Microanatomy and Histological Features of Central Myelin in the Root Exit Zone of Facial Nerve

Yee, Gi-Taek,Yoo, Chan-Jong,Han, Seong-Rok,Choi, Chan-Young The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.5

Objective : The aim of this study was to evaluate the microanatomy and histological features of the central myelin in the root exit zone of facial nerve. Methods : Forty facial nerves with brain stem were obtained from 20 formalin fixed cadavers. Among them 17 facial nerves were ruined during preparation and 23 root entry zone (REZ) of facial nerves could be examined. The length of medial REZ, from detach point of facial nerve at the brain stem to transitional area, and the thickness of glial membrane of central myelin was measured. We cut brain stem along the facial nerve and made a tissue block of facial nerve REZ. Each tissue block was embedded with paraffin and serially sectioned. Slices were stained with hematoxylin and eosin (H&E), periodic acid-Schiff, and glial fibrillary acid protein. Microscopy was used to measure the extent of central myelin and thickness of outer glial membrane of central myelin. Thickness of glial membrane was examined at two different points, the thickest area of proximal and distal REZ. Results : Special stain with PAS and GFAP could be differentiated the central and peripheral myelin of facial nerve. The length of medial REZ was mean 2.6 mm (1.6-3.5 mm). The glial limiting membrane of brain stem is continued to the end of central myelin. We called it glial sheath of REZ. The thickness of glial sheath was mean $66.5{\mu}m(40-110{\mu}m$) at proximal REZ and $7.4{\mu}m(5-10{\mu}m$) at distal REZ. Conclusion : Medial REZ of facial nerve is mean 2.6 mm in length and covered by glial sheath continued from glial limiting membrane of brain stem. Glial sheath of central myelin tends to become thin toward transitional zone.

Migration and Coiling of Peritoneal Catheter into the Subgaleal Space : A Very Rare Complication of Subgaleoperitoneal Shunt

Yee, Gi-Taek,Han, Seong-Rok,Choi, Chan-Young The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.6

Upward migration of the peritoneal catheter of a subgaleo-peritoneal (SP) shunt and coiling into the subgaleal space is an extremely rare complication of a SP shunt. A 32-year-old male patient visited our hospital presenting with a large skull defect due to a prior craniectomy performed elsewhere. The patient underwent a cranioplasty with methylmetacrylate, but subsequently developed progressive pseudomeningocele and subgaleal cerebrospinal fluid (CSF) collection. The patient underwent CSF diversion via a SP shunt. After SP shunting, the pseudomeningocele disappeared completely. Six months later, the patient presented with progressive scalp swelling. Skull X-ray showed migration and coiling of the distal catheter of the SP shunt. The patient was treated by removing the entire shunt catheter and the dura was covered with a subgaleal flap. We would like to report our experience with a very rare complication of subgaleo-peritoneal shunting.

Novalis Shaped Beam Radiation Treatment for Craniopharyngiomas

Yee, Gi-Taek,Han, Seong-Rok,Yoon, Sang-Won,Choi, Chan-Young,Lee, Dong-Joon,Whang, Choong-Jin The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.40 No.4

Objective : To evaluate the effectiveness of Novalis shaped beam radiation treatment as an adjuvant treatment in patients with craniopharyngiomas. Methods : We reviewed 8 patients with craniopharyngiomas who had recurring tumors during follow-up or had residual lesions after primary surgery. Three of 8 patients were found to have recurrence after gross total excision of the tumor and 5 patents had residual lesions after subtotal resection. All patients were treated with fractionated stereotactic radiation treatment[FSRT] using Novalis system. The mean age of patients was 28 years [range $16{\sim}52$]. The median irradiation dose per fraction was 17Gy [range $1.7{\sim}2.0$]. The median fraction number was 23 [range $15{\sim}25$], and the median total dose was 39.1 Gy [range $25.5{\sim}42.5$]. Follow-up included MR imaging, and ophthalmologic and endocrine examinations. Results : The median follow-up period was 23 months [range $12{\sim}43$]. The local tumor control rate was 87.5%. One patient had a recurring tumor, in which cystic change developed 2 months after FSRT. Four patients showed a decrease in size of their tumor, while 3 patients remained stable. Seven out of 8 patients had hormonal dysfunction that remained unchanged after initial surgery. No further progression of visual impairment was observed. Conclusion : FSRT using Novais system is effective and safe for the treatment of recurring or residual craniopharyngiomas without toxicity like optic neuropathy.

경두개 접근법을 이용한 전두개저 결손의 재건술

이기택(Gi-Taek Yee) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

두개인두종에 대한 정위적 분할 방사선 수술 -증례보고-

이기택 ( Gi Taek Yee ),최광영 ( Gwang Young Choi ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Shon ),이동준 ( Dong Joon Lee ),황금철 ( Gum Cheol Hwang ),황충진 ( Chung Jin Whang ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

A sixteen years old male patient was treated with the fractionated stereotactic radiosurgery(FSR) using Novalis system. The patient had surgery initially at other hospital before FSR and suffered from visual and endocrine dysfunctions which was required hormone replacement. Seven months after FRS, we found marked decrease of tumor volume. Now he is followed for 1 year. There is a still controversy regarding the ideal management of craniopharyngiomas. Radical resection is hazardous and can produce unacceptable mortality and morbidity. Many authors noted that postoperative conventional radiotherapy or Gamma knife radiosurgery after limited excision achieved better results than total excision of tumor for survival and postoperative complications. FRS delivered precise radiation to a target volume in close proximity to surrounding critical structures resulted in tumor regression. FRS using the relocatable mask frame may have a good role for adjuvant treatment of recurred or relapsed craniopharyngiomas.

요추 디스크 수술후 발생한 추간판염에 대한 적혈구 침강속도 변화의 비교 분석

이기택,김태성,임영진,이봉암,김국기,임언 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.8

From March 1986 to December 1994, 30 out of 1930 patients with lumbar HIVD or lumbar stenosis were diagnosed as discitis after laminectomy(total or hemilaminectomy) and discectomy in the Department of Neurosurgery. Kyung Hee University Hospital. The author had analysed the clinical features and diagnostic procedure of discitis Furthermore changes in ESR were continuously monitored in patients following laminectomy, with or without complications The incidence of discitis following lumbar laminectomy was relatively rare(1.6%) Severe back pain and muscle spasm were characteristic symptoms Patients with discitis showed elevations of ESR to its maximum after 2 weeks and then decreased slowly However patients without discitis reached maximum rate in the 9th day and decreased rapidly to within normal value 2 weeks after. Therefore, continuous increase of ESR after operation strongly suggests discitis and we believe that serial examination of ESR will be helpful in the early detection of discitis Compared with discitis patients. to determined the normal changes of the ESR after laminectomy. 100 patients60 females, 50 males) were randomly selected and serial erythrocyte sedimentation rate were recorded during the first 4 weeks after operation The parameters which affect postoperative ESR were operation time, sex, age. and postoperative steroid therapy The operative time. sex and postoperative steroid therapy had no effect on the postoperative ESR changes significantly(p>0.05). but the more increase of age(over 40 years). the ESR was elevated significantly(p<0.05)

영상유도장비를 이용한 연수부 해면상 혈관종의 제거 1예

이기택,최광영,최찬영,손문준,이동준,황금철,황충진,박성혜 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

With increased use of magnetic resonance imaging(MRI), diagnosis of cavernous ma formations has become easy. These malformations are often small and can be difficult to localize during surgery. Small deep lesions within the brain. and/or near the eloquent areas are difficult to localize and resect without significant morbidity. But using the interactive Image Guided System, provides the 3-dimensional view of the actual lesions and it also allows the surgeon to plan a surgical strategy that takes into account the relationship of the lesion. Therefore Image Guided Surgery for deep seated or brain stem lesions represent a very accurate and safe method.

뇌동맥류 수술시 혈관촬영상 음성으로 보였던 부위에 우연히 발견된 또다른 동맥류 : 증례보고 Case Report

이기택,이봉암,임영진,김태성,김국기,임언 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

The presently avalabie neuroradioiogical techniques including computed tomography and 4-vessel angiography, fail to identify any causes in 13% to 22% of patients with a subarachnoid hemmorhage. Recently, we experienced two small unexpected internal carotid artery aneurysms during the anterior communicating artstery aneurysm and basilar tip aneurysm surgery respectively. In general, the approach for aneurysm surgery was confined to the local aneurysm site with local cisternal opening. But we had performeda wide cisternal opening for the anterior communicating and basilar tip aneurysm surgery and we found unexpected angiogram-negative aneurysm These findings lead us to propose to a surgical approach of usual intracranial aneurysms. Therefore we recommened the approach of opening predilection sites(including MCA knee portion. ICA bifurcation area) of intracranial aneurysms during all intracranial aneurysm surgery.

시교차-시상하부 신경교종의 정위적 분할 방사선 수술

이기택 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

The natural history of optic pathway gliomas is variable. So, there has been still controversy about the roles of radiotherapy, surgery, chemotherapy and simple observation in the management. But, radiotherapy is considered to be effective and is recommended for patients suffering from recurrent optic chiasm gliomas after surgery. We treated two patients suffering from recurrent optic chiasm-hypothalamic gliomas after resection with FSRS(fractionated stereotactic radiosurgery) using NovalisR Shaped Beam Surgery System. Each of patients has been delivered total dose of 41.25Gy, 45Gy to the target with daily fraction size of 1.65Gy, 1.5Gy respectively. During the follow-up period(17 and 20 months after FSRS), the tumor volume and During the follow-up period(17 and 20 months after FSRS), the tumor volume and enhancement were decreased progressively and no other clinical significant effects attributable to radiation were observed. FSRS is advantageous compared to conventional radiotherapy, because of the possibility of the possibility to minimize the amount of normal tissue within the high dose volume. Therefore, FSRS offers a very good alternative for chiasm-hypothalamic glioma compare to conventional radiotherapy or surgical resection.

Immunoglobulin G4-related hypertrophic pachymeningitis with an isolated scalp mass mimicking a brain tumor: a case report and literature review

( Jina Yeo ),( Gi Taek Yee ),( Jaedeok Seo ),( Mi Ryoung Seo ),( Han Joo Baek ),( Hyo-jin Choi ) 대한류마티스학회 2024 대한류마티스학회지 Vol.31 No.1

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disorder associated with fibroinflammatory conditions that can affect multiple organs. Hallmark histopathological findings of IgG4-RD include lymphocytic infiltration of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. However, little is known about central nervous system involvement of IgG4-RD. Hypertrophic pachymeningitis (HP) has recently been reported as a manifestation of IgG4-RD, which may have previously been demonstrated in a significant percentage of idiopathic cases. Herein, we report a rare case of a 63-year-old male who presented with a scalp mass that mimicked a brain tumor. He was diagnosed with IgG4-related HP (IgG4-RP) after surgery. This case suggests that awareness of a possibility of IgG4-RP in patients with isolated scalp masses, even in the absence of systemic symptoms, is crucial. A combination of careful history taking, evaluation of serum IgG4-levels and imaging as an initial work-up, followed by tissue biopsy, is important for the differential diagnosis of IgG4-RP, malignancy, and other infectious diseases.