Journal of Korean Neurosurgical Society最新文献

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 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 subthalamic nucleus showing the highest risk.

Conclusion: Meticulous trajectory planning using both 1.5 T and 3.0 T 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.

Objective: The Leksell Gamma Knife (LGK) is one of the most precise radiosurgical tools available. However, the quality assurance (QA) practices for LGK vary considerably across institutions in Korea. In this study, we aim to identify and standardize key QA items, categorized into daily, monthly, biannual, and annual protocols, based on a nationwide survey conducted at 16 medical centers. Additionally, the tolerance values for each QA items were reviewed, comparing them with the American Association of Physicists in Medicine Task Group (TG-178), and tailored to establish distinct Korean Gamma Knife Radiosurgery (GKRS) tolerances reflecting local standards and regulatory requirements.

Methods: The survey focused on QA practices for the LGK Icon™/Esprit™ and Perfexion™ systems. The QA items were categorized into daily, monthly, biannual, and annual tasks in accordance with the guidelines set by TG-178. Sixteen participating institutions were asked to rate the importance of each QA item on a scale of 0 (not important) to 5 (extremely important). Items rated 4 or 5 were selected to create a national priority list.

Results: Eleven daily, six monthly, and three annual QA items were identified as high priority. Daily QA tasks primarily focused on radiation and patient safety, whereas the monthly tasks were largely related to dosimetric validation. Annual QA emphasizes mechanical and dosimetric checks. Biannual evaluations were not prioritized as they were routinely performed by the manufacturer's maintenance service (Elekta AB, Stockholm, Sweden).

Conclusion: We succeeded in making recommendations for Gamma Knife QA standardization in Korea. Continuous QA updates are essential to ensure treatment safety, particularly with the introduction of new LGK models. These findings may contribute to the development of unified national QA guidelines for GKRS.

A proposed program for competency-based neurosurgery training was presented for adaptation to a specialized project. The core of this training program is to reflect the contents of medicine that develop in the ordinary competency course necessary during the training period of residency and to systematize the training curriculum focused on competency. For that, the development project of the competency-based training program for neurosurgical residency was conducted under the leadership of the Training Education Committee under the Korean Neurosurgical Society (KNS), with the support of the Ministry of Health and Welfare. In this article, we introduce an educational program for a competency-oriented training system. The educational program sets the goal of the final competency that a neurosurgeon must possess and presents a list of core competencies and activities to perform for this purpose, called entrustable professional activity (EPA). The program structure includes the following domains : seven final competencies, four core competencies, 10 EPAs, and 12 neurosurgical procedures. These educational programs will be uploaded to the KNS website in the future, and we would like to encourage each training hospital to reflect on them.

Objective: Low back pain (LBP) is a multifactorial musculoskeletal condition that reduces productivity at work and causes disability. Due to their lengthy lectures and heavy workload, medical students are more prone to experience LBP. This study aims to investigate the relationship between central adiposity, stress, lumbar lordosis and LBP.

Methods: This study uses a cross-sectional analytical observational design. A total of 73 medical students served as the study's sample. Respondents self-completed the K-10 psychological assessment and the Nordic musculoskeletal questionnaire. Physical examination was then carried out to identify central adiposity and lumbar lordosis. Respondents having a history of malignancy, deformity, or spinal injury are excluded.

Results: In the prevalence of LBP, 53.21% of respondents reported not experiencing LBP symptoms, while the remaining 46.79% experienced pain. Central adiposity had no significant association with LBP (p=0.872). Although moderate stress was common among those with LBP, stress did not show a clear association in the chi-square test. Logistic regression showed that lumbar lordosis had the strongest impact on the presence of LBP, with an odds ratio of 10.524 (p=0.001), and stress also contributed to LBP complaints (p=0.044).

Conclusion: This study shows LBP is correlated with lumbar lordosis and stress; however, central adiposity is not correlated with LBP.

Objective: 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 (miRNAs) 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 subarachnoid hemorrhage (SAH).

Methods: 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 cerebrospinal fluid (CSF) samples collected on day 5 after aneurysmal SAH (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 quantitative real time polymerase chain reaction for evaluating the expression profiles of eight miRNAs.

Results: 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.

Conclusion: 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.

Persistent trigeminal artery (PTA) is the most common residual manifestation of persistent carotid-vertebrobasilar anastomosis, with the medial-type (intrasellar or sphenoidal) PTA being exceptionally rare. Aneurysms originating from the PTA trunk are not common. We present a unique case of an aneurysm located at the trunk of the medial-type PTA in a patient presenting with trigeminal neuralgia who successfully managed by endovascular procedure. Furthermore, we discuss the anatomical features of this aneurysm and relevant reports, and examine the possible pathomechanism of the associated pain.

The 2024 Journal Citation Reports (JCR) reveal that the impact factor (IF) for the Journal of Korean Neurosurgical Society (JKNS) has risen to 1.7, an increase from 1.4 in 2023. Meanwhile, Republic of Korea has been in turmoil in healthcare system since February 2024, provoked by government's sudden and drastic policy to increase medical school admissions. This situation has profoundly impacted medical research activities, in addition to clinical practice. There is concern about whether the Korean medical community can sustain and build upon its academic achievements once this situation is resolved. Maintaining the growth of a medical journal is becoming increasingly challenging. The JKNS must continue its previous efforts to sustain its current progress. To enhance its IF, JKNS should focus on recruiting high-quality review articles and becoming a preferred journal for authors by offering a rapid review process. Collaboration with subspecialty journals is also crucial to ensure that both JKNS and those journals can grow together.

Objective: Texture analysis is widely used in all walks of life, and also in medicine. This paper aims to discuss the value of texture analysis in postoperative recurrence of chronic subdural hematoma (CSDH).

Methods: A total of 173 patients with CSDH who were hospitalized in our hospital from January 2018 to August 2023 were selected . All the patients underwent magnetic resonance imaging (MRI) examinations before surgery. According to whether patients with CSDH have relapsed after surgery, the patients are divided into recurrence group and non-recurrence group. FireVoxel software (https://firevoxel.org) was used to manually delineate the region of interest on the largest level of the hematoma cavity during MRI plain scans and measure the texture parameters. The texture parameters with statistical difference were analyzed by receiver operating characteristic curve.

Results: Heterogeneity and entropy texture parameters in the recurrence group were statistically different from those in the nonrecurrence group (p<0.05). When the cut-off point of the heterogeneity parameter was 0.284, the sensitivity, specificity, and accuracy of judging whether CSDH relapsed were 83.3%, 80.4%, and 80.7%, respectively.

Conclusion: Texture analysis of CSDH can provide a new method to judge the recurrence of patients with CSDH.

Objective: Lumboperitoneal shunt (LPS) surgery is a widely used treatment for normal pressure hydrocephalus, especially in East Asia. Although LPS surgery has been widely studied internationally, large-scale data from the Republic of Korea are limited. This study aimed to evaluate clinical outcomes and complications of LPS surgery in NPH patients, with particular focus on anesthesia type and valve pressure management strategies.

Methods: A retrospective review was conducted of 244 patients with normal pressure hydrocephalus who underwent LPS surgery between February 2020 and February 2025. Valve pressures were initially set at the highest level and gradually adjusted downward based on clinical response. Functional outcomes-including the modified Rankin Scale (mRS), Timed Up and Go (TUG), 10-meter gait test, and Mini-Mental State Examination (MMSE)-were assessed at 1 year and followed for up to 4 years. Complications were categorized by type and whether surgical intervention was required.

Results: Among 244 patients, 119 completed at least 1 year of follow-up. At 1 year, 53.8% of patients showed mRS improvement, and 66.4% demonstrated gait improvements (TUG and 10-meter walk). Stable or improved function was observed in 93.3% of patients. MMSE scores did not show significant change. The overall complication rate was 16.8%, with 11.1% requiring surgical revision, primarily for chronic subdural hematoma and catheter-related issues. No surgery-related mortality occurred, but three patients (1.2%) died from falls despite improved gait, underscoring the need for fall prevention. The adoption of an initial high-pressure setting reduced overdrainage-related complications, contributing to a decreased annual revision rate of 5.6%.

Conclusion: A retrospective study showed that LPS surgery with local anesthesia is effective for NPH patients, demonstrating favorable functional outcomes and acceptable complications. Using higher initial valve pressures significantly decreased the need for revision surgeries and complications related to overdrainage.