Journal of Korean Neurosurgical Society最新文献

Objective: High-ratio plasma transfusion is proposed as a strategy for treating polytrauma with severe traumatic brain injury (TBI). This study analyzed outcomes based on the ratio and timing of plasma transfusion.

Methods: The clinical characteristics and results were collected from March 2016 to December 2022. Subjects included patients with severe TBI and polytrauma who underwent massive transfusion (MT). Severe TBI was defined as head abbreviated injury score (AIS) ≥3, and MT was defined as packed red blood cells (pRBCs) ≥4 units in the first 4 hours and ≥10 units in the first 24 hours. The 4-hour ratios were assigned to the "early group," and the 24-hour ratios to the "catch-up group." Next, the ratio of each group was divided into "≥1 : 1 (plasma ≥ pRBC)" and "<1 : 1 (plasma < pRBC)" groups, respectively.

Results: In this study, 532 patients participated. Mortality rates between the 1 : 2 and 1 : 1.5 ratios did not differ statistically; however, a significant difference was noted only at the 1 : 1 ratio (p=0.006). In the early group, outcomes did not significantly differ. The logistic regression for 30-day mortality identified independent risk factors, including advanced age, low Glasgow coma scale (GOS) scores, high AIS head scores, and a ratio <1 : 1. For the catch-up group, the odds ratio for a favorable GOS at ≥1 : 1 was 1.61, with a 30-day mortality rate of 0.60 when comparing ≥1 : 1 to <1 : 1 ratios.

Conclusion: This study showed that maintaining a ≥1 : 1 plasma ratio for 24 hours improved functional outcomes and survival, without increased morbidity. Therefore, high-ratio plasma transfusion may be effective in the treatment of patients with polytrauma and severe TBI.

Objective: Prestin, expressed in cochlear outer hair cells, is essential for auditory signal amplification and may serve as a biomarker for cochlear injury related to trauma. This study aimed to investigate the potential role of prestin in the diagnosis and prognosis of cranial trauma.

Methods: A total of 150 participants were included, comprising 110 patients aged 18-70 who were treated for head trauma and 40 age-matched healthy controls. The patients were divided into two groups of 55 each, with GCS≥13 and GCS≤8, according to the Glasgow Coma Scale (GCS). Prestin was measured by enzyme-linked immunosorbent assay (ELISA) in serum on days 1, 3, and 7 in the patient and also the control groups. In the diagnosis of trauma and determining trauma severity, important risk levels (cut-off values) according to prestin's measurement days were calculated by receiver operating characteristic (ROC) analysis.

Results: Prestin values in both the GCS≥13 and GCS≤8 groups were dramatically lower than those in the control on all measurement days. Additionally, prestin values in the GCS≤8 group on days 3 and 7 tended to be lower than those in the GCS≥13 group. Furthermore, there was a tendency for serum prestin values to increase as time progressed especially in the GCS≥13 group. ROC analysis showed that prestin values on the first, third, and seventh days showed high accuracy in detecting traumatized individuals with area under the curve (AUC) values of 85%, 81%, and 75%, respectively (sensitivity:84%, 79%, and 83%, respectively). Also, prestin data on the first day accurately detected the severity of trauma at a high rate (sensitivity:82%, AUC:90%).

Conclusion: Our findings suggest that serum prestin levels on the first day after trauma may provide supportive information regarding trauma severity. However, further controlled studies are needed before definitive diagnostic or prognostic use.

Objective: Recurrent lumbar disc herniation (RLDH) is a significant challenge following lumbar discectomy, with recurrence rates of 5%-15%. Established risk factors include male gender, diabetes mellitus, smoking, and obesity, but the role of paraspinal muscles in recurrence is unclear. This study was conducted to identify key risk factors for RLDH, including the volume of paraspinal muscles with machine learning.

Methods: We used data from 126 patients who underwent lumbar discectomy between January 2003 and September 2023 and had follow-up outpatient visits for more than 6 months at a single institution. Variables selected for the model, comprising demographic and clinical variables, medical history, LDH operation-related variables, and MRI measurements for RLDH. Based on clinical symptoms and radiologic results, the patients were classified into RLDH and non-RLDH groups, and RLDH was defined at the same surgical level on follow-up MRI.

Results: Totally, 38 patients were included in the RLDH group and 88 in the non-RLDH group. The volume of quadratus lumborum was identified as a risk factor for RLDH (odds ratio 7.894; P=0.001). Among the five different ML algorithms, XGBoost achieved the best result with an accuracy of 0.794 and area under the curve (AUC) of 0.811. In terms of SHAP value analysis, the weight, volume of quadratus lumborum, psoas major, and vertebra were key features for predicting RLDH.

Conclusion: The prediction model would be of great assistance for surgeons to make surgical decisions or establish observation intervals.

Objective: The 2024-2025 medical crisis in the Republic of Korea, triggered by mass trainee departures, caused severe staffing shortages in tertiary hospitals. The impact of this disruption on neurosurgeons' workload, lifestyle, and mental health has not been evaluated. In this study, we aimed to determine the prevalence of burnout among neurosurgeons during the crisis, assess associated changes in workload and lifestyle, and identify key factors linked to burnout severity.

Methods: We conducted a nationwide, questionnaire-based observational study from April 29 to June 4, 2025, targeting board-certified neurosurgeons in university hospitals across the Republic of Korea. Participants were recruited through departmental professional contacts and completed an online survey capturing baseline characteristics, paired pre-post crisis values for 14 workload and lifestyle variables, and 3 current-status items. Burnout was assessed using the Copenhagen Burnout Inventory (CBI) as the primary tool and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) as a supplementary measure.

Results: Of 61 respondents, 36 (59.0%) met high-burnout criteria. After the crisis onset, all workload and lifestyle factors shifted unfavorably, with the largest increases in weekend/holiday duty (86.9%), night duty (82.0%), and sleep disturbance call (68.9%), and the largest declines in number of colleagues (-50.8%), leisure time (-47.5%) and family time (-44.3%). High-burnout surgeons had greater workloads, more off-hour duties, and less recovery time than low-burnout peers. Burnout severity correlated with staffing levels, working hours, night duty, time spent with family and leisure activities, job satisfaction, intention to leave, and all MBI subscales.

Conclusion: Burnout among Korean neurosurgeons is widespread after the national medical crisis, with substantial deterioration in workload and lifestyle. Coordinated efforts at both hospital and national levels are essential to protect surgeon well-being and maintain the quality of neurosurgical care.

Objective: To evaluate the efficacy of individualized dual antiplatelet therapy (DAPT) using VerifyNow in reducing periprocedural ischemic complications following carotid artery stenting (CAS), particularly in patients with unstable plaques.

Methods: This retrospective, single-center study included 187 patients who underwent elective CAS between January 2018 and September 2024. Patients were divided into two groups: a conventional DAPT (c-DAPT) group treated with aspirin and clopidogrel (n = 89), and an individualized DAPT (i-DAPT) group (n = 98) where antiplatelet regimens were adjusted based on preoperative platelet reactivity measured by VerifyNow. The primary outcome was the incidence of ischemic lesions on diffusion-weighted imaging (DWI) following CAS. Risk factors and the impact of DAPT personalization on ischemic changes were analyzed using multivariate logistic regression.

Results: DWI-positive ischemic lesions were observed in 62.9% of the c-DAPT group and 51% of the i-DAPT group (p = 0.07). Although the difference was not statistically significant, there was a trend toward reduced ischemic changes with individualized therapy. Multivariate analysis identified hypertension, diabetes mellitus, and unstable plaque as independent predictors of post-CAS ischemic changes. Subgroup analysis showed that VerifyNow-guided i-DAPT significantly reduced ischemic events in patients with unstable plaques (odds ratio: 0.49, p = 0.03), whereas no significant effect was observed in other subgroups.

Conclusion: VerifyNow-guided personalization of antiplatelet therapy is a safe and may have the potential to reduce periprocedural ischemic complications in CAS, particularly in patients with unstable plaques. Further multicenter prospective studies are needed to validate these findings and optimize individualized antiplatelet regimens.

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.

Objectives: Reactive oxygen species generated by mitochondria contribute to the induction of programmed cell death (PCD), but their involvement in epilepsy remains uncertain. The present study investigates the biomarkers and underlying mechanisms of mitochondria-related genes (MRGs) and PCD-related genes (PCDRGs) in epilepsy.

Methods: The MRGs and PCDRGs were respectively intersected with differentially expressed genes (DEGs) in epilepsy and control samples within the GSE134697.Afterwards, Spearman correlation analysis was implemented to select candidate genes. Thereafter, candidate biomarkers were identified through intersection of eight algorithm results in cytoHubba plugin. The receiver operating characteristic (ROC) curve analysis and expression validation in GSE134697 and GSE168375 were implemented to select biomarkers. Moreover, functional analysis, drug prediction and molecular docking were carried out to explore the mechanism of biomarkers in epilepsy, as well as single cell RNA sequencing analysis. Finally, the expression of biomarkers in clinical sample was validated by RT-qPCR.

Results: LTBR and IRF1 were down-regulated in epilepsy samples in both GSE134697 and GSE168375 datasets, Therefore, they were identified as biomarkers for epilepsy related to PCD and mitochondria. IRF1 formed a hydrogen bond interaction with the RECOMBINANT CYTOKINE,indicating RECOMBINANT CYTOKINE was an effective drug target, while LTBR was not a suitable drug target. The macrophage was observed to engage in more frequent and intensive interactions with other cells. RT-qPCR showed that both biomarkers also low expression in epilepsy clinical samples.

Conclusion: LTBR, IRF1 were identified as biomarkers associated with mitochondria and PCD in epilepsy, providing novel perspectives on the management of this condition.

Remote spinal subdural hematoma (SSH) following unilateral biportal endoscopic (UBE) spine surgery is rare, even without intraoperative dural injury. We report two such cases. A 76-year-old woman underwent anterior lumbar interbody fusion and UBE decompression for lumbar spinal stenosis. Intraoperatively, dense adhesions were noted, but no cerebrospinal fluid (CSF) leakage occurred. Postoperatively, she developed left leg monoplegia. MRI revealed a subdural hematoma at L2-3, remote from the surgical site. She recovered completely with steroid therapy and conservative management. An 88-year-old man underwent left-sided UBE laminotomy for central stenosis. The procedure was uneventful. Postoperative MRI revealed an incidental subdural hematoma from L2-4 without neurological deficits. He was observed conservatively. Both patients showed favorable outcomes without surgical evacuation. Remote SSH is a rare but important complication following UBE surgery. It should be considered when unexpected neurological deficits occur postoperatively, even in the absence of visible dural tears. Prompt diagnosis is essential for optimal management.