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- 저자 : Hridayesh (검색결과 4 건)
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Hridayesh Pratap Malla,김승범,원준성,최만규 대한척추신경외과학회 2018 Neurospine Vol.15 No.2
Objective: The purpose of this study was to provide anatomical data on the dimensions and location of the subaxial transverse foramen (TF) in relation to surgical landmarks routinely used during anterior cervical procedures. Methods: A total of 116 patients who underwent preoperative computed tomography (CT) evaluations for degenerative cervical disease were enrolled. Axial and coronal CT images of the cervical vertebrae from C3 to C6 were analyzed to measure interforaminal distance, the TF distance from the anterior and posterior vertebral body margin, TF dimensions, and the TF medial margin from the tip and medial margin of the uncus. Comparative and correlative analyses were also performed according to age, body mass index (BMI), and sex. Results: All measurement values in male patients were larger than those in their female counterparts. The interforaminal distance gradually increased from C3 to C6. The distance of the TF medial margin from the tip of the uncus was found be above approximately 3 mm in all vertebrae except C6. Correlation analysis revealed that age had a significant negative relationship with the transverse diameter of TF. In contrast, BMI had a significant positive correlation with interforaminal distance. Moreover, the distances of the TF medial margin from the tip and medial margin of the uncus showed strong negative correlations with age. Conclusion: Useful morphometric data were obtained that may help the operating surgeon to avoid vertebral artery injury. The safe distance from the tip of the uncus to the TF medial margin was found to be approximately 3 mm, and this distance should not be violated during lateral decompression. In addition, this value may decrease with age.
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Giant Intrathoracic Meningocele and Breast Cancer in a Neurofibromatosis Type I Patient
Malla, Hridayesh Pratap,Park, Bong Jin,Koh, Jun Seok,Jo, Dae Jean The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.6
Intrathoracic meningoceles are relatively rare entities found in patients with neurofibromatosis type I (NF1). Given that both the BRCA1 and NF-1 genes are located on the same long arm of chromosome 17, one would expect concurrence of neurofibromatosis and breast cancer. However, incidence of such co-disorders is very rare in the literature. Here, the authors report a case of a 50-year-old female patient with NF-1 and concurrent cancer of the left breast, who had a huge bilobulated intrathoracic meningocele with thoracic dystrophic scoliosis, treated surgically via a posterior-only approach for the meningocele and spinal deformity in the same setting.
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Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease
Malla, Hridayesh Pratap,Kim, Min Ki,Kim, Tae Sung,Jo, Dae Jean The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.6
Parkinson's disease (PD) patients frequently have several spinal deformities leading to postural instabilities including camptocormia, myopathy-induced postural deformity, Pisa syndrome, and progressive degeneration, all of which adversely affect daily life activities. To improve these postural deformities and relieve the related neurologic symptoms, patients often undergo spinal instrumentation surgery. Due to progressive degenerative changes related to PD itself and other complicating factors, patients and surgeons are faced with instrument failure-related complications, which can ultimately result in multiple revision surgeries yielding various postoperative complications and morbidities. Here, we report a representative case of a 70-year-old PD patient with flat back syndrome who had undergone several revision surgeries, including anterior and posterior decompression and fusion for a lumbosacral spinal deformity. The patient ultimately benefitted from a relatively short segment fixation and corrective fusion surgery.
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A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment
Kang, Il Ho,Park, Bong Jin,Park, Chang Kyu,Malla, Hridayesh Pratap.,Lee, Sung Ho,Rhee, Bong Arm The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.6
Objective : Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. Methods : We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. Results : Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. Conclusion : Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.
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