1.Midline Glioblastoma Multiforme With Bilateral Symmetric Cysts.
Hai Ong LEE ; Eun Jeong KOH ; Young Min OH ; Ha Young CHOI
Journal of Korean Neurosurgical Society 2008;43(2):105-108
Cystic glioblastoma multiforme (GBM) is a rare disease. Its exact prevalence has not yet been reported. Also, the mechanism of cyst formation remains to be elucidated. We report a case of GBM with a large peripheral cyst. A 43-year-old woman visited our clinic with a 3-month history of severe headache, memory impairment and general weakness. T1-weighted gadolinium-enhanced magnetic resonance (MR) image revealed a midline enhanced solid mass and bilateral symmetric banana-shaped peripheral cysts. A centrally enhanced mass was measured 2x4 cm in size and both mass and cysts as 7x7 cm. Both the frontal lobe and the frontal horn were severely compressed inferiorly and posteriorly. We resected a midline solid tumor and cysts via the bilateral interhemispheric transcortical approach. Histopathologic examination revealed GBM. The patient was subsequently treated with fractionated conventional brain radiation therapy, followed by temozolomide chemotherapy. Eighteen months later, there was no tumor recurrence and no neurological deficits were noted. Our patient showed no tumor recurrence and a long survival at a long follow-up.
Adult
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Animals
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Brain
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Dacarbazine
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Female
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Follow-Up Studies
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Frontal Lobe
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Glioblastoma
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Headache
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Horns
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Humans
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Magnetic Resonance Spectroscopy
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Memory
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Prevalence
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Prognosis
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Rare Diseases
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Recurrence
2.Diagnostic Usefulness of High Resolution Cross Sectional MRI in Symptomatic Middle Cerabral Arterial Dissection.
Hai Ong LEE ; Hyo Sung KWAK ; Gyung Ho CHUNG ; Seung Bae HWANG
Journal of Korean Neurosurgical Society 2011;49(6):370-372
Dissection of the middle cerebral artery (MCA) is less frequent compared with dissection of the vertebrobasilar system or carotid artery. Recently, high-resolution cross sectional MR imaging (HRMRI) has emerged as a potential technique for atherosclerotic plaque imaging in MCA. We introduce the findings of HRMRI in a 56-year-old woman with traumatic MCA dissection. HRMRI showed an intimal flap and tapered pseudolumen with intraluminal hemorrhage. We performed stent deployment about MCA dissection after failed medical treatment. Three months later, there was no in-stent restenosis and no further neurological deficit were noted.
Carotid Arteries
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Female
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Hemorrhage
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Humans
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Magnetic Resonance Imaging
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Middle Aged
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Middle Cerebral Artery
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Plaque, Atherosclerotic
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Stents
3.Emergency Carotid Artery Stent Insertion for Acute ICA Occlusion.
Hai Ong LEE ; Eun Jeong KOH ; Ha Young CHOI
Journal of Korean Neurosurgical Society 2010;47(6):428-432
OBJECTIVE: An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. METHODS: Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. RESULTS: Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. CONCLUSION: Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.
Carotid Arteries
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Carotid Artery, Internal
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Carotid Stenosis
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Cerebral Hemorrhage
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Cerebral Infarction
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Constriction, Pathologic
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Emergencies
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Glasgow Outcome Scale
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Humans
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National Institutes of Health (U.S.)
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Neurologic Manifestations
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Recurrence
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Stents
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Stroke
4.Effect of Vagus Nerve Stimulation in Post-Traumatic Epilepsy and Failed Epilepsy Surgery : Preliminary Report.
Hai Ong LEE ; Eun Jeong KOH ; Young Min OH ; Seung Soo PARK ; Ki Hun KWON ; Ha Young CHOI
Journal of Korean Neurosurgical Society 2008;44(4):196-198
OBJECTIVE: Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. METHODS: We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. RESULTS: We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. CONCLUSION: We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.
Brain Injuries
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Electric Stimulation
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Epilepsy
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Epilepsy, Post-Traumatic
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Follow-Up Studies
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Humans
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Seizures
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Vagus Nerve
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Vagus Nerve Stimulation
5.Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion
Isabel SIOW ; Benjamin Y.Q. TAN ; Keng Siang LEE ; Natalie ONG ; Emma TOH ; Anil GOPINATHAN ; Cunli YANG ; Pervinder BHOGAL ; Erika LAM ; Oliver SPOONER ; Lukas MEYER ; Jens FIEHLER ; Panagiotis PAPANAGIOTOU ; Andreas KASTRUP ; Maria ALEXANDROU ; Seraphine ZUBEL ; Qingyu WU ; Anastasios MPOTSARIS ; Volker MAUS ; Tommy ANDERSON ; Vamsi GONTU ; Fabian ARNBERG ; Tsong Hai LEE ; Bernard P.L. CHAN ; Raymond C.S. SEET ; Hock Luen TEOH ; Vijay K. SHARMA ; Leonard L.L. YEO
Journal of Stroke 2022;24(1):128-137
Background:
and Purpose Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.
Methods:
This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0–3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).
Results:
Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not asComorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).
Conclusions
Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.