• Journal of Korean Neurosurgical Society
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• 제67권6호
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• pp.654-660
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• 2024

Objective : We aimed to determine anatomic features of the temporal branch (TB) of the facial nerve and its relation to various anatomic landmarks on the face in order to prevent damage in the surgical approach after head trauma or in planned neurosurgical interventions. Methods : Nine male cadavers preserved with formalin, were bilaterally dissected under a microscope at the laboratory of anatomy department of the university. The anatomical features of the branch and branching pattern of facial nerve and its relationships with adjacent neurovascular structures were evaluated using descriptive statistical data. Results : The mean distance at the lateral canthus level between the far most anterior branch and far most posterior branch of the TB (APD) was 14.93 mm. The mean distance to the tragus of the entrance point of the TB to the orbicularis oculi muscle (ETT) was 74.72 mm. The mean distance between the origin point of the TB to the tragus (TT) was 24.50 mm. The angle between the far most anterior branch and far most posterior branch at the level of the lateral canthus (APA) was minimum 15°, maximum 40° and the mean value of APA was 24.61°. The number of branches originating from the TB (NB) were one to three branches which lay under the zygomatic arch and two to five branches upper the zygomatic arch, respectively. The number of anastomosis between the TB and zygomatic branch (AN) varies between 1 and 4; AN was found to be less intense in 10 sides and very intense in eight sides. Conclusion : The APA and APD value is mentioned for the first time in this study and nerve angle is considered to be as important as temporal branching in directing facial neurosurgical operations. We found that the unsafety zone may be exist for a 40 degree and 1.5 cm long area at the lateral canthus level, especially on the zygomatic arc where branching pattern is greater and 2.5 cm in front of the tragus. The data is significant for neurosurgeons to reach exactly this area without causing postoperative complications such as facial paralysis.

• Anatomy and Cell Biology
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• 제55권1호
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• pp.28-39
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• 2022

The suprarenal arteries are arising from three sources: superior suprarenal artery, middle suprarenal artery, and inferior suprarenal artery. Variations in the arterial supply of the suprarenal glands in respect to origin and number are quite common and very frequently reported. The most common variation noted is in the inferior suprarenal artery followed by the middle suprarenal artery and the least common variations were observed in the superior suprarenal artery. Arteriogram of the inferior suprarenal artery is crucial in suprarenal tumour diagnosis but variation in the branching pattern and multiplicity of these arteries can cause hindrance in arteriography. The absence of middle suprarenal artery was seen to be associated with increased number of the inferior suprarenal artery. Variation in the multiplicity of arteries was observed more frequently in the inferior suprarenal artery and middle suprarenal artery which was more on the right side in most of the studies. Also, the variation in suprarenal arteries was often correlated to variations in inferior phrenic and gonadal arteries. The variations were observed to be more common on the left side therefore right adrenalectomy should be preferred over the left one. The loop formed by the inferior suprarenal artery around the right renal vein can cause venous obstruction. These variations of suprarenal vasculature are explained on the developmental basis, and prior knowledge of such variants is crucial for nephrologists to ensure minimum blood loss while performing laparoscopic adrenalectomy especially for large adrenal tumours and pheochromocytoma where the duration of surgery exceeds the usual.

• 대한의용생체공학회:의공학회지
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• 제19권4호
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• pp.393-401
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• 1998

임상학적인 관찰에 따르면, 반복적인 하중에 의하여 뼈/건의 접합부분에 발생하는 부분적인 파손은 병리학적인 변화를 유발시킴으로 인하여 주관절의 상골과염(Epicondylitis)으로 발전시킬 수 있는 주요한 원인으로 간주되고 있다. 반복적인 하중이나 정적인 하중 하에서의 주관절에 위치한 신전건 및 굴곡건의 기계학적인 물성치와 파괴양상은 지금까지 잘 알려져 있지 않다. 본 연구에서는 상골과염과 직접적인 관계가 되는 신전건 및 굴곡건의 기계학적인 물성치인 파괴강도, 반복하중의 회수와 변형율(Strain)간의 연관관계 및 반복하중에 있어서의 생체조직학적 변화의 향상, 특히 파괴의 진행양상을 관찰하였다. 적용하중의 속도에 따르는 신전건 및 굴곡건의 파괴강도의 통계학적인 차이는 보이지 않고 있으나, 파괴강도에 있어서 신전건은 1199.0 N/$cm^2{\pm}$388.8, 굴곡건 1922.0 N/$cm^2{\pm}$764.4로, 굴곡건이 신전건에 비하여 1.6배 정도 크게 나타났으며, 상호간의 파괴강도에 있어서 통계학적인 차이가 있음을 보여주고 있다.(p<0.05). 조직학적 관찰에 의하면, 반복하중 하에서 뼈/건의 접합부분 특히 Uncalcified Fibrocartilage 부분에서 분리가 시작되었으며, 이는 상골과염을 발생시키는 주요생체조직부분이라는 것을 시사하고 있다.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• 한국산림과학회지
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• 제49권1호
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• pp.11-31
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• 1980

주요조림수종(主要造林樹種)인 Populus alba ${\times}$ glandulosa에 대(対)하여 형태학(形態学), 해부학(解剖学) 그리고 생리학적(生理学的) 조가(調査)를 하여 다음과 같은 결과(結果)를 얻었다. 1. P. alba ${\times}$ glandulosa의 엽외형(葉外形)의 많은 형질(形質)과 Catkin의 Chaff의 외형(外形)은 불완전우성(不完全優性)이고, 밀선(蜜腺)은 우성(優性)으로 유전(遺伝)한다. 2. 선발(選抜)된 15Clone의 성비(性比)는 ♂성(性)이 9개체(個体), ♀성(性)이 2개체(個体), ♂ ♀동주(同株)가 2Clone 이다. 3. 수피(樹皮)에는 잘 발달(発達)한 Cork층(層)과 인피(靭皮) 섬유조직(纖維組織)이 있다. 4. Primodial leaf에서 3층(層)의 세포조직(細胞組織)으로 구성(構成)되는 시기(時期)의 엽(葉)과 책상(柵狀)과 해면조직(海綿組織)의 분화(分化)가 아직 일어나지 않은 시기(時期)의 엽(葉)은 발생부위(発生部位)가 다르다. 5. 엽적(葉跡)의 조직(組織)은 유관속(維管束)이 연결(連結)되었든 곳과 그렇지 않은 곳의 2종류(種類)의 조직(組織)으로 구성(構成)되는데 유관속(維管束)이 연결(連結)되었든 곳의 조직(組織)은 2~3층(層)의 Cork 세포(細胞)로만 외부(外部)와 차단(遮断)하고 있다. 6. 엽병(葉炳)의 유관속(維管束)의 배열상태(配列狀態)는 심(甚)히 복잡(複雑)하다. 7. P. alba ${\times}$ glandulosa의 생장(生長)은 외온(外溫), 일장(日長), 광량(光量)에 민감(敏感)하였는데, 수고(樹高)에서 더욱 심(甚)하였다. 8. 평지양토(平地壤土)에 $60{\times}60cm$로 식재(植栽)한 환경(環境)에서 P. alba ${\times}$ glandulosa의 최고인자(最高因子)를 추구(推究)할 수 있을것같다. 9. 15Clone의 발근성(抜根性)은 외인(外因)에 따라 다르게 나타난다. 10. P. alba ${\times}$ glandulosa는 포장용수량(圃場容水量)에 대(対)한 평균용수율(平均容水率)이 80% 전후(前后)일때, 가장 생장(生長)이 좋다. 11. 급경사지(急傾斜地)의 토양함수량(土壤含水量)의 감소속도(減少速度)는 완경사지(緩傾斜地)보다 속(速)하여, 수분격감(水分激減)으로 인(因)하여 생장(生長)이 억제(抑制)되는 것 같다. 12. 동계(冬季)의 남측방위(南測方位)의 간수온(幹樹溫)에 있어 10cm 부위이하(部位以下)의 체내(体內), 외간(外間)의 온도차(溫度差)는 어느계절(季節), 어느 방위(方位)보다도 크다. 13. 수액유속(樹液流速)은 임내관계온(林內関係溫), 습도(湿度)와 체내(体內)의 함수율(含水率)에 크게 영향 받는다. 14. 피층(皮層)의 전당량(全糖量)의 증감(増減)은 계절(季節)과 관계(関係)있고, 간(幹)의 부위(部位)와는 무관(無関)하다. 15. 15Clone의 엽(葉)의 Isoperoxidase 변화(变化)는 Clone 간(間)에 심(甚)히 상이(相異)하나, Clone식별(識別)에 이용(利用)될 수 있다.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.26-30
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• 1999

본 연구에서는 ERP검사 중에는 중뇌동맥의 MFV가 검사전후와 비교하여 유의하게 증가힌 소견을 보였다. 비록 중뇌동맥의 혈류속도의 변화가 뇌활동정도를 직접 반영할 수는 없다고 생각이 되지만 이 연구의 결과로 P300의 생성에 중뇌동맥에 의해서 영양받는 전두엽, 측두엽 및 두정엽이나 다른 대뇌부위가 관여할 것으로 사료된다. 경두개도플러검사는 다른 뇌기능활동을 반영할 수 있는 양전자방출단층촬영이나 단일광자방출단층촬영과 같이 혈류역학을 볼 수 있는 검사와 병행하여 연구하면 P300의 발생부위를 규명하는데 도움을 줄 것으로 사료되며 뇌활동을 역동적으로 평가하는데 도움을 줄 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.118-125
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• 2000

Objective : Trigeminal neurinomas are rare tumors that may locate in the middle fossa or posterior fossa and straddled both the middle and posterior fossa, according to their origin in the nerve complex. The aim of this study was to analyze the clinical presentation, operative approaches employed and outcome in 15 patients who were treated surgically, with special emphasis on surgical approach. Method : Between 1994 and 1998, a total of fifteen patients were histopathologically identified as neurinomas originating from the trigeminal nerve complex at the tumor clinic in the neuroscience center of the our university. Results : The surgical approach to these tumors depends on their anatomical location and tumor size. Six patients had tumors confined to the middle fossa, five patients had tumors limited to the posterior fossa, and four patients both in middle and posterior fossa components of their tumors. Nine neurinomas were removed via the conventional approach(pterional, subtemporal, suboccipital) and six were excised using skull base approach(transzygomatic subtemporal, orbitozygomatic, transpetrosal). Total resection of the tumor was possible in 10 cases. Total resection of tumor was accomplished in 83% of patients following skull base approach compared with 56% of patients following conventional approach. The surgical outcome was excellent or good in 13 cases, fair in one and, poor in one. There was no operative death. In the immediate postoperative period, aggravation of preoperative facial hypesthesia and 6th cranial nerve palsy were common. Although, these deficits were generally transient, eight patients remained with some degree of trigeminal hypesthesia, two had facial weakness, one neurotrophic keratitis, one diplopia, and one mastication difficulty. Conclusion : Surgical approach to the trigeminal neurinoma depends on the tumor location and tumor size. Skull base approach provides more complete tumor excision without increased morbidity compared to conventional approach. Surgeons have to be meticulous in order to reduce postoperative complication.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1361-1368
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• 2001

Objective : "Paraclinoid" aneurysms include those aneurysms arising from the internal carotid artery between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery. The authors reviewed and analysed the results of surgical approaches to paraclinoid aneurysms treated with transcranial surgery and endovascular surgery. Methods : Between January 1998 and May 1999, 14 patients were treated surgically through ipsilateral and contralateral pterional approaches, and anterior interhemispheric approach, and endovascular surgery for paraclinoid aneurysms. All transcranial approaches were performed by same surgeon. The medical records, neuroimaging studies and videotapes which had been recorded operations were reviewed retrospectively. Results : Twelve patients presented with subarachnoid hemorrhage and ICH. Nine of fourteen patients had multiple aneurysms. Thirteen cases were small and one was a large aneurysm. Six patients were treated through ipsilateral approaches, six contralateral pterional approaches, one anterior interhemispheric approach and one primarily by GDC embolization. All aneurysms treated through contralateral approaches were multiple aneurysms. Neck clipping was performed in 9(69.2%) of the thirteen aneurysms, wrapping in four cases, among them three cases were followed by GDC embolization. The surgical outcomes were : Glasgow Outcome Scale(GOS) I 71.4%, GOS II 21.4% and GOS V 7.1%. Conclusion : The surgical approaches to paraclinoid aneurysms should be chosen after careful anatomical evaluation of aneurysm and its neighboring structures. 3D-CT angiography and/or the raw data of MR angiography were useful. This study supports the usefulness of the contralateral approach to paraclinoid aneurysm associated with multiple aneurysms, unruptured and small aneurysms whose dome projecting medially, superiorly and dorsally. The determination of contralateral approach to small and medially projecting paraclinoid aneurysm may be stressful to operator, thus we believe anterior interhemispheric approach is better alternated. Also we recommend the endovascular surgery after reinforcement of aneurym neck and dome in the case with difficulty in clipping.

• 대한소아치과학회지
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• 제35권1호
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• pp.136-143
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• 2008

소아의 구강 악안면 부위의 감염은 부비동, 근막간극, 타액선, 악골, 치아 등의 다양한 해부학적 구조물과 연관되어 발생하며 적절히 치료되지 않는다면 짧은 시간 내에 치명적인 상태로 진행될 수 있어 조기 진단 및 치료가 요구된다. 원인은 다양하지만 대부분이 치성 원인으로서, 괴사된 치수로 인한 치근단 병소, 화농성 치주질환, 치관주위 감염 등으로부터 유래된다. 소아의 치성 감염은 치아우식증이 원인인 경우가 대부분이며 병원성 균이 치수를 통해 인접 조직으로 확산되어 치근단 감염 및 농양, 봉와직염, 골수염, Ludwig's angina, toxic shock syndrome 등의 질환을 유발한다고 알려져 있다. 근막간극이란 느슨한 결체조직으로 채워진 근층 사이에 존재하는 잠재적인 공간으로 일반적인 근막간극 농양의 진행과정은 괴사 치수 염증이 치조 농양 형태로 치근 주위로 퍼지고 점차 근막을 침투해 피질골을 통해 잠재적 간극을 이환시킨다. 구강 악안면 부위의 감염이 연조직으로 침투할 경우, 결체조직을 통하여 그리고 근막간극을 따라 가장 조직 저항이 적은 방향으로 확산된다. 이러한 감염은 치아발치, 근관치료, 배농을 포함한 외과적 치료, 항생제 투여 등에 의해 적절히 치료될 수 있다. 본 증례에서는 치성 원인의 견치 간극 농양 및 협부 간극 농양에 이환된 환자들에 대하여 항생제 투여 및 근관치료, 외과적 배농 등을 시행하여 양호한 치료 결과를 얻었기에 보고하는 바이다.

• Korean Journal of Acupuncture
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• 제27권3호
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• pp.129-142
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• 2010

Background : The Bonghan theory is a hypothesis on the anatomical structure of the acupuncture point and meridian system. It has been regarded as a misunderstanding of the lymphatic system, or as a made-up story, for the past 40 years. Since 2002, Many studies have been published either to support the theory or to refute the old viewpoint. Objective : The purpose of this study was to find out the validity of the refutation by reviewing the publications. Methods : Searches were made from online databases (Riss4u.net, Google.com, Sciencedirect.com, Pubmed.com, baidu.com, and ci.nii.ac.jp) from 1960 to 2009. The search terms that were used were "Bonghan," "Bong han," "봉한," "thread-like structure," "KИM БOH XaHOM", "CИCTEMA KEHPAK," "鳳漢," "鳳漢管," and "鳳漢学說." References from the searched publications were also used. Results : Since the 1960s, 107 publications were identified as related works, but only 11 publications sought to refute the Bonghan theory. Two publications were researches, and nine were reviews. In the analysis of the correlation of the arguments with the publication contents, it was found that the research of G. Kellner reviewed the Bonghan system properly but that V. V. Kosmatov did not classify the ear-reflex zone as a traditional acupuncture point. For the review publications, only two reviews contained proper arguments, but seven publications were identified as broad interpretations, wrong translations, etc. Moreover, the two proper reviews were grounded on the research of G. Kellner. Conclusions : We found that the scientific origin of the refutation of the Bonghan theory is only one research by G. Kellner. This result suggest that Bonghan theory was not discussed enough to determine the invention.