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Article: Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy.

Im, Sang-Hyuk / Yoo, Do-Sung / Park, Hae-Kwan

2024 Volume 67, Issue 2, Page(s) 227–236

Abstract: Objective: Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent ...

Abstract	Objective: Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction. Methods: This analysis included 67 patients with major anterior circulation major infarction who underwent DC after IA-Tx, with or without intravenous tissue plasminogen activator. We retrospectively reviewed the medical records, radiological findings, and compared the neurological outcomes based on the "surgical time window" and neurological status at the time of surgery. Results: For patients treated with DC following IA-Tx, a Glasgow coma scale (GCS) score of 7 was the lowest score correlated with a favorable outcome (p=0.013). Favorable outcomes were significantly associated with successful recanalization after IA-Tx (p=0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p=0.007). However, the surgical time window (within 36 hours, p=0.389; within 48 hours, p=0.283) did not correlate with neurological outcomes. Conclusion: To date, early DC surgery after major infarction is crucial for patient outcomes. However, this study suggests that the indication for DC following IA-Tx should include neurological status (GCS ≤7), as some patients treated with early DC without considering the neurological status may undergo unnecessary surgery. Recanalization of the occluded vessel and P/D-mismatch are important for long-term neurological outcomes.
Language	English
Publishing date	2024-01-04
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2023.0130
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Article: Recanalization Rate and Clinical Outcomes of Intravenous Tissue Plasminogen Activator Administration for Large Vessel Occlusion Stroke Patients.

Lee, Min-Hyung / Im, Sang-Hyuk / Jo, Kwang Wook / Yoo, Do-Sung

Journal of Korean Neurosurgical Society

2023 Volume 66, Issue 2, Page(s) 144–154

Abstract: Objective: Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as ... ...

Abstract	Objective: Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods: Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results: Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0-2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, nonrecanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/ D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion: The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.
Language	English
Publishing date	2023-02-27
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2022.0120
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Article: Changes in Blood Pressure and Heart Rate during Decompressive Craniectomy.

Jo, Kwang Wook / Jung, Hyun-Ju / Yoo, Do Sung / Park, Hae-Kwan

Journal of Korean Neurosurgical Society

2021 Volume 64, Issue 6, Page(s) 957–965

Abstract: Objective: Rapid increase in intracranial pressure (ICP) can result in hypertension, bradycardia and apnea, referred to as the Cushing phenomenon. During decompressive craniectomy (DC), rapid ICP decreases can cause changes in mean atrial blood pressure ...

Abstract	Objective: Rapid increase in intracranial pressure (ICP) can result in hypertension, bradycardia and apnea, referred to as the Cushing phenomenon. During decompressive craniectomy (DC), rapid ICP decreases can cause changes in mean atrial blood pressure (mABP) and heart rate (HR), which may be an indicator of intact autoregulation and vasomotor reflex. Methods: A total of 82 patients who underwent DC due to traumatic brain injury (42 cases), hypertensive intracerebral hematoma (19 cases), or major infarction (21 cases) were included in this prospective study. Simultaneous ICP, mABP, and HR changes were monitored in one minute intervals during, prior to and 5-10 minutes following the DC. Results: After DC, the ICP decreased from 38.1±16.3 mmHg to 9.5±14.2 mmHg (p<0.001) and the mABP decreased from 86.4±14.5 mmHg to 72.5±11.4 mmHg (p<0.001). Conversly, overall HR was no significantly changed in HR, which was 100.1±19.7 rate/min prior to DC and 99.7±18.2 rate/min (p=0.848) after DC. Notably when the HR increased after DC, it correlated with a favorable outcome (p<0.001), however mortality was increased (p=0.032) when the HR decreased or remained unchanged. Conclusion: In this study, ICP was decreased in all patients after DC. Changes in HR were an indicator of preserved autoregulation and vasomotor reflex. The clinical outcome was improved in patients with increased HR after DC.
Language	English
Publishing date	2021-11-01
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2020.0356
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Article: Clinical Significance of Decompressive Craniectomy Surface Area and Side.

Jo, KwangWook / Joo, Won Il / Yoo, Do Sung / Park, Hae-Kwan

Journal of Korean Neurosurgical Society

2020 Volume 64, Issue 2, Page(s) 261–270

Abstract: Objective: Decompressive craniectomy (DC) can partially remove the unyielding skull vault and make affordable space for the expansion of swelling brain contents. The objective of this study was to compare clinical outcome according to DC surface area ( ... ...

Abstract	Objective: Decompressive craniectomy (DC) can partially remove the unyielding skull vault and make affordable space for the expansion of swelling brain contents. The objective of this study was to compare clinical outcome according to DC surface area (DC area) and side. Methods: A total of 324 patients underwent different surgical methods (unilateral DC, 212 cases and bilateral DC, 112 cases) were included in this retrospective analysis. Their mean age was 53.4±16.6 years (median, 54 years). Neurological outcome (Glasgow outcome scale), ventricular intracranial pressure (ICP), and midline shift change (preoperative minus postoperative) were compared according to surgical methods and total DC area, DC surface removal rate (DC%) and side. Results: DC surgery was effective for ICP decrease (32.3±16.7 mmHg vs. 19.2±13.4 mmHg, p<0.001) and midline shift change (12.5±7.6 mm vs. 7.8±6.9 mm, p<0.001). The bilateral DC group showed larger total DC area (125.1±27.8 cm2 for unilateral vs. 198.2±43.0 cm2 for bilateral, p<0.001). Clinical outcomes were nonsignificant according to surgical side (favorable outcome, p=0.173 and mortality, p=0.470), significantly better when total DC area was over 160 cm2 and DC% was 46% (p=0.020 and p=0.037, respectively). Conclusion: DC surgery is effective in decrease the elevated ICP, decrease the midline shift and improve the clinical outcome in massive brain swelling patient. Total DC area and removal rate was larger in bilateral DC than unilateral DC but clinical outcome was not influenced by DC side. DC area more than 160 cm2 and DC surface removal rate more than 46% were more important than DC side.
Language	English
Publishing date	2020-12-07
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2020.0149
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Article: Temperature Difference between Brain and Axilla according to Body Temperature in the Patient with Brain Injury.

Oh, Jong-Yang / Jo, Kwangwook / Joo, Wonil / Yoo, Do-Sung / Park, Haekwan

Korean journal of neurotrauma

2020 Volume 16, Issue 2, Page(s) 147–156

Abstract: Objective: Commonly, brain temperature is estimated from measurements of body temperature. However, temperature difference between brain and body is still controversy. The objective of this study is to know temperature gradient between the brain and ... ...

Abstract	Objective: Commonly, brain temperature is estimated from measurements of body temperature. However, temperature difference between brain and body is still controversy. The objective of this study is to know temperature gradient between the brain and axilla according to body temperature in the patient with brain injury. Methods: A total of 135 patients who had undergone cranial operation and had the thermal diffusion flow meter (TDF) insert were included in this analysis. The brain and axilla temperatures were measured simultaneously every 2 hours with TDF (2 kinds of devices: SABER 2000 and Hemedex) and a mercury thermometer. Saved data were divided into 3 groups according to axillary temperature. Three groups are hypothermia group (less than 36.4°C), normothermia group (between 36.5°C and 37.5°C), and hyperthermia group (more than 37.6°C). Results: The temperature difference between brain temperature and axillary temperature was 0.93±0.50°C in all data pairs, whereas it was 1.28±0.56°C in hypothermia, 0.87±0.43°C in normothermia, and 0.71±0.41°C in hyperthermia. The temperature difference was statistically significant between the hypothermia and normothermia groups ( Conclusion: This study show that brain temperature is significantly higher than the axillary temperature and hypothermia therapy is associated with large brain-axilla temperature gradients. If you do not have a special brain temperature measuring device, the results of this study will help predict brain temperature by measuring axillary temperature.
Language	English
Publishing date	2020-10-21
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3028579-3
ISSN	2288-2243 ; 2234-8999
ISSN (online)	2288-2243
ISSN	2234-8999
DOI	10.13004/kjnt.2020.16.e40
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Article ; Online: Microsurgical anatomy of the facial nerve.

Yang, Seung H / Park, HaeKwan / Yoo, Do Sung / Joo, Wonil / Rhoton, Albert

Clinical anatomy (New York, N.Y.)

2020 Volume 34, Issue 1, Page(s) 90–102

Abstract: The facial nerve connections and pathways from the cortex to the brainstem are intricate and complicated. The extra-axial part of the facial nerve leaves the lateral part of the pontomedullary sulcus and enters the temporal bone through the internal ... ...

Abstract	The facial nerve connections and pathways from the cortex to the brainstem are intricate and complicated. The extra-axial part of the facial nerve leaves the lateral part of the pontomedullary sulcus and enters the temporal bone through the internal acoustic meatus. In the temporal bone, the facial nerve branches into fibers innervating the glands and tongue. After it emerges from the temporal bone it supplies various facial muscles. It contains a motor, general sensory, special sensory, and autonomic components. The physician needs comprehensive knowledge of the anatomy and courses of the facial nerve to diagnose and treat lesions and diseases of it so that surgical complications due to facial nerve injury can be avoided. This review describes the microsurgical anatomy of the facial nerve and illustrates its anatomy in relation to the surrounding bone, connective, and neurovascular structures.
MeSH term(s)	Facial Nerve/anatomy & histology ; Humans ; Microsurgery
Language	English
Publishing date	2020-08-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1025505-9
ISSN	1098-2353 ; 0897-3806
ISSN (online)	1098-2353
ISSN	0897-3806
DOI	10.1002/ca.23652
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Article: Effects of an Infection Control Protocol for Coronavirus Disease in Emergency Mechanical Thrombectomy.

Eun, Jin / Lee, Min-Hyung / Im, Sang-Hyuk / Joo, Won-Il / Ahn, Jae-Geun / Yoo, Do-Sung / Park, Hae-Kwan

Journal of Korean Neurosurgical Society

2021 Volume 65, Issue 2, Page(s) 224–235

Abstract: Objective: Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients ... ...

Abstract	Objective: Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time. Methods: The last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed. The recanalization time, success rate of mechanical thrombectomy, and modified Rankin score of patients at discharge were assessed. A multivariate analysis was conducted to identify variables that significantly influenced the time delay in the door-to-puncture time and total procedure time. Results: The door-to-imaging time significantly increased under the COVID-19 protection protocol (p=0.0257) compared to that with the conventional pre-COVID-19 protocol. This increase was even more pronounced in patients who were suspected to be COVID-19-positive than in those who were negative. The door-to-puncture time showed no statistical difference between the conventional and COVID-19 protocol groups (p=0.5042). However, in the multivariate analysis, the last-normal-to-door time and door-to-imaging time were shown to affect the door-to-puncture time (p=0.0068 and 0.0097). The total procedure time was affected by the occlusion site, last-normal-to-door time, door-to-imaging time, and type of anesthesia (p=0.0001, 0.0231, 0.0103, and 0.0207, respectively). Conclusion: The COVID-19 protection protocol significantly impacted the door-to-imaging time. Shortening the door-to-imaging time and performing the procedure under local anesthesia, if possible, may be required to reduce the door-to-puncture and doorto- recanalization times. The effect of various aspects of the protection protocol on emergency thrombectomy should be further studied.
Language	English
Publishing date	2021-12-10
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2021.0053
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Article ; Online: Contrast Media-Induced Nephropathy in Patients with Unruptured Cerebral Aneurysm After Coiling Endovascular Treatment.

Joo, Chunghee / Park, Eunhye / Min, Joo-Won / Kang, Hyun / Yoo, Do-Sung / Jung, Hyun Ju

World neurosurgery

2018 Volume 121, Page(s) e39–e44

Abstract: Background: The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have ... ...

Abstract	Background: The endovascular coiling procedure to treat cerebral aneurysms using contrast media has become more popular. However, studies of the incidence of, and risk factors for, contrast media-induced nephropathy (CIN) after coiling procedures have been limited. Thus, we evaluated the incidence and risk factors for CIN in patients who had undergone cerebral aneurysmal coiling procedures. Methods: We retrospectively reviewed the electric medical records of 380 patients who had undergone cerebral aneurysmal coiling treatment under general anesthesia. CIN was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or a relative increase (≥25%) in the baseline serum creatinine value at 48-72 hours after exposure to a contrast agent. Results: Elective cerebral aneurysmal coiling procedures were performed in 230 patients. Of the 230 patients, CIN developed in 13 (5.6%). The presence of diabetes mellitus (30.8% vs. 9.7%; P = 0.040) and patient age >75 years (30.8% vs. 6.5%; P = 0.012) were risk factors for CIN. Conclusions: Our study has demonstrated that the incidence of CIN in patients undergoing elective cerebral aneurysmal coiling procedures is ∼6.0%. We also identified underlying diabetes mellitus and advanced age (≥75 years) as potential risk factors.
MeSH term(s)	Aged ; Cerebral Angiography/methods ; Computed Tomography Angiography/methods ; Contrast Media/adverse effects ; Embolization, Therapeutic/adverse effects ; Endovascular Procedures/adverse effects ; Female ; Humans ; Intracranial Aneurysm/therapy ; Male ; Nervous System Diseases/chemically induced ; Neurosurgical Procedures/adverse effects ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Triiodobenzoic Acids/adverse effects
Chemical Substances	Contrast Media ; Triiodobenzoic Acids ; iodixanol (HW8W27HTXX)
Language	English
Publishing date	2018-09-07
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2018.08.206
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Article: Intracranial atherosclerotic disease; current options for surgical or medical treatment.

Huh, Pil-Woo / Yoo, Do-Sung

Journal of Korean Neurosurgical Society

2007 Volume 42, Issue 6, Page(s) 427–435

Abstract: Recently, intracranial atherosclerosis has become a major cause of ischemic stroke, appearing more frequently in Koreans than Caucasians. Symptomatic or asymptomatic intracranial atherosclerosis is a disease that could recur readily even during the ... ...

Abstract	Recently, intracranial atherosclerosis has become a major cause of ischemic stroke, appearing more frequently in Koreans than Caucasians. Symptomatic or asymptomatic intracranial atherosclerosis is a disease that could recur readily even during the treatment with anti-platelet agents. When the symptoms develop, ischemic stroke can not be recovered readily. Therefore, aggressive treatments such as endovascular therapy and bypass surgery are required in addition to medical treatment for the intracranial artery stenosis. Recent intracranial stenting and drug eluting stenting have shown as very advanced effective therapeutic modalities. Nevertheless, until now, a randomized controlled study has not been conducted. Regarding bypass surgery, since the failed EC-IC bypass surgery study performed 20 years ago, extensive studies on its efficacy has not been conducted yet, and thus it has to be performed strictly only in hemodynamically compromised patients. Unless breakthrough drugs that suppress the progression of intracranial atherosclerosis and the formation of thrombi, and facilitate the regression of the arterial stenosis, the treatment concept of the recovery of the blood flow of stenotic arterial territory by mechanical recanalization or bypass surgery would be remained for the prevention as well as treatment of ischemic stroke caused by intracranial atherosclerosis.
Language	English
Publishing date	2007-12-20
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2007.42.6.427
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Article: Current Status of Neurosurgical and Neurointensive Care Units in Korea : A Brief Report on Nationwide Survey Results.

Jo, Kwang Wook / Kim, Hoon / Yoo, Do Sung / Hyun, Dong-Keun / Cheong, Jin Hwan / Park, Hae-Kwan / Park, Bong Jin / Cho, Byung Moon / Kim, Young Woo / Kim, Tae Hee / Han, Insoo / Lee, Sang-Weon / Kwon, Taek Hyun

Journal of Korean Neurosurgical Society

2020 Volume 63, Issue 4, Page(s) 519–531

Abstract: Objective: The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean ... ...

Abstract	Objective: The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010. Method: This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010. Results: Seventy seven hospitals (87.5%) participated in the survey. Nineteen hospitals (24.7%) employed a neurointensivist or faculty member; Thirty seven hospitals (48.1%) reported high demand for neurointensivists, and 62 hospitals (80.5%) stated that the mandatory deployment of a neurointensivist improved the quality of patient care. Forty four hospitals (57.1%) believed that hiring neurointensivist would increase hospital costs, and in response to a question on potential earnings declines. In terms of potential solutions to these problems, 70 respondents (90.9%) maintained that additional fees were necessary for neurointensivists' work, and 64 (83.1%) answered that direct support was needed of the personnel expenses for neurointensivists. Conclusion: We hope the results of this survey will guide successful implementation of neurointensivist systems across Korea.
Language	English
Publishing date	2020-07-01
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2253817-3
ISSN	1598-7876 ; 2005-3711 ; 1225-8245
ISSN (online)	1598-7876
ISSN	2005-3711 ; 1225-8245
DOI	10.3340/jkns.2020.0026
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