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Biomedical subjects

H D Jho

Publications and source records attributed to H D Jho.

At least 19 recordsLinked to original sources
PubMed2006

Comparison between transuncal approach and upper vertebral transcorporeal approach for unilateral cervical radiculopathy - a preliminary report.

OBJECTIVE: The surgical treatments for unilateral cervical radiculopathy have been performed by either the anterior or posterior approach. The anterior approach has usually been used more than the posterior approach. The authors compared the results of newly advanced upper vertebral transcorporeal (UVTC) approach with those of the original transuncal (TU) approach in the anterior approach. METHODS: The anterior cervical microforaminotomy was performed for 60 patients (male:female=40:20) from June, 2000 to October, 2003. 40 patients were treated by the TU approach while 20 patients were operated on by the new UVTC approach. The authors analyzed postoperative changes of disc height, the spinal instability, the average length of hospital stay, the degree of patients' satisfaction and complications from each approach. The mean follow-up period was 9.5 months. RESULTS: In the TU approach, postoperative intervertebral disc height was decreased from 7.1+/-0.65 mm to 6.2+/-0.61 mm. In the UVTC approach, postoperative intervertebral disc height was decreased from 6.6+/-0.43 mm to 6.3+/-0.41 mm. The average length of hospital stay was 5.2 days for the TU approach and 3.4 days for the UVTC approach. In the TU approach, 28 patients experienced excellent results, 11 patients experienced good results, one patient who experienced a fair result was operated by anterior cervical fusion because of a recurrent herniated disc. In the UVTC approach, 16 patients had excellent results and four patients experienced good results. CONCLUSIONS: This comparative study demonstrates that the UVTC approach is a better surgical technique than the TU approach considering the preservation of disc height, spinal stability, length of hospital stay, degree of satisfaction and complications.

Activities of Daily Living↗
PubMed2001

Primum non nocere: Multimodality management strategies when multiple mass lesions strike a single patient.

BACKGROUND: The management of multiple symptomatic intracranial pathological processes in a single patient presents a rare and challenging problem for the neurosurgeon and the patient. Neurosurgeons must utilize a full spectrum of neurosurgical options to achieve the best patient outcome. CASE DESCRIPTION: We present a unique case of a 63-year-old woman who presented with a large convexity meningioma causing headaches, an acoustic neuroma causing deafness and imbalance and a suprasellar arachnoid cyst compromising the visual fields. Therapeutic intervention was staged based on the primum non nocere concept. First, the patient underwent stereotactic intracavitary cyst irradiation using colloidal 32P. Secondly, microsurgical resection of the convexity meningioma was performed. Finally, Gamma Knife radiosurgery of the acoustic neuroma was performed. One year after multimodality management, the patient was neurologically improved. There was no evidence of meningioma or cyst recurrence and the growth of the acoustic neuroma was arrested. CONCLUSION: This case demonstrates the value of multi-modality treatment of neurosurgical pathology, utilizing minimally invasive techniques when possible.

Arachnoid Cysts↗
PubMed2001

Endoscopic transsphenoidal surgery.

BACKGROUND: Endoscopic transsphenoidal surgery was developed under a minimally invasive surgical strategy. This endonasal transsphenoidal endoscopy eliminates a sublabial or transfixional incision, the use of a transsphenoidal retractor and any nasal packing. MATERIALS AND METHOD: Reported are 160 patients who had undergone endoscopic transsphenoidal surgery from 1993 to 1999. Seventy were men and ninety women. Age ranged from 14 to 88 years (median 43 years). Among the 160 patients, 128 had pituitary adenomas, 9 had anterior fossa meningiomas, 7 had clival chordomas and 16 patients had other pathologies. RESULTS: Among the 68 patients with hormone-none-secreting adenomas, 53 (78%) patients had gross total removal. Among the 35 patients with prolactinomas, 24 (71%) patients exhibited normalized prolactin levels postoperatively. Eleven (70%) patients among the 16 with Cushing's disease had normal postoperative cortisol levels. Among the 9 patients with acromegaly, 7 (78%) had normalized postoperative IGF-1 levels. Among the 9 patients with anterior cranial fossa meningiomas. 7 had gross total removal and 2 had subtotal removal. Among the 7 patients with clival chordomas, 5 had total removal and 2 had subtotal removal. One patient with a large calcified recurrent pituitary fibrosarcoma died postoperatively. Postoperative morbidities included cerebrospinal fluid (CSF) leak in 6%, meningitis in 1.2%, deterioration of anterior pituitary function in 11%, temporary diabetes insipidus in 4%, permanent diabetes insipidus in 3%, and sinusitis in 1.2%. Outpatient surgery was performed in 2 patients. One hundred and eleven patients (66%) stayed in the hospital only overnight. Postoperative discomfort was minimal. CONCLUSION: Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. Patients' quick recovery, short hospital stays, and minimal postoperative discomfort have been observed.

Adenoma↗
PubMed2001

Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations.

OBJECTIVE: The evolution of the senior author's (HD Jho) surgical experience on endoscopic endonasal transsphenoidal pituitary surgery is reviewed in order to introduce a standardized surgical technique for pituitary endoscopy. METHODS: The progressive evolution of the surgical technique and the development of surgical instrumentation in transsphenoidal endoscopy is reviewed based upon the experience of more than 150 operations performed by the senior author between the years 1993 and 1998. RESULTS: An endoscope was used to assist visualization during conventional microscopic surgery in the first four cases (endoscope-assisted microsurgery). Subsequently, endonasal pituitary endoscopy was performed via a nostril. When the endonasal route was adopted, it eliminated the use of a transsphenoidal retractor. The use of vasoconstrictors and any form of nasal packing was discovered to be unnecessary. The inferior margin of the middle turbinate was such a consistent surgical landmark leading to the sella that the use of an intraoperative fluoroscopic C-arm was also eliminated. The adoption of a septal breaker, variously angled suction cannulas and suction-coagulators has made the operation cleaner, easier and faster. As experience increased, the operation time progressively shortened and mucosal trauma became minimal. The median patient hospital stay was one night and postoperative discomfort was noted to be minimal. CONCLUSIONS: The evolution of the senior author's endoscopic pituitary surgery is reported with a description of our current standardized surgical technique.

Acromegaly↗
PubMed2001

Endoscopic endonasal approach to the optic nerve: a technical note.

An endoscopic endonasal technique was used in the surgical treatment of a meningioma compressing the optic nerve. The patient was a 58-year-old woman who had experienced progressive visual loss in her left eye. Magnetic resonance (MR) scans of the brain demonstrated a contrast-enhancing tumor mass, which was measured to be 10 x 15 mm in size, compressing the left optic nerve. Automated visual field examination confirmed left-eye visual field defects, the temporal visual field worse than the nasal. The tumor was excised in total endoscopically through her right nostril. Histological diagnosis was meningothelial meningioma. Her hospital stay was overnight. Her left-eye vision improved with a residual crescentic temporal-field defect. She has done well without tumor recurrence as evidenced by a 20-month follow-up. This is the first report describing endoscopic endonasal removal of an intracranial tumor compressing the optic nerve.

Brain Neoplasms↗
PubMed2001

Endoscopic endonasal approaches to the cavernous sinus: surgical approaches.

OBJECTIVE: After completion of an earlier endoscopic transsphenoidal anatomic study, we studied various endoscopic transsphenoidal approaches using cadaveric specimens to develop endoscopic endonasal surgical approaches to the cavernous sinus. METHODS: Ten cavernous sinuses in five artery-injected adult cadaveric heads were studied with 0-, 30-, and 70-degree angled 4-mm rod-lens endoscopes. The extent of the surgical exposure, the skewed endoscopic anatomic view, and the maneuverability of surgical instruments through their relative operating spaces were studied after various endoscopic endonasal approaches via one nostril. RESULTS: The paraseptal approach was used between the nasal septum and the middle turbinate and provided exposure at the anteromedial portion of the cavernous sinus. The contralateral paraseptal approach rendered a slightly more medial view at the cavernous sinus than did the ipsilateral approach. This approach offered limited surgical access to the lateral vertical compartment. The middle turbinectomy approach allowed surgical access to the lateral wall of the cavernous sinus, except for the superior orbital fissure and the orbital apex. The middle meatal approach, which was made between the middle turbinate and the lateral nasal wall, revealed the entire lateral vertical compartment of the cavernous sinus, including the orbital apex and the superior orbital fissure. However, its lateral tangential surgical trajectory and the absence of dedicated surgical tools limited the surgeon's surgical maneuverability. A combination of the middle turbinectomy and middle meatal approaches increased the operating space. CONCLUSION: Various endoscopic endonasal surgical approaches to the cavernous sinus were studied using adult cadaveric head specimens.

Adult↗
PubMed2001

Endoscopic endonasal cavernous sinus surgery: an anatomic study.

OBJECTIVE: The endoscopic surgical anatomy of the cavernous sinus was studied to establish an anatomic basis for endoscopic endonasal cavernous sinus surgery. METHODS: Five adult cadaveric heads were studied with 0-, 30-, and 70-degree 4-mm rod-lens endoscopes. The posterior wall of the sphenoidal sinus was approached via a paraseptal, middle turbinectomy, or middle meatal approach. RESULTS: The posterior bony wall of the sphenoidal sinus is subdivided into five vertical compartments: midline, bilateral paramedian, and bilateral lateral. The midline vertical compartment consists of the planum sphenoidale, tuberculum sellae, sella, and clival indentation. The paramedian vertical compartment is composed of the medial third of the optic canal and the carotid artery protuberance. The lateral vertical compartment contains four bony protuberances (optic, cavernous sinus apex, maxillary, and mandibular) and three depressions (carotico-optic, ophthalmomaxillary [V1-V2], and maxillomandibular [V2-V3]). The three depressions form anatomic triangles at the lateral vertical compartment: the optic strut triangle, which is bordered by the optic nerve, carotid artery, and oculomotor nerve (IIIrd cranial nerve); the V1-V2 triangle; and the V2-V3 triangle. The internal carotid artery at the posterior wall of the sphenoidal sinus can be subdivided into two main segments: the parasellar and the paraclival. The vidian canal is a landmark that leads to the foramen lacerum, the mandibular nerve, and the pterygopalatine fossa. CONCLUSION: Endoscopic anatomy of the cavernous sinus has been studied via an endonasal route in cadaveric specimens to provide an anatomic basis for endoscopic endonasal cavernous sinus surgery.

Adult↗
PubMed2000

Endoscopic transpedicular thoracic discectomy.

OBJECT: To reduce the invasiveness and risk of thoracic disc surgery, a transpedicular endoscopic approach has been created. The surgical technique and outcome of endoscopic transpedicular thoracic discectomy are reported. METHODS: The surgical technique of posterior transpedicular thoracic discectomy was modified to endoscopic transpedicular surgery. A 1.5-cm trocar was placed in the interlaminar space via a 2-cm transverse paramedian skin incision. At the ventral aspect of the spinal cord discectomy was performed under direct visualization by using a 70 degrees -lens endoscope. This surgical technique was used in 25 patients. Twelve patients were men and 13 were women, aged 29 to 70 years (median 46 years). Myelopathy, with or without radiculopathy was present in 13 patients, radiculopathy in 10, and segmental pain in two. The follow-up periods ranged from 4 to 60 months (median 27 months). In 12 of the 13 patients with myelopathy excellent improvement was shown postoperatively; the remaining patient suffered recurrence of symptoms after a motor vehicle accident three months postoperatively. In nine of the 10 patients with radiculopathy, pain was resolved completely. In one patient with right-sided hypochondral pain and two patients with segmental pain, relief was not achieved despite excellent results of discectomy demonstrated on postoperative magnetic resonance imaging. The average length of hospital stay was one night. CONCLUSIONS: Endoscopic transpedicular thoracic discectomy was found to be a minimally invasive and effective surgical treatment.

Adult↗
PubMed2000

Endoscopic transsphenoidal pituitary surgery: various surgical techniques and recommended steps for procedural transition.

Various techniques in pituitary endoscopy are reviewed in the attempt to assemble the transitional steps necessary to take a neurosurgeon from traditional microscopic transsphenoidal surgery to endoscopic endonasal pituitary surgery. The senior author's (HDJ) experiences of endonasal endoscopy in more than 200 operations as well as the reports in the literature on pituitary endoscopy are reviewed. Two distinct advantages that an endoscope has over an operating microscope are its ability to visualize through a narrow surgical corridor and its ability to provide angled, close-up views. An endoscope can be used to assist the operating microscope (endoscope-assisted microsurgery). Endoscopy can also be used for endonasal retractor placement when microscopic surgery is preferred (endoscopic sphenoidotomy). When endonasal endoscopy is chosen, the surgical approach can be made with a deep-transseptal, a paraseptal, a middle turbinectomy or a middle meatal approach (endonasal transsphenoidal endoscopy). Endonasal endoscopy can be performed via either one or two nostrils. Working-channel endoscopy can be performed for restricted purposes. When a neurosurgeon desires to adopt endoscopy into pituitary surgery, the author recommends endoscope-assisted microsurgery as the first step followed by endoscopic sphenoidotomy as a combined effort between an endoscopic rhinologist and the neurosurgeon as the next step leading finally to endonasal pituitary endoscopy. Various methods of transsphenoidal endoscopy and the authors' recommendations for transitional steps are reported based on the authors' personal experience and literature review.

Acromegaly↗
PubMed2000

Brain surgery with image guidance: current recommendations based on a 20-year assessment.

Image guidance promotes safe and effective surgical management of a wide array of intracranial diseases. To better define the historical importance of image guidance and to assess the relative contribution of each imaging modality to the safety and efficacy of selected procedures, we reviewed our 20-year experience at a single institution. A retrospective review of our departmental surgical records was performed to identify patients who underwent brain surgery with image guidance between January 1979 and January 1999. We identified the use of intraoperative fluoroscopy, endoscopy, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and angiography in 7,388 patients. During this 20-year interval, advances in neuroimaging were translated into the operating room environment. Fluoroscopic guidance received the highest overall rating and was deemed critical for the performance of successful transsphenoidal surgery (n = 436) and effective percutaneous trigeminal neuralgia management (n = 1,121). Ultrasound and angiography both had limited roles; the latter was important to successful outcomes in 64 patients undergoing aneurysm management (n = 64) and arteriovenous malformation Gamma Knife radiosurgery (n = 786). Endoscopy also had a small role but had limited cost. Beginning in 1982, a dedicated operating room CT scanner was used during both morphologic and functional stereotactic surgery (n = 1,749). After 1986, MRI was used increasingly in the management of selected functional and tumor cases (n = 337); despite great versatility for patients undergoing Gamma Knife radiosurgery, the costs were relatively high. Frameless neuronavigation (n = 263) had excellent versatility and was relatively low in cost. During the last 20 years, image guidance techniques have facilitated minimally invasive brain surgery at our institution. The relative merits of all these imaging tools depended mostly on their versatility and relative costs. Major centers currently contemplating the incorporation of image guidance into routine brain surgery need not reproduce our own learning curve.

Brain Diseases↗
PubMed1999

Endoscopic pituitary surgery.

Endoscopy has been adopted for transsphenoidal pituitary surgery. A rigid rod-lens endoscope, 4-mm in diameter and 18 cm in length, is used in replacement of the operating microscope. This endoscopic technique utilizes the patient's natural nasal air passage as a surgical corridor without a sublabial or nasal mucosal incision. The use of a transsphenoidal retractor is not necessary. Postoperative nasal packing is not required. The average length of a patient's hospital stay is overnight. Postoperative discomfort is minimal. An angled lens endoscope enables the surgeon to operate on tumors located in the suprasellar region under direct visualization. When the adoption of endoscopy in transsphenoidal pituitary surgery had demonstrated obvious advantages over conventional microscopic surgery, the use of this endoscopic endonasal technique has been expanded to include other skull base lesions at the anterior fossa skull base, cavernous sinus, clivus and clival posterior fossa. In this chapter, the author describes the evolution of this endoscopic transsphenoidal surgery, the pertinent sinonasal anatomy related to transsphenoidal endoscopy, the details of endoscopic endonasal transsphenoidal pituitary surgery, surgical approaches to the other skull base lesions, surgical results, and potential complications and their avoidance.

Adenoma↗
PubMed1999

Anterolateral approach for cervical spinal cord tumors via an anterior microforaminotomy: technical note.

A cervical spinal cord tumor located anteriorly to the spinal cord is conventionally approached through an anterior vertebrectomy followed by bone-graft reconstruction. In order to make a surgical approach minimally invasive, an anterior microforaminotomy technique is used for removal of a tumor located anterior to the spinal cord. When the senior author's experience increased with anterior microforaminotomy for cervical radiculopathy and myelopathy, it was observed that intradural pathology could also be taken care of through the anterior microforaminotomy which did not require bone fusion or postoperative immobilization. For tumor resection, the anterior foraminotomy is made like a flask-shaped hole, with a smaller outer opening similar to that for radiculopathy but incorporating a larger inner opening to accommodate the extent of the tumor in a longitudinal and transverse dimension. The surgical technique is described with two illustrated patients. Postoperatively, the patients did not require a cervical brace. Although their postoperative discomfort was minimal, they were kept in the hospital overnight postoperatively. Spinal stability was well maintained 6 weeks postoperatively. Postoperative imaging of the spine confirmed resection of the tumors. Anterior microforaminotomy is a minimally invasive microsurgical technique which can provide safe and successful removal of tumors located anteriorly to the spinal cord.

Cervical Vertebrae↗
PubMed1999

Endoscopic transpedicular thoracic discectomy.

OBJECT: To minimize the invasiveness and maximize the adequacy of the decompressive procedure in thoracic discectomy, a 70 degrees endoscope was adapted to perform transpedicular thoracic discectomy. METHODS: A posterior transpedicular approach was performed via a 2-cm transverse skin incision, aided by an operating microscope or a 0 degrees lens endoscope. Using a 70 degrees lens endoscope, discectomy was performed after obtaining direct visualization of the ventral aspect of the spinal cord dura mater. This surgical technique has been used in 25 patients. There were 12 men and 13 women whose ages ranged from 29 to 74 years (median 46 years). Thirteen patients experienced myelopathy, with or without radiculopathy, 10 presented with radiculopathy, and two patients suffered from segmental pain. The follow-up period ranged from 4 to 60 months (median 27 months). In 12 of 13 patients with myelopathy, excellent improvement was shown postoperatively. In the remaining patient, symptoms recurred after she was injured in a motor vehicle accident 3 months postsurgery. In nine of 10 patients with radiculopathy, pain resolved completely. In the one patient with right-sided hypochondral pain and in the two patients with segmental pain, no relief was obtained despite excellent discectomy results demonstrated on postoperative magnetic resonance images. The average length of hospital stay was overnight. CONCLUSIONS: The use of a 70 degrees lens endoscope through a transpedicular route has made thoracic discectomy comparable with cervical or lumbar discectomy in terms of minimal surgical invasiveness, recovery time, and complexity of the procedure.

Adult↗
PubMed1998

Endoscopic microscopic transpedicular thoracic discectomy. Technical note.

In an effort to make thoracic discectomy simple and less invasive while using direct visualization, a 70 degrees -angled lens endoscope has been adopted to visualize the ventral aspect of the spinal cord dura mater during microsurgical thoracic discectomy via a transpedicular approach. The patient is positioned in a 60 degrees forwardly inclined lateral position with the side of the lesion facing upward. After radiographic corroboration of the correct level, a transpedicular approach is made using a 1.5-cm-diameter tubular retractor through a 2-cm-long paramedian transverse skin incision. With the aid of an operating microscope, the ipsilateral facet joint, including the upper portion of the pedicle, is removed using a high-speed drill, thus exposing the neural foramen, intervertebral disc, and upper portion of the pedicle leading to the vertebral bodies. When the herniated disc and bone spur have been removed laterally in relation to the spinal cord, creating a cavity under the operating microscope, a 4-mm-diameter rigid endoscope with a 70 degrees -angled lens is mounted to an endoscope holder so that the ventral aspect of the spinal cord dura mater can be visualized directly. With the aid of direct endoscopic visualization, the disc and bone spur, which compress the spinal cord anteriorly, are pushed away toward a cavity created at the intervertebral space and are removed using a downward-biting long-armed curette. Patients with myelopathy are kept overnight in the hospital; however, those with radiculopathy are discharged home on the same day as their operation. The surgical technique and two illustrative cases are reported.

Journal Article↗
PubMed1998

Posterolateral approach for anteriorly located cervical spine tumors: technical note.

Cervical spinal cord tumors located anteriorly to the spinal cord often require an extensive anterior vertebrectomy approach for their removal followed by bone fusion and postoperative immobilization. To minimize the invasiveness of the conventional anterior approach for those tumors, the author has utilized the anterolateral approach which was originally developed for spondylotic disc disease. However, some of those tumors still can be removed by a less invasive posterior approach which violates spinal integrity to a much lesser degree. Anteriorly located tumors, in which the tumor-cord interface line extends posteriorly to a horizontal line drawn along the posterior margin of the vertebral body, can be removed by the posterolateral approach with a skin incision made at the point where the tumor-cord line intersects. Because the facet joint is thin and the pedicle is shallow in the cervical spine, only a hemilaminectomy bone window is required in this posterolateral approach for removal of such tumors. Surgical techniques of this posterolateral approach for removal of anteriorly located cervical cord tumors are described with two illustrated patients.

Cervical Vertebrae↗
PubMed1998

Death from a malignant cerebellopontine angle triton tumor despite stereotactic radiosurgery. Case report.

Malignant vestibular nerve tumors are rare: to date, only three cases have been reported in the literature. The authors report a case of an eighth cranial nerve tumor that progressed 5 years after stereotactic radiosurgery. The patient was a 44-year-old man who underwent stereotactic radiosurgery for a 27-mm cerebellopontine angle tumor that was discovered on investigation of tinnitus and hearing loss. He developed facial weakness after 5 years, and repeated imaging revealed tumor enlargement. Despite complete microsurgical excision, the tumor rapidly recurred locally and subsequently disseminated within the neuraxis. The patient died 1 year after tumor progression was detected. Histopathological analysis revealed a malignant spindle cell neoplasm with frequent mitotic figures. The presence of positive rhabdoid elements on immunohistochemical studies confirmed that it was a triton tumor. The authors review the relevant literature concerning the classification and management of malignant vestibular nerve tumors and discuss the implications of tumor progression after stereotactic radiosurgery.

Adult↗