• Title/Summary/Keyword: 신경외과적 수술

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Evaluation of Accuracy on Hitchcoke CT/angio localization system using QA head phantom (QA용 두부 팬톰을 이용한 Hitchcoke CT 및 혈관조영 정위적 시스템에 대한 정확도 평가)

  • 김성현;서태석;윤세철;손병철;김문찬;신경섭
    • Progress in Medical Physics
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    • v.9 no.1
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    • pp.1-9
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    • 1998
  • In order to provide complementary image data, CT(computed tomography), MR(magnetic resonance) and angiography have been used in the field of Stereotactic Radiosurgery(SRS) and neurosurgery. The aim of this work is to develop 3-D stereotactic localization system in order to determine the precise shape, size and location of the lesion in the brain in the field of Stereotactic Radiosurgery(SRS) and neurosurgery using multi-image modality and multi purpose QA phantom. In order to obtain accurate position of a target, Hitchcoke stereotactic frame and CT/angiography localizers were rigidly attached to the phantom with nine targets dispersed in 3-D space. The algorithms to obtain a 3-D stereotactic coordinates of the target have been developed using the images of the geometrical phantom which were taken by CT/angiography. Positions of targets computed by our algorithms were compared to the absolute position assigned in the phantom. Outlines of targets on each CT image were superimposed each other on angiography images. A spatial mean distance errors were 1.02${\pm}$0.17mm for CT with a 512${\times}$512 matrix and 2mm slice thickness, 0.41${\pm}$0.05mm for angiogra- phy localization. The resulting accuracy in the target localization suggests that the developed system has enough Qualification for Stereotactic Radiosurgery (SRS).

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Tracheoinnominate Artery Fistula after Tracheal Reconstruction (기관 재건술 후 발생한 기관 무명동맥루)

  • 곽영태;신원선;맹대현;이신영;김수철;박주철;김동원
    • Journal of Chest Surgery
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    • v.29 no.11
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    • pp.1288-1291
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    • 1996
  • Tracheoinnominate artery fistula is a rare but a catastrophic complication after tacheostomy or tracheal reconstruction. We experienced one case of tracheoinnominate artery fistula after tracheal reconstruction. The patient was a 11 year old girl with cerebral arteriovenous malformation who maintained tracheostomy for 6 months before undergoing tracheal reconstruction. She complained of dyspnea and paroxysmal cough 5 months after tracheostomy and was diagnosed as tracheal stenosis. We performed 4cm of tracheal resection and end to end anastomosis. Three days after tracheal reconstruction, massive bleeding occurred through the intubation tube. She underwent emergency reoperation of repair the innominate artery with 5-0 Prolene and re-reconstruction of trachea. The patient died of bleeding 3 days after the reoperation.

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Ultrasound-Guided Femorosciatic Nerve Block (초음파 유도 대퇴좌골 신경 차단술)

  • Kang, Chan;Kim, Young-Mo;Hwang, Deuk-Soo;Kim, Joung-Hun;Park, Jun-Young;Lee, Woo-Yong
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.3 no.2
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    • pp.74-78
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    • 2010
  • Since the extent of use of musculoskeletal ultrasound in orthopaedic surgery is expanding, popliteal block(sciatic nerve block) and femoral nerve block(saphenous nerve block) are easily and safely performed without complications such as nerve injury or incomplete block. Also, due to the expanding use of ultrasound, orthopaedic surgery of not only foot but also ankle and lower leg could be done without general anesthesia or spinal anesthesia. We describe a detailed technique for ultrasound-guided femorosciatic nerve block based on the experience over 120 cases.

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Video Assisted Thoracoscopic Thoracic Sympathectomy for Palmar Hyperhidrosis (비디오 흉강경을 이용한 수장부 다한증의 흉부 교감신경절 절제술)

  • 류지윤;한일용;조광현
    • Journal of Chest Surgery
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    • v.31 no.4
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    • pp.388-392
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    • 1998
  • Hyperhidrosis is one of abnormalities in autonomic nervous system, it has been treated with dermatologic principles or thoracic sympathectomy via thoracotomy. But these techniques were rather ineffective or invasive. Recently, Video Assisted Thoracoscopic Surgery(VATS) is widely applided in thoracic surgical area, and palmar & axillary hyperhidrosis is not the exception. From August 1995 to February 1997, 52 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic sympathectomy with VATS in the department of thoracic & cardiovascular surgery, Inje university, Pusan Paik Hospital. There were 27 men and 25 women and the mean age was 22 years. Mean operating time was 172 min and unilateral sympathectomy via minithoracotomy was applied in one patient due to severe pleural adhesion. Mean postoperative hospital stay was 2.6 days. During mean 12.5 months follow-up, there was no recurrence of sweating in the both hands. Thirty patients(57.7%) complained moderate degree of compensatory sweating, but the discomfort was decreased in severity. 83.8% of all patients were satisfied with the result of operation.

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A Case of Traumatic Laryngeal Stenosis (외상성 후두 협착 치험례)

  • 강연섭;정재봉;변우현;조윤태;박해수
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1981.05a
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    • pp.9.2-9
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    • 1981
  • Now we are encountering with a growing number of severe head and neck injuries owing to automobile accidents, violence, and industrial injuries etc. In these circumstances, emergency tracheostomy and neurosurgical treatment are frequently necessary. When cervical trauma was ignored at initial stage, significant complications and sequelae may follow. So it deserves attention that meticulous and thoughtful treatments should be given to the cervical injuries as well as head injuries. We have recently experienced a case of laryngeal stenosis resulted from head and neck trauma. The patient was a 20-year-old male who underwent craniectomy and tracheostomy at another hospital about one and a half years prior to admission. With multistaged operations, we were able to re-establish an adequate natural air way.

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Ultrasound Imaging for Position of the Sciatic Nerve Division in Korean Female (한국 여성에서 좌골 신경 분지 위치에 대한 초음파 영상)

  • Nam, Il Hyun;Yeo, Eui Dong;Yu, Ji Soo;Lee, Jun Ho;Lee, Young Koo
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.28-32
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    • 2014
  • Purpose: We aim to determine sciatic nerve bifurcation location and depth at the level of the popliteal fossa in Korean female. Materials and Methods: Thirty three subjects were enrolled in Korean female. M-turbo ultrasound system (SonoSite, bothell, WA, USA)with 38 mm high frequency linear array transducer, 13-6 MHz probe was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin to nerve distance were assessed via ultrasound. Analyses were performed with SAS version 9.3 using multiple linear regression. Results: Thirty three subjects were enrolled. Distance from the popliteal crease to the sciatic nerve was 4.5-7.5 (mean 5.7 cm), and the depth of the sciatic nerve from the skin was 1.8-3.2 (mean 2.4 cm). Multiple linear regression for the usefulness of the model has a p value of 0.036, shows between weight and depth. Conclusion: We show that variability exists for sciatic nerve bifurcation location in Korean female, The success rate is creased if consider the relations between weight and depth when performs sciatic nerve block in Korean female. In our study, a sciatic nerve block is recommend that performed 7.5 cm proximal to the crease in the popliteal fossa.

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Treatment of Intracranial Meningioma with Linac Based Radiosurgery (뇌수막종에서 선형가속기를 이용한 방사선수술 효과)

  • Kay Chul Seung;Yoon Sei Chul;Chung Su Mi;Ryu Mi Ryung;Kim Yeon Sil;Suh Tae Suk;Choi Kyuho;Son Byung Chul;Kim Moon Chan
    • Radiation Oncology Journal
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    • v.19 no.2
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    • pp.81-86
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    • 2001
  • Prupose : To evaluate the role of linac based radiosurgery (RS) in the treatment of meningiomas, we retrospectively analyzed the results of clinical and follow up CT/MRI studies. Methods and Materials : From the 1988 July to 1998 April, twenty patients of meningioma had been treated with 6 MV linear accelerator based radiosurgery. Of the 20 patients, four $(20\%)$ were male and 16 $(80\%)$ were female. Mean age was 51 years old ($22\~78$ years old). Majority of intracranial location of tumor for RS were parasagittal and sphenoid wing area. RS was done for primary treatment in 6 $(30\%)$, postoperative residual lesions in 11 $(55\%)$ and regrowth after surgery in 3 $(15\%)$. Mean tumor volume was $5.72\;cm^3\;(0.78\~15.1\;cm^3)$ and secondary collimator size was 2.04 cm $(1\~3\;cm)$. The periphery of tumor margin was prescribed with the mean dose of 19.6 Gy $(9\~30\;Gy)$ which was $40\~90\%$ of the tumor center dose. The follow up duration ranged from 2.5 to 109 months (median 53 months). Annual CT/MRI scan was checked. Results : By the follow up imaging studies, the tumor volume was reduced in 5 cases $(25\%)$, arrested growth in 14 cases $(70\%)$, and increased size in 1 case $(15\%)$. Among these responsive and stable 19 patients by imaging studies, there showed loss of contrast enhancement after CT/MRI in four patients. In clinical response, nine $(45\%)$ patients were considered improved condition, 10 $(50\%)$ patients were stable and one $(5\%)$ was worsened to be operated. This partly resulted in necrosis after surgery. Conclusion : The overall control rate of meningiomas with linac based RS was $95\%$ by both imaging follow-up and clinical evaluation. With this results, linac based RS is considered safe and effective treatment method for meningioma.

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Thyroplasty for the Restoration of a Normal Voice (음성개선을 위한 갑상연골성형술)

  • 김기령;김광문;정명현;이원상;정승규
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1982.05a
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    • pp.10.1-10
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    • 1982
  • The use of phonosurgery in the recent development of laryngomicrosurgery has enabled the restoration of a normal voice in respect to functional laryngeal surgery which in Korea in the past limited to simple removal of benign laryngeal tumor such as laryngeal polyp or nodules and cordal injection of $Teflon^{{\circledR}}$ for the treatment of recurrent nerve paralysis under the vision of suspension laryngoscopy. Performance of phonosurgery for the treatment of cord paralysis, mutational dysphonia, vocal cord atrophy, hyperkinetic dysphonia and sulcus vocalis is a happy event in the view point of development of phonosurgery in Korea. In this aspect thyroplasty to change the position and physical characteristics of the cord outside the glottis instead of the direct handling of the vocal cord through direct endoscopy is popular. Among the 4 types of thyroplasty, classified by Insshiki(1974), type I thyroplasty(1ateral compression of vocal cord) and type IV thyroplasty(lengthening of vocal cord) were effective in the treatment of unilateral vocal cord paralysis. Advantages of this operation are the fine adjustment of the degree of lateral compression under local anesthesia according to the phonation of the patient during operation and avoidance of dyspnea and intralaryngeal hemorrhage due to the manipulation outside the internal perichondrium of the thyroid cartilage. We did 7 cases of thyroplasty for the treatment of unilateral vocal cord paralysis in the 7 months from September 1981 to March 1982. Before the operation aerodynamic study, psychoacoustical evaluation, stroboscopy and sound spectrographic analysis were done. Two months after the operation the above procedures were performed again. Results of preoperative and postoperative examination were compared and the following results were obtained. 1) In the aerodynamic study, maximum phonation time increased to 158% of the preoperative value and the phonation quotient and the mean flow rate decreased to 58% and 54% of preoperative values. 2) The degree of hoarseness improved in the psychoacoustical evaluation and the glottic chink during phonation was decreased in the stroboscopic examiantion. 3) In the sound spectrographic analysis, periodicity was much restored and noise distribution decreased especially in the high frequency area.

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Recurrent Shoulder Dislocation and Proximal Humerus Fracture in Neurofibromatosis Type I - A Case Report - (제 1형 신경 섬유종증 환자에서 발생한 재발성 견관절 탈구 및 근위 상완골 골절 - 1예 보고 -)

  • Hwang, Tae Hyok;Cho, Hyung Lae;Wang, Tae Hyun;Yang, Hui Sun
    • Clinics in Shoulder and Elbow
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    • v.16 no.2
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    • pp.135-140
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    • 2013
  • We report a case of recurrent shoulder dislocation and combined proximal humerus fracture in neurofibromatosis type I. A twenty-year-old male patient with known neurofibromatosis type I presented with right shoulder dislocation and proximal humerus fracture following a minor trauma. His injured arm also had large plexiform neurofibromas on the elbow, and the dislocation of the shoulder joint was proven to be recurrent. Bony deformation of the humerus and scapula were revealed on X-ray and computed tomography, as well as multiple neurofibromatic changes of the deltoid and periscapular muscles were noted on magnetic resonance imaging. Open reduction and capsular reconstruction were performed and humeral fracture was stabilized with a reconstruction plate. Satisfactory union and functional result were achieved and the dislocation did not recur until the 7-month followup after the procedure. Recurrent shoulder dislocation and combined proximal humerus fracture in neurofibromatosis type I are rare complications. However, it should still be considered in the orthopaedic evaluation process of the diseases.

Component proteins in cystic fluid of Taenia sodium metacestodes collected surgically from neurocysticercosis patients (인체 유구낭미충증 환자에서 수거한 낭미충 낭액의 성분 단백질의 양상)

  • Yoon Kong;Shin-Yong Kang;Seung-Yull Cho
    • Parasites, Hosts and Diseases
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    • v.28 no.2
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    • pp.101-108
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    • 1990
  • Surgically collected cystic fluid of Taenia solium metacestodes from patients of intracranial cystic lesion were compared in their protein composition with those from naturally infected pigs in Cheju Do, Korea and Ecuador. In non-denaturing discontinuous-polyacryla aide gel electrophoresis (disc-PAGE) , no discernible differences were recognized in banding patterns between the cystic fluids from Cheju Do and Ecuador, and between the cystic quids from pigs and human lesions except wider bands that corresponded to human albumin and T-globulin (in 4 of 9 patients). In reducing SDS-PAGE, bands in the cystic Ruid from Ecuador showed the same banding pattern with that from Cheju Do but two bands of 21 and 17 kDa were stained darker. Cystic quids (rom patients revealed the same protein compositions of the major protein bands of 94, 64, 15, 10 and 7 kDa as in the cystic fluid of pig origin, but human albumin (66 kDa), heavy and light chains of gamma globulin (55 and 22.5 kDa) were contaminated in 4 of 9 cystic fluids. Human CSF proteins seem to have been contaminated during cystic ftuid collection. In any cystic quid from patients, the majcr Protein component was 150 kDa which was subdivided into 15, 10 and 7 kDa in reducing SDS-PAGE.

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