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June-Ho Lee and Dong Gyu Kim

✓ The authors report a case of symptomatic brain abscess in a 51-year-old man who presented with personality changes and generalized seizures. He had survived a grenade explosion injury during the Korean War 47 years previously. Computerized tomography scanning revealed multiple conglomerate rim-enhancing lesions and metallic foreign bodies in the right frontal lobe. The mass was totally removed and Pseudomonas aeruginosa was isolated from microbial cultures.

Retained foreign bodies in the brain, whether bone or metal, should be removed at the time of injury if at all possible. If this cannot be accomplished, patients with such retained foreign bodies should be carefully monitored for life.

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Dong Gyu Kim, Chul-Kee Park, and Sun Ha Paek

✓ Bo Sung Sim (1924–2001) stands as a prominent figure in the history of Korean neurosurgery. His devoted contributions have led to the fruitful development of modern neurosurgery in Korea. Sim practiced advanced neurosurgical techniques, undertook basic research, was passionate about education in the early years of neurosurgery in Korea, and played an essential role in founding the Korean Neurosurgical Society. Sim was a true neurosurgeon—a teacher, a scientist, and a superb pioneer in Korean neurosurgery.

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Hyun-Seung Kang, Dong Gyu Kim, and Dae Hee Han

✓ The authors report on a patient who presented with a large symptomatic glial cyst of the pineal gland communicating with the third ventricle. The hole between the ventricle and the cyst, suspected on magnetic resonance images, was found at surgery. The to-and-fro flow mechanism is considered to be involved in the pathogenesis of growth in this unusual large glial cyst of the pineal gland, although this mechanism cannot be applied universally.

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June Ho Lee, Chae-Yong Kim, Dong Gyu Kim, and Hee-Won Jung

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Chang-Hyun Lee, Young Eun Kim, Hak Joong Lee, Dong Gyu Kim, and Chi Heon Kim

OBJECTIVE

Pedicle screw-rod–based hybrid stabilization (PH) and interspinous device–based hybrid stabilization (IH) have been proposed to prevent adjacent-segment degeneration (ASD) and their effectiveness has been reported. However, a comparative study based on sound biomechanical proof has not yet been reported. The aim of this study was to compare the biomechanical effects of IH and PH on the transition and adjacent segments.

METHODS

A validated finite element model of the normal lumbosacral spine was used. Based on the normal model, a rigid fusion model was immobilized at the L4–5 level by a rigid fixator. The DIAM or NFlex model was added on the L3–4 segment of the fusion model to construct the IH and PH models, respectively. The developed models simulated 4 different loading directions using the hybrid loading protocol.

RESULTS

Compared with the intact case, fusion on L4–5 produced 18.8%, 9.3%, 11.7%, and 13.7% increments in motion at L3–4 under flexion, extension, lateral bending, and axial rotation, respectively. Additional instrumentation at L3–4 (transition segment) in hybrid models reduced motion changes at this level. The IH model showed 8.4%, −33.9%, 6.9%, and 2.0% change in motion at the segment, whereas the PH model showed −30.4%, −26.7%, −23.0%, and 12.9%. At L2–3 (adjacent segment), the PH model showed 14.3%, 3.4%, 15.0%, and 0.8% of motion increment compared with the motion in the IH model. Both hybrid models showed decreased intradiscal pressure (IDP) at the transition segment compared with the fusion model, but the pressure at L2–3 (adjacent segment) increased in all loading directions except under extension.

CONCLUSIONS

Both IH and PH models limited excessive motion and IDP at the transition segment compared with the fusion model. At the segment adjacent to the transition level, PH induced higher stress than IH model. Such differences may eventually influence the likelihood of ASD.

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Dae Hee Han, Dong Gyu Kim, Je G. Chi, Sung Hye Park, Hee-Won Jung, and Young Gyu Kim

✓ The authors present the clinical, radiological, pathological features, and autopsy findings of a patient with malignant triton tumor of the acoustic nerve, which probably arose from a pre-existing acoustic schwannoma. The term “malignant triton tumor” is applied to malignant schwannomas with rhabdomyoblastic differentiation. A cerebellopontine angle tumor with spinal drop metastasis occurred in this patient 10 months after near-total removal of the original tumor.

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Sung Kwon Kim, Dong Gyu Kim, Young-Bem Se, Jin Wook Kim, Yong Hwy Kim, Hyun-Tai Chung, and Sun Ha Paek

OBJECTIVE

Gamma Knife surgery (GKS) represents an alternative treatment for patients with tumor-related trigeminal neuralgia (TRTN). However, in previous studies, the primary GKS target was limited to mass lesions. The authors evaluated whether GKS could target both the tumor and the trigeminal root exit zone (REZ) in a single session while providing durable pain relief and minimizing radiation dose–related complications for TRTN patients.

METHODS

The authors' institutional review board approved the retrospective analysis of data from 15 consecutive patients (6 men and 9 women, median age 67 years, range 45–79 years) with TRTN who had undergone GKS. In all cases, the radiation was delivered in a single session targeting both the tumor and trigeminal REZ. The authors assessed the clinical outcomes, including the extent of pain relief, durability of the treatment response, and complications. Radiation doses to organs at risk (OARs), including the brainstem and the cranial nerve VII–VIII complex, were analyzed as doses received by 2% or 50% of the tissue volume and the tissue volume covered by a dose of 12 Gy (V12Gy).

RESULTS

The median length of clinical follow-up was 38 months (range 12–78 months). Pain relief with GKS was initially achieved in 14 patients (93.3%) and at the last follow-up in 13 patients (86.7%). The actuarial recurrence-free survival rates were 93%, 83%, and 69% at 1, 3, and 5 years after GKS, respectively. Persistent facial numbness was observed in 3 patients (20.0%). There were no complications such as facial weakness, altered taste function, hearing impairment, and balance difficulties indicating impaired function of the cranial nerve VII–VIII complex. The V12Gy in the brainstem was less than or equal to 0.24 cm3 in all patients. There were no significant differences in any OAR values in the brainstem between patients with and without facial numbness after GKS.

CONCLUSIONS

The strategy of performing GKS for both tumor and trigeminal REZ in a single session is a safe and effective radiosurgical approach that achieves durable pain control for TRTN patients.

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Dae Kyu Lee, Dong Gyu Kim, Gheeyoung Choe, Je G. Chi, and Hee-Won Jung

✓ The authors present a case of chordoid meningioma in a 55-year-old woman who manifested headache and personality change. Magnetic resonance imaging of the brain and cerebral angiography demonstrated a mass in the right frontal lobe that resembled a typical convexity meningioma. However, the pathological diagnosis was chordoid meningioma, a rare subtype of this tumor that usually occurs in adolescence and is known to be associated with Castleman syndrome. A meningothelial meningiomatous pattern suggestive of a meningothelial origin was focally present, and cytokeratin-positive squamoid cells were noted in the tumor. The lesion lacked dense infiltration of lymphocytes and plasma cells. Polyclonal gammopathy was the only sign of Castleman syndrome and hypochromic microcytic anemia was absent in this case. Polyclonal gammopathy resolved completely 6 months after total removal of the mass.