Journal of Korean Neurosurgical Society最新文献

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.

Objective: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

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.

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.

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.

Neurofibromatosis type 2 (NF2) is a rare genetic disorder caused by mutations in the NF2 tumor suppressor gene, characterized by bilateral vestibular schwannomas (VSs) and other central and peripheral nervous system tumors. Pediatric patients often present with more aggressive disease, greater tumor burdens, and increased morbidity compared to adults. Management requires a multidisciplinary approach that balances tumor control with functional preservation. While surgery and radiosurgery remain key treatment options, they carry risks such as hearing loss and malignant transformation of existing tumors. Bevacizumab and emerging therapies like gene therapy show promising therapeutic effects but are limited by variability in efficacy. Comprehensive care, including psychosocial support, is essential to improve clinical outcomes and quality of life for children with NF2.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Pathogenic germline variants (PGVs) are increasingly recognized as critical elements in pediatric cancer predisposition. Determining the pathogenicity of germline variants is a dynamic process, with advancements in next-generation sequencing (NGS) and expanding genome databases reshaping our understanding of cancer genomics. This article reviews the role of PGVs in key oncogenic pathways, including RTK/RAS/MAPK, PI3K/AKT, WNT, and Hedgehog signaling, highlighting their associations with specific cancer predisposition syndromes and neurosurgical implications. Most PGVs are inherited in an autosomal dominant pattern and are frequent in tumor suppressor genes, while autosomal recessive conditions like Ataxia-telangiectasia and Fanconi anemia are less common. Germline variants in proto-oncogenes such as PTPN11, KRAS, and HRAS are associated with RASopathies, including Noonan and Costello syndromes, which show variable cancer risks. Similarly, PTEN PGVs, linked to Cowden syndrome, and DICER1 PGVs, responsible for DICER1 syndrome, exemplify the diverse clinical presentations and risks of pediatric cancer predisposition syndromes. Medulloblastoma, a pediatric-specific brain tumor, shows an increasing proportion of PGVs, with approximately 12% of all medulloblastomas harboring PGVs in APC, PTCH1, SUFU, and ELP1 in the WNT-activated and SHH-activated subtypes. Emerging evidence suggests that approximately 8.5-20% of pediatric cancer patients harbor PGVs, with a substantial proportion arising de novo. Routine germline screening for pediatric cancer patients is increasingly recommended, as many PGVs lack family history. Programs like STREAM (Solid Tumor REsearch And Magic) in Korea underscore the importance of comprehensive pediatric genome databases for personalized precision medicine. As neurosurgeons are frequently the first to encounter central nervous system tumor manifestations, a robust understanding of genomic medicine is essential. This review emphasizes the need for international collaboration to develop actionable insights into pediatric cancer genomics, ultimately improving diagnostic, therapeutic, and preventive strategies.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.