Journal of Korean Neurosurgical Society最新文献

Objective: This study aims to evaluate the effects of poly(3-hydroxybutyrate)/alginate (PHBA/ALG) tubular graft containing cytidine 5'-diphosphocholine (citicoline) on axonal regeneration in an experimental rat sciatic nerve injury model and to compare the results of this method with autologous nerve grafting.

Methods: A total of 24 Wistar-Hannover albino rats were randomly divided into three groups (n=8). In all animals, a 10 mm segment was removed from the right sciatic nerve under microscope. The nerve defect was repaired using autologous nerve graft (group O), PHBA graft only (group T), and PHBA graft containing citicoline (group S). Sixteen weeks later, all animals were euthanized and sciatic nerve samples were taken for histopathological examination. Sections were stained with hematoxylin-eosin and Masson Trichrome.

Results: The groups were compared statistically in terms of regenerated axon diameter, number of blood vessels, nerve sheath degeneration, edema, inflammatory cell infiltration, and necrosis. Histopathological evaluation showed that regenerative axons were formed in all three groups. PHBA and citicoline-containing PHBA grafts successfully bridged the damaged area. While the best results were obtained in the autograft group, the results of the PHBA group containing citicoline were statistically significantly better than the PHBA group. In general, the distribution of histopathological parameters showed that citicoline administration showed protective effects on parameters such as inflammation and cell death. Axon diameter : group S had significantly larger axon diameters than group T (p<0.05). Number of blood vessels : the highest values were in the autograft group and the difference between groups O and T was significant (p<0.05).

Conclusion: PHBA-based tubular graft with oriented nanofiber structure containing citicoline supports peripheral nerve regeneration. Although our results are not better than autograft, it may be a promising alternative for cases where autologous graft is not available.

Robot-assisted deep brain stimulation (DBS) has emerged as a major advancement in stereotactic and functional neurosurgery, enhancing precision, reproducibility, and efficiency in targeting deep brain structures for Parkinson's disease (PD). This comprehensive review synthesizes the current state of robotic DBS platforms, comparing their technical mechanisms, targeting accuracy, clinical outcomes, workflow efficiency, and safety profiles. Across diverse robotic systems, reported robotic targeting errors are typically around 1 mm, with values ranging from submillimeter to approximately 1.5 mm. Clinical outcomes, including 40-60 % improvements in UPDRS-III scores and significant reductions in dopaminergic medication, parallel those achieved with traditional approaches, while complication rates remain within the expected range. Robotic systems further enhance procedural efficiency through automated trajectory alignment, image-guided verification, and reduced intraoperative variability, with a clear learning-curve effect observed across centers. This review summarizes published evidence, highlights the unique strengths of robot assisted DBS, and discusses the evolving role of robotic DBS in modern neurosurgical practice.

Objective: We developed ERAS-based same-day surgery (SDS) and non-same-day surgery (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.

Methods: 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 (VAS) for pain, modified McCormick scale, the American Spinal Injury Association (ASIA) Impairment scale, Karnofsky Performance Status (KPS) scale, Eastern Cooperative Oncology Group (ECOG) 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.

Results: 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 1,200 US dollars (USD). Facility costs showed the largest difference (600 USD) between the groups.

Conclusion: 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.

Objective: 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).

Methods: 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 (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 ROC analysis.

Results: A total of 37,450 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% 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 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.

Conclusion: 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.

Eisenmenger syndrome (ES) is a complex multisystem disorder caused by untreated congenital heart disease. Management of brain abscess in ES is challenging, as treatment decisions must balance infection control with altered cardiopulmonary physiology, necessitating a multidisciplinary approach. We present a case of a 45-year-old male with ES and symptomatic brain abscess treated successfully with abscess aspiration under monitored anesthesia care (MAC) and appropriate antibiotic therapy. We share our experience, outline key perioperative considerations, and discuss relevant literature.

Objective: We aim to develop an interactive segmentation model that can offer accuracy and reliability for the segmentation of the irregularly shaped spinal cord and canal in degenerative cervical myelopathy (DCM) through manual click and model refinement.

Methods: A dataset of 1444 frames from 294 magnetic resonance imaging records of DCM patients was used and we developed two different segmentation models for comparison : auto-segmentation and interactive segmentation. The former was based on U-Net and utilized a pretrained ConvNeXT-tiny as its encoder. For the latter, we employed an interactive segmentation model structured by SimpleClick, a large model that utilizes a vision transformer as its backbone, together with simple fine-tuning. The segmentation performance of the two models were compared in terms of their Dice scores, mean intersection over union (mIoU), Average Precision and Hausdorff distance. The efficiency of the interactive segmentation model was evaluated by the number of clicks required to achieve a target mIoU.

Results: Our model achieved better scores across all four-evaluation metrics for segmentation accuracy, showing improvements of +6.4%, +1.8%, +3.7%, and -53.0% for canal segmentation, and +11.7%, +6.0%, +18.2%, and -70.9% for cord segmentation with 15 clicks, respectively. The required clicks for the interactive segmentation model to achieve a 90% mIoU for spinal canal with cord cases and 80% mIoU for spinal cord cases were 11.71 and 11.99, respectively.

Conclusion: We found that the interactive segmentation model significantly outperformed the auto-segmentation model. By incorporating simple manual inputs, the interactive model effectively identified regions of interest, particularly in the complex and irregular shapes of the spinal cord, demonstrating both enhanced accuracy and adaptability.

Professor Chung, an Emeritus Professor at Hanyang University School of Medicine, was a pioneering figure in Korean neurosurgery. After serving as an Army Surgeon during the Korean War, he specialized in neurosurgery, training under Professor Joo Geol Lee at Capital Medical College. Throughout his career, Professor Chung introduced numerous innovations in spinal surgery, including lumbar interbody fusion with metal support, anterior cervical foraminotomy, and the early adoption of microsurgery and motorized drills. In 1972, he became the first Chairman of the Department of Neurosurgery at Hanyang University Hospital, where he established a leading neurosurgical center. His contributions extended beyond clinical practice-he founded the Korean Spinal Neurosurgery Society in 1987 and served as President of Hanyang University Hospital from 1986 to 1987. Even after retirement, he remained active in the field, practicing and contributing to neurosurgery until his passing in 2016. He strongly emphasized continuous learning and international collaboration, fostering relationships with global spine surgery leaders and actively participating in international conferences. His dedication to minimally invasive techniques and surgical innovation profoundly impacted Korean neurosurgery, inspiring future generations and significantly advancing the field.

Objective: The efficacy of brachial plexus decompression through a supraclavicular approach for neurogenic thoracic outlet syndrome (TOS) and its impact on surgical outcomes were investigated.

Methods: The outcomes of pain reduction and functional improvement were evaluated in 31 patients with neurogenic TOS who underwent a supraclavicular decompression. These patients were followed for at least 12 months. Pain reduction was quantified using a numerical rating scale-11 (NRS-11) score and percentage pain relief before and after the last follow-up. Functional and symptomatic outcomes were assessed using the QuickDASH (Disability of the Arm, Shoulder, and Hand 11-item version) questionnaire, and changes in functional disability were measured by the percentage change in QuickDASH scores. Success was defined as at least a 50% reduction in pain as measured by the NRS-11, and factors influencing surgical success were also explored.

Results: At a follow-up of 31.7±11.7 months, supraclavicular brachial plexus decompression was successful in 24 of 31 patients (77.4%), with a mean pain relief rate of 54.3±29.0. Functional outcomes assessed by QuickDASH scores improved significantly (from 52.7±12.6 to 23.6±17.9), with a percentage reduction of 56.36±31.56. There were no neurological complications associated with the surgery, although one reoperation was required due to postoperative chyle leakage.

Conclusion: Brachial plexus decompression through a supraclavicular approach proved effective in alleviating pain and functional disability in patients with neurogenic TOS.

Objective: Postoperative spondylodiscitis is a rare but serious complication of spinal surgery. The difficulty in establishing an early diagnosis necessitates the evaluation of novel biomarkers. This study aims to determine the diagnostic value of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ESR/CRP, and ESR/PCT ratios in the diagnosis of postoperative spondylodiscitis and to compare the sensitivity and specificity of these parameters.

Methods: This retrospective study was conducted by evaluating 55 patients who underwent two-level lumbar instrumentation (foraminotomy-medial facetectomy and microdiscectomy, autologous graft with fusion) between 2019 and 2023. Laboratory values of 28 patients diagnosed with postoperative spondylodiscitis and 27 control patients with no signs of infection were analyzed. The cut-off values, sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of CRP, ESR, PCT, ESR/CRP, and ESR/PCT ratios were calculated using receiver operating characteristic (ROC) analysis.

Results: CRP, ESR, and PCT levels were significantly elevated in patients with spondylodiscitis (p<0.05). The ESR/PCT ratio demonstrated 96% specificity and was considered a supportive marker for the diagnosis of spondylodiscitis. However, the ESR/CRP ratio did not show a significant difference between the two groups (p=0.222). The cut-off value for CRP was determined as 43.7 mg/L, with a specificity of 100%. The cut-off value for ESR was 46 mm/hr, with a sensitivity of 92.9%. The cut-off value for PCT was found to be 0.034 ng/mL, with a sensitivity of 96.2%.

Conclusion: CRP and ESR/PCT ratios were found to be effective in supporting the diagnosis of postoperative spondylodiscitis due to their high specificity. On the other hand, ESR and PCT demonstrated higher sensitivity, making them more successful in distinguishing non-infected individuals. However, no single biomarker was deemed sufficient on its own, emphasizing the necessity of clinical evaluation alongside laboratory findings. Prospective studies are needed in the future to enhance the diagnostic accuracy of these biomarkers.