Pub Date : 2019-10-28DOI: 10.21129/nerve.2019.5.2.65
C. Hong, Yeongu Chung, Y. Won, M. Rho, P. Chung
Corresponding author: Yu Sam Won Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea Tel: +82-2-2001-2159 Fax: +82-2-2001-2157 E-mail: yusam.won@samsung.com Objective: Thromboembolism is the most common complication in stent-assisted coiling (SAC) procedures. This study aimed to evaluate the incidence and risk factors of thromboembolic complication in patients who underwent SAC for intracerebral aneurysm. Methods: Between January 2006 and December 2017, 35 patients (35 aneurysms) in the acute phase of subarachnoid hemorrhage (SAH) underwent SAC without antiplatelet premedication. Additionally, 45 patients (48 unruptured aneurysms) underwent SAC with antiplatelet premedication. Baseline patient characteristics were compared between the unruptured and ruptured aneurysm groups. Risk factors of thromboembolic complications were also analyzed. Results: Thromboembolic complications occurred in 11 of 83 aneurysms treated with SAC, among which 3 occurred in 48 unruptured aneurysms (6.3%; p=0.046) and 8 occurred in 35 ruptured aneurysms (22.9%; p=0.046). However, there was no permanent morbidity due to thromboembolic complications in either group. Conclusion: The thromboembolic complication rate for SAC in patients with ruptured aneurysms was significantly higher than for those with unruptured aneurysms. However, there was no permanent morbidity of thromboembolic complications, there seems to be no reason to reluctant SAC due to the risk of thromboembolic complications in patients with SAH.
通讯作者:Yu Sam Won韩国成均馆大学医学院江北三星医院神经外科电话:+82-2-2001-2159传真:+82-2-2001-2157 E-mail: yusam.won@samsung.com目的:血栓栓塞是支架辅助卷取(SAC)手术中最常见的并发症。本研究旨在评估颅内动脉瘤SAC患者血栓栓塞并发症的发生率及危险因素。方法:2006年1月至2017年12月，对35例蛛网膜下腔出血(SAH)急性期患者(35个动脉瘤)行SAC治疗，未进行抗血小板预用药。此外，45例患者(48例未破裂动脉瘤)行SAC术前抗血小板药物治疗。比较未破裂和破裂动脉瘤组的基线患者特征。并分析血栓栓塞并发症的危险因素。结果:SAC治疗83例动脉瘤中11例发生血栓栓塞并发症，其中48例未破裂动脉瘤中3例发生血栓栓塞并发症(6.3%;P =0.046)， 35例破裂动脉瘤中出现8例(22.9%;p = 0.046)。然而，两组患者均未出现因血栓栓塞并发症而导致的永久性发病。结论:动脉瘤破裂患者SAC血栓栓塞并发症发生率明显高于未破裂患者。然而，没有血栓栓塞并发症的永久性发病率，由于SAH患者血栓栓塞并发症的风险，似乎没有理由不愿意进行SAC。
{"title":"Thromboembolic Complications of Stent-Assisted Coiling for Intracranial Aneurysms: A Single-Center Experience","authors":"C. Hong, Yeongu Chung, Y. Won, M. Rho, P. Chung","doi":"10.21129/nerve.2019.5.2.65","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.65","url":null,"abstract":"Corresponding author: Yu Sam Won Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea Tel: +82-2-2001-2159 Fax: +82-2-2001-2157 E-mail: yusam.won@samsung.com Objective: Thromboembolism is the most common complication in stent-assisted coiling (SAC) procedures. This study aimed to evaluate the incidence and risk factors of thromboembolic complication in patients who underwent SAC for intracerebral aneurysm. Methods: Between January 2006 and December 2017, 35 patients (35 aneurysms) in the acute phase of subarachnoid hemorrhage (SAH) underwent SAC without antiplatelet premedication. Additionally, 45 patients (48 unruptured aneurysms) underwent SAC with antiplatelet premedication. Baseline patient characteristics were compared between the unruptured and ruptured aneurysm groups. Risk factors of thromboembolic complications were also analyzed. Results: Thromboembolic complications occurred in 11 of 83 aneurysms treated with SAC, among which 3 occurred in 48 unruptured aneurysms (6.3%; p=0.046) and 8 occurred in 35 ruptured aneurysms (22.9%; p=0.046). However, there was no permanent morbidity due to thromboembolic complications in either group. Conclusion: The thromboembolic complication rate for SAC in patients with ruptured aneurysms was significantly higher than for those with unruptured aneurysms. However, there was no permanent morbidity of thromboembolic complications, there seems to be no reason to reluctant SAC due to the risk of thromboembolic complications in patients with SAH.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128672133","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.55
Hyeong Rae Lee, Jong Yeon Kim, Y. Lim, S. Yoon
Corresponding author: Soo Han Yoon Department of Neurosurgery, Ajou University Medical Center, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5233 Fax: +82-31-219-5238 E-mail: ee80@hanmail.net Objective: Skull fractures are one of the most common trauma injuries among children, and pediatric skull fractures are more complex due to incomplete ossification of sutures. Because 3-dimensional computed tomography (3DCT) can provide a more accurate assessment of all skull fracture types that also increase the detection rate of skull fractures, we need to review pediatric skull fractures based on 3DCT. Methods: Two hundred ninety-one patients younger than 12 years were included in this study. We retrospectively studied the correlation of the skull fracture types, location, severity, and accompanying head injuries with surgery rates. Results: The most common skull fracture type was linear (64.6%), followed by mixed (20.6%) and diastatic (7.6%). The most common location of skull fractures was parietal (43.3%), followed by occipital (26.1%) and frontal (13.4%). Thirty-six patients (12.4%) underwent surgery. Statistically significant difference in surgical risk was observed in the presence of subgaleal hemorrhage, epidural hemorrhage, subdural hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, and brain swelling (p<0.05). Conclusion: In most pediatric patients with skull fractures, 3DCT studies seem to be important in terms of diagnostic accuracy for skull fracture types, locations, and risk of surgery. We suggest that skull fracture severity, type, and location with degree of other accompanying head injury lesions may be significant prognostic factors.
通讯作者:Soo Han Yoon亚洲大学医学院神经外科亚洲大学医学中心，亚洲大学医学院，164，世界杯，水原永通区16499，大韩民国电话:+82-31-219-5233传真:+82-31-219-5238 E-mail: ee80@hanmail.net目的:颅骨骨折是儿童最常见的创伤性损伤之一，儿童颅骨骨折由于缝合不完全骨化而更为复杂。由于三维计算机断层扫描(3DCT)可以更准确地评估所有颅骨骨折类型，并提高颅骨骨折的检出率，因此我们需要对基于3DCT的儿童颅骨骨折进行综述。方法:本研究纳入291例年龄小于12岁的患者。我们回顾性地研究了颅骨骨折类型、位置、严重程度和伴随的头部损伤与手术率的相关性。结果:颅骨骨折类型以线形为主(64.6%)，混合型次之(20.6%)，散裂型次之(7.6%)。颅骨骨折最常见的部位是顶骨(43.3%)，其次是枕骨(26.1%)和额骨(13.4%)。36例(12.4%)患者行手术治疗。硬膜下出血、硬膜外出血、硬膜下出血、脑出血、蛛网膜下腔出血、脑肿胀的手术风险差异有统计学意义(p<0.05)。结论:在大多数儿童颅骨骨折患者中，3DCT研究在颅骨骨折类型、部位和手术风险的诊断准确性方面似乎很重要。我们认为颅骨骨折的严重程度，类型和位置以及其他伴随的头部损伤病变的程度可能是重要的预后因素。
{"title":"Pediatric Skull Fractures Based on Three-Dimensional Computed Tomography: Correlation of Skull Fracture Types, Location, Severity, and Accompanying Head Injuries with Surgical Risk in 291 Children","authors":"Hyeong Rae Lee, Jong Yeon Kim, Y. Lim, S. Yoon","doi":"10.21129/nerve.2019.5.2.55","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.55","url":null,"abstract":"Corresponding author: Soo Han Yoon Department of Neurosurgery, Ajou University Medical Center, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5233 Fax: +82-31-219-5238 E-mail: ee80@hanmail.net Objective: Skull fractures are one of the most common trauma injuries among children, and pediatric skull fractures are more complex due to incomplete ossification of sutures. Because 3-dimensional computed tomography (3DCT) can provide a more accurate assessment of all skull fracture types that also increase the detection rate of skull fractures, we need to review pediatric skull fractures based on 3DCT. Methods: Two hundred ninety-one patients younger than 12 years were included in this study. We retrospectively studied the correlation of the skull fracture types, location, severity, and accompanying head injuries with surgery rates. Results: The most common skull fracture type was linear (64.6%), followed by mixed (20.6%) and diastatic (7.6%). The most common location of skull fractures was parietal (43.3%), followed by occipital (26.1%) and frontal (13.4%). Thirty-six patients (12.4%) underwent surgery. Statistically significant difference in surgical risk was observed in the presence of subgaleal hemorrhage, epidural hemorrhage, subdural hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, and brain swelling (p<0.05). Conclusion: In most pediatric patients with skull fractures, 3DCT studies seem to be important in terms of diagnostic accuracy for skull fracture types, locations, and risk of surgery. We suggest that skull fracture severity, type, and location with degree of other accompanying head injury lesions may be significant prognostic factors.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114705849","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.87
Y. Shin, Young Woo Lee, Dongho Shin, Woo-ram Shin
Corresponding author: Young-Woo Lee Department of Neurosurgery, Presbyterian Medical Center, 365, Seowon-ro, Wansan-gu, Jeonju 54987, Republic of Korea Tel: +82-63-230-1420 Fax: +82-63-230-1429 E-mail: yyong0411@naver.com Chronic subdural hematoma (CSDH) is a common condition. However, it is rarely calcified. Among various causes, hydrocephalus and ventriculoperitoneal shunts in CSDH are uncommon causes of calcification. A 38-year-old woman presented with visual disturbance. Computed tomography and magnetic resonance imaging of the brain demonstrated compressed optic chiasm by planum sphenoidale meningioma. And massive bilateral calcified CSDH with cerebral convexity. Surgery was performed to remove the tumor and ipsilateral calcification. The symptoms improved following discharge after surgery. As this is a rarely performed surgery, caution is advised to prevent damaging the dura matter when cutting the bone and to prevent damaging the brain during dissection.
{"title":"Bilateral Calcified Chronic Subdural Hematoma in a Patient with Ventriculoperitoneal Shunt: A Case Report","authors":"Y. Shin, Young Woo Lee, Dongho Shin, Woo-ram Shin","doi":"10.21129/nerve.2019.5.2.87","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.87","url":null,"abstract":"Corresponding author: Young-Woo Lee Department of Neurosurgery, Presbyterian Medical Center, 365, Seowon-ro, Wansan-gu, Jeonju 54987, Republic of Korea Tel: +82-63-230-1420 Fax: +82-63-230-1429 E-mail: yyong0411@naver.com Chronic subdural hematoma (CSDH) is a common condition. However, it is rarely calcified. Among various causes, hydrocephalus and ventriculoperitoneal shunts in CSDH are uncommon causes of calcification. A 38-year-old woman presented with visual disturbance. Computed tomography and magnetic resonance imaging of the brain demonstrated compressed optic chiasm by planum sphenoidale meningioma. And massive bilateral calcified CSDH with cerebral convexity. Surgery was performed to remove the tumor and ipsilateral calcification. The symptoms improved following discharge after surgery. As this is a rarely performed surgery, caution is advised to prevent damaging the dura matter when cutting the bone and to prevent damaging the brain during dissection.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133912079","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.49
Kyoung Jae Park, Dae Hwan Kim, K. Park, J. Park, N. Yoo, K. Cho, Sang Hyun Kim
Corresponding author: Sang Hyun Kim Department of Neurosurgery, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5230 Fax: +82-31-219-5238 E-mail: kaliemd@naver.com Objective: The main purpose of this study was to evaluate radiologic outcomes and Finite element method (FEM) results of anterior cervical discectomy and fusion (ACDF) using H-beam shaped allospacer, in comparison with rim-shaped allospacer. Methods: From March 2011 to February 2014, 95 patients underwent ACDF using allospacers (H-beam shaped and rim shaped). Sixty-two patients were divided into 2 groups: Hbeam shaped allospacer in group A (n=31); rim shaped allospacer in group B (n=31). We retrospectively estimated clinical outcomes, such as, neck and arm pain, radiographic fusion rate and adverse effects. In the FEM study, we compared the performance of 3 different shaped allospacer; i.e., H-beam shaped, H-hole shaped, rim-shaped. We tested the effectiveness of stress distribution from the 3 types of allospacer, using the evaluation criteria of (a) compression; (b) shear; and (c) torsion, under the same load. Results: Neck and arm pain was reduced similarly by 63% to 73% in 2 groups. Fusion rates after 1 year in group A and B were 100% and 98% retrospectively. The complication rates of breakage and displacement in Group B were 16% and 3%. Group A show no adverse effects. From the FEM study, in the cases of the (a), (b), (c), we found that H-beam shaped allospacer resulted in effectiveness stress distribution and diversification regarding compression, shear and torsion compared with rim shaped allospacer. Conclusion: In ACDF using allospacer, H-beam shaped allospacer shows more stable fusion rates with low incidence of complication compared with rim shaped allospacer.
{"title":"Clinical Outcomes and Finite Element Method Results of Anterior Cervical Discectomy and Fusion Using H-Beam Shaped Allospacer: A Comparison with Rim-Shaped Allospacer","authors":"Kyoung Jae Park, Dae Hwan Kim, K. Park, J. Park, N. Yoo, K. Cho, Sang Hyun Kim","doi":"10.21129/nerve.2019.5.2.49","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.49","url":null,"abstract":"Corresponding author: Sang Hyun Kim Department of Neurosurgery, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5230 Fax: +82-31-219-5238 E-mail: kaliemd@naver.com Objective: The main purpose of this study was to evaluate radiologic outcomes and Finite element method (FEM) results of anterior cervical discectomy and fusion (ACDF) using H-beam shaped allospacer, in comparison with rim-shaped allospacer. Methods: From March 2011 to February 2014, 95 patients underwent ACDF using allospacers (H-beam shaped and rim shaped). Sixty-two patients were divided into 2 groups: Hbeam shaped allospacer in group A (n=31); rim shaped allospacer in group B (n=31). We retrospectively estimated clinical outcomes, such as, neck and arm pain, radiographic fusion rate and adverse effects. In the FEM study, we compared the performance of 3 different shaped allospacer; i.e., H-beam shaped, H-hole shaped, rim-shaped. We tested the effectiveness of stress distribution from the 3 types of allospacer, using the evaluation criteria of (a) compression; (b) shear; and (c) torsion, under the same load. Results: Neck and arm pain was reduced similarly by 63% to 73% in 2 groups. Fusion rates after 1 year in group A and B were 100% and 98% retrospectively. The complication rates of breakage and displacement in Group B were 16% and 3%. Group A show no adverse effects. From the FEM study, in the cases of the (a), (b), (c), we found that H-beam shaped allospacer resulted in effectiveness stress distribution and diversification regarding compression, shear and torsion compared with rim shaped allospacer. Conclusion: In ACDF using allospacer, H-beam shaped allospacer shows more stable fusion rates with low incidence of complication compared with rim shaped allospacer.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115073557","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.97
Jae-Seong Kang, S. Oh, Jong-Joo Lee, E. Han
Corresponding author: Sung-Han Oh Department of Neurosurgery, Bundang Jesaeng Hospital, 20, Seohyeon-ro, 180 beon-gil, Bundang-gu, Seongnam 13590, Republic of Korea Tel: +82-31-779-0114 Fax: +82-31-779-8095 E-mail: shoh1@dmc.or.kr Spinal meningiomas account for 12% of all meningiomas and are usually located in the intradural extramedullary space. Among them, spinal metaplastic meningiomas are extremely rare. This is a case report on a 59-year-old man with thoracic spinal metaplastic meningioma. This male presented with progressively worsening right leg weakness, radiating pain and paresthesia. We present a rare case of pathologically confirmed metaplastic meningioma in the thoracic spine. Additionally, we review the pathological aspects and radiographic features of spinal metaplastic meningioma.
{"title":"Metaplastic Spinal Meningioma in the Thoracic Spine: A Case Report and Review of the Literature","authors":"Jae-Seong Kang, S. Oh, Jong-Joo Lee, E. Han","doi":"10.21129/nerve.2019.5.2.97","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.97","url":null,"abstract":"Corresponding author: Sung-Han Oh Department of Neurosurgery, Bundang Jesaeng Hospital, 20, Seohyeon-ro, 180 beon-gil, Bundang-gu, Seongnam 13590, Republic of Korea Tel: +82-31-779-0114 Fax: +82-31-779-8095 E-mail: shoh1@dmc.or.kr Spinal meningiomas account for 12% of all meningiomas and are usually located in the intradural extramedullary space. Among them, spinal metaplastic meningiomas are extremely rare. This is a case report on a 59-year-old man with thoracic spinal metaplastic meningioma. This male presented with progressively worsening right leg weakness, radiating pain and paresthesia. We present a rare case of pathologically confirmed metaplastic meningioma in the thoracic spine. Additionally, we review the pathological aspects and radiographic features of spinal metaplastic meningioma.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123105844","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.83
In Kyung Lee, S. Song
Corresponding author: Sang Woo Song Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea Tel: +82-2-2030-7357 Fax: +82-2-2030-7729 E-mail: 20120168@kuh.ac.kr Acute subdural hematoma (ASDH) usually occurs with severe traumatic head injury, which could result in neurologic deteriorations and/or intracranial hypertension, requiring emergency decompression surgery. Even after vigorous medical treatment, ASDH with poor neurologic status and severe midline shift with brain herniation could bring a serious socioeconomic loss to patients and their families, and death is generally expected without surgical intervention. Here, we report a case of a 74-year-old man with ASDH who spontaneously disappeared under conservative treatment and discuss the possible mechanisms with a literature review.
{"title":"Spontaneous Resolution of Acute Subdural Hematoma with a Good Clinical Outcome: A Case Report","authors":"In Kyung Lee, S. Song","doi":"10.21129/nerve.2019.5.2.83","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.83","url":null,"abstract":"Corresponding author: Sang Woo Song Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea Tel: +82-2-2030-7357 Fax: +82-2-2030-7729 E-mail: 20120168@kuh.ac.kr Acute subdural hematoma (ASDH) usually occurs with severe traumatic head injury, which could result in neurologic deteriorations and/or intracranial hypertension, requiring emergency decompression surgery. Even after vigorous medical treatment, ASDH with poor neurologic status and severe midline shift with brain herniation could bring a serious socioeconomic loss to patients and their families, and death is generally expected without surgical intervention. Here, we report a case of a 74-year-old man with ASDH who spontaneously disappeared under conservative treatment and discuss the possible mechanisms with a literature review.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123351133","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.60
Y. Shin, Tae-Sik Gong, Hyo-Joon Kim, Min-jee Park
Corresponding author: Tae-Sik Gong Department of Neurosurgery, Presbyterian Medical Center, 365, Seowon-ro, Wansan-gu, Jeonju 54987, Republic of Korea Tel: +82-63-230-1420 Fax: +82-63-230-1429 E-mail: nskts@hanmail.net Objective: The use of selective carotid stents to reduce ipsilateral stroke in patients with cerebral artery stenosis has been increasing recently. The insertion of carotid stents can cause complications of embolism, and many efforts are involved to reduce such effects. This study investigated the risk factors and complications by examining 125 cases that underwent carotid artery stenting (CAS) in a single center in the past 5 years. Methods: The prognosis of 125 patients who underwent CAS in the past 5 years was evaluated by considering the following 2 outcomes: postprocedure symptomatic events and stroke or other vascular problems (SOVP). The prognosis also considered the following: non-modifiable factors, such as age and sex; modifiable factors, such as a smoking history, hypertension, and diabetes; and magnetic resonance imaging changes that occurred after CAS. Results: In this study, an age above 80 years (p=0.031) and a history of cerebrovascular accidents (p=0.016) were identified as the significant risk factors for the incidence of stroke among patients after stent insertion. The presence of a distal filter device and the type of maintenance therapy administered before and after CAS (aspirin, clopidogrel, or aspirin+clopidogrel) exhibited no significant effects on post-procedure outcomes. Conclusion: This study indicated that 2.6% of stroke symptoms are directly related to CAS and that 3.2% of SOVP occurred within 30 days after the procedure. Patients above the age of 80 or with a history of stroke should be fully informed of the risk factors and side effects of CAS procedures.
{"title":"Risk Factors and Complications Associated with Carotid Artery Stenting: A Retrospective Study","authors":"Y. Shin, Tae-Sik Gong, Hyo-Joon Kim, Min-jee Park","doi":"10.21129/nerve.2019.5.2.60","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.60","url":null,"abstract":"Corresponding author: Tae-Sik Gong Department of Neurosurgery, Presbyterian Medical Center, 365, Seowon-ro, Wansan-gu, Jeonju 54987, Republic of Korea Tel: +82-63-230-1420 Fax: +82-63-230-1429 E-mail: nskts@hanmail.net Objective: The use of selective carotid stents to reduce ipsilateral stroke in patients with cerebral artery stenosis has been increasing recently. The insertion of carotid stents can cause complications of embolism, and many efforts are involved to reduce such effects. This study investigated the risk factors and complications by examining 125 cases that underwent carotid artery stenting (CAS) in a single center in the past 5 years. Methods: The prognosis of 125 patients who underwent CAS in the past 5 years was evaluated by considering the following 2 outcomes: postprocedure symptomatic events and stroke or other vascular problems (SOVP). The prognosis also considered the following: non-modifiable factors, such as age and sex; modifiable factors, such as a smoking history, hypertension, and diabetes; and magnetic resonance imaging changes that occurred after CAS. Results: In this study, an age above 80 years (p=0.031) and a history of cerebrovascular accidents (p=0.016) were identified as the significant risk factors for the incidence of stroke among patients after stent insertion. The presence of a distal filter device and the type of maintenance therapy administered before and after CAS (aspirin, clopidogrel, or aspirin+clopidogrel) exhibited no significant effects on post-procedure outcomes. Conclusion: This study indicated that 2.6% of stroke symptoms are directly related to CAS and that 3.2% of SOVP occurred within 30 days after the procedure. Patients above the age of 80 or with a history of stroke should be fully informed of the risk factors and side effects of CAS procedures.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122012573","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.41
Woong Han, B. Moon, D. Kim, Jae Hoon Kim, H. Kang, J. Kim
Corresponding author: Woong Han Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Republic of Korea Tel: +82-2-970-8312 Fax: +82-2-970-8313 E-mail: hanw881210@naver.com Objective: Anterior cervical discectomy and fusion (ACDF) is a treatment for cervical degenerative disease. However, there are few in vivo or long-term data sets including complete graft consolidation. This study aimed to verify the validity of bi-cortical screw fixation in patients undergoing ACDF. Methods: We enrolled 133 patients who underwent ACDF between February 2002 and March 2017. Patients were divided into the mono-cortical fixation group (group A) and bi-cortical fixation group (group B). Consecutive cervical radiography was performed. The end point of data collection was completion of fusion. We evaluated graft subsidence, the global cervical angle (C2-C7 Cobb’s angle), and segmental angle (SA; index level Cobb’s angle). Results: There were no significant differences or surgical level between groups A and B (graft type p= 0.292, surgical level p=0.065). However, types of plate were statistically different (plate type p-value=0.011), and the difference in subsidence between groups A and B was significant (group A, 3.946±2.43 mm; group B, 2.369±1.96 mm, p<0.001). In the logistic regression, bi-cortical screw fixation was found to be the most important factor contributing to subsidence reduction (β-coefficient, 1.002; odds ratio=2.725; p=0.012). There was a significant difference in the SA when fusion was achieved (group A, 2.14±5.05°; group B, 4.84±4.83°; p=0.002). The change in the SA (ΔSA) was significantly different between group A and group B (group A, ΔSA -4.42±4.04°; group B, ΔSA -1.15±3.64°; p=0.001). Conclusion: Bi-cortical screw fixation in ACDF led to reduced graft subsidence and a less kyphotic SA change.
{"title":"The Effect of Bi-Cortical Screw Fixation for Subsidence and Cervical Alignment in Patients Undergoing Single-Level Anterior Cervical Discectomy and Fusion","authors":"Woong Han, B. Moon, D. Kim, Jae Hoon Kim, H. Kang, J. Kim","doi":"10.21129/nerve.2019.5.2.41","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.41","url":null,"abstract":"Corresponding author: Woong Han Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Republic of Korea Tel: +82-2-970-8312 Fax: +82-2-970-8313 E-mail: hanw881210@naver.com Objective: Anterior cervical discectomy and fusion (ACDF) is a treatment for cervical degenerative disease. However, there are few in vivo or long-term data sets including complete graft consolidation. This study aimed to verify the validity of bi-cortical screw fixation in patients undergoing ACDF. Methods: We enrolled 133 patients who underwent ACDF between February 2002 and March 2017. Patients were divided into the mono-cortical fixation group (group A) and bi-cortical fixation group (group B). Consecutive cervical radiography was performed. The end point of data collection was completion of fusion. We evaluated graft subsidence, the global cervical angle (C2-C7 Cobb’s angle), and segmental angle (SA; index level Cobb’s angle). Results: There were no significant differences or surgical level between groups A and B (graft type p= 0.292, surgical level p=0.065). However, types of plate were statistically different (plate type p-value=0.011), and the difference in subsidence between groups A and B was significant (group A, 3.946±2.43 mm; group B, 2.369±1.96 mm, p<0.001). In the logistic regression, bi-cortical screw fixation was found to be the most important factor contributing to subsidence reduction (β-coefficient, 1.002; odds ratio=2.725; p=0.012). There was a significant difference in the SA when fusion was achieved (group A, 2.14±5.05°; group B, 4.84±4.83°; p=0.002). The change in the SA (ΔSA) was significantly different between group A and group B (group A, ΔSA -4.42±4.04°; group B, ΔSA -1.15±3.64°; p=0.001). Conclusion: Bi-cortical screw fixation in ACDF led to reduced graft subsidence and a less kyphotic SA change.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116379892","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.78
Changik Lee, B. Son
Corresponding author: Byung-chul Son Department of Neurosurgery, Seoul St. Mary’s Hospital, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea Tel: +82-2-2258-6122 Fax: +82-2-594-4248 E-mail: sbc@catholic.ac.kr Although the cause of occipital neuralgia is mostly unknown, entrapment of the greater occipital nerve (GON) at its piercing point of the tendinous aponeurotic attachment of the trapezius at the superior nuchal line has been reported to be the most common cause. We report an occurrence of unilateral facial pain associated with continuous aching and stabbing headache in the frontotemporal and occipital regions in a patient whose occipital neuralgia has lasted for years. These symptoms were completely different from those of typical occipital neuralgia, making diagnosis very difficult. A 52-year-old male patient with a 6-year history of intermittent stabbing pain in his right suboccipital area presented with an unremitting continuous pain in his right frontotemporal and malar areas that lasted 5 months. The aching and stabling pain in his frontotemporal and malar areas developed suddenly 5 months prior to presentation. Although he was treated after visiting neurology, dentistry, opthalmology, ENT, and pain clinic, the pain was not controlled. It spread to right periorbital and right occipital areas. At 3 months following decompression of the right GON, he reported no more pain and was able to stop the medication. Until 12 months after the operation, his craniofacial pain did not recur.
{"title":"Chronic Craniofacial Pain from Entrapment of the Greater Occipital Nerve Misdiagnosed as Chronic Migraine, Idiopathic Odontalgia, and Atypical Facial Pain","authors":"Changik Lee, B. Son","doi":"10.21129/nerve.2019.5.2.78","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.78","url":null,"abstract":"Corresponding author: Byung-chul Son Department of Neurosurgery, Seoul St. Mary’s Hospital, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea Tel: +82-2-2258-6122 Fax: +82-2-594-4248 E-mail: sbc@catholic.ac.kr Although the cause of occipital neuralgia is mostly unknown, entrapment of the greater occipital nerve (GON) at its piercing point of the tendinous aponeurotic attachment of the trapezius at the superior nuchal line has been reported to be the most common cause. We report an occurrence of unilateral facial pain associated with continuous aching and stabbing headache in the frontotemporal and occipital regions in a patient whose occipital neuralgia has lasted for years. These symptoms were completely different from those of typical occipital neuralgia, making diagnosis very difficult. A 52-year-old male patient with a 6-year history of intermittent stabbing pain in his right suboccipital area presented with an unremitting continuous pain in his right frontotemporal and malar areas that lasted 5 months. The aching and stabling pain in his frontotemporal and malar areas developed suddenly 5 months prior to presentation. Although he was treated after visiting neurology, dentistry, opthalmology, ENT, and pain clinic, the pain was not controlled. It spread to right periorbital and right occipital areas. At 3 months following decompression of the right GON, he reported no more pain and was able to stop the medication. Until 12 months after the operation, his craniofacial pain did not recur.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"75 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132086550","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 : 2019-10-28DOI: 10.21129/nerve.2019.5.2.27
Seongil Choi, K. Kim, U. Choi, Jeong-Yoon Park, S. Kuh, D. Chin, Keun-Su Kim, Y. Cho
Corresponding author: Kyung-Hyun Kim Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea Tel: +82-2-2019-3390 Fax: +82-3-3461-9229 E-mail: nskhk@yuhs.ac Objective: Trans-oral approach or occipitocervical/atlantoaxial fusion with/without posterior decompression has been considered to be an appropriate surgical strategy for craniovertebral junction (CVJ) stenosis with myelopathy. However, decompressive C1 laminectomy without posterior stabilization was reported recently for treating retro-odontoid pseudotumor. This study aimed to evaluate surgical outcomes of the patients treated with decompressive C1 laminectomy without posterior stabilization for CVJ stenosis with myelopathy. Methods: Ten patients underwent decompressive C1 laminectomy without posterior stabilization for CVJ stenosis with myelopathy from August 2007 to December 2016. All patients were evaluated preoperatively for spinal canal stenosis, cord signal changes, and instability based on preoperative computed tomography, magnetic resonance imaging, and plain dynamogram. We retrospectively reviewed the clinic charts and radiographs for investigating clinical outcomes such as the visual analog scale (VAS), and Ranawat grade scale and complications. Radiographic parameters including preand postoperative atlas-dens interval change in flexion and extension, O-C2 angle, C2-C7 Cobb angle, and C2-C7 sagittal vertical axis were measured. Results: The mean follow-up time was 41 months. Eight men and 2 women with a mean age of 58 years (range, 45-69 years) were enrolled. Preoperative neck pain by the VAS was improved significantly in all patients (p<0.01). Nine of 10 patients showed improvement on the Ranawat grading scale, but 1 patient who required a Halo-vest due to aggravated instability after surgery remained unchanged. The statistical results of the preoperative and postoperative radiographic measurements were not significant. Conclusion: In select patients with certain indications, decompressive C1 laminectomy could be a viable option, especially in the elderly, patients with comorbidity, and patients with poor bone quality.
{"title":"Decompressive C1 Laminectomy without Fusion for the Treatment of Craniovertebral Junction Stenosis with Myelopathy: Could It be One of Option?","authors":"Seongil Choi, K. Kim, U. Choi, Jeong-Yoon Park, S. Kuh, D. Chin, Keun-Su Kim, Y. Cho","doi":"10.21129/nerve.2019.5.2.27","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.27","url":null,"abstract":"Corresponding author: Kyung-Hyun Kim Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea Tel: +82-2-2019-3390 Fax: +82-3-3461-9229 E-mail: nskhk@yuhs.ac Objective: Trans-oral approach or occipitocervical/atlantoaxial fusion with/without posterior decompression has been considered to be an appropriate surgical strategy for craniovertebral junction (CVJ) stenosis with myelopathy. However, decompressive C1 laminectomy without posterior stabilization was reported recently for treating retro-odontoid pseudotumor. This study aimed to evaluate surgical outcomes of the patients treated with decompressive C1 laminectomy without posterior stabilization for CVJ stenosis with myelopathy. Methods: Ten patients underwent decompressive C1 laminectomy without posterior stabilization for CVJ stenosis with myelopathy from August 2007 to December 2016. All patients were evaluated preoperatively for spinal canal stenosis, cord signal changes, and instability based on preoperative computed tomography, magnetic resonance imaging, and plain dynamogram. We retrospectively reviewed the clinic charts and radiographs for investigating clinical outcomes such as the visual analog scale (VAS), and Ranawat grade scale and complications. Radiographic parameters including preand postoperative atlas-dens interval change in flexion and extension, O-C2 angle, C2-C7 Cobb angle, and C2-C7 sagittal vertical axis were measured. Results: The mean follow-up time was 41 months. Eight men and 2 women with a mean age of 58 years (range, 45-69 years) were enrolled. Preoperative neck pain by the VAS was improved significantly in all patients (p<0.01). Nine of 10 patients showed improvement on the Ranawat grading scale, but 1 patient who required a Halo-vest due to aggravated instability after surgery remained unchanged. The statistical results of the preoperative and postoperative radiographic measurements were not significant. Conclusion: In select patients with certain indications, decompressive C1 laminectomy could be a viable option, especially in the elderly, patients with comorbidity, and patients with poor bone quality.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128646746","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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