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Seung-Hoon Lim, Dae-Jean Jo, Sung-Min Kim, and Young-Jin Lim

Despite various complications associated with sacrectomy to remove sacral tumors, total or en bloc sacrectomy has been suggested as the most appropriate surgical treatment in such cases. The authors present the case of a 62-year-old male patient with intractable back pain and voiding difficulty whom they treated with posterior en bloc sacral hemiresection followed by reconstruction using dual U-shaped rods. They report that good spinopelvic stability was achieved without complications. The authors conclude that this technique is relatively simple compared with other sacral reconstructive techniques and can prevent complications, including herniation.

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*Jaejoon Lim, Kyoung Su Sung, Woohyun Kim, Jihwan Yoo, In-Ho Jung, Seonah Choi, Seung Hoon Lim, Tae Hoon Roh, Chang-Ki Hong, and Ju Hyung Moon

OBJECTIVE

The endoscopic transorbital approach (ETOA) has been developed, permitting a new surgical corridor. Due to the vertical limitation of the ETOA, some lesions of the anterior cranial fossa are difficult to access. The ETOA with superior-lateral orbital rim (SLOR) osteotomy can achieve surgical freedom of vertical as well as horizontal movement. The purpose of this study was to confirm the feasibility of the ETOA with SLOR osteotomy.

METHODS

Anatomical dissections were performed in 5 cadaveric heads with a neuroendoscope and neuronavigation system. ETOA with SLOR osteotomy was performed on one side of the head, and ETOA with lateral orbital rim (LOR) osteotomy was performed on the other side. After analysis of the results of the cadaveric study, the ETOA with SLOR osteotomy was applied in 6 clinical cases.

RESULTS

The horizontal and vertical movement range through ETOA with SLOR osteotomy (43.8° ± 7.49° and 36.1° ± 3.32°, respectively) was improved over ETOA with LOR osteotomy (31.8° ± 5.49° and 23.3° ± 1.34°, respectively) (p < 0.01). Surgical freedom through ETOA with SLOR osteotomy (6025.1 ± 220.1 mm3) was increased relative to ETOA with LOR osteotomy (4191.3 ± 57.2 mm3) (p < 0.01); these values are expressed as the mean ± SD. Access levels of ETOA with SLOR osteotomy were comfortable, including anterior skull base lesion and superior orbital area. The view range of the endoscope for anterior skull base lesions was increased through ETOA with SLOR osteotomy. After SLOR osteotomy, the space for moving surgical instruments and the endoscope was widened. Anterior clinoidectomy could be achieved successfully using ETOA with SLOR osteotomy.

The authors performed ETOA with SLOR osteotomy in 6 cases of brain tumor. In all 6 cases, complete removal of the tumor was successfully accomplished. In the 3 cases of anterior clinoidal meningioma, anterior clinoidectomy was performed easily and safely, and manipulation of the extended dural margin and origin dura mater was possible. There was no complication related to this approach.

CONCLUSIONS

The authors evaluated the clinical feasibility of ETOA with SLOR osteotomy based on a cadaveric study. ETOA with SLOR osteotomy could be applied to more diverse disease groups that do not permit conventional ETOA or to cases in which surgical application is challenging. ETOA with SLOR osteotomy might serve as an opportunity to broaden the indication for the ETOA.

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Byung Chan Lim, Jong Hee Chae, Seung-Ki Kim, Sung-Hye Park, Kyu-Chang Wang, Ji Yeoun Lee, and Ji Hoon Phi

Brainstem glioma is a highly devastating disease, and any mass-like lesion in the brainstem can raise suspicion of this diagnosis. However, other inflammatory, demyelinating, or degenerative diseases can mimic brainstem glioma in clinical presentation and imaging features. Therefore, diagnosis based solely on imaging is often insufficient for brainstem lesions and may lead to incorrect diagnosis and treatment.

This case report is the first description of central nervous system aquaporin-4 (AQP4) autoimmunity confined mainly to the brainstem. It demonstrates the wide spectrum of neuroinflammatory diseases in children and highlights the utility of surgical biopsy for suspicious brainstem lesions with atypical imaging features for glioma.

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Do-Hun Lee, Eun Young Kim, Sepill Park, Ji Hoon Phi, Seung-Ki Kim, Byung-Kyu Cho, Jinho Lim, and Kyu-Chang Wang

Object

The authors previously reported that human embryonic stem cells (hESCs) injected into the amniotic cavity of chick embryos immediately after neural tube incision in a surgically induced spinal open neural tube defect (ONTD) model promote the reclosure capacity of neural tubes. To simulate more closely the clinical situation of human ONTDs, in which a ssubstantial time period elapses before the prenatal diagnosis of spinal ONTDs, the authors investigated whether this reclosure capacity remains enhanced by the intraamniotic injection of hESCs at 24 hours after ONTD induction.

Methods

One hundred twenty-two chick embryos with ONTDs were randomly assigned to two groups: the control group (59 embryos) and the hESC-injection group (hESC group, 63 embryos). After the neural tubes of both groups had been opened, the hESC group underwent direct intraamniotic injection with hESCs marked with an enhanced green fluorescent protein at 24 hours after ONTD induction. The lengths of the remnant ONTDs were measured and the presence of hESCs was determined at 4, 6, and 8 days after ONTD induction. No difference in survival rates was observed between the two groups. The mean length of the ONTDs, adjusted for body length at the time of death and initial lesion length, was significantly shorter in the hESC group than in the control group (p < 0.001). No hESCs were found within reclosed neural tubes; rather, they covered the defect area during the reclosure process.

Conclusions

The authors demonstrate that hESCs injected into the amniotic cavity at 24 hours after ONTD induction enhance reclosure ability in chick embryos.