Journal of Korean Neurosurgical Society最新文献

Objective: Neck pain is a common musculoskeletal disorder frequently experienced by motorbike riders and stands as a leading cause of high disability rates globally. Research on neck pain among motorcyclist in metropolitan universities remains limited. However, given the rising population of urban motorcyclists, identifying factors contributing to neck pain becomes increasingly crucial.

Methods: This is a cross-sectional, observational analytic study utilizing convenience sampling method that included 421 study respondents. Demographics, motorcycle riding habits, perceived stress, and neck pain history were collected using a questionnaire which was then analyzed statistically applying Chi-Square Test, Spearman's Rank, and Logistic Regression analysis.

Results: Two-thirds (67%) of motorcycle riders in productive age report history of neck pain. Logistic regression analysis discovers that occupations as lecturers or teaching staff (OR = 3,940; 95% CI = 1,193 - 13,007; p-value = 0,024) and daily sleep duration of less than 7 hours per day (OR = 1,774; 95% CI = 1,094 - 2,875; p-value = 0,020) is a contributing factor for the occurrence of neck pain among productive adult motorcyclist in metropolitan university settings with age, marital status, and daily commuting distance as confounding factors.

Conclusion: Neck pain is a common complaint among productive adult motorcyclists. In our university, occupational factors and daily sleep duration pose as risk factors for neck pain in this demographic. It is crucial for both productive adult motorbike riders and healthcare professionals to identify and address these risk factors according to established guidelines.

Objective: In degenerative lumbar spondylolisthesis, interbody fusion surgery (IFS) has long been recommended as the gold standard of surgical management. However, IFS is less recommended for high-risk patients such as the elderly because it involves extensive surgery, with a long operation time and high volumes of blood loss, which lead to marked perioperative morbidity. We report an alternative primary and salvage treatment technique for high-risk lumbar spondylolisthesis through posterior lumbar element reinforcement using interspinous fixation (ISF) and decompression alone without interbody fusion.

Methods: Plain radiographs, computed tomography scans, and magnetic resonance imaging, taken at different intervals, were used to measure local disc height (DH), vertebral body slippage (BS), and segmental motion angle (SMA). A visual analogue scale (VAS) and the Oswestry disability index (ODI) were applied pre-operation and at the last follow-up.

Results: The local SMA decreased significantly by 3.46±3.07°, from 10.61±3.42° preoperatively to 7.15±3.70 at the last follow-up (p<0.001). The DH decreased from 8.61±2.88 mm preoperatively to 8.41±2.48 mm at the last follow-up (p=0.074). The BS decreased from 3.49±4.29 mm preoperatively to 3.41±4.91 mm at the last follow-up (p=0.092). None of the patients reported worsening pain or an increased ODI after surgery, and there were no surgery-related complications.

Conclusion: Posterior lumbar element reinforcement by decompression alone with SPIRE™ fixation is an alternative primary and salvage treatment option for select patients with spondylolisthesis.

The femoral artery is the preferred access route for neurointerventions. The transfemoral approach (TFA) offers advantages such as a large diameter and easy access. However, it also entails disadvantages such as patient discomfort and high risk of complications. Following the initial report of coronary angiography using the transradial approach (TRA) in 1989, cardiologists discovered the advantages of TRA over the TFA and gradually replaced it with the TRA. In 1997, Matsumoto et al. used the TRA for cerebral angiography and neurointervention. Thereafter, the adoption of TRA for neurointervention gradually increased and good outcomes were reported. However, despite these developments, the adoption rate of TRA is relatively low. We reviewed the relevant studies to increase the accessibility of TRA for neurointerventionists.

Objective: Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU.

Methods: Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity.

Results: Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow Coma Scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS>8), total calorie intake (751.4 vs 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI.

Conclusion: More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.

Managing giant partially thrombosed intracranial aneurysms presents significant challenges due to their unfavorable natural history and the lack of standardized treatment approaches. Conventional treatments, whether open surgical or endovascular, often struggle to manage these aneurysms effectively, resulting in high recurrence rates or significant morbidity. The patient was a 62-year-old male with a symptomatic giant partially thrombosed aneurysm at the tip of the basilar artery, presenting with left-sided hemiparesis and dysarthria. Diagnostic imaging revealed a giant aneurysm with a wide-necked, canalized portion. A two-stage endovascular treatment was conducted, involving a balloon occlusion test (BOT) and intraoperative monitoring (IOM) for maximum patient safety. The treatment utilized stent-assisted Woven EndoBridge (WEB) embolization and serial bilateral vertebral artery trapping. The procedure successfully isolated the aneurysm and postoperative imaging confirmed the absence of recanalization, preserving the intact posterior circulation. The patient showed stable recovery and no neurological deficits during the 12-month follow-up period. This technical note demonstrates the feasibility and efficacy of strategically integrating intrasaccular flow diversion using a WEB device and flow reversal through bilateral vertebral artery trapping for treating giant partially thrombosed aneurysms.

Objective: The objective of this study was to assess the relationship between spermine synthase (SMS) expression, tumor occurrence, and prognosis in lower-grade gliomas (LGGs).

Methods: A total of 523 LGG patients and 1152 normal brain tissues were included as controls. Mann-Whitney U test was performed to evaluate SMS expression in the LGG group. Functional annotation analysis was conducted to explore the biological processes associated with high SMS expression. Immune cell infiltration analysis was performed to examine the correlation between SMS expression and immune cell types. The association between SMS expression and clinical and pathological features was assessed using Spearman correlation analysis. In vitro experiments were conducted to investigate the effects of overexpressing or downregulating SMS on cell proliferation, apoptosis, migration, invasion, and key proteins in the protein kinase B (AKT)/epithelialmesenchymal transition signaling pathway.

Results: The study revealed a significant upregulation of SMS expression in LGGs compared to normal brain tissues. High SMS expression was associated with certain clinical and pathological features, including older age, astrocytoma, higher World Health Organization grade, poor disease-specific survival, disease progression, non-1p/19q codeletion, and wild-type isocitrate dehydrogenase. Cox regression analysis identified SMS as a risk factor for overall survival. Bioinformatics analysis showed enrichment of eosinophils, T cells, and macrophages in LGG samples, while proportions of dendritic (DC) cells, plasmacytoid DC (pDC) cells, and CD8+ T cells were decreased.

Conclusion: High SMS expression in LGGs may promote tumor occurrence through cellular proliferation and modulation of immune cell infiltration. These findings suggest the prognostic value of SMS in predicting clinical outcomes for LGG patients.

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.

This is the first report of the successive development and rupture of blister-like anterior communicating artery (ACoA) aneurysms at mirror locations with a short interval. A 49-year-old man presented with an angiogram-negative subarachnoid hemorrhage with significant basal frontal interhemispheric blood. Surgical exploration revealed a blister-like aneurysm on the left side of the superior wall of the ACoA, which was treated using a microsuturing technique. On the 18th day after the initial subarachnoid hemorrhage, the second operation due to another angiogram-negative hemorrhage revealed a de novo blister-like aneurysm with a small blood clot on the posterosuperior wall of the ACoA close to the right A1/A2 junction. The rupture point and ACoA on the right side were occluded using an aneurysm clip. Follow-up digital subtraction angiogram at 4 years and computed tomography angiogram at 14 years after the surgery showed no recurrence or associated abnormality.