Effectiveness of Selective Peripheral Denervation for the Treatment of Spasmodic Torticollis

Huh, Ryoong,Ahn, Jung-Yong,Chung, Young-Sun,Chang, Jong-Hee,Chang, Jin-Woo,Chung, Sang-Sup The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.38 No.5

Objective : The Bertrand's method of selective peripheral denervation for spasmodic torticollis has already been established as being an effective and safe method. However, such effectiveness has not yet been established in Korea. The authors have performed several cases of selective denervation for the treatment of spasmodic torticollis and we hereby describe the details of the operative method to determine the effectiveness of the method. Methods : Ten patients who had the selective denervation for the spasmodic torticollis from October 1997 to December 2003, were analyzed. There were 4 rotational and 6 combined types [3 rotational plus retrocollis, 3 rotational plus laterocollis]. We performed preoperative electromyograms and neck muscle tonograms in all cases. The technique was used to involve denervation of the ipsilateral posterior paraspinal muscles. Denervation of the sternocleidomastoid muscle was performed on the contralateral side for rotational torticollis and on the ipsilateral side for laterocollis combined type. The surgery was followed by a rigorous physical therapy program. Results : The surgical results were divided into 4 groups labeled excellent, good, fair, and poor. There were 5 excellent patients who showed no detectable abnormal movements, 4 good patients who showed slight residual deviations or slight residual abnormal movements, and 1 fair patient with appreciable residual abnormal movements. Postoperative pain was well tolerated. There was no significant surgical complications. Conclusion : The study confirms that selective peripheral denervation for the treatment of spasmodic torticollis is a very useful and safe surgical technique.

경증 뇌손상 환자의 뇌전산화단층촬영의 의의

허륭,배학근,도재원,이경석,배원경,윤일규,변박장 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.9

The purpose of this study is to identify a group of mild head injury patients having lesions on computerized tomography(CT) and to investigate the risk factors affecting the abnormal findings on CT scan. The study was limited to patients 16 years of age and older with a initial Glasgow Coma Scale(GCS) scores of at least 13 at the time of admission. Of a total of 243 patients studied 156(64.2%) had abnormal CT findings. 49 patients(20.2%) required neurosurgical intervention(craniotomies for hematoma in 33, hematoma in 1 and subdural hygroma in 3). Four patients(2.4%) died of their cranial injury and three died of extracranial causes. The incidence of CT abnormalities for each GCS score was 86.7% in GCS of 13, 68.6% in GCS of 14, and 58.6% in GCS of 15. The factors affecting GCS scores at the time of admission were the presence of loss of consciousness and posttraumatic amnesia. The factors affecting abnormal CT scans were the presence of posttraumatic amnesia and skull fracture. A new lesion or extension of the initial finding on follow-up CT scans was found in 9.3% of 75 patients who underwent follow-up CT scans Even though routine CT scans for mild head injury patients are not always necessary, these results suggest that all patients admitted to hospital after mild head injury should undergo CT scanning to enable early detection of an intracranial lesion.

복강내의 가성낭포(Pseudocyst)로 인한 뇌실복강 단락(Ventriculoperitoneal Shunt)의 기능부전에 대한 뇌실요관 단락(Ventriculoureteral Shunt) 수술 : Case Report and Technical Note

허륭,신원한,이규,최순관,변박장,김민의,문철,이인수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.5

We report a case of ventriculoureteral shunt to revise malfunctioning ventriculoperitoned shunt in a Byear-old man. The patient had 4 times recurrent pseudocyst filled with cerebrospinal fluid caused by complications at the distal end of the abdominal cathetex. The presence of an abdominal pseudocyst can be detected by performing an ultrasound examination of the abdomen We shall describe the operative technique of the ventriadoureteral shunt procedure without nephrectomy by reimplantation of the ureter and a psoas hitch.

成人의 輕度 頭部外傷에 對한 臨床硏究

허륭,최순관 순천향대학교 1993 논문집 Vol.16 No.4

경도 두부외상은 두부외상의 많은 부분을 차지할 뿐만 아니라, 중증 두부외상에 비해 더 작은 노력으로도, 더 많은 치료효과를 얻을수 있다. 저자는 1991년 1월부터 1992년 12월까지 2년동안 두부외상으로 순천향대학병원에 입원했던 성인(15세이상) 경도 (Glasgow coma scale;GCS, GCS 13점 이상)두부외상 472례를 대상으로 하여, 경도 두부외상의 임상적 특성과 방사선학적 소견, 그리고 예후를 조사, 분석하였다. 경도 두부외상은 성인 두부외상의 66%를 차지하였고, 남녀비는 2.8:1로 가장 많았고, 46-60세(24.6%), 31-45세(22.7%), 그리고 60세이상 (21.0%) 순이었다. 추락의 비율이 조금 높은점이 경도 두부외상의 특징 중 하나였다. 입원경로는 경도 두부외상이라도 91.5%가 응급실을 경유하여 입원하였고, 외래를 통한 입원(4.9%)과 전과(3.6%)는 적었다. 외상후 내원까지의 시간은 평균 2.8시간 으로서, 68.0%가 6시간 이내로 중등도나 중증에 비해 조금 늦은 편이었다. 입원 유형별로는 직접 응급실로 내원한 경우가 평균 1.0시간으로 가장 짧았고, 인근 병원을 들렸다 올 경우 평균 6.0시간으로 5시간 정도가 더 소요되었다. 내원 당시의 의식은 15점이 66.7%로 가장 많았고, 14점이 20.8%, 그리고 13점이 12.5%였다. 가장 흔한 증상은 두통(77.5%)이었고, 의식소실력 (54.0%), 기억상실(34.5%), 현훈증(19.5%), 그리고 구토(12.5%)등이 비교적 흔한 증상이었으며, 뇌신경 손상(5.7%), 무기력(4.0%), 그리고 발작(1.7%)등은 비교적 드문 증상이었다. 동반손상은 36.6%에서 관찰되었고, 32.8%가 사지골의 골절이었다. 신경외과에 입원한 기간은 평균 19.3일(표준편차 22.8일), 2주 이하가 51.1%였다. 89.6%는 보존적으로 치료할 수 있었으나, 10.4%는 수술이 필요하였다. 수술은 GCS가 낮을수록, 그리고 두개골 골절이 있을 때 많았다. 나이가 많을수록 수술율이 더 높았지만 통계학적 유의성은 없었다. 두개골 골절은 23.9%에서 관찰되었고, 가장 흔한 골절은 선상골절로 전체두개골 골절의 68.1%를 차지하였다. 내원당시의 의식 수준이 낮을수록 골절의 빈도가 높았다. CT는 골절이 발견된 환자와 GCS가 13점과 14점 환자 모두에서 시행하였고, 골절도 없고 GCS가 15점인 환자는 43.4%에서만 시행하였다. 전체적으로 70.1%에서 CT를 시행하였고, 이중 40.2%에서 이상 소견이 발견되었으며, 수술이 필요한 경우는 10.4%였다. 퇴원할 때의 예후는 완전 회복 90.7%, 중등도 장애 5.9%, 중증 장애 1.7% 식물인간 상태0.2%, 그리고 사망이 1.5%였다. 내원시 환자의 의식이 나쁠때, 두개골 골절이 있을 때, CT 소견상 수술을 필요로 하는 병소가 있을 때, 그리고 수술을 했던 예에서 예후가 좋지 않았고, 이 차이들은 통계학적으로도 유의하였다. 연령이 많을수록 예후가 좋지 않는 경향이 있었으나 통계학적으로는 유의하지 않았다. 결론적으로 경도두부외상이라 할지라도 의식수준이 낮거나, 두개골 골절이 있으면서, 신경학적 증상이 있는 경우에는 곧바로 CT를 촬영하여 두개강내 병변을 확인하여야 하고 신경학적 감시를 소홀히 해서는 안된다고 사료된다. Minor head injury shares majority of head injury and we can obtain better results with less efforts than moderate or severe ones. The author investigated clinical features, radiological characteristics, and outcome of the mild(Glasgow Coma Score over 12) head injury. Total 472 adult (over 15 years of age)patients who admitted with minor head trauma to Soonchunhyang University Hospital after head trauma from January 1991 to December 1992 were analyzed. The results obtained were as follows. 1) Minor head injury occupied 66% of all head injuries. 2) The peak incidence was 16-30% years of age (31.8%) and the second was 46-60(24.6%) years of age. 3) The most common cause of minor had injury was traffic road accident (59.8%) 4) Mean time from injury to arrival at hospital was 27.5 hours, and 68% of patients arrived within 6 hours. 5) The GCS on admission was 15 in 66.7%, 14 in 20.8%, and 13 in 12.5%. 6) The most common symptom was headache (77.5%), and episode of loss of consciousness (54.0%), post-traumatic amnesia (34.5%), dizziness (19.5%), and vomiting(12.5%) in order. 7) Fifty-one percent of patients was hospitalized for less than 2 weeks. 8) Most of the patients were treated conservatively, and only 10.4% of patients who had lower GCS or skull fracture. 9) The brain CT scan was performed for the patients with skull fracture, whose GCS was 13 or 14. 10) The final outcome was good recovery in 90.7%, moderate disability 5.9%, severe disability 1.7%, vegetative state 0.2%, and death 1.5%. These data suggested that we should know that in a significant number of patients, the prognosis is poor even though the head injury was mild, and it is necessary to pay attention for those patients with low GCS, skull fracture, and neurologic deficits.

척추강내에 발생한 선천성 표피양 낭종

김용배,허륭,김동석,윤도흠,최중언 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

Neuromodulation for Trigeminal Neuralgia

Moonyoung Chung,Ryoong Huh 대한신경외과학회 2022 Journal of Korean neurosurgical society Vol.65 No.5

Clinical studies on neuromodulation intervention for trigeminal neuralgia have not yet shown promising results. This might be due to the fact that the pathophysiology of chronic trigeminal neuropathy is not yet fully understood. Chronic trigeminal neuropathy includes trigeminal autonomic neuropathy, painful trigeminal neuropathy, and persistent idiopathic facial pain. This disorder is caused by complex abnormalities in the pain processing system, which is comprised of the affective, emotional, and sensory components, rather than mere abnormal sensation. Therefore, integrative understanding of the pain system is necessary for appropriate neuromodulation of chronic trigeminal neuropathy. The possible neuromodulation targets that participate in complex pain processing are as follows : the ventral posterior medial nucleus, periaqueductal gray, motor cortex, nucleus accumbens, subthalamic nucleus, globus pallidus internus, anterior cingulate cortex, hypothalamus, sphenopalatine ganglion, and occipital nerve. In conclusion, neuromodulation interventions for trigeminal neuralgia is yet to be elucidated; future advancements in this area are required.

Clinical Outcomes after Spinal Cord Stimulation According to Pain Characteristics

Jong-Ho Ha,Ryoong Huh,Shin-gyeom Kim,Soo-Bin Im,Je Hoon Jeong,Sun-Chul Hwang,Shin Dong-Seong,Bum-Tae Kim,Moonyoung Chung 대한신경외과학회 2022 Journal of Korean neurosurgical society Vol.65 No.2

Objective : Spinal cord stimulation (SCS) is an effective treatment for chronic neuropathic pain. However, its clinical efficacy in regard to specific types of pain has not been well studied. The primary objective of this study was to retrospectively analyze the clinical outcomes of paddle-type SCS according to the type of neuropathic pain. Methods : Seventeen patients who underwent paddle-lead SCS at our hospital were examined. Clinical outcomes were evaluated pre- and postoperatively (3 months, 1 year, and last follow-up) using the Neuropathic Pain Symptom Inventory (NPSI). The NPSI categorizes pain as superficial, deep, paroxysmal, evoked, or dysesthesia and assess the duration of the pain (pain time score). Changes in NPSI scores were compared with change in Visual analogue scale (VAS) scores. Results : After SCS, the pain time score improved by 45% (independent t-test, p=0.0002) and the deep pain score improved by 58% (independent t-test, p=0.001). Improvements in the pain time score significantly correlated with improvements in the VAS score (r=0.667, p=0.003, Spearman correlation). Additionally, the morphine milligram equivalent value was markedly lower after vs. before surgery (~49 mg, pared t-test, p=0.002). No preoperative value was associated with clinical outcome. Conclusion : The NPSI is a useful tool for evaluating the therapeutic effects of SCS. Chronic use of a paddle-type spinal cord stimulation improved the deep pain and the pain time scores.

Meningeal Chloroma in Acute Lymphoblastic Leukemia

Jung Yong Ahn,Ryoong Huh,Seong Oh Kwon,Shin Heh Kang,Young Rae Kim 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.31 No.5

Isolated chloromas(granulocytic sarcomas) are rare tumors. Chloromas are masses composed of immature granulocytic cells. Granulocytic sarcoma occurs primarily in patients with acute myelogenous leukemia as well as in patients with other myeloproliferative disorders, but rarely in patients with acute lymphoblastic leukemia(ALL). We now describe one patient affected by ALL with isolated granulocytic sarcoma as initial CNS relapses. These unusual clinical manifestation and radiological finding in acute lymphoblastic leukemia should be considered as recurrence of leukemia. Early detection and antileukemic treatment of granulocytic sarcoma are necessarily important for favorable prognosis. Key words:Acute lymphoblastic leukemia;Chloroma;Granulocytic sarcoma.

두개강내 "De Novo" 동맥류 : 증례 보고 Case Report

현동근,이강목,허륭,최순관,변박장 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.6

There are numerous theories of pathophysiology in intracranial aneurysm, but currently accepted hypothesis was congenital defect of medial layer of vascular wall and the major developing factor was hemodynamics. Almost physcians were belived that treatment of intracranial aneurysm was completely through clipping of aneurysmal neck But many reports were emphasized newly developed intracranial(De Novo) aneurysm after clipping of initially identitied intracranial aneurysm. The authors have same experienced of 2 cases intracranial 'Do Novo" aneurysm. We are stress there were never completed treatment of aneurysm that cliiping of initially identified intracranial aneurysm and should be attention to 'De Novo" aneurysm.

원발성 중추신경계 임파종의 임상적 특징과 예후인자에 대한 연구

권흠대,허륭,김동석,박용구,최중언,정상섭,Kwon, Heum Dai,Huh, Ryoong,Kim, Dong Seok,Park, Yong Gou,Choi, Joong Uhn,Chung, Sang Sup 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12

Objective : The incidence of primary CNS lymphoma(PCNSL) has been increasing recently. The purpose of this study is to establish of prognostic factors and treatment options for PCNSL. Methods : Thirty-one PCNSL patients were treated in our institute between 1985 and 1997. All patients were histologically confirmed via stereotactic biopsy or open biopsy. The authors retrospectively analyzed clinical characteristics of PCNSL and prognostic factors, including histological cell types, immunohistological cell types and treatment options of PCNSL. Our data were statistically analyzed using Kaplan Meier survival curve and multivariated ANOVA test. Results : The clinical and radiological characteristics of PCNSL were resembled to those of other reports. The most common histological subtype was diffuse large cell type(55.5%). In immunohistolgical study, the incidence of T-cell lymphoma(35.7%) was very higher than that of others. The radiotherapy could prolonged patients' survival(p=0.021). One-year and 3-year survival rate of PCNSL were 66.9% and 45.9%, respectively. One-year survival rate of B cell and T cell lymphoma were 72.7% and 50.0%, respectively. The patients with B-cell lymphoma showed better prognosis than patients with T-cell lymphoma(p=0.049). Conclusion : On the basis of our data, active radiotherapy could prolong patients' survival. the T-cell lymphoma revealed higher incidence than those of other reports and had poor prognosis than that of B cell lymphoma.