1.Effectiveness of Bypass Surgery in Treatment and Prevention for Cerebrovascular Occlusive Disease.
Journal of the Korean Medical Association 2004;47(7):645-652
To study the effect of extracranial-intracranial(EC/IC) bypass on symptomatic patients with hemodynamic cerebral ischemia, we prospectively reviewed 76 patients who underwent EC/IC bypass surgery in patients with occlusive cerebrovascular disease. A series of 76 patients treated in a 7 years period met following criteria. (1) symptomatic internal carotid artery(ICA) or middle cerebral artery(MCA) obstruction or stenosis over 80%. (2) decrease in basal cerebral blood flow(CBF) over 10%. (3) decreased reactivity of CBF in response to acetazolamide. Among these, the types of ischemic episodes were transient ischemic attack(TIA) or reversible ischemic neurological deficit(RIND) in 39, minor stroke in 22, and major stroke in 15. Based on our criteria, superficial temporal artery(STA)-MCA anastomosis was performed in 67 cases and EC-IC bypass grafting using saphenous vein or radial artery in 9. Average follow up period was 26 months(3 months~7 year). Patency of bypass was confirmed by postoperative angiography or magnetic resonence angiography(MRA) in all case except four cases. Of the 72 patients with patiency of bypass, 68 patients(94%) have had an excellent to good outcome with improvement of preoperative neurologic or cognitive dysfunction, 3 patients showed no improvement of preoperative neurologic symptoms and remaining one patient had new developed deficit. All 72 patients with patency of bypass had experienced no further cerebral ischemic events during following period. Postoperative significant improvement of CBF to acetazolamide was showed in 68 cases(94%) of the 72 cases with patency of bypass, while the basal CBF showed significant improved in 31cases. Postoperative permanent neurologic deficit occurred only in one. In view of these finding, the author suggest that EC-IC bypass surgery is a reliable and resonably safe method for establishing new pathways of collateral circulation to the brain and to be considered as an appropriate therapy for improvement of the cerebrovascular reserve capacity in patients with hemodynamic cerebral ischemia, defined using the strict selection criteria employed in this study.
Acetazolamide
;
Angiography
;
Brain
;
Brain Ischemia
;
Collateral Circulation
;
Constriction, Pathologic
;
Follow-Up Studies
;
Hemodynamics
;
Humans
;
Neurologic Manifestations
;
Patient Selection
;
Prospective Studies
;
Radial Artery
;
Saphenous Vein
;
Stroke
;
Transplants
2.A Case of Intramedullary Cysticercosis in Thoracic Cord.
Hyoung Kyun RHA ; Moon Chan KIM ; Joon Ki KANG ; Jin Un SONG
Journal of Korean Neurosurgical Society 1981;10(2):659-664
A rare case of intramedullary Cysticercosis, at the thoracic cord is introduced which was misdiagnosed as intramedullary tumor and was confirmed after operation. After myelogram developed progressive paraplegia, which was not improved after operation. The myelographic finding of intramedullary Cysticercosis can't differenciate from intramedullary tumor and we have to consider this condition making diagnosis of intramedullary tumor.
Cysticercosis*
;
Diagnosis
;
Paraplegia
3.Microvascular Decompression for Hemifacial Spasm.
Chang Rak CHOI ; Hyoung Kyun RHA ; Kyung Jin LEE ; Kyung Keun CHO ; Sung Chan PARK ; Hae Kwan PARK ; Jung Ki CHO
Journal of Korean Neurosurgical Society 1999;28(4):493-497
The authors analysed the results of 300 microvascular decompression(MVD) procedures for hemifacial spasm. The follow up period ranged from 6months to 3years. Of these, 70% were women(mean age 54). The vessel most frequently found to compress the facial nerve was the posterior inferior cerebellar artery(43.3%) followed by anterior inferior cerebellar artery(26.7%). For the surgical results, 210 patients(70%) had complete relief of spasm within 3 days after MVD, 65 patients(21.7%) subsequently experienced complete relief, noted in 4 days to 6 months after MVD, ten patients had delayed partial relief and remaining 15 patients showed no improvement. Twelve patients of these 15 unresponsive patients underwent reoperation without beneficial results. Recently the authors have monitored facial elctromyography(EMG) intraoperatively to observe the abnormal late response. There were few cases of permanant major complications, including two cases of ipsilateral hearing loss, ataxia and no operation-related death. These results suggest that MVD is a safe and definite treatment for hemifacial spasm, if performed by experienced surgeon with gentle operative technique, and with intraoperative monitoring such as auditory evoked potential and facial EMG, better surgical results with less complications can be expected.
Ataxia
;
Evoked Potentials, Auditory
;
Facial Nerve
;
Follow-Up Studies
;
Hearing Loss
;
Hemifacial Spasm*
;
Humans
;
Microvascular Decompression Surgery*
;
Monitoring, Intraoperative
;
Reoperation
;
Spasm
4.Revascularization in the Management of Complex Cerebral Aneurysm.
Hyoung Kyun RHA ; Seoung Lim KIM ; Won Il JOO ; Min Woo BAIK ; Dal Soo KIM ; Chang Rak CHOI
Korean Journal of Cerebrovascular Surgery 2003;5(2):137-142
The objective of aneurysm surgery is to exclude the aneurysm from the circulation while preserving blood flow distal to the lesion. In certain situations, the aneurysm neck cannot be clipped safely or the parent vessel reconstructed, primarily in large or giant size with incorporation of parent vessels or perforating arteries, calcification at the aneurysm base, and fusiform or dissecting aneurysms. In such cases, occlusion of the parent vessel is a treatment of option. In many patients, however, sacrifice of the parent artery has an associated risk of ischemic stroke. Therefore, sacrifice of the parent vessel can be supplimented with distal revascularization to provide the necessary distal blood flow while allowing the aneurysm to be trapped. The indications, options, and surgical approaches are described with review of literatures. Finally the authors' experiences of revascularization in 7 patients with unclippable aneurysms are reported.
Aneurysm
;
Aneurysm, Dissecting
;
Arteries
;
Humans
;
Intracranial Aneurysm*
;
Neck
;
Parents
;
Stroke
5.Primary Occipital Malignant Melanoma.
Jong Yang OH ; Won Il JOO ; Hyoung Kyun RHA ; Young Woo KIM
Journal of Korean Neurosurgical Society 2007;41(1):39-42
Primary intracranial melanoma is uncommon. These tumors most commonly occur at the temporal lobe, cerebellum and cerebellopontine angle. We report a case of intracranial malignant melanoma of the occipital lobe in a 60-year-old man who presented with headache and visual disturbance. The mass showed hyperintensity on T1-weighted images and hypointensity on T2-weighted magnetic resonance images. He underwent gross total removal of tumor and received radiotherapy. Followup imaging studies showed neither recurrence nor any signs of residual disease for 4 months.
Cerebellopontine Angle
;
Cerebellum
;
Follow-Up Studies
;
Headache
;
Humans
;
Melanoma*
;
Middle Aged
;
Occipital Lobe
;
Radiotherapy
;
Recurrence
;
Temporal Lobe
6.An Analysis of Follow up Results of 1500 Intracranial Ruptured Aneurysms with Surgery.
Chang Rak CHOI ; Hyoung Kyun RHA ; Kyoung Jin LEE ; Hae Kwan PARK ; Sung Chan PARK
Journal of Korean Neurosurgical Society 1998;27(3):309-314
The surgical results of 1500 patients with intracranial aneurysms operated in the neurosurgical department of our university hospital during the 17 year period from 1978 to 1994 were analysed with regard to the preoperative neurological status, preoperative CT findings and timing of surgical intervention. On the follow up examinations taken between 6 months to 9 years after operations, 1115 patients(74.3%) were classified as those having a good recovery, but 206 patients(13.7%) and 88 patients(5.9%) suffered some morbidity(fair and poor outcome respectively), and 91 patients(6.1%) died. Surgical results for the patients with good neurological status at admission were generally good: good outcome for the patients with Hunt and Hess grade 1 was 87.8% and that for those with grade 2 was 80.9%, while it was 29.6% and 6.7% for patients with grade 4 and 5, respectively. There was no difference of the rate of good outcome between early(0 to 3 days after bleeding) and late surgery(14 days or more after subarachnoid hemorrhage) groups, if poor graded cases were excluded from the early surgery group. Outcome was worse if the surgery was performed during the period between 4th and 10th days after initial bleeding. The major causes of unfavorable outcome(poor and dead) were initial hemorrhagic insults and delayed ischemic deficits. For further improvement of the overall surgical outcome, several factors must be concerned. First, early surgical intervention is recommended in good grade patients on admission but it should probably be delayed in patients with poor grades. Second, active management of poor grade patients should be scrutinized. Third, incidence of delayed ischemia may be lowered with positive consideration and preventive treatment towards vasospasm.
Aneurysm, Ruptured*
;
Follow-Up Studies*
;
Hemorrhage
;
Humans
;
Incidence
;
Intracranial Aneurysm
;
Ischemia
7.Stereotactic Radiosurgery with the CyberKnife for Pituitary Adenomas.
Chul Bum CHO ; Hae Kwan PARK ; Won Il JOO ; Chung Kee CHOUGH ; Kyung Jin LEE ; Hyoung Kyun RHA
Journal of Korean Neurosurgical Society 2009;45(3):157-163
OBJECTIVE: In recent years, CyberKnife has emerged as an important treatment modality in the management of pituitary adenomas. Treatment results after performing CyberKnife and the complications of this procedure are reviewed. METHODS: Twenty-six patients with pituitary adenomas received stereotactic radiosurgery with the CyberKnife (CKRS). The follow-up periods ranged from 7 months to 47 months (mean+/-SD : 30+/-12.7 months). The patients consisted of 17 with non-functioning adenomas, 3 with prolactinomas and 6 with acromegaly. The change in the tumor volume, visual acuity, hormonal function, and complications by this therapy were analyzed in each case. RESULTS: The tumor control rate was 92.3%. Hormonal function was improved in all of the 9 (100%) functioning adenomas. Hormonal normalization was observed in 4 of the 9 (44%) patients with a mean duration of 16 months. In two patients (7.6%), visual acuity worsened due to cystic enlargement of the tumor after CKRS. No other complications were observed. CONCLUSION: CyberKnife is considered safe and effective in selected patients with pituitary adenomas. However, longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.
Acromegaly
;
Adenoma
;
Follow-Up Studies
;
Humans
;
Pituitary Neoplasms
;
Prolactinoma
;
Radiosurgery
;
Treatment Outcome
;
Tumor Burden
;
Visual Acuity
8.Management of the Extracranial and Intracranial Traumatic Arterial Lesions.
Young Hoon PI ; Hyoung Kyun RHA ; Kyung Jin LEE ; Hea Kwan PARK ; Jeong Gi CHO ; Min Woo BAEK ; Dal Soo KIM ; Mun Chan KIM ; Chang Rak CHOI
Journal of Korean Neurosurgical Society 2002;32(3):211-216
OBJECTIVE: This study is designed to elucidate the requirements for angiographic evaluation and the selection of appropriate therapeutic approaches in patients who had strongly suggestive traumatic carotid arterial lesions. METHODS: Ten cases of traumatic internal carotid arterial lesions were analysed in this study. Injury mechanisms, neurological status, computed tomography scans, pre-and postoperative angiograms, and methods and results of the treatment were included. RESULTS: Of 10 cases, carotid-cavernous fistula(CCF) alone in three, CCF with intracranial pseudoaneurysms in three, pseudoaneurysm with dissection in one, extracranial internal carotid artery thrombosis in one, extracranial pseudoaneurysm in one, and the remaining one had all of the CCF, intracranial pseudoaneurysm and dissection. Seven of these 10 cases had sphenoid sinus wall fractures and six had subarachnoid hemorrhage. Six cases were treated with endovascular techniques, and four with direct parent artery occlusion and bypass surgery. No postoperative morbidity or additional permanent neurological deficits occurred except one patient who suffered from reperfusion hemorrhage after bypass surgery. CONCLUSION: Head trauma patients with facial bone fractures and thick subarachnoid hemorrhage should be evaluated for the development of traumatic injuries to the carotid artery as soon as possible. Endovascular treatment to these lesions have come to play an increasing role. Patients with traumatic internal carotid artery lesions who do not tolerate test occlusion require extracranial to intracranial bypass surgery before occlusion.
Aneurysm, False
;
Arteries
;
Carotid Arteries
;
Carotid Artery Thrombosis
;
Carotid Artery, Internal
;
Craniocerebral Trauma
;
Endovascular Procedures
;
Facial Bones
;
Hemorrhage
;
Humans
;
Parents
;
Reperfusion
;
Sphenoid Sinus
;
Subarachnoid Hemorrhage
9.Prevalence and Epidemiological Features of Moyamoya Disease in Korea.
Sang Hyuk YIM ; Chul Bum CHO ; Won Il JOO ; Chung Kee CHOUGH ; Hae Kwan PARK ; Kyung Jin LEE ; Hyoung Kyun RHA
Journal of Cerebrovascular and Endovascular Neurosurgery 2012;14(2):75-78
OBJECTIVE: The objectives of the present study were to investigate the annual detection rate of patients with Moyamoya disease (MMD) and to describe the prevalence and epidemiological features of the Moyamoya patients in Korea. MATERIALS AND METHODS: The authors analyzed the epidemiological data of Korean patients taken from the National Health Insurance Corporation in Korea among Moyamoya patients who were treated from 2004 until 2008. RESULTS: Based on 2004 data, 2,539 MMD patients were treated in Korea and the prevalence rate was 5.2 per 100,000 people. There were 2,987 in 2005, 3,429 in 2006, 4,051 in 2007, and 4,517 cases in 2008, and the prevalence rates per 100.000 people were 6.3, 7.0, 8.6, and 9.1, for those respective years. This represents an annual increase of 15% of new cases during this period. In 2008, 466 people were newly diagnosed with MMD, representing an incidence rate of 1 per 100,000 persons. The gender ratio was 1,547 men (34%) and 2,970 women (66%). Women had a higher incidence rate than men (1.94 times). There were two age peaks: teenagers and those in their forties. CONCLUSION: The present study shows that the number of Moyamoya patients in Korea is increasing. This increase could partly be explained by a recent increase in newly diagnosed cases, suggesting that a more careful consideration of the disease and better diagnostic techniques should be promoted among clinicians.
Adolescent
;
Female
;
Humans
;
Incidence
;
Korea
;
Male
;
Moyamoya Disease
;
National Health Programs
;
Prevalence
10.Fractionated Stereotactic Radiation Therapy Using Linear Accolerator in Brain Tumor and Arteriovenous Malformation.
Kyung Jin LEE ; Jung Ki CHO ; Hae Kwan PARK ; Sung Chan PARK ; Kyung Keun CHO ; Hyoung Kyun RHA ; Il Bong CHOI ; In Ah KIM ; Ji Young JANG ; Joon Ki KANG ; Chang Rak CHOI
Journal of Korean Neurosurgical Society 1999;28(6):802-808
With a frame-based system, stereotactic dose of radiation is delivered to the target in one day. The patient is uncomfortable with a frame based system and the staff is forced to produce a treatment plan under time pressure. And then a single dose of radiation is delivered. Our frameless fractionated conformal stereotactic radiotherapy system uses markers, permanently placed in the head. There is more time to prepare and perform the treatment. The point reference system is a frameless system, allowing a separation in time between all of the steps in a stereotactic procedure. And these reference points allow physician precisely to set up the patient again and again. Our system is made to spare normal cells within target volume by fractionating the tumor dose. We have treated 43 patients with multifraction regimen using 6-MV linear accelerator. All patient tolerated the treatment well and no significant complication were seen. Although small in number experienced, this technique seems to be feasible and safe for treating brain tumor and vascular malformation.
Arteriovenous Malformations*
;
Brain Neoplasms*
;
Brain*
;
Head
;
Humans
;
Particle Accelerators
;
Radiotherapy
;
Vascular Malformations