Epidemiological Study of Malignant Gliomas in Korea Using Nationwide Dataset from 2007 to 2017

Background@#The purpose of the study was to investigate the incidence, prevalence, and survival of malignant gliomas (MGs) using population-based Korean National Health Insurance Database (NHID) data. @*Methods@#Using the Korean NHID, we identified patients with MG as C71 codes in KCD 5–7 according to ICD-10 from January 1, 2007 to December 31, 2017. Epidemiological characteristics of MG, including annual incidence, prevalence, mortality rates, and survival rates, were collected and analyzed according to socioeconomic state (SES) and treatments received. @*Results@#We identified 45,066 newly diagnosed-MG patients from 2007 to 2017, for an age-adjusted incidence of 7.47 per 100,000 people. The mean age at diagnosis was 54 years. The male to female ratio was 1.11. Mortality and survival probability were analyzed among total subjects and in subgroups. The mortality rates were lower in female than that of male patients (hazard ratio, 0.69; 95% confidence interval, 0.67–0.71), and in younger age population and in higher income group. Patients operated had a slightly higher survival rate. The 1-, 3-, 5-, and 10-year survival rates were estimated at 63.4%, 46.2%, 39.4%, and 34.8%, respectively. This is the first population-based study to determine the incidence and prevalence of MG according to epidemiological characteristics in Korea using NHID. @*Conclusion@#Our study found that female sex and high SES were factors that significantly lowered the mortality rate in MG, and younger groups and operated patients showed significantly higher survival rates.

Epidemiological Study of Malignant Gliomas in Korea Using Nationwide Dataset from 2007 to 2017

Background@#The purpose of the study was to investigate the incidence, prevalence, and survival of malignant gliomas (MGs) using population-based Korean National Health Insurance Database (NHID) data. @*Methods@#Using the Korean NHID, we identified patients with MG as C71 codes in KCD 5–7 according to ICD-10 from January 1, 2007 to December 31, 2017. Epidemiological characteristics of MG, including annual incidence, prevalence, mortality rates, and survival rates, were collected and analyzed according to socioeconomic state (SES) and treatments received. @*Results@#We identified 45,066 newly diagnosed-MG patients from 2007 to 2017, for an age-adjusted incidence of 7.47 per 100,000 people. The mean age at diagnosis was 54 years. The male to female ratio was 1.11. Mortality and survival probability were analyzed among total subjects and in subgroups. The mortality rates were lower in female than that of male patients (hazard ratio, 0.69; 95% confidence interval, 0.67–0.71), and in younger age population and in higher income group. Patients operated had a slightly higher survival rate. The 1-, 3-, 5-, and 10-year survival rates were estimated at 63.4%, 46.2%, 39.4%, and 34.8%, respectively. This is the first population-based study to determine the incidence and prevalence of MG according to epidemiological characteristics in Korea using NHID. @*Conclusion@#Our study found that female sex and high SES were factors that significantly lowered the mortality rate in MG, and younger groups and operated patients showed significantly higher survival rates.

The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography

OBJECTIVE: The spot sign on computed tomography angiography is little known about the relationship between the spot sign and the results of cerebral angiography We retrospectively analyzed the spot sign, digital subtraction angiography results, and other factors.MATERIAL AND METHODS: From December 2009 to May 2014, DSA was performed in 52 ICH patients with non-specific location or abnormalities on CTA findings. 26 of those patients, whose initial CTA showed the spot sign, were analyzed. Two groups, one with the spot sign in the ventricle (Group A) and others with the spot sign in another location (Group B) were statistically compared.RESULTS: The mean age of the study subjects was 46.9 years (range, 15 to 80 years) and the percentage of males was 53.8%. Thirteen of 26 patients had ICH without intraventricular hemorrhage, and 6 patients had co-existing IVH. In 17 cases, the DSA results were negative. Seven patients were diagnosed with pseudoaneurysms, and two cases showed developmental venous anomalies. Group A consisted of the 8 patients (30.8%) who showed the spot sign in a ventricle. The number of pseudoaneurysms was statistically significantly higher in Group A than in Group B (71.4% versus 28.6%; OR, 13.3; 95% CI, 1.7-103.8 P = 0.014). All three patients who underwent endovascular treatment were members of Group A (P = 0.022), whereas most (92.3%) of those in Group B underwent surgical evacuation. (P = 0.030).CONCLUSION: When CTA shows the spot sign in a ventricle, it is a clue that an existing underlying vascular lesion requires endovascular treatment.

Successful Mechanical Thrombectomy Using Solumbra Technique In a 35-year-old Man With Achondroplasia: a case report

BACKGROUND: Achondroplasia is one of the most common types of dwarfism and is inherited as an autosomal dominant disease. The patients with achondroplasia suffer from various complications such as craniofacial, central nervous system, spinal, respiratory and cardiac anomalies.CASE DESCRIPTION: We report a case of a 35-year-old man with achondroplasia who visited the emergency room with right hemiplegia and aphasia within 6 hours after onset. An Initial CT angiography showed the total occlusion of a left internal cerebral artery due to the thrombus. We treated the patient with endovascular thrombectomy using “Solumbra technique” with balloon guiding catheter. The procedure was successful and result was completely recanalized with Thrombolysis in Cerebral Infarction (TICI) scale 3 and the weakness also improved from grade II to grade IV.CONCLUSION: Acute ischemic stroke patients with achondroplasia could be treated with mechanical thrombectomy.

Risk factors of bilateral chronic subdural hematoma compared to unilateral chronic subdural hematoma

Chronic subdural hematoma (CSDH) is a common and relatively benign disease. The aim of this study was to investigate the differences between unilateral and bilateral chronic subdural hematoma in terms of predisposing factors. A retrospective analysis was made of all patients who underwent operation for CSDH at our institution between January 2010 and December 2015. Patients were divided into two groups (unilateral versus bilateral CSDH) and univariate and multivariate analysis was performed to assess demographic data, symptoms, cause of SDH, medical history, laboratory data, and initial radiologic findings. A total of 246 patients were enrolled. There were 63 (25.6%) patients with bilateral CSDH. There were no significant differences concerning sex and initial symptoms between the two groups. Only malignancy history was a significant risk factor for bilateral CSDH in both univariate and multivariate analysis (p = 0.002 and 0.001, respectively). In multivariate analysis, diabetes mellitus (OR 2.03, 95% CI: 1.05 - 3.92, p = 0.0350), malignancy (OR 5.09, 95% CI: 1.93 - 13.40, p= 0.0010), membrane septation (OR 0.50, 95% CI: 0.25 - 0.96, p = 0.0392), and brain atrophy (mild: OR 2.34, 95% CI: 1.16 - 4.71, p = 0.0164, moderate: OR 3.85, 95% CI: 1.32-11.18, p = 0.0131) were significantly associated with bilateral CSDH. The present study suggests that diabetes mellitus, malignancy, membrane septation and mild to moderate brain atrophy is independent predisposing factors of bilateral CSDH.

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients: A Single Center Experience

OBJECTIVE: Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ≥80 years) and aged patients (60–79 years) treated with mechanical thrombectomy. METHODS: Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (≥80 years) and aged (60–79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. RESULTS: The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4–11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2–51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. CONCLUSION: Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

Predictive Factors for Recurrence after Burr-Hole Craniostomy of Chronic Subdural Hematoma

OBJECTIVE: Chronic subdural hematoma is a common and relatively benign disease. However, recurrence is common after surgical treatment, and the recurrence rate varies from 5% to 33%. The aim of this study was to investigate the predictive factors for recurrence of chronic subdural hematoma. METHODS: We analyzed data from 248 patients with chronic subdural hematoma who were treated by burr-hole craniostomy with a closed drainage system for hematoma evacuation in this five-year retrospective study. RESULTS: Thirty-one (12.6%) patients underwent re-operation for recurrence of chronic subdural hematoma. Univariate analysis revealed that anticoagulation (p=0.0279), headache (p=0.0323), and preoperative midline shifting (p=0.0321) showed significant differences with respect to recurrent chronic subdural hematoma. We performed a multivariate logistic regression analysis and found that diabetes mellitus (odds ratio [OR], 2.618; 95% confidence interval [CI], 1.0899–6.2898; p=0.0314), anticoagulation (OR, 6.739; 95% CI, 1.1287–40.2369; p=0.0364), headache (OR, 2.951; 95% CI, 1.1464–7.5964; p=0.0249), and preoperative midline shifting (OR, 1.0838; 95% CI, 1.0040–1.1699; p=0.0391) were independent predictive factors for recurrence of chronic subdural hematoma. CONCLUSION: We showed that diabetes mellitus, anticoagulation, headache, and preoperative midline shifting were independent predictors of recurrence of chronic subdural hematoma.

Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.

The Clinical Experience of Computed Tomographic-Guided Navigation System in C1-2 Spine Instrumentation Surgery

OBJECTIVE: To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports. METHODS: Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach. RESULTS: Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases. CONCLUSION: Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.

Effectiveness of Multiple Burrhole Operation in Adult Moyamoya Disease / 대한뇌혈관외과학회지

OBJECTIVE: Most of the studies that have described surgical procedures for moyamoya disease(MMD) have had the aim to improve the blood flow mainly in the middle cerebral artery(MCA) territory. The purpose of this study is to clarify the good indications for a multiple burrhole operation to treat MMD. METHODS: With the patient under local anesthesia, burrhole trephination with a diameter of 1.5 to 2cm at 3 to 5cm lateral to the midline was performed in a total of 18 hemispheres during 12 procedures. The burrholes were opened in the frontal lobe at 19 sites in 10 patients and in the parietal lobe at 22 sites in 12 patients. Revascularization through multiple burrholes and arachnoid openings was performed in 12 patients who suffered from MMD. RESULTS: As seen on the follow up angiograms, good revascularization was achieved in 27 of 41 burrholes, and mainly from the middle meningeal artery and then from the superficial temporal artery. The moyamoya vessels were decreased in four patients. The neovascularization covered 68.4% of the frontal lobe and 63.5% of the parietal lobe. Compared with the preoperative 99mTc-HMPAO-SPECT, 6 patients showed improvement of cerebral blood flow on the postoperative 99mTc-HMPAO-SPECT. Transient ischemic attack disappeared in three of the four patients who presented with this symptom, and the preoperative symptoms improved in both of the patients who presented with headache and cerebral infarction. CONCLUSIONS: A multiple burrhole operation is a simple technique. The results of our series suggest that the revascularization obtained for adult MMD patients who underwent a multiple burrhole operation is similar to that obtained with other indirect surgeries, but long term follow up studies are needed.

Production of Re-188 / 대한핵의학회잡지

188Re (beta=22 MeV; gamma=155 keV; T1/2=16.9 hours) is an attractive therapeutic radioisotope which is produced from decay of reactor-produced tungsten-188 parent (T1/2=69 days). 188W has been produced from the double neutron capture reaction of 186W. 188Re can be easily obtained by elution of saline on alumina based 186W/188Re generator, which is commercially available. Complexes labelled with 188Re have been developed for the radiotherapy treatment of diseases because of the desirable nuclear properties of the radioisotope and it's chemical properties similar to those of technetium, a well established diagnostic agent.