Journal of Korean Neurosurgical Society最新文献

Objective: The Albert-Wong (AW) stereotactic frame for brain biopsy was created by a Malaysian neurosurgeon in 2015. A phantom-based accuracy study demonstrated that its accuracy was non-inferior to well-established stereotactic frames. The objective of our study is to compare the diagnostic yield and accuracy between two stereotactic frame systems: the CRW and AW frame.

Methods: This was a retrospective cross-sectional study. All patients who had undergone frame-based biopsy for intracranial lesions using the CRW or AW frame from the year 2014 to 2022 were included in this study. Sociodemographic details, biopsy characteristics, and histopathological reports were collected, tabulated, and analyzed. A p-value of < 0.05 was regarded as statistically significant.

Results: A total of 38 patients underwent frame-based stereotactic biopsy from January 2014 to January 2022. The CRW frame was used for 19 (50%) of the patients, and the remaining utilized the AW frame. Deep lesions were biopsied in 27 (71%) of the patients, and the overall diagnostic yield was 89.5%. When comparing sociodemography and lesion characteristics between the CRW and AW frame groups, no statistically significant differences were found. The diagnostic yield and accuracy of these frames were 100% vs 84% and 100% vs 90% (AW vs CRW), respectively, with no statistical difference between them (p > 0.05).

Conclusion: This study found that biopsies with the AW frame demonstrated diagnostic yield and accuracy which were non-inferior to the older more established frame (CRW).

Objective: To evaluate clinical and radiological outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy (BE-PCIF) to treat cervical spondylotic radiculopathy (CSR).

Methods: This retrospective study included patients with CSR who underwent BE-PCIF between April 2020 and April 2023. Patient demographic data were collected and clinical outcomes were assessed using the Visual analog scale (VAS) and MacNab criteria. Various radiological parameters, including inclinatory angles, were collected and correlations with demographic or radiological factors were evaluated.

Results: We included 101 patients (46 men and 55 women) with a mean age of 56.99 years, encompassing 162 surgical levels primarily affecting the C5-6 and C6-7 vertebrae. The postoperative VAS scores decreased to less than 1, with 90.1% of patients reporting excellence according to the MacNab criteria. None of the patients experienced any major postoperative complications, including instability. The isthmic distance (ID) expansion ratio, representing the degree of distal decompression, was 2.4, with a minor facet resection rate of 0.4. Right-sided surgeries or surgeries at lower cervical levels correlated with higher inclinatory angles, with a p-value of 0.003 each. Significant correlations were noted between the inclinatory angle and both the facet resection rate and ID expansion ratio, with coefficients of 0.45 and 0.3, respectively, both having a p-value of <0.001, indicating strong statistical significance.

Conclusion: BE-PCIF effectively relieves pain and enhances clinical outcomes in CSR patients. The use of the inclinatory angle approach facilitates cervical foraminal expansion and sufficient neural decompression, with higher angles required for adequate decompression at lower cervical levels.

Objective: Clazosentan is a recently approved endothelin receptor antagonist indicated for the prevention of vasospasm and related complications following aneurysmal subarachnoid hemorrhage (aSAH). To date, no direct, head-to-head comparison between clazosentan and nimodipine has been conducted. In this study, we indirectly assessed the efficacy and safety of these two drugs in preventing vasospasm and its associated outcomes after aSAH.

Methods: Participants from six randomized clinical trials of clazosentan were reclassified into three subgroups based on their concomitant use of oral nimodipine : 1) a clazosentan subgroup (without nimodipine), 2) a nimodipine subgroup (without clazosentan), and 3) a placebo subgroup (receiving neither clazosentan nor nimodipine). Data from participants who received the approved dose of clazosentan 10 mg/h was analyzed. To account for heterogeneities among the analyzed studies, we performed within-study comparisons of subgroups and pooled data from the same subgroup. To further balance the three groups, we conducted a propensity score-matching and compared the outcomes among subgroups. The outcomes measured were angiographic vasospasm within 14 days after aSAH and vasospasm-related morbidity and all-cause mortality (MM) within 6 weeks, defined as death, vasospasm-related new cerebral infarcts, delayed ischemic neurological deficits, or initiation of rescue therapy. Incidence and relative risk reduction (RRR) were analyzed across subgroups, and overall safety was reviewed.

Results: The pooled data from within-study comparisons demonstrated that clazosentan significantly reduced the risk of vasospasm (RRR, 0.48; 95% confidence interval [CI], 0.35 to 0.58) and MM (RRR, 0.47; 95% CI, 0.30 to 0.60) compared to placebo, whereas nimodipine did not. In the propensity score-matched analysis, clazosentan demonstrated a significant risk reduction in outcomes when compared to nimodipine (RRR, 0.63; 95% CI, 0.46 to 0.75 for vasospasm; RRR, 0.29; 95% CI, 0.04 to 0.48 for MM) and placebo (RRR, 0.59; 95% CI, 0.40 to 0.72 for vasospasm; RRR, 0.41; 95% CI, 0.21 to 0.56 for MM).The overall safety results were comparable across the three subgroups and consistent with the expected range for endothelin receptor antagonists.

Conclusion: Clazosentan at 10 mg/h significantly reduced the incidence of cerebral vasospasm and MM following aSAH, compared to both placebo and nimodipine. Further clinical studies are warranted to compare the efficacy of clazosentan and nimodipine to optimize treatment strategies for aSAH.

Objective: This retrospective study evaluates our experience with transarterial embolization (TAE) of dural arteriovenous fistulas (dAVFs) using the ascending pharyngeal artery (APA), considering its selective application as a route for the treatment.

Methods: We performed a retrospective analysis of medical records and radiologic data of all patients who underwent TAE through the APA at our institution from January 2009 to April 2021.

Results: We identified 305 patients with cranial dAVFs treated endovascularly at our center, focusing on 11 cases (3.6%) where the APA was used for Onyx embolization. Of the 11 dAVFs, five (45%) were completely occluded, three (27%) showed residual shunt but cortical venous reflux disappeared, and three (27%) showed decreased shunt flow but persistent cortical venous reflux. Cranial nerve palsy occurred in two of the cases in which TAE was performed with the jugular branch and hypoglossal branch of the neuromeningeal trunk, which partially improved over 4 to 6 months. No new instances of infarction or hemorrhage were noted on subsequent magnetic resonance angiography.

Conclusion: Transarterial Onyx embolization through the APA could be a limited option reserved for cases where embolization using other branches is challenging or carries a high risk of incomplete treatment. While embolizing through the jugular and hypoglossal branches of the APA neuromeningeal trunk requires greater caution, selecting the posterior meningeal artery or pharyngeal trunk appears to be associated with a lower risk. A comprehensive understanding of angiography is crucial for identifying cases suitable for this approach and those with a higher risk of complications.

Stereotactic bilateral anterior cingulotomy, including lesions in the anterior and midcingulate cortex, is one of the methods used for treating thalamic pain syndrome. In cases of non-ischemic thalamic lesions, simultaneous stereotactic biopsy of the lesion can be performed in combination with cingulotomy. In this paper we present a case of a 45-year-old male with a lesion in the right thalamus, causing a severe contralateral hemi-pain syndrome. Bilateral radiofrequency anterior cingulotomy and stereotactic biopsy were performed during a single surgery. Pain completely subsided within a few days following the anterior cingulotomy. Histological examination identified a diffuse astrocytoma (World Health Organization grade II, ICD-O 9400/3), and the patient was subsequently referred for LINAC-based radiosurgery. The pain syndrome was controlled for 4 years, after which the pain syndrome returned with an increase in tumor size. Simultaneous anterior cingulotomy and stereotactic biopsy of the thalamic lesion represent a safe intervention for thalamic pain syndrome, enabling the alleviation of pain, verification of the lesion's etiology, and the application of appropriate treatment.

Objective: This study aims to evaluate the efficacy of the multiplanar deformity reducer (MDR) and direct vertebral rotation (DVR) techniques in surgically treating adolescent idiopathic scoliosis (AIS), focusing on surgical and radiographic outcomes.

Methods: A retrospective analysis was conducted on AIS patients who underwent surgery between December 2017 and August 2019, comparing the outcomes of those treated with MDR system and DVR technique. Data on demographics and surgical characteristics were collected, while radiographic parameters were measured manually by three spine surgeons and by EOS 3D analysis (EOS imaging, Paris, France).

Results: Nine patients were surgically corrected with the MDR system and 13 with DVR, who were predominantly females with an average age in their late teens. Despite more fusion levels in the MDR group (12.3±1.0) compared to the DVR group (10.0±3.2), operation time, blood loss, overall radiographic correction, and patient-reported outcome was comparable. Moreover, only the interrater reliability for manual apical vertebral rotation measurements was below good, which necessitates the use of EOS 3D analysis.

Conclusion: The MDR technique is effective and safe for AIS surgery, offering comparable corrective efficacy to the DVR technique. Furthermore, EOS 3D imaging was more reliable for assessing rotational deformities, which incorporates pelvic position.

Objective: The dominant vertebral artery (VA) approach is primarily considered in mechanical thrombectomy (MT) for acute occlusion of the vertebrobasilar (VB) artery. As accessing the dominant artery is sometimes difficult, we present our experience treating acute VB stroke via a nondominant VA approach through a comparison with the dominant VA approach.

Methods: Among 2785 patients diagnosed with hyperacute ischemic stroke between January 2014 and December 2022, 50 patients with VB ischemic stroke underwent recanalization therapy through either dominant, nondominant, or bilateral VA approach. We evaluated patient characteristics and clinical course, highlighting the pros and cons of the access routes.

Results: The patients with hyperacute VB ischemic stroke were predominantly male (72%), with a mean age of 68.12 years and an initial National Institutes of Health Stroke Scale score mean of 17.1. Large-artery atherosclerosis (48%) and cardioembolism (36%) were the main etiologic factors in the Trial of Org 10172 in Acute Stroke Treatment classification. After thrombectomy, 45 cases (90%) had final modified thrombolysis in cerebral infarction score of 2b or higher. In summary, 41 patients were treated through the dominant VA, and eight patients underwent the nondominant VA approach. However, there was no statistically significant difference in functional outcome or mortality between the two approaches.

Conclusion: In MT for VB occlusions, nondominant VA approach may be an option in situations when the vessel is accessible, stable, or less risky, as recanalization can be achieved without rescue balloon angioplasty and/or stenting.

Microscopic polyangiitis (MPA) is a rare autoimmune disorder characterized by small-vessel vasculitis and the presence of anti-neutrophil cytoplasmic antibody (ANCA). Typically, MPA primarily affects the respiratory system, kidneys, and skin, with infrequent involvement of the nervous system, resulting in neuropathy. However, the occurrence of subarachnoid hemorrhage (SAH) in MPA is exceedingly rare, especially when it is accompanied by hemorrhagic events in multiple organs. This case report details the clinical presentation of a 61-yearold male patient diagnosed with MPA who experienced an exceptionally uncommon occurrence of SAH, coupled with extensive bleeding manifestations including epistaxis, skin purpura, and gastrointestinal bleeding. Notably, the patient's symptoms exhibited potential improvement following a treatment regimen consisting of rituximab and glucocorticoids. This case emphasizes the critical importance of promptly recognizing and comprehensively managing rare complications in MPA patients to optimize clinical outcomes.

Objective: Neck pain is a common musculoskeletal disorder frequently experienced by motorbike riders and stands as a leading cause of high disability rates globally. Research on neck pain among motorcyclist in metropolitan universities remains limited. However, given the rising population of urban motorcyclists, identifying factors contributing to neck pain becomes increasingly crucial.

Methods: This is a cross-sectional, observational analytic study utilizing convenience sampling method that included 421 study respondents. Demographics, motorcycle riding habits, perceived stress, and neck pain history were collected using a questionnaire which was then analyzed statistically applying chi-square test, Spearman's rank, and logistic regression analysis.

Results: Two-thirds (67%) of motorcycle riders in productive age report history of neck pain. Logistic regression analysis discovers that occupations as lecturers or teaching staff (odds ratio [OR], 3940; 95% confidence interval [CI], 1193-13007; p=0.024) and daily sleep duration of less than 7 hours per day (OR, 1774; 95% CI, 1094-2875; p=0.020) is a contributing factor for the occurrence of neck pain among productive adult motorcyclist in metropolitan university settings with age, marital status, and daily commuting distance as confounding factors.

Conclusion: Neck pain is a common complaint among productive adult motorcyclists. In our university, occupational factors and daily sleep duration pose as risk factors for neck pain in this demographic. It is crucial for both productive adult motorbike riders and healthcare professionals to identify and address these risk factors according to established guidelines.

Objective: Massive cerebral infarction caused by middle cerebral artery infarction leads to extensive cerebral infarction in one hemisphere, resulting in swelling of the brain and further compression of surrounding normal brain tissue, ultimately leading to a complete cerebral infarction and a mortality rate of about 50-80% for patients. Although early decompressive craniectomy and partial internal decompression can reduce mortality rates, neurosurgeons should strive to achieve lower mortality rates in the face of patients' lives. This study introduces a surgical method with lower mortality rate, which is a rapid internal decompression technique for cerebral hemisphere resection through a flat bone window after decompressive craniectomy (DC) and partial temporal lobe resection.

Methods: From March 2022 to March 2024, 18 patients with extensive cerebral infarction underwent craniotomy and partial temporal lobectomy, craniectomy combined with rapid internal decompression (CCRID). Standard large bone flap craniotomy and anterior temporal lobe resection were performed. Circular electrocoagulation of the arachnoid membrane 1 cm inside the bone window, with sharp cutting, and then rapid resection of necrotic brain tissue outside the bone window (the height of the removed necrotic brain tissue is about 1-2 cm), while electrocoagulating the blood vessels from front to back along the direction of blood vessel formation. Place the drainage tube and intracranial pressure monitoring catheter for 1-2 days. Clinical outcomes were compared to 24 patients who underwent DC combined with partial temporal/frontal pole resection (DCPTR).

Results: The average age of 18 patients was 63 years. The mean cerebral hemisphere resection time was 6.8 minutes with total surgery averaging 2.82 hours. Postoperative ICP averaged 4 mmHg, and the midline shifted back by 0.45 cm. At 3 months, there was one intracerebral hemorrhage, no infections, and a mortality rate of 11.1%. The mean modified Rankin scale score was 4.45. Compared to DCPTR, CCRID showed similar midline shift, shorter surgery time, and lower mortality.

Conclusion: CCRID may represent a viable decompression technique for patients with massive hemispheric infarctions, warranting further consideration for future applications.