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Chang-Hyun Lee, Young II Won, Young San Ko, Seung Heon Yang, Chi Heon Kim, Sung Bae Park, and Chun Kee Chung

OBJECTIVE

Combined anterior-posterior (AP) surgery is considered the gold standard for surgical treatment of Scheuermann kyphosis. There are trends toward posterior-only (PO) surgery for correcting this deformity because of the availability of multisegmental compression instruments and posterior shortening osteotomy. To date, surgical strategies for Scheuermann kyphosis remain controversial. The purpose of this study was to compare various surgical approaches for the treatment of Scheuermann kyphosis, including radiological correction and intraoperative outcomes, using a systematic review and meta-analysis.

METHODS

A comprehensive database search of PubMed, EMBASE, Web of Science, and Cochrane Library was performed to identify studies concerning Scheuermann kyphosis. The inclusion criteria were direct comparisons between AP and PO surgeries for Scheuermann kyphosis and assessment of the angle of thoracic kyphosis preoperatively and postoperatively. The authors used the principles of a cumulative meta-analysis by updating the pooled estimate of the treatment effect.

RESULTS

Data from 13 studies involving 1147 participants (542 patients in the AP group and 605 patients in the PO group) were included. The average age was 18.2 years for the AP and 17.9 years for the PO group. The overall mean difference of changes in thoracic kyphosis angles between the AP and PO surgeries was 0.23° (95% CI −2.24° to 2.71°). In studies in which posterior shortening osteotomies were not performed, PO surgery resulted in a significantly low degree of correction of thoracic kyphosis, with a mean difference of 5.59° (95% CI 0.34°–10.83°). Studies in which osteotomies were performed revealed that the angle of correction for PO surgery was comparable to that of AP surgery. Regardless of fixation methods, PO surgical approaches achieved comparable angles.

CONCLUSIONS

PO surgery using posterior osteotomies can achieve correction of Scheuermann kyphosis as successfully as AP surgery does. Reflecting the advancement of surgical technology, large prospective studies are necessary to identify the proper treatments for Scheuermann kyphosis.

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Yong Hwy Kim, Chiman Jeon, Young-Bem Se, Sang Duk Hong, Ho Jun Seol, Jung-II Lee, Chul-Kee Park, Dong Gyu Kim, Hee-Won Jung, Doo Hee Han, Do-Hyun Nam, and Doo-Sik Kong

OBJECTIVE

The endoscopic endonasal approach for treating primary skull base malignancies involving the clivus is a formidable task. The authors hypothesized that tumor involvement of nearby critical anatomical structures creates hurdles to endoscopic gross-total resection (GTR). The aim of this study was to retrospectively review the clinical outcomes of patients who underwent an endoscopic endonasal approach to treat primary malignancies involving the clivus and to analyze prognostic factors for GTR.

METHODS

Between January 2009 and November 2015, 42 patients underwent the endoscopic endonasal approach for resection of primary skull base malignancies involving the clivus at 2 independent institutions. Clinical data; tumor locations within the clivus; and anatomical involvement of the cavernous or paraclival internal carotid artery, cisternal trigeminal nerve, hypoglossal canal, and dura mater were investigated to assess the extent of resection. Possible prognostic factors affecting GTR were also analyzed.

RESULTS

Of the 42 patients, 37 were diagnosed with chordomas and 5 were diagnosed with chondrosarcomas. The mean (± SD) preoperative tumor volume was 25.2 ± 30.5 cm3 (range 0.8–166.7 cm3). GTR was achieved in 28 patients (66.7%) and subtotal resection in 14 patients (33.3%). All tumors were classified as upper (n = 17), middle (n = 17), or lower (n = 8) clival tumors based on clival involvement, and as central (24 [57.1%]) or paramedian (18 [42.9%]) based on laterality of the tumor. Univariate analysis identified the tumor laterality (OR 6.25, 95% CI 1.51–25.86; p = 0.011) as significantly predictive of GTR. In addition, the laterality of the tumor was found to be a statistically significant predictor in multivariate analysis (OR 41.16, 95% CI 1.12–1512.65; p = 0.043).

CONCLUSIONS

An endoscopic endonasal approach can provide favorable clinical and surgical outcomes. However, the tumor laterality should be considered as a potential obstacle to total removal.