacked sufficient information. The investigation assessed demographic and clinical characteristics at consultation, along with post-consultation hospital outcomes derived from medical records and interview notes.</p><p><strong>Results: </strong>In this study involving 38 enrolled patients, the median age was 65, with 42.1% females. The most prevalent diagnosis was nontraumatic brain hemorrhage (47.4%). Reasons for palliative care consultation included psychosocial support (95%), goal-of-care discussions (68%), decision-making support (50%), and communication facilitation (39%). The median time from NS-ICU admission to consultation was 3.5 days (interquartile range, 1-8 days), and all interviews involved family members. Key decision topics encompassed mechanical ventilation (23.7%) and tracheostomy (21.1%). Patient preferences for life-sustaining treatment could be estimated in only 47.4% of cases, often resulting in treatment disagreement. Among the 38 patients, 26 (68.4%) died during admission. Before the consultation, full code status, partial code status, and comfort care alone were reported as 32%, 66%, and 2%, respectively; post-consultation, these figures shifted to 11%, 42%, and 47%, respectively.</p><p><strong>Conclusion: </strong>Palliative care was predominantly sought for psychosocial support and discussions concerning goals of care. Despite challenges in ascertaining patient treatment preferences, palliative care consultations proved invaluable in aiding family members and facilitating treatment decision-making. Our study suggests the potential integration of palliative care within neuro-critical care, contributing to a heightened utilization of comfort care at the end-of-life.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"213-222"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307888","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":"A Parasellar Hydatid Cyst Extending to the Opticocarotid Triangle, Pediatric Case.","authors":"Mustafa Cemil Kilinc, Altan Demirel","doi":"10.3340/jkns.2024.0184","DOIUrl":"10.3340/jkns.2024.0184","url":null,"abstract":"<p><p>The causes of sudden vision loss in one eye include isolated eye diseases, vascular pathologies, and optic nerve compression. This report highlights a case of parasitosis (Echinococcus granulosus) causing sudden vision loss due to optic nerve compression. To our knowledge, this is the first reported case of a hydatid cyst extending into the optic canal through opticocarotid triangle in a pediatric patient. A 12-year-old girl presented to the ophthalmologist with progressive visual deterioration over a period of 1 week. Examination revealed reduced visual acuity in her right eye. No ocular abnormality was detected on examination, cranial imaging revealed a lesion compressing the right optic nerve and the patient was referred to neurosurgery. The bright white lesion with a microscopic appearance resembling an epidermoid tumor was completely excised after aspirating the contents with transcranial access. Pathology was reported as hydatid cyst. Hydatid cysts invading the optic canal should be considered in the differential diagnosis of sudden visual loss in the pediatric age group; however, it continues to be an important health problem in developing countries. Meticulous excision of the cyst capsule without rupture ensures the success of surgical treatment.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"229-233"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080258","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":"Cement-Augmented Pedicle Screw Fixation in Patients with Osteoporosis : Safety, Efficacy and Complications.","authors":"Tomasz Olbrycht, Kajetan Latka, Waldemar Kolodziej, Tomasz Krzeszowiec, Dariusz Latka","doi":"10.3340/jkns.2024.0081","DOIUrl":"10.3340/jkns.2024.0081","url":null,"abstract":"<p><p>Cement-augmented pedicle screw instrumentation is a widely accepted method for managing osteoporotic fractures, but it carries inherent risks, particularly related to cement leakage and embolism. This study aimed to analyze a clinical case of complications following cement fixation and provide a detailed review of relevant literature. A 70-year-old patient underwent transpedicular screw instrumentation from L2-L4 with polymethyl methacrylate augmentation, which resulted in cement leakage into the spinal canal and subsequent pulmonary embolism. After revision surgery and conservative treatment for the embolism, the patient's condition stabilized, demonstrating that conservative measures can be effective in managing cement embolism. To complement this case, a comprehensive literature review was conducted to explore the causes, prevention, and treatment of complications related to cement augmentation. The findings support that while cement-augmented pedicle screw instrumentation remains a leading technique for osteoporotic fractures, the associated risks are manageable with proper treatment protocols. This study holds practical significance for healthcare professionals by highlighting both the risks and solutions associated with cement fixation, thus contributing to improved patient outcomes and the development of standardized treatment guidelines.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"127-136"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023836","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":"Envisioning the Future of the Neurosurgical Operating Room with the Concept of the Medical Metaverse.","authors":"Sun Mo Nam, Yoon Hwan Byun, Yun-Sik Dho, Chul-Kee Park","doi":"10.3340/jkns.2024.0160","DOIUrl":"10.3340/jkns.2024.0160","url":null,"abstract":"<p><p>The medical metaverse can be defined as a virtual spatiotemporal framework wherein higher-dimensional medical information is generated, exchanged, and utilized through communication among medical personnel or patients. This occurs through the integration of cutting-edge technologies such as augmented reality (AR), virtual reality (VR), artificial intelligence (AI), big data, cloud computing, and others. We can envision a future neurosurgical operating room that utilizes such medical metaverse concept such as shared extended reality (AR/VR) of surgical field, AI-powered intraoperative neurophysiological monitoring, and real-time intraoperative tissue diagnosis. The future neurosurgical operation room will evolve into a true medical metaverse where participants of surgery can communicate in overlapping virtual layers of surgery, monitoring, and diagnosis.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"137-149"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568916","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":"Editors' Pick in March 2025.","authors":"Hee-Jin Yang","doi":"10.3340/jkns.2025.0046","DOIUrl":"https://doi.org/10.3340/jkns.2025.0046","url":null,"abstract":"","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483413","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":"Neurochemical Characterization of A53T-alpha-synuclein and 6-OHDA Rat Models for Parkinson's Disease through Animal PET Imaging Analysis.","authors":"Junhyung Kim, Hyung Ho Yoon, Jin Hwa Chung, Seok Ho Hong, Sang Ryong Jeon","doi":"10.3340/jkns.2024.0109","DOIUrl":"https://doi.org/10.3340/jkns.2024.0109","url":null,"abstract":"<p><strong>Objective: </strong>In preclinical research of Parkinson's disease, several rodent models, notably the classical 6-hydroxydopamine (6-OHDA) model and the A53T-alpha-synuclein model, have been widely used, yet their distinct neurochemical characteristics in conjunction with behavioral and histopathological changes have been scarcely documented.</p><p><strong>Methods: </strong>We examined the two rat models of Parkinson's disease and characterized them using [18F]FP-CIT animal PET imaging. The 6-OHDA model (n=10) was induced by unilateral injection of 6-OHDA into the middle forebrain bundle, while the A53T-alpha-synuclein model (n=10) was mediated by the adeno-associated viral vectors injected into the substantia nigra. We hypothesized that these models would present differential neurochemical profiles, which could reflect their behavioral and histopathological features and potentially serve as a supplementary tool for evaluating the outcomes of interventions in animal experiments.</p><p><strong>Results: </strong>The striatum showed decreased PET uptake on the affected side compared to the unaffected control side, which was highly correlated with the stepping behaviors (R = 0.854 [95% CI, 0.606 to 0.951]). The decrease in striatal PET uptake was more pronounced in the 6-OHDA model than in the A53T-alpha-synuclein model: the 6-OHDA model exhibited a 60% [95% CI, 48% to 65%] decrease in the affected side compared the control side, while the A53T-alpha-synuclein model exhibited a 20% [95% CI, -16% to 47%] decrease. Interestingly, PET uptake in the forebrain cortical region, including the motor cortex, was exclusively decreased in the 6-OHDA model (p = 1.0×10-4 and p = 1.2×10-3, respectively), indicating that 6-OHDA model is affected not only in the nigrostriatal system but also in other cortical regions. Conversely, the A53T-alpha-synuclein model showed no significant alterations in these cortical regions.</p><p><strong>Conclusion: </strong>Although the A53T-alpha-synuclein model demonstrates less definitive behavioral changes compared to the 6-OHDA model, it presents a more confined pathophysiological representation of Parkinson's disease and may be better suited for evaluating certain therapeutic interventions when utilized with adequate neurochemical characterization.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441104","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":"Minimizing Hemorrhage Complications in Deep Brain Stimulation Surgery - The Impact of Imaging Modalities and Trajectory Planning.","authors":"Seung Woo Hong, Dao Duy Phuong, Kyung Won Chang, Hyun Ho Jung, Jin Woo Chang","doi":"10.3340/jkns.2024.0198","DOIUrl":"https://doi.org/10.3340/jkns.2024.0198","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective study aims to analyze hemorrhage complications in patients undergoing deep brain stimulation (DBS) surgery, focusing on the impact of imaging modalities and trajectory planning.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients who underwent DBS at a single institution from September 2018 to February 2023. Surgical planning data were analyzed using a combination of 1.5 Tesla(T) and 3.0 T Magnetic resonance image (MRI) for trajectory planning. Trajectories were classified into four types (Type 1-4) based on the proximity of vascular structures within 2 mm on preoperative MRI scans, as defined in this study. Hemorrhage presence was evaluated through postoperative computed tomography (CT) scans.</p><p><strong>Results: </strong>Out of 200 patients analyzed, Type 1 trajectories (no vascular structures within 2 mm on both MRIs) accounted for 72.70% of cases with the lowest hemorrhage rate. Significant differences in hemorrhage rates were observed among the types, with higher risks associated with Type 4 trajectories. Additionally, significant variations in vascular structure types were noted across DBS targets, with STN showing the highest risk.</p><p><strong>Conclusion: </strong>Meticulous trajectory planning using both 1.5T and 3.0T MRI is crucial in minimizing hemorrhagic complications in DBS. The study underscores the need for precise imaging and planning to enhance patient safety and surgical outcomes.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441100","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":"Assessment of Clinical and Radiologic Outcomes of Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy : A Retrospective Cohort Study.","authors":"Kwan-Su Song, Pius Kim","doi":"10.3340/jkns.2024.0197","DOIUrl":"https://doi.org/10.3340/jkns.2024.0197","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate clinical and radiological outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy (BE-PCIF) to treat cervical spondylotic radiculopathy (CSR).</p><p><strong>Methods: </strong>This retrospective study included patients with CSR who underwent BE-PCIF between April 2020 and April 2023. Patient demographic data were collected and clinical outcomes were assessed using the visual analog scale (VAS) and MacNab criteria. Various radiological parameters, including inclinatory angles, were collected and correlations with demographic or radiological factors were evaluated.</p><p><strong>Results: </strong>We included 101 patients (46 men and 55 women) with a mean age of 56.99 years, encompassing 162 surgical levels primarily affecting the C5-6 and C6-7 vertebrae. The postoperative VAS scores decreased to <1, with 90.1% of patients reporting excellence according to the MacNab criteria. None of the patients experienced any major postoperative complications, including instability. The isthmic distance (ID) expansion ratio, representing the degree of distal decompression, was 2.4, with a minor facet resection rate of 0.4. Right-sided surgeries or surgeries at lower cervical levels correlated with higher inclinatory angles, with a p-value of 0.003 each. Significant correlations were noted between the inclinatory angle and both the facet resection rate and ID expansion ratio, with coefficients of 0.45 and 0.3, respectively, both having a p-value of <0.001, indicating strong statistical significance.</p><p><strong>Conclusion: </strong>BE-PCIF effectively relieves pain and enhances clinical outcomes in CSR patients. The use of the inclinatory angle approach facilitates cervical foraminal expansion and sufficient neural decompression, with higher angles required for adequate decompression at lower cervical levels.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189172","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":"Prediction of Ambulatory Functions Based on Somatosensory and Motor-Evoked Potentials in Patients with Intracerebral Hemorrhage and Intraventricular Hemorrhage Extension.","authors":"Min Cheol Chang, Seong Yeob Kwak, Soyoung Kwak","doi":"10.3340/jkns.2024.0192","DOIUrl":"https://doi.org/10.3340/jkns.2024.0192","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the usefulness of somatosensory-evoked potentials (SEP) and motor-evoked potentials (MEP) in predicting motor outcomes in patients with intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) extension.</p><p><strong>Methods: </strong>We retrospectively evaluated 124 patients with ICH and IVH extensions. SEPs of posterior tibial nerve and MEPs of tibialis anterior muscles were evaluated.</p><p><strong>Results: </strong>About 30% of the patients could walk independently at 6 months from the onset. Patients who exhibited SEP in both bilateral posterior tibial nerves demonstrated better ambulatory function compared to those with SEP in only one unilateral posterior tibial nerve or no SEP in both sides of the posterior tibial nerves. Likewise, patients who displayed MEP in both bilateral tibialis anterior muscles exhibited better ambulatory capacity compared to those with MEP on only one side or no MEP on both sides. In addition, when the posterior tibial nerve SEP was present bilaterally, 54.9% of the patients could walk independently, and when the MEP from the tibialis anterior muscles was present bilaterally, 41.0% of the patients could walk without any assistance.</p><p><strong>Conclusion: </strong>SEP and MEP could be useful tools for predicting ambulatory function in patients with ICH accompanied by IVH.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189184","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":"The Role of miRNA Expression Profiles in Different Biofluids İn Aneurysm Rupture.","authors":"Sara Khadem Ansari, Ebru Erzurumluoglu Gokalp, Emre Ozkara, Ozlem Aykac, Oguz Cilingir, Ertugrul Colak, Atilla Ozcan Ozdemir, Sevilhan Artan","doi":"10.3340/jkns.2024.0171","DOIUrl":"https://doi.org/10.3340/jkns.2024.0171","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial aneurysm (IA) is a cerebrovascular disease in which the cerebral arteries become pathologically weakened. The molecular mechanisms behind the pathogenesis of IAs are poorly understood. MicroRNAs are highly stable in body fluids and the expression signatures of specific circulating miRNAs may be associated with high rupture risk, severity, and clinical outcome of SAH.</p><p><strong>Methods: </strong>The presented study aimed to detect miRNA-based biomarkers and evaluating the usability of blood for a non-invasive approach. Blood samples from 24 patients with unruptured IA (Group 1), blood and CSF samples collected on day five after aSAH from 24 patients with ruptured IA (Group 2), and both the blood and CSF samples from 24 individuals without any positive IA history (Control group) were subjected to qRT-PCR for evaluating the expression profiles of 8 miRNAs.</p><p><strong>Results: </strong>MiR-29a, miR-200a-3p, miR-451a, miR-1297, and miR-502-5p in blood and miR-29a, miR-200a-3p, miR-451a, miR-126, miR-146a-5p, and miR-27b-3p in CSF were found to be differentially expressed in ruptured patients compared to controls. In both biofluids of ruptured cases, the differences in the expression profiles of miR-29a, miR-200a-3p, and miR-451a compared to controls were striking. The upregulation of miR-126, miR-200a-3p, miR-451a, and miR-502-5p in the ruptured group compared to unruptured patients suggesting that these miRNAs may be informative in predicting the risk of an aneurysmal rupture.</p><p><strong>Conclusion: </strong>MiR-29a, miR-200a-3p, and miR-451 were significantly altered in patients with aSAH compared to controls in both biofluids. These findings suggest that these miRNAs could be candidate non-invasive biomarkers for aSAH.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080260","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}