Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00262
Mooseong Kim, Seong Min Kim, W. Lee, S. Pyo
The Gamma Knife is a specialized tool for precisely delivering high-dose radiation to treat benign brain tumors, arteriovenous malformations, metastatic brain tumors, and some functional brain diseases. In recent years, more brain diseases have been treated with minimally invasive approaches, including radiosurgery or craniotomy followed by radiosurgery, to avoid surgery-related neurological deficits as much as possible. The Gamma Knife is playing a leading role as a precise radiosurgical tool, and it is very popular. The users of the Gamma Knife—and, in fact, all neurosurgeons—can benefit from knowledge regarding the process of radiosurgery. In this article, we introduce the process of planning radiosurgery with GammaPlan®.
{"title":"How to use Leksell GammaPlan","authors":"Mooseong Kim, Seong Min Kim, W. Lee, S. Pyo","doi":"10.52662/jksfn.2022.00262","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00262","url":null,"abstract":"The Gamma Knife is a specialized tool for precisely delivering high-dose radiation to treat benign brain tumors, arteriovenous malformations, metastatic brain tumors, and some functional brain diseases. In recent years, more brain diseases have been treated with minimally invasive approaches, including radiosurgery or craniotomy followed by radiosurgery, to avoid surgery-related neurological deficits as much as possible. The Gamma Knife is playing a leading role as a precise radiosurgical tool, and it is very popular. The users of the Gamma Knife—and, in fact, all neurosurgeons—can benefit from knowledge regarding the process of radiosurgery. In this article, we introduce the process of planning radiosurgery with GammaPlan®.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114868243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00234
Y. Choi, I. Kim, J. Sung, C. Cho
Neurovascular compression syndrome is generally caused by vascular compression at the root entry or exit zone of the corresponding cranial nerve. Trigeminal neuralgia is the most frequent syndrome, followed by hemifacial spasm. Despite ongoing debate in the literature, pulsatile tinnitus is also known to be a neurovascular compression syndrome resulting from vascular compression of the vestibulocochlear nerve. Combined manifestations of neurovascular compression symptoms are very rare. We report a case with a simultaneous manifestation of trigeminal neuralgia, hemifacial spasm, and pulsatile tinnitus as neurovascular compression syndrome with separate offending vessels. A 53-year-old female presented with lancinating pain in the left face, left hemifacial spasm, and ipsilateral pulsatile tinnitus for 2 years. Trigeminal neuralgia and hemifacial spasm were diagnosed after a neurological examination, imaging study, and electromyography. Microvascular decompression via a retrosigmoid approach for separate offenders, including the superior cerebellar artery, anterior inferior cerebellar artery, and posterior inferior cerebellar artery was performed using Teflon sponges. The patient’s hemifacial spasm, pulsatile tinnitus, and hemifacial pain improved immediately after microvascular decompression.
{"title":"Microvascular triple decompression for combined simultaneous trigeminal neuralgia, hemifacial spasm, and pulsatile tinnitus due to separate offending vessels","authors":"Y. Choi, I. Kim, J. Sung, C. Cho","doi":"10.52662/jksfn.2022.00234","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00234","url":null,"abstract":"Neurovascular compression syndrome is generally caused by vascular compression at the root entry or exit zone of the corresponding cranial nerve. Trigeminal neuralgia is the most frequent syndrome, followed by hemifacial spasm. Despite ongoing debate in the literature, pulsatile tinnitus is also known to be a neurovascular compression syndrome resulting from vascular compression of the vestibulocochlear nerve. Combined manifestations of neurovascular compression symptoms are very rare. We report a case with a simultaneous manifestation of trigeminal neuralgia, hemifacial spasm, and pulsatile tinnitus as neurovascular compression syndrome with separate offending vessels. A 53-year-old female presented with lancinating pain in the left face, left hemifacial spasm, and ipsilateral pulsatile tinnitus for 2 years. Trigeminal neuralgia and hemifacial spasm were diagnosed after a neurological examination, imaging study, and electromyography. Microvascular decompression via a retrosigmoid approach for separate offenders, including the superior cerebellar artery, anterior inferior cerebellar artery, and posterior inferior cerebellar artery was performed using Teflon sponges. The patient’s hemifacial spasm, pulsatile tinnitus, and hemifacial pain improved immediately after microvascular decompression.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114723487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00241
Seung Cheol Lee, Hyeon Don Hong, H. Lim, Seung Woo Song
Drugs administered for anesthesia can trigger seizure attacks in patients with epilepsy. Benzodiazepines have been consistently reported to be anticonvulsants, and a novel benzodiazepine, remimazolam, was recently introduced. We report a case of total intravenous anesthesia maintained with remimazolam in a patient with epilepsy who underwent deep brain stimulation of both anterior thalamic nuclei. Despite the administration of multiple anti-epileptic drugs, no tolerance to remimazolam was observed. Perioperative seizures were also not observed. Remimazolam can be considered the anesthetic of choice in patients with epilepsy.
{"title":"Total intravenous anesthesia with remimazolam in a patient with epilepsy who underwent deep brain stimulation: a case report","authors":"Seung Cheol Lee, Hyeon Don Hong, H. Lim, Seung Woo Song","doi":"10.52662/jksfn.2022.00241","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00241","url":null,"abstract":"Drugs administered for anesthesia can trigger seizure attacks in patients with epilepsy. Benzodiazepines have been consistently reported to be anticonvulsants, and a novel benzodiazepine, remimazolam, was recently introduced. We report a case of total intravenous anesthesia maintained with remimazolam in a patient with epilepsy who underwent deep brain stimulation of both anterior thalamic nuclei. Despite the administration of multiple anti-epileptic drugs, no tolerance to remimazolam was observed. Perioperative seizures were also not observed. Remimazolam can be considered the anesthetic of choice in patients with epilepsy.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116705480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00206
D. Seo, K. Cho, Kwan Park
Sole vein offenders are rare and can be difficult to identify on preoperative magnetic resonance imaging (MRI) and intraoperative microscopy. The objective of this case review was to investigate factors resulting in successful decompression in venous offender cases. Among 234 cases of microvascular decompression surgery performed for hemifacial spasm from September 2020 to April 2022 at Konkuk University Medical Center, only two cases were identified as having a definite venous offender. We reviewed preoperative MRI and intraoperative microscopic findings and studied the correlation between decompression and lateral spread response (LSR) changes. Our two patients had possibility of a small venous offender on preoperative MRI, but it was ambiguous. A definite venous offender was identified on the operative microscopic findings and decompressed successfully, referring to the disappearance of the LSR waveform. Postoperatively, spasm disappeared or significantly improved. A venous offender is difficult to identify on preoperative MRI findings or even on intraoperative microscopic findings. In such cases, changes in the LSR waveform in response to decompressing the suspected vein can be a valuable reference for successful facial outcomes.
{"title":"Sole vein offenders confirmed by disappearance of the lateral spread response during microvascular decompression for hemifacial spasm","authors":"D. Seo, K. Cho, Kwan Park","doi":"10.52662/jksfn.2022.00206","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00206","url":null,"abstract":"Sole vein offenders are rare and can be difficult to identify on preoperative magnetic resonance imaging (MRI) and intraoperative microscopy. The objective of this case review was to investigate factors resulting in successful decompression in venous offender cases. Among 234 cases of microvascular decompression surgery performed for hemifacial spasm from September 2020 to April 2022 at Konkuk University Medical Center, only two cases were identified as having a definite venous offender. We reviewed preoperative MRI and intraoperative microscopic findings and studied the correlation between decompression and lateral spread response (LSR) changes. Our two patients had possibility of a small venous offender on preoperative MRI, but it was ambiguous. A definite venous offender was identified on the operative microscopic findings and decompressed successfully, referring to the disappearance of the LSR waveform. Postoperatively, spasm disappeared or significantly improved. A venous offender is difficult to identify on preoperative MRI findings or even on intraoperative microscopic findings. In such cases, changes in the LSR waveform in response to decompressing the suspected vein can be a valuable reference for successful facial outcomes.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"172 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115987256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00220
M. Lee
Transcutaneous afferent patterned stimulation (TAPS), also referred to as non-invasive peripheral nerve stimulation, at the wrist provides a promising option for the management of essential tremor. This new wrist-worn neuromodulation method avoids the risks of surgical interventions and can be easily used at home. TAPS therapy is indicated to aid in the temporary relief of hand tremors following stimulation in adults with essential tremor. No serious device-related side effects have been reported. Future studies will be needed to determine the optimal parameters of stimulation. This article introduces a wrist-worn TAPS device and reviews the tremor-reducing mechanism and the clinical effectiveness of TAPS therapy for essential tremor.
{"title":"Transcutaneous afferent patterned stimulation therapy at the wrist for essential tremor relief","authors":"M. Lee","doi":"10.52662/jksfn.2022.00220","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00220","url":null,"abstract":"Transcutaneous afferent patterned stimulation (TAPS), also referred to as non-invasive peripheral nerve stimulation, at the wrist provides a promising option for the management of essential tremor. This new wrist-worn neuromodulation method avoids the risks of surgical interventions and can be easily used at home. TAPS therapy is indicated to aid in the temporary relief of hand tremors following stimulation in adults with essential tremor. No serious device-related side effects have been reported. Future studies will be needed to determine the optimal parameters of stimulation. This article introduces a wrist-worn TAPS device and reviews the tremor-reducing mechanism and the clinical effectiveness of TAPS therapy for essential tremor.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131197046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00255
Joon Cho
Objective: A cavernous malformation (CM) is a type of an abnormally large collection of “low-flow” vascular channels without brain parenchyma intervening between the sinusoidal vessels; these occult lesions on transfemoral catheter angiograms were formerly known as “cryptic” vascular lesions. In this review, we briefly describe the overall characteristics of cerebral CMs and summarize radiosurgical methods and results of radiosurgery as treatment for CMs. Methods: The incidence, definition, and natural history of cerebral CMs are described. The principal issues of CMs are recurrent bleeding and seizures. These issues are compared to the radiosurgical interventions for CMs.Results: The rebleeding rates of CMs after radiosurgery is difficult to compare directly with untreated lesions because treated lesions are innately more vulnerable to rebleeding. Seizure outcomes after radiosurgery are also not easily estimated because of the various lesion locations; nevertheless, radiosurgery is an important treatment option for CMs in eloquent areas.Conclusion: Stereotactic radiosurgery (SRS) for CM has been effectively and widely used in recent years. Advances in magnetic resonance imaging and radiosurgery, as well as better studies of this condition’s natural history, are increasingly supporting the role of SRS as a complementary tool in CM treatment. More research is needed.
{"title":"Radiosurgery for cerebral cavernous malformations","authors":"Joon Cho","doi":"10.52662/jksfn.2022.00255","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00255","url":null,"abstract":"Objective: A cavernous malformation (CM) is a type of an abnormally large collection of “low-flow” vascular channels without brain parenchyma intervening between the sinusoidal vessels; these occult lesions on transfemoral catheter angiograms were formerly known as “cryptic” vascular lesions. In this review, we briefly describe the overall characteristics of cerebral CMs and summarize radiosurgical methods and results of radiosurgery as treatment for CMs. Methods: The incidence, definition, and natural history of cerebral CMs are described. The principal issues of CMs are recurrent bleeding and seizures. These issues are compared to the radiosurgical interventions for CMs.Results: The rebleeding rates of CMs after radiosurgery is difficult to compare directly with untreated lesions because treated lesions are innately more vulnerable to rebleeding. Seizure outcomes after radiosurgery are also not easily estimated because of the various lesion locations; nevertheless, radiosurgery is an important treatment option for CMs in eloquent areas.Conclusion: Stereotactic radiosurgery (SRS) for CM has been effectively and widely used in recent years. Advances in magnetic resonance imaging and radiosurgery, as well as better studies of this condition’s natural history, are increasingly supporting the role of SRS as a complementary tool in CM treatment. More research is needed.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128389757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00199
S. Jeong, R. Huh, Il Jang
Objective: Blepharospasm (BSP) is a disease in which the closure rate of the bilateral eyelids increases, mainly due to involuntary contraction of the orbicularis oculi, procerus, and corrugator muscles. The objective of this study was to report postoperative outcomes after deep brain stimulation (DBS) in 10 cases of pure BSP after at least 12 months of follow-up.Methods: Ten patients with pure BSP who underwent bilateral globus pallidus interna (GPi) DBS at The Catholic University of Korea, Incheon St. Mary’s Hospital, between 2019 and 2021 were included. The Burke-Fahn-Marsden dystonia rating scale (BFMDRS), Blepharospasm Disability Index, and Jankovic Rating Scale were used for analysis before surgery, at 6 months of follow-up as short-term outcomes, and at follow-up over 1 year (12–37 months) as long-term results. Results: The median age of patients at surgery was 56.5 years (interquartile range [IQR], 50.5–65.8 years) and the median length of time from disease onset to the time of surgery was 58.0 months (IQR, 46.8–64.3 months). The median postoperative follow-up period was 22.5 months (IQR, 15.3–29.0 months). The median BFMDRS movement subscale scores at the three time points (preoperative baseline, 6 months, and over 1 year of follow-up) were 7.0 (IQR, 6.0–8.0), 4.5 (IQR, 3.9–6.0; 35.7% improvement, p<0.001), and 3.8 (IQR, 2.8–5.3; 45.7% improvement, p=0.002), respectively.Conclusion: Bilateral GPi DBS for pure BSP can be effective if conservative treatment options fail. Its benefit is not only observed in the short term, but is also maintained during long-term follow-up.
{"title":"Outcomes of pallidal deep brain stimulation for treating pure blepharospasm","authors":"S. Jeong, R. Huh, Il Jang","doi":"10.52662/jksfn.2022.00199","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00199","url":null,"abstract":"Objective: Blepharospasm (BSP) is a disease in which the closure rate of the bilateral eyelids increases, mainly due to involuntary contraction of the orbicularis oculi, procerus, and corrugator muscles. The objective of this study was to report postoperative outcomes after deep brain stimulation (DBS) in 10 cases of pure BSP after at least 12 months of follow-up.Methods: Ten patients with pure BSP who underwent bilateral globus pallidus interna (GPi) DBS at The Catholic University of Korea, Incheon St. Mary’s Hospital, between 2019 and 2021 were included. The Burke-Fahn-Marsden dystonia rating scale (BFMDRS), Blepharospasm Disability Index, and Jankovic Rating Scale were used for analysis before surgery, at 6 months of follow-up as short-term outcomes, and at follow-up over 1 year (12–37 months) as long-term results. Results: The median age of patients at surgery was 56.5 years (interquartile range [IQR], 50.5–65.8 years) and the median length of time from disease onset to the time of surgery was 58.0 months (IQR, 46.8–64.3 months). The median postoperative follow-up period was 22.5 months (IQR, 15.3–29.0 months). The median BFMDRS movement subscale scores at the three time points (preoperative baseline, 6 months, and over 1 year of follow-up) were 7.0 (IQR, 6.0–8.0), 4.5 (IQR, 3.9–6.0; 35.7% improvement, p<0.001), and 3.8 (IQR, 2.8–5.3; 45.7% improvement, p=0.002), respectively.Conclusion: Bilateral GPi DBS for pure BSP can be effective if conservative treatment options fail. Its benefit is not only observed in the short term, but is also maintained during long-term follow-up.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130843036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00227
Y. M. Park, Jin-Gyu Choi
Advances in intraoperative neurophysiological monitoring (IONM) have enabled safer peripheral nerve tumor surgery. We report a patient in whom a large sciatic nerve schwannoma was successfully removed using intraoperative nerve stimulation. A 62-year-old male presented with a palpable mass in the right posterior upper thigh, just below the gluteal fold. Magnetic resonance imaging showed an approximately 9-cm encapsulated solid mass in the middle of the sciatic nerve. After a vertical skin incision with a laterally curved upper end extending to the inferior gluteal region, the proximal sciatic nerve was secured laterally to the biceps femoris and the distal nerve medial to the muscle. We avoided causing trauma to the viable nerve fascicles by dissecting through the “safe zone,” as confirmed by monitoring the distal muscle contractions induced by intraoperative nerve stimulation on the tumor surface. In this report, we present the details of our surgical approach to the middle portion of the sciatic nerve and the use of IONM for safe tumor excision.
{"title":"Successful enucleation of a large sciatic schwannoma with intraoperative neurostimulation-guided dissection: a case report","authors":"Y. M. Park, Jin-Gyu Choi","doi":"10.52662/jksfn.2022.00227","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00227","url":null,"abstract":"Advances in intraoperative neurophysiological monitoring (IONM) have enabled safer peripheral nerve tumor surgery. We report a patient in whom a large sciatic nerve schwannoma was successfully removed using intraoperative nerve stimulation. A 62-year-old male presented with a palpable mass in the right posterior upper thigh, just below the gluteal fold. Magnetic resonance imaging showed an approximately 9-cm encapsulated solid mass in the middle of the sciatic nerve. After a vertical skin incision with a laterally curved upper end extending to the inferior gluteal region, the proximal sciatic nerve was secured laterally to the biceps femoris and the distal nerve medial to the muscle. We avoided causing trauma to the viable nerve fascicles by dissecting through the “safe zone,” as confirmed by monitoring the distal muscle contractions induced by intraoperative nerve stimulation on the tumor surface. In this report, we present the details of our surgical approach to the middle portion of the sciatic nerve and the use of IONM for safe tumor excision.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124392798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-30DOI: 10.52662/jksfn.2022.00248
D. Seo, K. Cho, Hyun Seok Lee, Kwan Park
Objective: In posterior fossa surgery such as microvascular decompression (MVD), cerebrospinal fluid (CSF) leakage is a crucial problem. In this study, we explored the accurate diagnosis and effective non-surgical management of postoperative CSF leakage.Methods: We reviewed 749 patients who underwent MVD surgery from August 2018 to April 2022. Although we significantly reduced the CSF leakage problem by using the triple-layer closing technique (TLCT), CSF leakage was still a problem in a few cases. We managed these patients with the same diagnostic flow and treatment regimen using a lumbar drain (LD).Results: Among the 749 patients in the cohort, 11 (1.4%) had CSF leakage, and each of those cases presented with rhinorrhea. Five patients (45.5%) had the symptom on the first day, two patients (18.2%) on the second day, one patient (9.1%) on the third day, and three patients (27.3%) on the fifth day after surgery. After conservative treatment including CSF drainage via LD for 5.4 days on average, none of the patients had recurrent symptoms suggesting CSF leakage; thus, there was no need for wound repair surgery.Conclusion: Despite diligent attempts to prevent CSF leakage in open microsurgery, leaks inevitably occur in some cases and are more frequent in posterior fossa surgery. Although we cannot fully prevent leakage, we should limit the complication to ensure that it does not progress into other severe problems, such as meningitis. A closing technique such as TLCT is useful, but the early diagnosis and management of CSF leakage with LD is also important.
{"title":"The diagnosis of cerebrospinal fluid leakage after microvascular decompression surgery and management via lumbar drain","authors":"D. Seo, K. Cho, Hyun Seok Lee, Kwan Park","doi":"10.52662/jksfn.2022.00248","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00248","url":null,"abstract":"Objective: In posterior fossa surgery such as microvascular decompression (MVD), cerebrospinal fluid (CSF) leakage is a crucial problem. In this study, we explored the accurate diagnosis and effective non-surgical management of postoperative CSF leakage.Methods: We reviewed 749 patients who underwent MVD surgery from August 2018 to April 2022. Although we significantly reduced the CSF leakage problem by using the triple-layer closing technique (TLCT), CSF leakage was still a problem in a few cases. We managed these patients with the same diagnostic flow and treatment regimen using a lumbar drain (LD).Results: Among the 749 patients in the cohort, 11 (1.4%) had CSF leakage, and each of those cases presented with rhinorrhea. Five patients (45.5%) had the symptom on the first day, two patients (18.2%) on the second day, one patient (9.1%) on the third day, and three patients (27.3%) on the fifth day after surgery. After conservative treatment including CSF drainage via LD for 5.4 days on average, none of the patients had recurrent symptoms suggesting CSF leakage; thus, there was no need for wound repair surgery.Conclusion: Despite diligent attempts to prevent CSF leakage in open microsurgery, leaks inevitably occur in some cases and are more frequent in posterior fossa surgery. Although we cannot fully prevent leakage, we should limit the complication to ensure that it does not progress into other severe problems, such as meningitis. A closing technique such as TLCT is useful, but the early diagnosis and management of CSF leakage with LD is also important.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"170 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121345042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-26DOI: 10.52662/jksfn.2022.00185
E. Choi, Seung-Uk Hong, W. Chang
It to differentiate radiation necrosis (RN) from tumor recurrence because these conditions require different treatments. Despite the use of various imaging techniques, this distinction remains difficult due to the high heterogeneity of brain tissue. Stereotactic biopsy is still considered the gold standard for a definitive diagnosis of RN despite its invasiveness. However, if the location of the lesion is in the brainstem, stereotactic biopsy is very difficult to even for skillful surgeons. We herein report a case of a 24-year-old male with a history of medulloblastoma at the age of 5, who presented with distinct gait disturbance and dysarthria at a regular visit. The initial radiological diagnosis of a brain mass was recurrent medulloblastoma. Considering the initial diagnosis, additional radiotherapy was considered. Nevertheless, the chance of the mass being RN could not be eliminated. Despite the high risk due to the location of the lesion, a frame-based stereotactic biopsy was performed. The pathological diagnosis after the biopsy confirmed the lesion as RN. This case illustrates the importance of stereotactic biopsy in differentiating between tumor recurrence and RN, even when the location of the lesion makes it challenging.
{"title":"A delayed radiation-induced necrotic lesion in the brainstem mimicking tumor recurrence confirmed by stereotactic biopsy: a case report and literature review","authors":"E. Choi, Seung-Uk Hong, W. Chang","doi":"10.52662/jksfn.2022.00185","DOIUrl":"https://doi.org/10.52662/jksfn.2022.00185","url":null,"abstract":"It to differentiate radiation necrosis (RN) from tumor recurrence because these conditions require different treatments. Despite the use of various imaging techniques, this distinction remains difficult due to the high heterogeneity of brain tissue. Stereotactic biopsy is still considered the gold standard for a definitive diagnosis of RN despite its invasiveness. However, if the location of the lesion is in the brainstem, stereotactic biopsy is very difficult to even for skillful surgeons. We herein report a case of a 24-year-old male with a history of medulloblastoma at the age of 5, who presented with distinct gait disturbance and dysarthria at a regular visit. The initial radiological diagnosis of a brain mass was recurrent medulloblastoma. Considering the initial diagnosis, additional radiotherapy was considered. Nevertheless, the chance of the mass being RN could not be eliminated. Despite the high risk due to the location of the lesion, a frame-based stereotactic biopsy was performed. The pathological diagnosis after the biopsy confirmed the lesion as RN. This case illustrates the importance of stereotactic biopsy in differentiating between tumor recurrence and RN, even when the location of the lesion makes it challenging.","PeriodicalId":193825,"journal":{"name":"Journal of the Korean Society of Stereotactic and Functional Neurosurgery","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132387025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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