• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.33-40
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• 2001

Objective : Aneurysms of vertebral artery and its branches make up approximately 3% of all intracranial aneurysms. As the aneurysm have an intimate relationship with lower cranial nerves and medulla, surgical management of the aneurysms are one of the challenging neurosurgical problems. The authors analyzed the management outcomes for aneurysms arising from vertebral artery and its branches. Methods : At the authors' institution between May 1989 and Jan. 2000, 42 patients were treated with transcranial and endovascular surgery for aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Forty two patients were comprised of 28 female and 14 male patients aged from 26-80 year old(mean : 51.8). Of the 42 patients, 37 patients(88%) had subarachnoid hemorrhage. Of the 37 patients with subarachnoid hemorrahge, 35 patients(95%) were in good neurological status(Hunt Hess grade I-III), 2 patients(5%) in poor grade(H-H grade IV-V) before operation. Location of the aneurysm were 16 in vertebral artery, 12 in vertebro-PICA junction, and 14 in the peripheral PICA. Twenty nine patients were treated with transcranial surgery and 13 patients with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I and II ; 24, GOS III ; 2, GOS IV ; 1 and GOS V(death) ; 2. The causes of mortality related to transcranial surgery were rebleeding after failure in clipping in one and suspected brainstem infarct in one. Morbidity was attributed to vasospasm(3), lower CN palsy(7, including temporary dysfunction) and pseudomeningocele(1). The management outcome of the endovascular surgery was : Glasgow outcome scale(GOS) I-II ; 9, GOS III ; 1, GOS IV ; 1, and GOS V(death) ; 2. The causes of mortality related to endovascular surgery were sepsis from pneumonia(1) and vasospasm(1). There were one cerebellar infarct and one lateral medullary syndrome. Conclusion : Excellent and good surgical results can be expected in 80% of the patients with aneurysms of vertebral arery and its branches. The outcomes of endovascular surgery in treating vertebral artery aneurysm were satisfactory and endovascular surgery may offer a therapeutic alternative especially in vertebral dissecting aneurysm.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.315-318
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• 2011

Purpose: An aneurysm is defined as a permanent, localized dilation of an artery with a 50% increase in diameter over its expected normal diameter. Aneurysms can be classified by cause as traumatic and nontraumatic. Traumatic aneurysms can be divided into true and false aneurysms. Nontraumatic causes of peripheral artery aneurysms include mycotic, atherosclerotic, inflammatory, and idiopathic. In the hand, true aneurysms occurring at the common digital artery have been rarely reported. We present a rare case of a true aneurysm of the common digital artery that was resected and reconstructed using a reversed vein graft. Methods: A 49-year-old male patient was refered to our institution with a $0.73{\times}0.44{\times}1.37cm$ sized pulsating mass between 2nd and 3rd flexor digitorum tendons on Lt. palm area. The mass had been present for 5 years and had increased in size over the previous year. No history of trauma was reported. After a physical examination and ultrasound sonography review, a diagnosis of aneurismal dilatation of common digital artery was made. Surgical treatment by excision of the aneurysm, and a reversed vein graft was performed. Results: Histologic examination of the specimen ($3.4{\times}0.7cm$) showed aneurismal dilatation, with elastin fibers present in the arterial wall. The lesions were healed without any complications and there were no evidence of recurrence. Doppler examination of the reconstruction showed good perfusion. Conclusion: Early excision is recommended to relieve symptoms and avoid neurologic damage. Also, artery reconstruction can be performed by primary end-to-end anastomosis or the placement of a reversed interposition vein graft. Micro surgical repair was the only possible treatment in this case. The authors believe that the vascular anatomy should always be restored as natural as possible.

• Journal of Chest Surgery
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• 제39권2호
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• pp.162-165
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• 2006

무명동맥에 단독으로 발생하는 동맥류는 드문 질환으로 외상, 감염 또는 동맥경화증에 의해 발생하는 것으로 알려져 있다. 증례는 36세 남자 환자로 16년 전 교통사고의 병력 이외에는 특이한 과거력이 없었으며 신체검사에서 우연히 우상종격동 종양이 발견되어 본원으로 전원되었다. 컴퓨터단층촬영에서 흉골과 경계가 불분명한 5 cm크기의 진성 무명동맥류를 볼 수 있었으며 동맥류의 내부에는 혈전이 관찰되었다 수술은 중등도 이상의 저체온법을 이용하여 체외순환 하에서 Dacron Y-이식편을 사용하여 상행대동맥과 우측 경동맥 및 쇄골하동맥 사이에 우회도관을 연결하였으며 동맥류는 절제하였다. 환자는 수술 후 특별한 합병증 없이 회복되어 퇴원하였고 현재 추적 관찰 중이다.

• Journal of Korean Neurosurgical Society
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• 제46권6호
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• pp.577-580
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• 2009

A 47-year-old man presented with a subarachnoid hemorrhage (SAH) and right cerebellar hematoma was referred for evaluation. Cerebral angiography revealed a distal anterior inferior cerebellar artery (AICA) aneurysm associated with an arteriovenous malformation (AVM). Successful obliteration and complete removal of the aneurysm and AVM were obtained using transcortical approach under the guidance of neuronavigation system. The association of a peripheral AICA aneurysm and a cerebellar AVM by the same artery is unique. The reported cases of conventional surgery for this disease complex are not common and their results are variable. Less invasive surgery using image-guided neuronavigation system would be helpful and feasible for a peripheral aneurysm combining an AVM of the posterior fossa in selective cases

• Journal of Chest Surgery
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• 제10권1호
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• pp.82-89
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• 1977

A rupture of a dissecting aneurysm of the aorta is life threatening disease and calls for emergency surgical treatment. The author recently experienced one case of ruptured dissecting aneurysm of the descending thoracic aorta complicated with left hemothorax who was recovered after emergency operation of Aug. 11, 1976. The patient was a 43 years old farmer with known hypertension [260/120] for 20 years but without any venereal disease and had experienced sudden throbbing chest pain. Chest film and aortogram revealed this case ruptured aneurysm of descending thoracic aorta complicated with left hemothorax. In this case, large dissecting aneurysm extend from proximal part of left subclavian artery below diaphragm and involved with 3.0 and 4.0cm sized elliptical rupture in proximal part of descending thoracic aorta. And so, neither fenestration procedure nor replacement of dacron artificial vessel was suitable for this case. Finally, only the rupture site of aneurysm was treated by covering with fibrous pleura and teflon patch. The post-operative management of this case was planned to control hypertension with antihypertensive drugs. The follow-up was possible up to date about 2months. The patient has been doing well with ordinary activities except mild chest discomfort.

• Journal of Chest Surgery
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• 제36권4호
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• pp.261-266
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• 2003

배경： 복부 대동맥류 수술은 높은 사망률을 나타낸다. 저자들은 지난 11년간의 복부대동맥류 수술결과를 토대로 앞으로의 치료에 도움을 받고자 연구를 시행하였다. 대상 및 방법： 1990년 1월부터 2000년 12월까지 연세대학교 흉부외과에서 복부 대동맥류로 수술 받은 환자 48명을 대상으로 하였는데, 평균 나이는 $62.8{\pm}12.7$ (27~85)세였고 남자가 40명, 여자가 8명이었다. 48명의 환자들 중 9명은 대동맥류가 파열되었고, 파열되지 않았던 환자들의 대동맥류 평균 직경은 $8.8{\pm}2.4$ (5.0~15) cm였다. 결과： 48명의 환자들 중 6명이 조기에 사망하여 조기 사망률은 12.5%였다. 수술 전 동맥류의 파열이 있었던 9명의 환자 중 3명이 사망했고(33.3%), 동맥류의 파열이 없었던 환자들은 39명 중 3명이 사망하였다(7.7%). 수술 전에 확인한 여러 변수들 중 나이(p=0.00690), 수술 전 BUN 수치(p=0.0278), 당뇨(p=0.038) 등이 수술 사망의 위험인자로 확인되었다. 퇴원한 42명의 환자들 중 40명에서 추적이 되어 추적률은 95.2%였으며 평균 추적 기간은 $3.6{\pm}0.2$(0.3~10.7)년이었다. 추적 기간 동안 5명의 환자가 사망하였으며(만기 사망률=11.9%), Kaplan-Meier 생존 분석에 의한 5년과 10년 생존률은 각각 $81.7{\pm}7.6$%, $81.7{\pm}7.6$%였고, 인조혈관과 관련된 사건이 일어날 확률은 3.53%/환자-년이었다. 결론： 파열된 복부 대동맥류의 수술 사망률은 파열되지 않은 경우에 비해 높기에 조기에 복부 대동맥류를 제거하는 것이 수술 사망률을 낮출 수 있으리라 생각한다.교육, 추적 관찰이 이루어진다면 좋은 결과를 얻을 수 있을 것으로 생각된다.막은 판막과 관련된 합병증 및 사망률이 낮았다.고 Rastelli술식을 시행하였고, 7례에서 중복치환술(Senning+Rastelli)을 시행하였으며, 1례는 심실중격결손증을 폐쇄하고 REV형 술식을 시행하였다. 술후 추적 기간동안 우심실을 체순환으로 사용한 환 자들에서의 삼첨판막폐쇄부전은 술전 평균 1.3$\pm$1.4도에서 2.2$\pm$1.0도로 통계적으로 의미있게 증가하였다 (p<0.05). 그러나 중복치환술을 시행받은 환자들은 술후 삼첨판막의 폐쇄부전의 증가가 없었다. 술전 완전 방 실차단을 보인 환자는 2례(3.1%)있었으며 술후 새롭게 발생한 완전방실차단은 7례(10.8%)있었다. 술후 기타 장,단기 합병증으로는 폐동맥심실유출로도관(conduit) 재협착이 10례, 혈전증(판막: 2례, 인조혈관: 1례, 폐동 맥: 1례)이 4례, 2주 이상의 지속적 흉관배액이 4례, 유미흉이 3례, 출혈에 의한 재수술이 3례, 기타 급성 신 부전, 종격동염, 횡경막신경 마비가 각각 2례씩 있었으며, 중복치환술을 받은 환자들과 전통적 술식으로 수 술받은 환자에서 술후 합병증의 차이는 없었다. 65명의 환자를 평균 54$\pm$49개월(0~177개월)간 추적관찰하였 으며, 수술 초기에 사망한 환자는 13명으로 20.0%(13/65)의 수술사망율을 보였으며 3명의 환자가 추적기간중 사망하여 24.6%(16/65)의 전체사망율을 보였다. 중복치환술을 받은 환자의 수술사망율은 33.3%(4/12)였다. 술 후 1년, 5년, 10년 누적생존율은 각각 75.0$\pm$5.6%, 75.0$\pm$5.6%, 69.2$\pm$7.

• Journal of Chest Surgery
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• 제19권2호
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• pp.300-305
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• 1986

We have experienced two cases of ascending aorta aneurysm with aortic regurgitation in Marfan`s syndrome. There were abnormal findings in cardiovascular system associated with abnormalities of skeletal systems. They had total replacement of the ascending aorta and aortic valve with Bjork-Shiley`s aortic valve composite graft and reimplantation of coronary ostia on the graft. Their postoperative courses were uneventful and discharged with good clinical results for follow up.

• Journal of Korean Neurosurgical Society
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• 제51권5호
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• pp.292-295
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• 2012

Many reports have been published on complications related to middle cerebral artery (MCA) aneurysm surgical clipping procedures. We report an emergency intracranial in situ bypass surgery case which was performed as a rescue procedure after aneurysmal neck laceration during clipping of an MCA large aneurysm. In this case, we performed in situ M3-superficial temporal artery (STA) interposition graft-M3 bypass procedure. If a STA-MCA anastomosis is not available under MCA flow obstruction, we can consider an emergency in situ MCA-MCA bypass procedure with or without an STA interposition graft.

• Journal of Chest Surgery
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• 제17권1호
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• pp.19-25
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• 1984

Aneurysms of the subclavian artery are rare in comparison with other peripheral aneurysm. Most of these aneurysms arise from atherosclerosis, thoracic outlet obstruction, or trauma. We have experienced two cases of false aneurysms occurring the subclavian artery. One was occurred in right subclavian artery distal to right thyrocervical trunk due to trauma [falling] and was corrected with resection of the aneurysm and replacement with right external jugular vein. The other was occurred in the left subclavian artery lateral to the left internal mammary artery with complication of left hemothorax probably due to infection and was corrected with resection of aneurysm and replacement with Dacron graft. Postoperative course of both were uneventful without complication.

• Journal of Chest Surgery
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• 제18권3호
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• pp.461-465
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• 1985

Rupture of the aorta following blunt trauma of the thorax may occur more frequently than has generally been recognized. Actual complete transection of the aorta usually results in immediate death but varying degrees of lesser disruption permit increased chance of survival. Chronic traumatic aneurysms are so designated following a period of 3 months from the traumatic incident. The exact time required for the acute process and hematoma to convert into an aneurysm is unknown. Because a thoracic surgeon encounters so few of these aneurysms, it is difficult for him to arrive at sound dicta of management from his personal experience. It is not surprising that controversy exists concerning the therapeutic approach to the aneurysm which is asymptomatic and is discovered months or years after the causative injury. In the hope of improving the surgical treatment of patients with this condition, we reported one case with chronic traumatic aneurysm of the descending thoracic aorta.