Morphological Characteristics of the Thalamoperforating Arteries

Park, Sukh-Que,Bae, Hack-Gun,Yoon, Seok-Mann,Shim, Jai-Joon,Yun, Il-Gyu,Choi, Soon-Kwan The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.47 No.1

Objective: The aim of this study was to investigate the morphological characteristics of the thalamoperforating arteries that arise from the P1 segment of the posterior cerebral artery. Methods: Thalamoperforating arteries located in the interpeduncular fossa were dissected in 26 formalin-fixed human cadaver brains. We investigated the origin site of thalamoperforating arteries from the P1 segment, number and diameter. and variations in their origin. Results: Thalamoperforating arteries arose from the superior, posterior or posterosuperior surfaces of the P1 segment at the mean 1.93 mm (range, 0.41-4.71 mm) distance from the basilar apex and entered the brain through the posterior perforated substance. The average number was 3.6 (range 1-8) and mean diameter was 0.70 mm (range 0.24-1.18 mm). Thalamoperforating arteries could be classified into five different types according to their origin at the P1 segment: Type I (bilateral multiple), 38.5%; Type II (unilateral single, unilateral multiple), 26.9%; Type III (bilateral single), 19.2%; Type IV (unilateral single), 11.5%; Type V (unilateral multiple), 3.8%. In 15.4% of all specimens. thalamoperforating arteries arose from the only one side of P1 segment and were not noted in the other side. In such cases, the branches arising from the one side of P1 segment supplied the opposite side. Conclusion: Variations in the origin of the thalamoperforating arteries should be keep in mind to perform the surgical clipping, endovascular treatment or operation involving the interpeduncular fossa. In particular, unilateral single branch seems to be very risky and significant for surgical technique or endovascular treatment.

The Influence of Comorbidities on Reoperations Following Primary Surgery of Lumbar Degenerative Diseases : A Nationwide Population-Based Retrospective Cohort Study from 2009-2016

Park, Hyung-Ki,Park, Su-Yeon,Lee, Poong-Hhoon,Park, Hye-Ran,Park, Sukh-Que,Cho, Sung-Jin,Chang, Jae-Chil The Korean Neurosurgical Society 2020 Journal of Korean neurosurgical society Vol.63 No.6

Objective : Spinal degeneration is a progressive disease, worsening over time. Lumbar degenerative disease (LDD) is a major spinal disease in elderly patients. Surgical treatment is considered for medically intractable patients with LDD and reoperation after primary surgery is not uncommon. The surgical outcome is occasionally unpredictable because of comorbidities. In the present study, the relationship between comorbidities and the incidence of reoperation for LDD over time was determined. Methods : The claims data of the health insurance national database were used to identify a cohort of patients who underwent spinal surgery for LDD in 2009. The patients were followed up until 2016. Medical comorbidity was assessed according to the Charlson comorbidity index (CCI). Cox proportional hazard regression modeling was used to identify significant differences in sex, surgery, age, causative disease, and comorbidity. Results : The study cohort included 78241 patients; 10328 patients (13.2%) underwent reoperation during the observation period. The reoperation rate was statistically higher (p<0.01) in males, patients 55-74 years and 65-74 years of age, and patients with decompression or discectomy. Significant association was found between increasing reoperation rate and CCI score (p<0.01). Based on multivariate analysis of comorbidities, the significantly higher reoperation rates were observed in patients with peripheral vascular disease, pulmonary lung disease, peptic ulcer, diabetes, and diabetes complications (p<0.01). Conclusion : The study results indicate the reoperation rate for LDD is associated with patient comorbidities. The comorbidities identified in this study could be helpful in future LDD studies.

제1형 신경섬유종증 환자에서 양측성으로 흉추에 발생한 신경섬유종 - 증례 보고 -

박석규,장재칠,도재원,김범태,신원한,최순관,변박장,이만복,고은석 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.1

중뇌동맥 경색증 환자에서 감압개두술의 적응증

박석규,윤일규,김범태,도재원,배학근,이경석,최순관,변박장 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.11

Geographic Analysis of Neurosurgery Workforce in Korea

Park, Hye Ran,Park, Sukh Que,Kim, Jae Hyun,Hwang, Jae Chan,Lee, Gwang Soo,Chang, Jae-Chil The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.1

Objective : In respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea. Methods : Population data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps. Results : Between 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000). Conclusion : Distribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.

Brachial Plexus Neurofibroma: A Case Report

Lee Mu Ha,Park Hyung Ki,Park Hye Ran,Park Sukh Que,Chang Jae-Chil,Cho Sung Jin 대한말초신경학회 2020 The Nerve Vol.6 No.1

The brachial plexus is an anatomically complex structure. Tumors that originate from the brachial plexus are rare and present clinical challenge for neurosurgeons due to the anatomical complexity. We present the case of 59-year-old male patient with right hand weakness who was diagnosed with a neurogenic tumor originating from brachial plexus. He underwent wide the excision of tumor through the anterior supraclavicular approach. Postoperatively, the patient developed right arm numbness and motor weakness. At 2 month following the removal of tumor, he recovered normal function.

Thromboembolic Complications of Elective Coil Embolization of Unruptured Aneurysms

Hwang, Gyojun,Jung, Chulkyu,Park, Sukh Que,Kang, Hyun Sung,Lee, Sang Hyung,Oh, Chang Wan,Chung, Young Seob,Han, Moon Hee,Kwon, O-Ki Oxford University Press 2010 Neurosurgery Vol.67 No.3

<B>Abstract</B><B>OBJECTIVE</B><P>We retrospectively evaluated whether antiplatelet preparation lowered the thromboembolic complication rate during the perioperative period.</P><B>METHODS</B><P>We reviewed 328 elective coil embolization procedures in which only microcatheters were used for coiling. No antiplatelet medication was prescribed before the procedure in 95 cases (29%, group 1), whereas antiplatelet therapy was used in 233 cases (71%, group 2; 61 [18.6%] with a single agent [aspirin or clopidogrel] and 172 [52.4%] with both agents). Antiplatelet agents were not given after coiling unless atherosclerosis, severe coil protrusion, or a thromboembolic complication occurred during the procedure. A thromboembolic complication was defined as a procedural thromboembolic event or transient ischemic attack or stroke occurring within 2 days of embolization.</P><B>RESULTS</B><P>Thromboembolic complications occurred in 11 cases (3.4%): 6 (6.3%) in group 1 and 5 (2.1%) in group 2 (P = .085). In 195 cases (59.5%) treated by the single microcatheter technique, the risk of thromboembolic complications was low and not affected by antiplatelet preparation (1.8% [no preparation] vs 2.2% [preparation]; P = 1.000). However, in 133 cases (40.5%) treated by the multiple microcatheter technique, antiplatelet preparation significantly reduced the thromboembolic complication risk by 85.2% (12.8% [no preparation] vs 2.1% [preparation]; odds ratio, 0.148; 95% confidence interval, 0.027-0.798; P = .023). The aneurysms treated by the multiple microcatheter technique had more complex configurations for coiling (P &lt; .001). The risk of hemorrhage was not increased by antiplatelet preparation (P = .171).</P><B>CONCLUSION</B><P>Antiplatelet preparation lowered the periprocedural thromboembolic complication rate in unruptured aneurysms treated by the multiple microcatheter technique and did not increase the risk of hemorrhage. Therefore, antiplatelet preparation can help to reduce complications in patients in whom technical difficulties are expected without the risk of hemorrhage.</P>

Unexpected Severe Cerebral Edema after Cranioplasty : Case Report and Literature Review

Lee, Gwang Soo,Park, Sukh Que,Kim, Rasun,Cho, Sung Jin The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.46 No.4

This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.

Demonstration of Traumatic Subarachnoid Hemorrhage from the Anterior Choroidal Artery

Sim, Ki-Bum,Park, Sukh Que,Choi, H. Alex,Kim, Daniel H. The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.56 No.6

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.

Minimum 3-Year Outcomes in Patients with Lumbar Spinal Stenosis after Bilateral Microdecompression by Unilateral or Bilateral Laminotomy

Yang, Sang-Mi,Park, Hyung-Ki,Chang, Jae-Chil,Kim, Ra-Sun,Park, Sukh-Que,Cho, Sung-Jin The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.3

Objective : Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. Methods : Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. Results : Twenty-one patients (10 men, 11 women) aged 53-82 years ($64.1{\pm}8.9$ years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. Conclusion : BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.