Journal of Korean Neurosurgical Society最新文献

Objective: The Leksell Gamma Knife (LGK) Icon™ facilitates frameless (mask-based) fixation through its high-definition motion management (HDMM) system. However, the HDMM only records the intra-fractional motion values of patient marker without specifying changes along the X, Y, and Z axes. This study investigates the coordinate shifts in patient markers using the HDMM system during frameless gamma knife radiosurgery (GKRS) in patients with meningioma and metastases.

Methods: We conducted a retrospective study of patients diagnosed with meningioma or metastases who underwent frameless GKRS using the LGK Icon™ between January and September 2023. All patients were immobilized using a Nanor thermoplastic mask (Orfit Industries, Wijnegem, Belgium) for frameless fixation. Sequential data of the patients' nose marker coordinates (X, Y, Z) were imported into the LGK system, and subsequent coordinate changes were analyzed.

Results: We evaluated patients with meningiomas (n=30) and metastases (n=30) who underwent GKRS with frameless fixation. None of the patients exhibited cognitive impairment or compliance issues. The median beam-on time was 44.2 minutes in patients with meningioma and 93.75 minutes in patients with metastases. In patients with meningioma, no significant intra-fractional displacements were found along the X (0.07±0.06 mm), Y (0.08±0.46 mm), and Z (0.08±0.04 mm) axes. However, in patients with metastases, the Y axis (0.57±0.37 mm, p<0.05) exhibited significantly greater intra-fractional displacements compared with the X axis (0.33±0.23 mm). No significant differences in intra-fractional displacement were observed between the X and Z (0.43±0.31 mm) axes or between the Y and Z axes. An analysis of movement over time revealed a significant increase in Y axis displacement after 30 minutes.

Conclusion: Y axis movement, as indicated by the HDMM, was most prominent in patients with metastases. We recommend pressing the forehead when securing a mask to minimize nose marker movement. Additionally, when creating treatment plans for managing patients with metastases using the LGK Icon™, we suggest adding a 0.5 mm margin to the Y axis.

Objective: Partially thrombosed intracranial aneurysms (PTIAs) are known to occur for both large and small aneurysms; however, standardized treatment guidelines remain undefined. This study aimed to evaluate and compare the efficacy of surgical and endovascular strategies for managing PTIAs to identify the optimal treatment approach.

Methods: A retrospective analysis was performed on patients diagnosed with PTIAs who underwent surgical or endovascular treatment at our institution from January 2005 to December 2022. Patients with intraluminal thrombi confirmed via brain imaging were categorized based on the treatment modality. A total of 45 patients were included. Clinical outcomes, including preoperative and postoperative modified Rankin scale scores, complication rates, and recurrent or remnant aneurysm rates, were reviewed to analyze the treatment results.

Results: Of the 45 enrolled patients, 31 patients (68.9%) underwent surgical treatment, and 14 patients (31.1%) received endovascular treatment. Surgical approaches included direct clipping, trapping with bypass, and aneurysm wrapping. Multivariate analysis revealed a statistically significant association between the treatment modality and recurrent or remnant aneurysms (p<0.001). However, no significant differences were identified between the two treatment groups in terms of complication rates or functional outcomes.

Conclusion: In comparison to endovascular treatment, surgical management of PTIAs demonstrated superior efficacy in minimizing recurrent and remnant aneurysms. Considering the comparable rates of postoperative complications and functional outcomes, surgical treatment may be the preferred treatment strategy, particularly for younger patients with longer follow-up periods or for cases requiring decompression.

Endoscopic spine surgery is the perfect culmination of the concept of minimally invasive spine surgery. Among the various endoscopic spine procedures, full-endoscopic spine surgery (FESS) is an endoscopic technique characterized by the performance of the entire spinal procedure via the percutaneous approach using a uniportal working-channel endoscope with continuous saline perfusion. FESS effectively decompresses the tissues and allows for instrumentation while preserving the normal musculoskeletal structures. It also has fewer complications and enables quicker return to work. However, potential disadvantages include its steep learning curves and limited indications. Previously, the indications for endoscopic procedures had been limited to soft disc herniations or focal neural impingement, with most degenerative spinal diseases other than disc herniation being considered contraindications. However, owing to the remarkable advancements in endoscopic technology, nearly all degenerative spinal diseases, including spinal stenosis and instability, can currently be treated using FESS. Furthermore, the application of spinal endoscopes has expanded to other spinal disorders, including infections, traumas, and tumors. Unfortunately, the steep learning curve and technical limitations of FESS cannot be overlooked by most standard spine surgeons. To ensure the clinical success of endoscopic procedures in actual clinical practice, a comprehensive understanding of the core properties of working channel endoscopes is necessary to facilitate the learning process. With the ongoing development of endoscopic technology, endoscopic surgery can be expected to become the standard treatment approach for all degenerative spinal diseases in the near future.

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: Primary intraventricular hemorrhage (PIVH) is a rare type of neurologic disorder and remains a challenge for cerebrovascular surgeons. This study intended to investigate the factors associated with neurosurgical intervention and its impact on outcome after PIVH.

Methods: We retrospectively included consecutive patients with PIVH admitted to at a single tertiary academic medical center in China. Conservative treatment or neurosurgical intervention options (including endovascular therapy, craniotomy, stereotactic radiotherapy, endoscopic surgery or external ventricular drain) were assessed. Multivariable logistic regression was applied to determine associations.

Results: In total, 174 patients with PIVH were included in our analysis. There were 79 patients (45.4%) underwent surgery, which was associated with younger age (p=0.004), higher baseline Graeb score (p=0.001), acute hydrocephalus (p=0.02) and underlying cerebrovascular diseases (p<0.001) in an adjusted model. In multivariable logistic regression analysis, significant predictors of external ventricular drain after PIVH were higher baseline Graeb score (p=0.04), and acute hydrocephalus (p<0.001). Furthermore, after adjustment for confounders, our analysis showed that neurosurgical intervention could decrease 90-day mortality after PIVH (p=0.04).

Conclusion: After PIVH, younger patients with higher baseline Graeb score, acute hydrocephalus and underlying cerebrovascular diseases were more likely to undergo neurosurgical intervention. Surgical treatment of PVIH patients should be optimized to decrease mortality. However, further clinical trials are still needed to determine which patients would benefit from neurosurgical intervention.

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: 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.

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.