• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1406-1416
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• 2001

Objective : The goal of this study was to evaluate the effect of Gamma Knife radiosurgery(GKS) on cerebral arteriovenous malformation(AVM) and the factors associated with complete occlusion. Patients and Methods : A total of 369 radiosurgical procedures for 336 patients with cerebral AVMs were performed between December 1988 and June 2001. Three hundreds and twenty-four cases of 293 patients who were treated with GKS procedures from May 1992 to December 2000 were analyzed. Various clinical and radiologic parameters were evaluated. Results : The total obliteration rate for the cases with satisfactory radiological follow-up(more than 2 years) after GKS was 79.3%. In multivariate analysis, maximal diameter, angiographic form of AVM nidus, and number of draining veins significantly influenced the result of radiosurgery. In addition, marginal radiation dose, Spetzler-Martin grade, and flow pattern of AVM nidi also partly influenced the radiosurgical outcome. Conclusion : GKS on cerebral AVM is considered as an effective treatment modality. The risk of hemorrhage seems to decrease within the latency interval between GKS and complete occlusion of nidus. Along with the size, topography, or radiosurgical parameters of AVMs, it is necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

• 대한한의학회지
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• 제22권4호
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• pp.69-78
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• 2001

Objectives : It is known that cigarette smoking is associated with increased risk of both thrombotic and hemorrhagic stroke. However, in Korea, especially in the academic world of Korean Medicine, there is a lack of study about the relation between cigarette smoking and stroke. We carried out a case-control study to clarify the relation between cigarette smoking and stroke. Method : We interviewed 441 stroke patients (236 men, 205 women) as a case group and 432 non-stroke patients (208 men, 224 women) as a control group. We investigated the smoking pattern of all patients and stroke-subtype of the case group. Smoking pattern is classed into two (Class I), four (Class II) and five groups (Class III). Class I consists of current non-smokers and current smokers. Class II consists of non-smokers, former smokers, current light smokers and current heavy smokers. Class III consists of never smoked, secondhand smokers, former smokers, Current light smokers and current heavy smokers. Stroke-subtype consists of cerebral infarction and cerebral hemorrhage. Results : The percentage of current smokers of case group is higher significantly than that of control group. The number of cigarettes smoked per day is associated positively with the risk of stroke. According to our study, generally cigarette smoking is related with ischemic stroke. The percentage of secondhand smokers of the case group is lower than that of the control group. According to our study, characteristically secondhand smoking is associated with hemorrhagic stroke. Conclusions : From the above results we found that cigarette smoking is an important risk factor of stroke - especially cerebral infarction - and the number of cigarettes smoked per day is associated positively with the risk of stroke. Characteristically according to our study, secondhand smoking is associated with hemorrhagic stroke. Overall we conclude that cigarette smoking may be an important preventable factor for stroke.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.518-520
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• 2016

Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device ($4{\times}20mm$) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR ($6{\times}20mm$). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.289-294
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• 2014

Objective : The purpose of this study is to investigate the clinical characteristics of cerebral venous thrombosis (CVT) in a single center in Korea. Methods : A total of 36 patients were diagnosed with CVT from August 2005 to May 2013. The patient data regarding age, sex, disease stage, pathogenesis, location, laboratory findings, radiological findings, and treatment modalities were retrospectively collected. The results were compared with those of previous studies in other countries. Results : The patient group comprised 21 men and 15 women with a mean age of 46.9 years (ranging from three months to 77 years). The most common cause was a prothrombotic condition (8 patients, 22.2%). Within the patient group, 13 patients (36.1%) had a hemorrhagic infarction, whereas 23 (63.9%) had a venous infarction without hemorrhage. By location, the incidence of hemorrhagic infarction was the highest in the group with a transverse and/or sigmoid sinus thrombosis (n=9); however, the proportion of hemorrhagic infarction was higher in the cortical venous thrombosis group (75%) and the deep venous thrombosis group (100%). By pathogenesis, the incidence of hemorrhagic infarction was the highest in the prothrombotic group (n=6), which was statistically significant (p=0.016). Conclusion : According to this study, CVT was more prevalent in men, and the peak age group comprised patients in the sixth decade. The most common cause was a prothrombotic condition. This finding was comparable with reports from Europe or America, in which CVT was more common in younger women. Hemorrhagic infarction was more common in the prothrombotic group (p=0.016) than in the non-prothrombotic group in this study.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.75-80
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• 2013

Objective : Aneurysms arising from the proximal segment of the anterior cerebral artery (A1) are rare and challenging to treat. The aim of this study was to report our experience with endovascular treatment of A1 Aneurysms. Methods : From August 2007 through May 2012, eleven A1 aneurysms in eleven patients were treated endovascularly. Six aneurysms were unruptured and 5 were ruptured. One patient with an unruptured A1 aneurysm presented with subarachnoid hemorrhage due to rupture of an anterior communicating artery aneurysm. Procedural data, clinical and angiographic results were reviewed retrospectively. Results : All of the aneurysms were successfully treated with coil embolization. Six were treated with a simple technique while the remaining 5 required adjunctive technique : double catheters (n=2), balloon-assisted (n=2), and stent-assisted (n=1). The immediate angiographic control showed a complete occlusion in all cases. Procedure-related complication occurred in only one patient : parent artery occlusion, which was not clinically significant. All patients had excellent clinical outcomes but one patient was discharged with a slight disability. No neurologic deterioration or bleeding was seen during the follow-up period in this cohort of patients. Follow-up angiography (mean, 20 months) was available in ten patients and revealed stable occlusion in all cases. Conclusion : Endovascular treatment is a feasible and effective therapeutic modality for A1 aneurysms. Tailored microcatheter shaping and/or adjunctive techniques are necessary for successful aneurysm embolization because of the projection and location of A1 aneurysms.

• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.329-335
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• 2005

Objective: Acute spontaneous subdural hematoma(SDH) secondary to a ruptured intracranial aneurysm is a rare event. The authors present nine cases with aneurysmal SDH. Methods: We analyzed nine cases of aneurysmal SDH from 337 patients who underwent treatment for a ruptured aneurysm between January 1998 and May 2004. Clinical and radiological characteristics and postoperative course were evaluated by reviewing medical records, surgical charts and intraoperative videos. Results: The nine patients comprised four males and five females with a mean age of 53years (range 15-67years). The World Federation of Neurosurgical Societies grades on admission were I in one patient, II in two patients, III in five patients and V in one patient. With respect to location, there were four internal carotid-posterior communicating artery(ICA-Pcom) aneurysms, one distal anterior cerebral artery(DACA) aneurysm, one anterior communicating artery and three middle cerebral artery aneurysms. CT scans obtained from the four patients with ICA-Pcom aneurysms revealed SDH over the convexity and along the tentorium, and two of these patients presented with pure SDH without subarachnoid hemorrhage(SAH). In three patients with ICA-Pcom aneurysm, the ruptured aneurysm domes adhered to the petroclinoid fold. In the patient with the DACA aneurysm, the domes adhered tightiy to the pia mater and the falx. Conclusion: Ruptured intracranial aneurysm may cause SDH with or without SAH. In the absence of trauma, the possibility of aneurysmal SDH should be considered.

• 대한영상의학회지
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• 제82권4호
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• pp.953-958
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• 2021

고소 뇌부종은 높은 지대를 여행하는 사람들에게서 발병하는, 잠재적 치명성을 갖는 신경학적 증후군이다. 본 증례는 높은 지대를 여행한 후 수 시간의 의식불명이 있었던 49세 남자에서 나타난 고소 뇌부종의 비전형적 영상 소견에 대한 보고이다. 환자의 자기공명영상 자기화율강조영상에서 미세한 점상의 다수의 미세출혈이 양쪽 뇌량을 따라 분포하고 있었고 몇 개의 미세출혈이 전두엽과 두정엽의 피질하 백질에서 관찰되었으나 T2 강조영상에서는 이에 상응하는 부위에 신호강도의 증가가 관찰되지 않았다. 확산강조영상에서는 양쪽 기저핵에서 작은 결절형의 고신호강도가 관찰되었다. 본 증례는 T2 강조영상에서 비정상적인 신호강도 없이 양쪽 뇌량에서 다수의 미세출혈을 보였던, 비전형적인 사례로서의 고소 뇌부종의 증례에 대해 문헌 고찰과 함께 보고하고자 한다.

• The Korean Journal of Physiology and Pharmacology
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• 제2권6호
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• pp.695-703
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• 1998

$[K^+]_o$ can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of $[K^+]_o$ in the range of $5{\sim}15$ mM may affect tensions of blood vessels and can change their sensitivity to various vasoactive substances. Therefore, it was examined in the present study whether the sensitivity of cerebral arteries to vasoactive substances can be changed with the moderate increase of $[K^+]_o$, using Mulvany-type myograph and $[Ca^{2+}]_c$ measurement. The contractions of basilar artery and branch of middle cerebral artery induced by histamine were not increased with the elevation of $[K^+]_o$ from 6 mM to 9 mM or 12 mM. On the contrary, the contractions induced by serotonin were significantly increased with the elevation of $[K^+]_o$. The contractions were also significantly increased by the treatment with nitro-L-arginine $(10^{-4}$ M for 20 minutes). In the nitro-L-arginine treated arteries, the contractions induced by serotonin were significantly increased with the elevation of $[K^+]_o$ from 6 mM to 12 mM. $K^+-induced$ relaxation was evoked with the stepwise increment of extracellular $K^+$ from 0 or 2 mM to 12 mM by 2 mM in basilar arterial rings, which were contracted by histamine. But $[K^+]_o$ elevation from 4 or 6 mM to 12 mM by the stepwise increment evoked no significant relaxation. Basal tension of basilar artery was increased with $[K^+]_o$ elevation from 6 mM to 12 mM by 2 mM steps or by the treatment with ouabain and the increase of basal tension was blocked by verapamil. The cytosolic free $Ca^{2+}$ level was not increased by the single treatment with serotonin or with the elevation of $[K^+]_o$ from 4 mM to 8 or 12 mM. In contrast to the single treatment, the $Ca^{2+}$ level was increased by the combined treatment with serotonin and the elevation of $[K^+]_o$. The increase of free $Ca^{2+}$ concentration was blocked by the treatment with verapamil. These data suggest that the sensitivity of cerebral artery to serotonin is increased with the moderate increase of $[K^+]_o$ and the increased sensitivity to serotonin is due to the increased $[Ca^{2+}]_i$ induced by extracellular $Ca^{2+}$ influx.

• 한국의학물리학회지:의학물리
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• 제21권3호
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• pp.274-280
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• 2010

선형가속기를 이용하여 single-fraction stereotactic radiosurgery (SRS)를 시행하였던 뇌동맥 기형 치료 환자 25예 중 13예의 임상결과와 혈관조영술 소견에 대해 알아보고자 하였다. 2002년부터 2009년까지 뇌동정맥 기형으로 SRS를 시행하였던 25명 중 추적 혈관조영술이 시행된 기간이 12개월 이상인 환자 15명(남자 6명, 여자 9명)을 대상으로 하였으며 후향적으로 MRI와 혈관조영술에서 동정맥기형 핵의 크기와, 위치, 파열유무, 추적기간 동안의 합병증 유무, 혈관조영술에서의 변화를 분석하였다. 평균 30개월(12~89개월) 동안 추적 혈관조영술이 시행되었던 15명의 환자 (평균나이 33세, 14~56세) 중 모든 환자에서(100%) 동정맥기형이 완전 소실되었고 3명(20%)에서 유출정맥만이 동맥기 촬영에서 확인되었다. 추적기간 중 1명에서 경련이 있었으며 출혈이나 뇌부종에 의한 임상증상이 있었던 환자는 없었다. 동정맥기형 핵의 부피는 평균 4.3 cc (SD 3.7 cc, 범위 0.69~11.7 cc)였으며 방사선 조사 선량은 평균 17 Gy (12~20 Gy)였다. 동정맥기형의 위치는 대엽이 11예, 기저핵이 1예, 뇌교가 1예, 소뇌가 2예였다. 9예는 파열, 나머지 6예는 비 파열 예였다. 선형가속기를 이용한 뇌동정맥기형 방사선 치료의 성적은 추적기간을 4년 이상으로 할 때 높은 완치율을 보이며 동맥기에 유출정맥이 남아 있을 경우 유출정맥이 완전히 소멸될 때까지 추적 관찰이 요구된다.

• 대한영상의학회지
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• 제83권4호
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• pp.887-897
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• 2022

목적 심각한 증상이 없는 파열된 급성뇌동맥류에서 스텐트를 이용한 코일 색전술 기법의 안전성과 유효성을 평가하고, 지주막하출혈 환자에서 스텐트 자체의 유용성을 평가해 보고자 한다. 대상과 방법 2017년 1월부터 2019년 6월까지 심한 증상이 없는(헌트 앤드 헤스 등급 3 이하) 파열된 뇌동맥류에 대해 코일 색전술로 치료받은 118명의 환자를 대상으로 하였다. 스텐트를 사용한 56명과 스텐트를 사용하지 않은 62명에 대해 시술 이후 합병증, 6개월 수정 랜킨척도, 6개월 영상의학적 결과에 대해 비교하였다. 결과 스텐트를 사용한 군과 스텐트 사용하지 않은 군에서 좋은 임상 결과의 비율(수정 랜킨척도 2 이하)과 출혈성 및 허혈성 합병증의 비율은 유의한 차이를 보이지 않았다. 그러나 스텐트를 사용한 군은 6개월 추적 뇌혈관조영술에서 재개통률이 낮았다(20.0% 대 39.3%, p = 0.001). 결론 심한 증상이 없는(헌트 앤드 헤스 등급 3 이하) 파열된 뇌동맥류의 코일 색전술에서 스텐트의 사용은 임상 결과와 유의한 관련성이 없었다. 스텐트를 사용함으로써 추적 뇌혈관조영술에서 재개통률이 감소하였다.