Cerebral Paragonimiasis and Bo Sung Sim's Hemispherectomy in Korea in 1950s-1960s / 의사학

This paper deals with cerebral paragonimiasis and cerebral hemispherectomy conducted as a treatment of cerebral paragonimiasis by Bo Sung Sim in Korea in 1950s-1960s. He demonstrated that cerebral hemispherectomy could be used for unilateral diffuse cerebral paragonimiasis. Sim learned cerebral hemispherectomy from Dr. L. A. French. at the University of Minnesota from 1955 to 1957 in America. The authors argues that Bo Sung Sim's introduction of cerebral hemispherectomy to Korea was not a simple application of an advanced medical technology, but a complicated and active process in that Sim used the technique to intervene intractable complications from cerebral paragonimiasis such as generalized convulsions, spastic hemiplegia and mental deterioration. Bo Sung Sim, one of the neurosurgeons of the first generation in Korea, was trained in neurology, neuropathology, neuroradiology and animal experiments as well as in neurosurgery at the University of Minnesota. After returning to Korea, Sim faced parasitic diseases, one of the most serious public health problems at that time, which were far different from what he learned in America. As a neurosurgeon, Sim tackled with parasitic diseases of the central nervous system with various diagnostics and therapeutics. In 1950s, more than one million populations suffered from pulmonary paragonimiasis acquired by eating raw crabs or by feeding juice of crushed crayfish for the treatment of measles in Korea. About 26.6 percent of people with paragonimiasis had cerebral paragonimiasis. Before bithionol therapy was introduced in 1962, neurosurgery was the only available treatment to control increased intracranial pressures, intractable epilepsy, paralysis and mental deterioration. Between 1958 to 1962, Bo Sung Sim operated on 24 patients of cerebral paragonimiasis. In two of them, he performed cerebral hemispherectomy to control intractable convulsions when he found diffuse cerebral paragonimiasis and cerebral atrophy at the operating table. The two patients were recovered dramatically after the operation. The first patient became a part of medical campus for 20 years after hemispherectomy, doing chores at the hospital and helping Bo Sung Sim for his teaching neuroanatomy. The presence of the hemispherectomized patient in the classroom impressed the students deeply. Furthermore, the hemispherectomized patient stimulated Sim and his school to perform research upon the neuroanatomy and neurophysiology of the brain with hemispherectomized animals.

Hemispherectomy

Hemispherectomy became a more widely accepted surgical treatment for intractable epilepsy, secondary to severe unilateral hemisphere damage. Basic concept of the hemispherectomy changed from hemispheric resection in anatomical hemispherectomy to a less tissue removal with disconnection of the rest of the hemisphere in the functional hemispherectomy, up to minimal tissue resection with maximal disconnection in the hemispherotomy. This change away from extended resections to predominant disconnection methods lead to reduction of the complications and at the same time maintained the favourable seizure freedom rate. In our current review, we review the hemispherectomy history and techniques in literature with details of our modified surgical technique of hemispherotomy. We also outline the indications, appropriate patient selection, and present our results in a large series of 74 patients who underwent hemispherotomy in our clinic between 1995 and 2006. In our clinical series, the 2-year follow-up shows that 72% of our patients [54 out of 74] had class I and II outcome according to Engel's classification system. No mortality occurred in the current series and postoperative complication was significantly lowered. Hemispherotomy represents an efficacious, technically simple and safe surgical treatment for the management of patients with medically intractable seizures