OBJECTIVE: The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis. METHODS: A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets. RESULTS: Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild. CONCLUSION: In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.
Humans ; Incidence ; Neoplasm Metastasis ; Neoplasm, Residual ; Prevalence ; Radiation Tolerance ; Radiosurgery ; Reoperation ; Spinal Cord ; Spine

OBJECTIVE: We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. METHODS: From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. RESULTS: Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. CONCLUSION: Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.
Arachnoid ; Cerebellum ; Deglutition Disorders ; Dysarthria ; Follow-Up Studies ; Foramen Magnum* ; Humans ; Membranes ; Meningioma* ; Recurrence ; Spinal Cord

Introduction of western surgery into Korea is closely related to the introduction of western medicine itself into Korea. In December 4th, 1884 Allen, who came to Korea as a Missionary Doctor of North Presbyterian Church of America, had a chance to treat a patient with severe stab wounds. The patient was a nephew of Queen Myungsung. The paitent, Min Young Ik was recovered completely. These happenings led to the establishment of 'Kwangheywon (renamed to Jejoongwon 2 weeks later)', the first westernized hospital in Korea. With the great financial aids from Severance family, Jejoongwon developed into Severance Hospital and Medical School in 1904, and greatly contributed to education of Surgery for Korean medical students. Meanwhile Korean Government established the Medical School and Hospital to train Korean Doctors in 1899. But the original intentions became to be impaired by occupation of Korea by Japan in 1910. As a colony, many Japanese Surgeons came to Korea as a professors of Kyungsung Medical College, and gave only few chances for Koreans to became a professor. On the contrary, several surgeons became professors in the private, missionary 'Severance Union Medical College'. After liberation from Japanese occupation in 1945, American medical system was introduced into Korea, and many surgeons had a chance to be trained in America. There were great advancements in the field of surgery, especially of neurosurgery, during a tragic Korean War. With the restoration of economy after 1960s, surgery in Korea continued to develop toward an independent and consolidated fields of medicine.
Colonialism/*history ; English Abstract ; History of Medicine, 19th Cent. ; History of Medicine, 20th Cent. ; History of Medicine, 21st Cent. ; Japan ; Korea ; Missions and Missionaries/*history ; Surgery/*history ; United States ; War/*history ; Western World/*history

There are a number of complications associated with ventriculoperitoneal shunt (VPS) surgery. The authors present a rare case of iatrogenic common carotid artery injury during VPS surgery.
Carotid Artery, Common* ; Ventriculoperitoneal Shunt*

Chondromas are benign tumor of cartilaginous tissue that is rarely found in spine. The authors document a rare case of a 72 year old male patient with a cervical spinal chondroma compressing the spinal cord. The patient had symptoms of motor and sensory deficits, dysphagia and dysarthria. C1 and C2 laminotomy was done and the spinal tumor was removed. The patient gradually recovered from his previous symptom after the surgery.
Chondroma* ; Deglutition Disorders ; Dysarthria ; Humans ; Laminectomy ; Male ; Spinal Cord* ; Spine*

OBJECTIVE: This 2009–2011 nation-wide study of adult Koreans was aimed to provide characteristics, medical utilization states, and survival rates for newly diagnosed patients with primary nonmalignant and malignant spine tumors. METHODS: Data for patients with primary spine tumors were selected from the Korean Health Insurance Review and Assessment Service database. The data included their age, sex, health insurance type, co-morbidities, medical cost, and hospital stay duration. Hospital stay duration and medical costs per person occurring in one calendar year were used. In addition, survival rates of patients with primary malignant spine tumors were evaluated. RESULTS: The incidence rate of a primary spine tumor increased with age, and the year of diagnosis (p≤0.0001). Average annual medical costs ranged from 1627 USD (pelvis & sacrum & coccyx tumors) to 6601 USD (spinal cord tumor) for primary nonmalignant spine tumor and from 12137 USD (spinal meningomas) to 20825 USD (pelvis & sacrum & coccyx tumors) for a primary malignant spine tumor. Overall survival rates for those with a primary malignant spine tumor were 87.0%, 75.3%, and 70.6% at 3, 12, and 24 months, respectively. The Cox regression model results showed that male sex, medicare insurance were significantly positive factors affecting survival after a diagnosis of primary malignant spine tumor. CONCLUSION: Our study provides a detailed view of the characteristics, medical utilization states, and survival rates of patients newly diagnosed with primary spine tumors in Korea.
Adult* ; Coccyx ; Diagnosis ; Epidemiologic Studies* ; Epidemiology ; Humans ; Incidence ; Insurance ; Insurance, Health ; Korea ; Length of Stay ; Male ; Medicare ; Sacrum ; Spine* ; Survival Rate

OBJECTIVE: The aim of this multicenter, matched-pair study was to compare the outcomes of stereotactic radiosurgery (SRS) and conventional external radiation therapy (RT) when used as a primary treatment in spine metastasis from hepatocellular carcinoma (HCC). METHODS: From 2005 to 2012, 28 patients underwent SRS as the primary treatment in spine metastasis from HCC. Based on sex, age, number of spine metastasis, Child-Pugh classification, interval from original tumor to spine metastasis, and year of treatment, 28 patients who underwent RT were paired. Outcomes of interest were pain relief, progression free survival, toxicities, and further treatment. RESULTS: The perioperative visual analog scale (VAS) decrease was larger in SRS group than in RT group, but the difference was not significant (3.7 vs. 2.8, p=0.13). When pain medication was adjusted, the number of patients with complete (n=6 vs.3) or partial (n=12 vs.13) relief was larger in SRS group than in RT group; however, the difference was not significant (p=0.83). There was no significant difference in progression free survival (p=0.48). In SRS group, 32.1% of patients had 1 or more toxicities whereas the percentage in RT group was 63.0%, a significant difference (p=0.04). Six SRS patients and 7 RT patients received further intervention at the treated segment. CONCLUSION: Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.
Carcinoma, Hepatocellular* ; Classification ; Disease-Free Survival ; Humans ; Neoplasm Metastasis* ; Radiosurgery* ; Spine* ; Visual Analog Scale

OBJECTIVE: The aim of this nationwide study was to analyze the current state of patients with newly diagnosed metastatic spine tumors according to surgical methods.METHODS: Data was extracted from the Korean Health Insurance Review and Assessment Service database. Surgery was categorized into three methods : fusion, decompression, and vertebroplasty. Data included patient age, sex, health insurance type, and co-morbidities. Survival rates of metastatic spine tumor patients according to each surgical method were evaluated.RESULTS: Among 1677 patients who had an operation, 823 patients were treated by fusion, 141 patients underwent decompression, and 713 patients were treated by vertebroplasty. The three most prevalent primary tumor sites were the lung, breast, and liver & biliary. On the other hand, the three most prevalent primary tumor sites of patients who underwent surgery were the lung, liver & biliary, and the prostate. The median survival periods for each surgical method in the metastatic spine tumor patients were 228 days for those who underwent surgery, 249 days for decompression, and 154 days for vertebroplasty. Age, sex, and comorbidities significantly affected survival rate.CONCLUSION: For every primary tumor site, decompression was the least common surgical method during the study period. Although the three surgical methods did not significantly affect the survival period, patients with a poor prognosis tended to undergo vertebroplasty.
Breast ; Comorbidity ; Decompression ; Hand ; Humans ; Insurance, Health ; Liver ; Lung ; Methods ; Neoplasm Metastasis ; Prognosis ; Prostate ; Spine ; Survival Rate ; Vertebroplasty

In patients with nonvalvular atrial fibrillation (AF), the risk of stroke varies considerably according to individual clinical status. The CHA2DS2-VASc score is better than the CHADS2 score for identifying truly lower risk patients with AF. With the advent of novel oral anticoagulants (NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety and convenience compared with warfarin. Furthermore, new aspects of antithrombotic therapy and risk assessment of stroke have been revealed: the efficacy of stroke prevention with aspirin is weak, while the risk of major bleeding is not significantly different from that of oral anticoagulant (OAC) therapy, especially in the elderly. Reflecting these pivotal aspects, previous guidelines have been updated in recent years by overseas societies and associations. The Korean Heart Rhythm Society has summarized the new evidence and updated recommendations for stroke prevention of patients with nonvalvular AF. First of all, antithrombotic therapy must be considered carefully and incorporate the clinical characteristics and circumstances of each individual patient, especially with regards to balancing the benefits of stroke prevention with the risk of bleeding, recommending the CHA2DS2-VASc score rather than the CHADS2 score for assessing the risk of stroke, and employing the HAS-BLED score to validate bleeding risk. In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2-3) or NOACs, is recommended for patients with a CHA2DS2-VASc score > or =2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy could be permitted.
Aged ; Anticoagulants ; Aspirin ; Atrial Fibrillation* ; Heart* ; Hemorrhage ; Humans ; Patient Preference ; Risk Assessment ; Stroke ; Warfarin

Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrioventricular Block ; Bundle-Branch Block ; Catheter Ablation ; Defibrillators ; Follow-Up Studies ; Humans ; Korea ; Male ; Observational Study ; Retrospective Studies ; Sick Sinus Syndrome ; Syncope ; Tachycardia