Primary Spinal Cord Oligodendroglioma with Postoperative Adjuvant Radiotherapy: A Case Report

Yuh, Woon Tak,Chung, Chun Kee,Park, Sung-Hye The Korean Spinal Neurosurgery Society 2015 Neurospine Vol.12 No.3

<P>Primary spinal cord oligodendrogliomas are rare tumors comprising two percent of all spinal cord tumors. Although a treatment guideline has yet to be established, maximal surgical resection is primary in the treatment of spinal cord oligodendrogliomas. Adjuvant radiotherapy has remained controversial, and it is unclear whether chemotherapy adds any benefit. In this case report, the authors present a 24-year-old male who had a seven-year history of left leg weakness and a radiating pain in both legs. Magnetic resonance image (MRI) showed an intramedullary mass at the T4-T8 level. He underwent subtotal removal of the tumor and pathologic diagnosis revealed a WHO grade II oligodendroglioma. The patient was treated with radiotherapy postoperatively and followed up with MRI annually. Clinical and radiological status of the patient had been stationary for four years after the surgery. The five-year follow-up MRI showed an increase in the size and extent of the residual tumor. Despite radiological progression, considering that symptoms and the performance status of the patient had remained unchanged, further treatment has not been performed. Given the clinical outcome of this patient, close observation after subtotal removal with adjuvant radiotherapy is one of the acceptable treatment options for WHO grade II spinal cord oligodendrogliomas.</P>

Surgical Outcome of Adult Idiopathic Chiari Malformation Type 1

Yuh, Woon Tak,Kim, Chi Heon,Chung, Chun Kee,Kim, Hyun-Jib,Jahng, Tae-Ahn,Park, Sung Bae The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.5

Objective : The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. Methods : Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (${\geq}50%$ decrease in the diameter of the syrinx) were investigated. The follow-up period was $72.7{\pm}55.6$ months. Results : Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. Conclusion : Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.

Spinal Cord Subependymoma Surgery : A Multi-Institutional Experience

Yuh, Woon Tak,Chung, Chun Kee,Park, Sung-Hye,Kim, Ki-Jeong,Lee, Sun-Ho,Kim, Kyoung-Tae The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.2

Objective : A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. Methods : We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. Results : The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). Conclusion : Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.

Narrative Review of Uniportal, Transforaminal Endoscopic Lumbar Discectomy

Woon Tak Yuh,Chang-Hyun Lee,Chun Kee Chung,Chi Heon Kim 대한통증연구학회 2022 International Journal of Pain Vol.13 No.1

Since the first use of arthroscopy for lumbar spinal surgery in 1990, endoscopic lumbar spinal surgery has evolved both technically and instrumentally. Transforaminal endoscopic lumbar discectomy (TELD) was the first and remains the most commonly used method. This study aimed to review evidence of TELD in systematic reviews and randomized controlled trials (RCTs). This narrative review included systematic reviews and RCTs that compared TELD with open discectomy (OD), microdiscectomy (MD), or tubular retractor–assisted microendoscopic discectomy (MED). PubMed was searched using the following keywords: for RCTs, ((((lumbar) AND (spine)) AND (endoscope)) AND (randomized[Title])) AND (trial[Title])); and for systematic reviews, ((((lumbar) AND (spine)) AND (endoscope)) AND (systematic[Title/Abstract]))). Two spine surgeons ultimately included 6 RCTs and 4 systematic reviews in the study. The current study reviewed the clinical outcomes, complications, recurrence, and length of hospital stay of the included studies. There were no significant differences in clinical outcomes, complications, or recurrence rates between TELD and OD, MD, or MED. However, the length of hospitalization was lower and intraoperative bleeding was lower after TELD than after MD. The quality of the evidence was moderate. The clinical outcomes of TELD and OD, MD, and MED seemed similar with a moderate quality of evidence.

The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis

Woon Tak Yuh,Junghoon Han,Chang-Hyun Lee,Chi Heon Kim,Hyun-Seung Kang,Chun Kee Chung 대한신경외과학회 2023 Journal of Korean neurosurgical society Vol.66 No.4

Objective : Preoperative transarterial embolization (TAE) of tumor feeders in hypervascular spine metastasis is known to reduce intraoperative estimated blood loss (EBL) during surgery. The effect of TAE varies for several reasons, and one controllable factor is the timing between embolization and surgery. However, the adequate timing remains unclear. This study aimed to evaluate the timing and other factors that reduce EBL in spinal metastasis surgery through a meta-analysis. Methods : A comprehensive database search was performed to identify direct comparative studies of EBL stratified by the timing of surgery after TAE for spinal metastasis. EBL was analyzed according to the timing of surgery and other factors. Subgroup analyses were also performed. The difference in EBL was calculated as the mean difference (MD) and 95% confidence interval (CI). Results : Among seven studies, 196 and 194 patients underwent early and late surgery after TAE, respectively. The early surgery was defined as within 1–2 days after TAE, while the late surgery group received surgery later. Overall, the MD in EBL was not different according to the timing of surgery (MD, 86.3 mL; 95% CI, -95.5 to 268.1 mL; p=0.35). A subgroup analysis of the complete embolization group demonstrated that patients who underwent early surgery within 24 hours after TAE had significantly less bleeding (MD, 233.3 mL; 95% CI, 76.0 to 390.5 mL; p=0.004). In cases of partial embolization, EBL was not significantly different regardless of the time interval. Conclusion : Complete embolization followed by early spinal surgery within 24 hours may reduce intraoperative bleeding for the patients with hypervascular spinal metastasis.

The Influence of Spondylolisthesis Reduction on the Adjacent Lumbar Segment

Park Tae-Hwan,Choi Yunhee,Kim Tae-Shin,Kim Jun-Hoe,Lee Chang-Hyun,Kim Sum,Kim Young Rak,Ko Yong San,Yuh Woon Tak,Rhee John M.,Kim Kyoung-Tae,Chung Chun Kee,Kim Chi-Heon 대한말초신경학회 2023 The Nerve Vol.9 No.2

Objective: Mild to moderate stenosis at the adjacent level sometimes co-occurs with lumbar spondylolisthesis, but whether to include the adjacent level during surgery for the index level is a matter of debate. Spondylolisthesis causes anterior slipping of the vertebra and reduces the segmental angle at the index level, and the adjacent level may compensate for this change through hyperextension to maintain spinal balance. This study investigated the radiological changes and clinical outcomes of adjacent segment stenosis in patients with lumbar spondylolisthesis. Methods: Forty consecutive patients (12 men and 28 women, age 66.6±10.4 years) underwent single-level oblique lumbar interbody fusion for L4-5 or L5-S1 spondylolisthesis. Lumbar central stenosis at the cranial adjacent segment was present in 16 patients (stenosis group) and absent in 24 patients (no-stenosis group). Clinical and radiological parameters were longitudinally compared between the stenosis and no-stenosis groups. Results: Both groups showed similar and significant clinical improvement. The segmental angle at the index level significantly improved in both groups (p<0.05), but the segmental angle at the cranial adjacent segment significantly decreased only in the stenosis group (p<0.05). The spinal canal area at the adjacent level significantly improved only in the stenosis group (p<0.05). Conclusion: Realigned spondylolisthesis may reduce hyperextension of the adjacent segment. If mild lumbar spinal stenosis is present at an adjacent level to spondylolisthesis, it may not be essential to include it in surgery.