• 대한두개안면성형외과학회지
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• 제16권2호
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• pp.80-83
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• 2015

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.180-184
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• 2010

Objective : To prevent temporal depression after the pterional craniotomy, this study was designed to examine the safety and aesthetic efficacy of the brushite calcium phosphate cement (CPC) in the repair and augmentation of bone defects following the pterional craniotomy. Methods : The brushite CPC was used for the repair of surgically induced cranial defects, with or without augmentation, in 17 cases of pterional approach between March, 2005 and December, 2006. The average follow-up month was 20 with range of 12-36 months. In the first 5 cases, bone defects were repaired with only brushite CPC following the contour of the original bone. In the next 12 cases, bone defects were augmented with the brushite CPC rather than original bone contour. For a stability monitoring of the implanted brushite CPC, post-implantation evaluations including serial X-ray, repeated physical examination for aesthetic efficacy, and three-dimensional computed tomography (3D-CT) were taken 1 year after the implantation. Results : The brushite CPC paste provided precise and easy contouring in restoration of the bony defect site. No adverse effects such as infection or inflammation were noticed during the follow-up periods from all patients. 3D-CT was taken 1 year subsequent to implantation showed good preservation of the brushite CPC restoration material. In the cases of the augmentation group, aesthetic outcomes were superior compared to the simple repair group. Conclusion : The results of this clinical study indicate that the brushite CPC is a biocompatible alloplastic material, which is useful for prevention of temporal depression after pterional craniotomy. Additional study is required to determine the long-term stability and effectiveness of the brushite calcium phosphate cement for the replacement of bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권3호
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• pp.221-226
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• 2007

Purpose The purpose of this study is to evaluation of effect on bone formation of PRP and fibrin sealant with deproteinized bovine bone(Bio-Oss) grafts on rabbit cranial defect. Material and Methods Twelve rabbits were used as experimental animal Two equal 9mm diameter cranial bone defects were created in each rabbit and immediately grafted with Bio-Oss only, Bio-Oss and PRP, and Bio-Oss and Fibrin sealant. Rabbits were sacrificed at 4 and 8 week. The defects were evaluated by histomorphometric analysis. Results Kruskal-Wallis tests were performed comparing new bone formation via histomorphometric analysis. No statistically significant difference of new bone formation was found between Bio-Oss only, Bio-Oss and PRP, and Bio-Oss and fibrin sealant at 4 and 8 weeks (P>0.05). Conclusion This study fails to find a stimulatory effect of PRP and Fibrin sealant on New bone formation of Bio-Oss grafts by histomorphometric analyses.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.454-461
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• 2015

Objective : In this study, we aimed to investigate the underlying ethiological factors in chiari malformation (CM) type-I (CMI) via performing volumetric and morphometric length-angle measurements. Methods : A total of 66 individuals [33 patients (20-65 years) with CMI and 33 control subjects] were included in this study. In sagittal MR images, tonsillar herniation length and concurrent anomalies were evaluated. Supratentorial, infratentorial, and total intracranial volumes were measured using Cavalieri method. Various cranial distances and angles were used to evaluate the platybasia and posterior cranial fossa (PCF) development. Results : Tonsillar herniation length was measured $9.09{\pm}3.39mm$ below foramen magnum in CM group. Tonsillar herniation/concurrent syringomyelia, concavity/defect of clivus, herniation of bulbus and fourth ventricle, basilar invagination and craniovertebral junction abnormality rates were 30.3, 27, 18, 2, 3, and 3 percent, respectively. Absence of cisterna magna was encountered in 87.9% of the patients. Total, IT and ST volumes and distance between Chamberlain line and tip of dens axis, Klaus index, clivus length, distance between internal occipital protuberance and opisthion were significantly decreased in patient group. Also in patient group, it was found that Welcher basal angle/Boogard angle increased and tentorial slope angle decreased. Conclusion : Mean cranial volume and length-angle measurement values significantly decreased and there was a congenital abnormality association in nearly 81.5 percent of the CM cases. As a result, it was concluded that CM ethiology can be attributed to multifactorial causes. Moreover, congenital defects can also give rise to this condition.

• 대한두개안면성형외과학회지
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• 제19권2호
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• pp.94-101
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• 2018

Background: Atrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap. Methods: This study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up. Results: The mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2. Conclusion: This study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.37-39
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• 2009

Purpose: Langerhans cell histiocytosis is a heterogenous group of Langerhans cell proliferative disorders and includes eosinophilic granuloma, Letterer-Siwe diseases, and Hand-Schuller Christian disease. We report a case of eosinophilic granuloma on frontal area. Methods: A 17-year-old male presented with swelling and tenderness on Lt. frontal and periorbital area. CT and MRI showed a $33{\times}25mm$ sized mass that involved Lt. frontal calvarium, frontotemporal meninges, and orbital roof. Results: Total excision of the mass and adjacent soft tissue, calvarium, and orbital roof was performed. Orbital roof defect was reconstructed with absorbable plate and calvarial defect was done with outer cortex of temporal bone flap. The histology revealed proliferation of histiocytes and eosinophils. Immunologically, these histiocytic cells expressed S-100 protein and CD1a. The patient is currently taking conservative treatment. Conclusion: The severity of these disease and their prognosis and treatments are various. For unifocal cranial Langerhans cell histiocytosis, complete excision is the treatment of choice. We report this case with review of literature.

• 한국임상수의학회지
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• 제25권1호
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• pp.58-63
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• 2008

Peritoneopericardial diaphragmatic hernia(PPDH) is uncommon and congenital disease in dogs and cats. In PPDH, the peritoneal organs such as liver, small intestine, stomach and omentum are displaced into the congenital defect between pericardial sac and diaphragm and cause the abnormal round and enlarged cardiac silhouette. Abnormal cardiac silhouette contacts with the cranial diaphragmatic border consistently and soft tissue- and/or gas- density structures are summated over the cardiac density in radiography. The contrast medium flows from peritoneal cavity into the pericardial sac and demonstrates the herniated abdominal organs and the abnormal defect in positive peritoneography. In this study, 4 dogs was diagnosed as PPDH using radiography, peritoneography and thoracic ultrasonography and showed various clinical signs according to the kind, amount and clinical state of herniated abdominal organs.

• Journal of Korean Neurosurgical Society
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• 제48권1호
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• pp.73-78
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• 2010

Objective : Streptococcus pyogenes is a beta-hemolytic bacterium that belongs to Lancefield serogroup A, also known as group A streptococci (GAS). There have been five reported case in terms of PubMed-based search but no reported case of brain abscess caused by Streptococcus pyogenes as a result of penetrating skull injury. We present a patient who suffered from penetrating skull injury that resulted in a brain abscess caused by Streptococcus pyogenes. Methods : The patient was a 12-year-old boy who fell down from his bicycle while cycling and ran into a tree. A wooden stick penetrated his skin below the right lower eyelid and advanced to the cranium. He lost consciousness on the fifth day of the incident and his body temperature was measured as $40^{\circ}C$. While being admitted to our hospital, a cranial computed tomography revealed a frontal cystic mass with a perilesional hypodense zone of edema. There was no capsule formation around the lesion after intravenous contrast injection. Paranasal CT showed a bone defect located between the ethmoidal sinus and lamina cribrosa. Results : Bifrontal craniotomy was performed. The abscess located at the left frontal lobe was drained and the bone defect was repaired. Conclusion : Any penetrating lesion showing a connection between the lamina cribrosa and ethmoidal sinus may result in brain abscess caused by Streptococcus pyogenes. These patients should be treated urgently to repair the defect and drain the abscess with appropriate antibiotic therapy started due to the fulminant course of the brain abscess caused by this microorganism.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권1호
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• pp.49-58
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• 2008

Objective: The Purpose of the study was to investigate the bone morphogenic protein expression of rhBMP-2(recombinant human bone morphogenic protein-2) as singnaling molecule and ${\beta}-TCP$(Tricalcium phosphate) as a bone substitute and carrier medium of rhBMP-2. Materials and Methods: 16 rabbits divided into 2 group of each 8 rabbit. Two standardized bone defect, round bilateral defect was made in the cranium of the 8 rabbit of first group, and was grafted with $150{\sim}500{\mu}m$ diameter ${\beta}-TCP$ 0.25g in one side, which was soaked with rhBMP-2, and autogenous bone was grafted on another side as a positive control. Second group of 8 rabbit, only ${\beta}-TCP$ was grafted with same size and same manner. After 2, 4, 8, and 12 weeks, specimen was taken for microscopic immunohiostochemical and histomorphometric analysis. Result: Grafting ${\beta}-TCP$ with rhBMP show the early formation of the bone regenerative factor (BMP-4) and more quantity of new bone formation than only use of ${\beta}-TCP$ (8,12 week), even show less new bone formation than autogenous bone. Conclusion : The experimental study result that ${\beta}-TCP$ graft combination with rhBMP-2 as a delivery system is an effective with osteoinductive capacity and biodegradable properties, so that provide clinical availibility of composite use in reconstruction of bony defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.82-87
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• 1991

반안면왜소증이란 제1및 제2새궁에서 유래되는 기관에 결손이 옴으로써 초래되는 안면기형을 일컫는 것으로 선천성 악안면기형 중 순열 및 구개파열 다음으로 빈발하는 질환이다. 결손부는 하악골을 포함한 안면골의 여러 부위와 안면근 및 저작근, 뇌신경, 이개등여러 부위에 다양하게 나타나며, 그 기형의 발현 정도도 아주 다양하다. 본 교실에서는 안면비대칭과 교합부전을 주소로 내원한 20 세된 남자환자에 있어서 먼저 경조직을 바로잡기 위하여 상${\cdot}$하악골에 대한 악교정수술과 onlay골이식을 시행한 후, 남아있는 연조직 결손부에 대하여 진피-지방이식을 시행하여 심미적으로 만족할만한 결과를 얻었기에 보고하는 바이다.