• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.112-118
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• 2010

Objective : There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. Methods : A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 3D-day morbidity and mortality. Results : The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p=0.000), age (p=0.000), presence of symptom (p=0.003), and location of aneurysm (p=0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p=0.010), presence of symptoms (p=0.034), size (p=0.000) of aneurysm, and diabetes mellitus (p=0.000) were significant prognostic factors, while treatment modality was not. Conclusion : This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.

• Korean Journal of Radiology
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• 제23권2호
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• pp.246-255
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• 2022

Objective: To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. Materials and Methods: Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. Results: The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). Conclusion: Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.

• Journal of Korean Neurosurgical Society
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• 제44권5호
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• pp.314-319
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• 2008

Objective: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. Methods: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall. 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients Results: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. Conclusion: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.518-526
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• 2017

Objective : Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. Methods : We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading ($5{\mu}g/kg$, respectively) for 3-5 minutes followed by IV maintenance ($0.08{\mu}g/kg/min$) for approximately 4-24 hours. Results : In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. Conclusion : IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

• Journal of Chest Surgery
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• 제43권6호
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• pp.753-757
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• 2010

식도 파열 후 발생한 식도 흉막루 및 대동맥 흉막루를 식도와 대동맥 이중 우회술로 치험하여 보고하고자 한다. 48세 남자가 폭발 사고로 인한 손상으로 하부 식도 파열을 진단받았다. 외부 병원에서 1차례 식도 봉합술을 시행받았으나 식도 누출이 지속되었고, 이로 인해 좌측 흉강의 농흉이 동반되어 있었고, 이차적인 대동맥 손상으로 흉부 하행 대동맥에 스텐트를 삽입한 상태로 본원으로 전원되었다. 반복적인 수술 및 농흉으로 인한 유착 및 대동맥 손상을 고려하여 흉골 하행 경로를 통해 식도-위 우회술을 시행하였다. 남아있는 농흉은 감염 징후 없이 만성화 단계를 거치던 중 흉관 삽입 부위로 출혈이 관찰되었다. 검사 결과 흉부 하행 대동맥의 감염성 동맥류로 대동맥 벽이 약해진 상태가 확인되어 대동맥 우회술을 시행하였다. 우측 흉강을 통해 상행 대동맥과 복부 대동맥에 인조혈관으로 우회술을 시행하였고, 흉부 대동액 부위는 결찰하였다. 이후 원위부 결찰 부위에 남아 있는 개통 부위에 대해 혈관 플러그(vascular plug)를 이용하여 색전술을 시행하였다. 환자는 더 이상 출혈 없이 4개월째 외래 관찰 중이다.

• Journal of Chest Surgery
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• 제42권1호
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• pp.96-99
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• 2009

좌관상동맥동과 비관상동맥동에서 발생하여 좌심실로 파열된 발살바동 동맥류에 기인한 울혈성 심부전을 주소로 내원한 37세 남자 환자의 수술적 체험 1예를 보고하고자 한다. 술전 심초음파에서 발살바동 주위의 낭성 구조물이 관찰되었고 좌심실 비대와 심한 대동맥판폐쇄부전이 관찰되었고 발살바동맥류와 대동맥-좌심실터널을 감별진단의 범주에 두었다. 수술 소견에서 좌관상동맥동과 비관상동맥동 모두 좌심실로 통하는 누공을 가지고 있었다. 좌심실로 파열된 누공은 bovine pericardium으로 봉합하였으며 대동맥근부는 21 mm St. Jude Epic Supra tissue valve와 24 mm Hemashild의 복합도관을 사용하여 교정된 Bentall 수술을 시행하였다. 환자는 수술 후 15일째 퇴원하였으며, 2개월간 정기적으로 외래추적 관찰중이다. 이에 저자들은 본 질환의 희귀성과 함께 수술적 방법을 알리고자 증례보고 하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.397-418
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• 1994

Microvascular surgery has been widely used in the clinical field of replantation and reconstructive surgery. Since the last 20 years, microsurgical techniques and instruments have been rapidly developed and the success rate is remarkably increased. But thrombotic occlusion of vessels remains the major reason for clinical failure. The change of vessel wall is the most important factor in thrombus formation. If we can reduce the traumatic changes in the vessel walls during surgery, the success rate can be markedly increased. For this study, femoral arteries and veins of 36 Sprague-Dawley rats with average weights of 300gm were used. The author observed the histological changes and healing process in the anastomostic site after 1 hour, 24 hours, 1, 2, 3 and 4 weeks under light microscopy and scanning electron microscopy. The results were as follows : 1. The patency rate was 100% in femoral arteries and 85% in femoral vein. 2. At the early stages after microvascular anastomosis, the loss of endothelial cell in the vessel walls was observed in the wide area including anastomotic site. In scanning electron microscopic finding the anastomotic site was covered with much fibrin, many red blood cells and some platelets. 3. At 1st week, new endothelial cells were formed toward anastomotic site and at 3rd week, the anastomotic site was completely covered by new endothelial cells. At 4th week, the complete endothelialization over the threads was observed. 4. The media extended from the anastomotic site toward the end of the specimen. At later stages, the extent of media necrosis was markedly decreased. But the media necrosis of anastomotic site was not regenerated till 4th week. 5. Intimal hyperplasia appeared at 1st week and increased till 4th week. The layer consisted of endothelialization the most luminal layers and smooth muscle in the deeper layers. But in veins, the response was less pronounced than in arteries. 6. Foreign body granuloma remained during 4 weeks and aneurysm was observed at 3rd week in artery. In aneurismal wall, media necrosis, loss of elastic lamina and intimal hyperplasia were seen.

• Journal of Chest Surgery
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• 제34권10호
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• pp.787-791
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• 2001

관상동맥류는 매우 드문 질환으로, 통상적으로 주위 정상 분절보다 내경이 1.5배 이상 초과하여 비정상적으로 확장되어 있는 경우로 정의된다. 유병률은 백인종에서는 2.6%, 동양인에서는 0.25%로, 전자는 약 반수이상이 죽상경화성 관상동맥질환과 관련되어 있으나, 후자는 70% 정도가 비폐쇄성 동맥류와 관련되어 있는 것으로 보고 된 바 있다. 관상동맥루 또한 매우 드문 질환으로, 10년간 실시한 심혈관조영촬영술에서 단지 0.2% 만이 발견되었다고 보고된 바 있다. 증상은 없을 수도 있고, 무증상적 심잡음, 운동시 호흡 곤란, 피로감, 울혈성 심부전 등으로 나타날 수 있다. 주침범 관상동맥은 우관상동맥(56%), 좌관상동맥(36%) 순이고, 원위부 연결 부위는 우심실(39%), 우심방(33%), 폐동맥(20%)으로 보고된 바 있다. 저자들의 경우 단순흉부사진과 흉부전산화단층촬영상 종격동 종양이 의심되어 좌측전측방 개흉술로 종양제거를 시도했다. 그러나 종양은 좌실실에서 기원하고, 수술 중 실시한 거대종괴(6$\times$6$\times$6cm)내 바늘흡입검사 상 박동성의 동맥혈이 분출하여서, 심장 박동 중에 제거하는 것이 매우 위험하다고 판단되어 수술을 계속 진행하지 않았다. 개흉술 4일 후 실시한 심혈관조영술 상 첫사선관상동맥(1st diagonal artery)에서 혈류를 받는 심장종양이 의심되었고, 상행대동맥에서 총폐동맥간으로 연결되는 관상동맥루가 우연히 발견되었다. 정중흉골절개술 후, 체외순환 하에서 종양 제거술과 관상동맥루 결찰술을 성공적으로 실시하였다. 수술후 병리 조직소견상 심장종양이 아닌 관상 동맥류로 판명되었으며 수술 후 합병증 없이 경쾌 퇴원하였다.

• Journal of Chest Surgery
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• 제41권5호
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• pp.647-650
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• 2008

대동맥수술 후 대동맥질환의 재발은 주로 하부에 대동맥류의 형태로 나타나며 상부에 침투성 동맥경화성 궤양의 형태로 나타나는 것은 매우 드물다. 대동맥류 수술의 기왕력을 가진 환자에서 대동맥궁과 하행대동맥의 근위부에 걸쳐 발생한 침투성 동맥경화성 궤양의 파열을 완전순환정지 하에 인조혈관을 사용하여 패취봉합을 성공적으로 시행하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.335-339
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• 2006

Objective : The authors present eight cases of immediate post-operative epidural hematomas[EDHs] adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. Methods : Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. Results : In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography[CT] scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. Conclusion : Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.