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Intracranial Pressure Monitoring for Acute Brain Injured Patients: When, How, What Should We Monitor
Youngbo Shim,Jungook Kim,Hye Seon Kim,Jiwoong Oh,Seungjoo Lee,Eun Jin Ha 대한신경손상학회 2023 Korean Journal of Neurotrauma Vol.19 No.2
While there is no level I recommendation for intracranial pressure (ICP) monitoring, it is typically indicated for patients with severe traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score of 3–8 (class II). Even for moderate TBI patients with GCS 9–12, ICP monitoring should be considered for risk of increased ICP. The impact of ICP monitoring on patient outcomes is still not well-established, but recent studies reported a reduction of early mortality (class III) in TBI patients. There is no standard protocol for the application of ICP monitoring. In cases where cerebrospinal fluid drainage is required, an external ventricular drain is commonly used. In other cases, parenchymal ICP monitoring devices are generally employed. Subdural or non-invasive forms are not suitable for ICP monitoring. The mean value of ICP is the parameter recommended for observation in many guidelines. In TBI, values above 22 mmHg are associated with increased mortality. However, recent studies proposed various parameters including cumulative time with ICP above 20 mmHg (pressure-time dose), pressure reactivity index, ICP waveform characteristics (pulse amplitude of ICP, mean ICP wave amplitude), and the compensatory reserve of the brain (reserve-amplitude-pressure), which are useful in predicting patient outcomes and guiding treatment. Further research is required for validation of these parameters compared to simple ICP monitoring.
( Youngbo Shim ),( Sang Hyung Lee ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2016 Brain Tumor Research and Treatment Vol.4 No.2
Parasagittal meningioma often presents as peritumoral brain edema (PTBE). The risk of edema increases when the tumor occludes the superior sagittal sinus (SSS). Although PTBE may be expected based on the patient’s symptoms or radiologic findings, extensive brain swelling and extracranial herniation during elective surgery are rare. Herniation during surgery could lead to irreversible neurological damage and even brain rupture. We report a case of a failed routine craniotomy for a parasagittal meningioma with complete occlusion of the posterior third of the SSS in a 30-year-old male patient. The patient developed extensive brain swelling and extracranial herniation during surgery.
Shim, Youngbo,Gwak, Ho-Shin,Kim, Sohee,Joo, Jungnam,Shin, Sang-Hoon,Yoo, Heon The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.6
Objective : Elevated cell counts and protein levels in cerebrospinal fluid (CSF) result from disease activity in patients with leptomeningeal carcinomatosis (LMC). Previous studies evaluated the use of CSF profiles to monitor a treatment response or predict prognosis. CSF profiles vary, however, according to the sampling site and the patient's systemic condition. We compared lumbar and ventricular CSF profiles collected before intraventricular chemotherapy for LMC and evaluated the association of these profiles with patients' systemic factors and LMC disease activity. Methods : CSF profiles were retrospectively collected from 228 patients who underwent Ommaya reservoir insertion for intraventricular chemotherapy after a diagnosis of LMC. Lumbar samples taken via lumbar puncture were used for the diagnosis, and ventricular samples were obtained later at the time of Ommaya reservoir insertion. LMC disease activity was defined as the presence of LMC-related symptoms such as increased intracranial pressure, hydrocephalus, cranial neuropathy, and cauda equina syndrome. Results : Cell counts (median : 8 vs. 1 cells/mL) and protein levels (median : 68 vs. 17 mg/dL) significantly higher in lumbar CSF than in ventricular CSF (p<0.001). Among the evaluated systemic factors, concomitant brain metastasis and previous radiation were significantly correlated with higher protein levels in the lumbar CSF (p=0.01 and <0.001, respectively). Among the LMC disease activity, patients presenting with hydrocephalus or cauda equina syndrome showed higher lumbar CSF protein level compared with that in patients without those symptoms (p=0.049 and p<0.001, respectively). The lumbar CSF cell count was significantly lower in patients with cranial neuropathy (p=0.046). The ventricular CSF cell counts and protein levels showed no correlation with LMC symptoms. Carcinoembryonic antigen (CEA), which was measured from ventricular CSF after the diagnosis in 109 patients, showed a significant association with the presence of hydrocephalus (p=0.01). Conclusion : The protein level in lumbar CSF indicated the localized disease activity of hydrocephalus and cauda equina syndrome. In the ventricular CSF, only the CEA level reflected the presence of hydrocephalus. We suggest using more specific biomarkers for the evaluation of ventricular CSF to monitor disease activity and treatment response.
심영보(Youngbo Shim),김윤정(Yunjeong Kim),민경원(Kyungwon Min),이선영(Seonyoung Lee),손행선(Haengseon Son) 한국자동차공학회 2020 한국자동차공학회 부문종합 학술대회 Vol.2020 No.7
There are many curved roads as well as straight roads in urban environments. The autonomous vehicle should drive at an appropriate speed on such a curved road, but it will be more comfortable for passengers riding in the car. In this paper, we propose a velocity profile with a sharp curve in urban. First, a maximum velocity is generated considering the curvature of the global path, and a smooth velocity profiling planning is performed based on the generated maximum velocity. The experiment results show the validity of the proposed method.
정밀지도 기반 경로계획을 위한 정밀지도 에디터에 관한 연구
심영보(Youngbo Shim),김윤정(Yunjeong Kim),민경원(Kyungwon Min),이선영(Seonyoung Lee),손행선(Haengseon Son) 한국자동차공학회 2020 한국자동차공학회 부문종합 학술대회 Vol.2020 No.7
Similar to a typical driver driving to a destination using a navigation map, autonomous vehicles use the HD Map(High Definition Map) to search for the optimal route to the destination. Unlike navigation maps, the HD Map has lane-level data, and in addition, information such as traffic lights, road markings, and signs is provided with very accurate location information. For the autonomous driving technology of level 4 or higher, the importance of the HD Map is rising, and the National Geographic Information Institute in Korea and private companies are collaborating to build the HD Map. However, the HD Map that has been constructed until now needs to be modified according to the method used the path planning. In this paper, for the HD Map based path planning, we introduce the editor that automatically edits the map, and it appears as a result of the path planning experiment on the automatically edited the map.