Previously, we reported the concept of a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local emergency rooms in rural and medically underserved areas in Gangwon state by combining artificial intelligence and remote consultation with a neurosurgeon. Developing a telemedicine ICH treatment protocol exclusively for doctors with less ICH expertise working in emergency rooms should be part of establishing this system. Difficulties arise in providing appropriate early treatment for ICH in rural and underserved areas before the patient is transferred to a nearby hub hospital with stroke specialists. This has been an unmet medical need for decade. The available reporting ICH guidelines are realistically possible in university hospitals with a well-equipped infrastructure. However, it is very difficult for doctors inexperienced with ICH treatment to appropriately select and deliver ICH treatment based on the guidelines. To address these issues, we developed an ICH telemedicine protocol. Neurosurgeons from four university hospitals in Gangwon state first wrote the guidelines, and professors with extensive ICH expertise across the country revised them. Guidelines and recommendations for ICH management were described as simply as possible to allow more doctors to use them easily. We hope that our effort in developing the telemedicine protocols will ultimately improve the quality of ICH treatment in local emergency rooms in rural and underserved areas in Gangwon state.

We aimed to develop a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local hospitals in rural and underserved areas in Gangwon-do using artificial intelligence and non-face-to-face collaboration treatment technology. This is a prospective and multi-center development project in which neurosurgeons from four university hospitals in Gangwondo will participate. Information technology experts will verify and improve the performance of the cloud-based telemedicine collaboration platform while treating ICH patients in the actual medical field. Problems identified will be resolved, and the function, performance, security, and safety of the telemedicine platform will be checked through an accredited certification authority. The project will be carried out over 4 years and consists of two phases. The first phase will be from April 2022 to December 2023, and the second phase will be from April 2024 to December 2025. The platform will be developed by dividing the work of the neurosurgeons and information technology experts by setting the order of items through mutual feedback. This article provides information on a project to develop a cloud-based telemedicine platform for acute ICH patients in Gangwon-do.

OBJECTIVE: The increasing use of sensitive neuroimaging techniques has demonstrated that significant percentage of patients with intractable complex partial seizures have brain masses, especially in temporal lobe. The optimal surgical solution for these patients is still open to debate. The purpose of our investigation is to evaluate the surgical outcome of patient with lesion-related temporal lobe epilepsy with respect to the types of surgery and the location of lesion. PATIENTS AND METHODS: From DEC. 1993 to Dec. 1997, 35 patients with intractable epilepsy and space occupying temporal lobe lesion identified in preoperative MRI were included in this study. The types of surgery were lesionectomy, anterior temporal lobectomy with or without hippocampectomy. The location of lesion was divided as anteromedial group and lateral cortical group. The postoperative seizure outcomes according to the type of surgery and location of the lesion were compared. RESULTS: Twenty-six of 34 patients(76.5%) were seizure-free after surgery. The Engel's class was favorable after anterior temporal lobectomy with or without hippocampectomy(p=.044). CONCLUSION: It is favorable to perform anterior temporal lobectomy for the treatment of intractable epilepsy with space-occipying lesion in temporal lobe. The resection of the hippocampus can be individualized.
Anterior Temporal Lobectomy ; Brain ; Epilepsy ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Seizures* ; Temporal Lobe*

OBJECTIVE: Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. METHODS: This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. RESULTS: There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. CONCLUSION: The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.
Distance Perception ; Drainage ; Endoscopes ; Endoscopy* ; Follow-Up Studies ; Humans ; Nasal Cavity ; Pituitary Neoplasms* ; Postoperative Complications ; Radiosurgery ; Reoperation

Vertebral artery injury is a rare complication of anterior cervical approach. We report two patients who suffered injury to vertebral artery during anterior cervical spine surgery. The mechanism of injury, their operative management, and the subsequent outcome were assessed and relevant literatures reviewed. The awareness of the possibility of vertebral artery injury is most important to prevent and it's occurrence is best avoided by a thorough understanding of the anatomical relationships of the artery, the spinal canal, and the vertebral body and careful use of surgical instruments.
Arteries ; Humans ; Spinal Canal ; Spine* ; Surgical Instruments ; Vertebral Artery*

OBJECTIVE: This study was undertaken to review the mortality, complications, risk factors and the surgical outcome in long-term follow-up cases of brain abscess. METHODS: The authors studied medical records and radiological findings in patients with brain abscess who underwent operations in our hospital from 1990 to 1997. RESULTS: There were 44 cases and the ratio of male to female was 32:12 which shows predominance in male. The ages of patients ranged from 2 to 73(average: 40). Lesions were located at frontal lobe in 16 cases, temporal in 8, parietal in 7, occipital in 5, cerebellum in 6, and multiple in 2. The ranges of follow-up periods were from 1 month to 96 months(average: 20.5 months). The primary origins of infection were found in only 15 cases(34%) and in 32 cases(73%), the organisms were identified from culture. The operative modalities were as follows; abscess aspiration (stereotactic or sono-guided) in 42 times and abscess excision in 13 times. There were 2 operations in 7 cases and 3 in 2 cases. In 2 cases, recurrences were occurred during antibiotics therapy after first operation. Three patients(6.8%) died due to sepsis in 2 cases, increased intracranial pressure in 1 case. We analysed 19 cases who were followed-up more than 12 months. In this group, there were intermittent seizures in 2 cases, antibiotics(metronidazole) induced polyneuropathy in 1 case, and avascular necrosis of hip in 2 cases which were suspected to have relation to long-term high dose steroid therapy. But there were no other sequalae or neurological deficits. CONCLUSION: The complication rate from long-term follow-up was high(26%) but the mortality rate was low(6.8%). Additionally, the findings such as multiple lesions, empyema, and fungal infection are suspected to be risk factors in mortality cases.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Cerebellum ; Empyema ; Female ; Follow-Up Studies ; Frontal Lobe ; Hip ; Humans ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Necrosis ; Polyneuropathies ; Rabeprazole ; Recurrence ; Risk Factors ; Seizures ; Sepsis

Moyamoya disease is a cerebrovascular disease of unknown etiology which leads to spontaneous occlusion of circle of Willis. Cerebral ischemic or hemorrhagic episodes occur as moyamoya disease progresses. To establish an efficient collateral circulation for the ischemic brain of this disease many surgical the therapeutic methods have been proposed. We analyzed the surgical results of encephaloduroarteriomyosynangiosis(EDAMS) and compared with that of direct bypass surgery, superfical temporal artery to middle ce rebral artery(STA-MCA) anastomosis to determine the efficacy of new indirect revascularization procedure, EDAMS, in the treatment of moyamoya disease. Twenty three patients with moyamoya disease who underwent revascularization procedure were included in this study. EDAMS was performed on 18 sides in 16 patients and STA-MCA anastomosis was done on 12 sides in 7 patients. Two patients underwent encephaloduroarteriosynangiosis(EDAS). The surgical results of EDAMS were excellent to good in 14 patients and fair in 2 patients. No statistical significance of the outcome was observed in comparision of EDAMS and STA-MCA anastomosis(p-value=0.471). Regardless of surgical procedures, outcome of child-onset moyamoya disease was found to be superior to those of adult-onset moyamoya disease(p-delete=0.024). In conclusion, EDAMS is considered to be one of the effective indirect revascularization methods to prevent the ischemic attack and establish the revascularization for moyamoya disease.
Brain ; Circle of Willis ; Collateral Circulation ; Humans ; Moyamoya Disease ; Temporal Arteries

The authors analyzed the surgical results of posterior C1-C2 fusion in 18 cases of atlantoaxial instability. Posterior C1-C2 wiring with bone fusion(11 cases), C1-C2 transarticular screw fixation(6 cases), and occipitocervical fusion(1 case) have been performed for unstable odontoid process fractures(10 cases), transverse ligament injury(4 cases), os odontoideum(3 cases), rheumatoid C1-2 instability(1 case). Follow-up examination was performed in all patientts after a mean postoperativeduration of 39.9 months. Follow-up x-rays showed successful stabilization in 17 cases(94%). Postoperative neurological evaluation showed improvement in 16 cases(89%), stabilization in 2 cases(11%) and there was no major operative complication.
Follow-Up Studies ; Ligaments ; Odontoid Process

Leiomyoma is a neoplasm of smooth muscle relatively common in the stomach, but very rare in the duodenal location. Recurrent bouts of severe melana remain the most frequent presenting symptom for leiomyoma. A 69-year-old man presented to us with a 4-day history of melena. Endoscopy revealed norinal mucosa covered ovoid elevated lesion with central linear depression and ulcer at the second portion of duodenum. Endoscopic biopsy showed chronic inflammation only. Duodenal mass was excised through a duodenotomy. Pathological diagnosis was leiomycena.
Aged ; Biopsy ; Depression ; Diagnosis ; Duodenum ; Endoscopy ; Esophagus* ; Hemorrhage* ; Humans ; Inflammation ; Intestines* ; Leiomyoma* ; MART-1 Antigen ; Melena ; Mucous Membrane ; Muscle, Smooth ; Stomach* ; Ulcer

Malignant CNS lymphoma is a malignant intracranial tumor and in most cases they run a fulminating course if left untreated, with 3 to 5 months survival after appearance of the initial symptoms. Sixteen patients with malignant lymphoma were treated in Asan Medical Center from 1989 to 1994. All patients were underwent tissue diagnosis with subtotal resection or stereotactic biopsy and followed by cranial or craniospinal irradiation with or without systemic chemotherapy. One and three year survival rate of the patients was 88% and 78% respectively. In conclusion, addition of chemotherapy and/or cranial radiation for treatment of the CNS lymphoma may improve survival.
Biopsy ; Chungcheongnam-do ; Craniospinal Irradiation ; Diagnosis ; Drug Therapy ; Humans ; Lymphoma* ; Survival Rate