• Archives of Craniofacial Surgery
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• v.15 no.2
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• pp.89-93
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• 2014

Background: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. Methods: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. Results: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). Conclusion: The rat hemifacial transplantation model is suitable as a standard transplantation training model.

• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.136-143
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• 2019

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging. Insufficiency of this 'IC-EC conversion system' could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.44-47
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• 2019

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotid-cavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7-8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.356-360
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• 2014

The coexistence of moyamoya disease (MMD) with an arteriovenous malformation (AVM) is exceedingly rare. We report two cases of AVM associated with MMD. The first case was an incidental AVM diagnosed simultaneously with MMD. This AVM was managed expectantly after encephalo-duro-arterio-synangiosis (EDAS) as the main feeders stemmed from the internal carotid artery, which we believed would be obliterated with the progression of MMD. However, the AVM persisted with replacement of the internal carotid artery feeders by new external carotid artery feeders from the EDAS site. The AVM was eventually treated with gamma knife radiosurgery considering an increasing steal effect. The second case was a de novo AVM case. The patient was initially diagnosed with MMD, and acquired an AVM eight years later that was slowly fed by the reconstituted anterior cerebral artery. Because the patient remained asymptomatic, the AVM is currently being closely followed for more than 2 years without further surgical intervention. Possible differences in the pathogenesis and the radiologic presentation of these AVMs are discussed with a literature review. No solid consensus exists on the optimal treatment of MMD-associated AVMs. Gamma knife radiosurgery appears to be an effective treatment option for an incidental AVM. However, a de novo AVM may be managed expectantly considering the possible risks of damaging established collaterals, low flow characteristics, and probably low risks of rupture.

• Journal of Pharmaceutical Investigation
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• v.30 no.2
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• pp.99-105
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• 2000

This study compared the permeability of $[^3H]taurine,\;[^3H]phenylalanine,\;and\;[^3H]oxytocin$ through the blood-brain barrier (BBB) in mice and rats with common carotid artery perfusion (CCAP) method that modified internal carotid artery perfusion (ICAP) method. External carotid artery (ECA) was cannulated with coagulating pterygopalatine artery (PPA) in ICAP method, while CCA was cannulated without coagulating PPA in CCAP method. Also, for evaluation of BBB permeability of drugs in mice and rats, we used intravenous injection technique. The results of CCAP method in mice at a perfusion flow-rate of 2 ml/min, the brian volume of distribution $(V_D)$ of $[^{14}C]sucrose,\;[^3H]taurine,\;[^3H]phenylalanine,\;and\;[^3H]oxytocin$ were similar to the result of ICAP method in rats at perfusion flow rate of 4 ml/min. The area under the plasma concentration-time curve and brain uptake of $[^3H]taurine$ by intravenous injection technique, were $65.5{\pm}9.7%ID^*min/ml\;and\;0.515{\pm}0.093%ID/g$, respectively, in mice, and the corresponding values were $8.00{\pm}0.03%ID^*min/ml\;and\;0.052{\pm}0.003%ID/g$ in rats. But the BBB permeability surface-area product of $[^3H]taurine$ was similar between mice and rats. In conclusion, the CCAP method in mice was simple, fast and comparable to ICAP method in rats for drug permeability through the BBB.

• Korean Journal of Acupuncture
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• v.41 no.1
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• pp.16-26
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• 2024

Objectives : The Purpose of this study is to identify the anatomical correlates of the three Hand Yang meridians in the head (HYMH), i.e. the arteries of the head. Methods : The original text describing the HYMH in the Yellow Emperor's Inner Cannon is presented and translated into Korean. Anatomical literature related to the arteries of the head are reviewed to identify those that correspond to the HYMH. Results : Arteries corresponding to the HYMH are as follows: The Hand yangming large intestine meridian corresponds to the facial artery and the superior and inferior labial arteries. The Hand Taiyang small intestine meridian's first branch corresponds to the superficial temporal artery, the zygomatico-orbital artery, and the anterior auricular artery. The second branch corresponds to the transverse facial artery. The Hand Shaoyang triple energizer meridian's first branch corresponds to the posterior auricular artery, the superficial temporal artery, and the transverse facial artery. The second branch corresponds to the posterior auricular artery, the anterior auricular artery, and the zygomatico-orbital artery. Conclusions : The HYMH correspond as arteries, specifically branches of the external carotid artery. It is anticipated that arteries corresponding to other meridians in the head can also be identified.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.253-261
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• 2012

Objective : This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA). Methods : Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB). Results : The shortest distance from the MPT to the stylomastoid foramen was $14.1{\pm}2.9$ mm. The distance from the MPT to the FN origin was $8.6{\pm}2.8$ mm anteriorly and $5.9{\pm}2.8$ mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was $18.5{\pm}6.7$ mm, and that to the crossing point of the HGN and the external carotid artery was $15.1{\pm}5.7$ mm. The distance from the CCAB to the HGN bifurcation was $26.6{\pm}7.5$ mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about $35.8{\pm}5.7$ mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB. Conclusion : This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.221-225
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• 2001

Carotid body tumor is a rare benign tumor arising from the paraganglionic tissue of neural crest. Surgical management remains the prefered treatment. Large carotid body tumors frequently encircle the internal carotid and external carotid arteries, and extensive bleeding often complicates the resection, increasing the risk of carotid artery rupture and damage to major cranial nerves. Recent improvements in surgical techniques and selective embolization have lessened the risks of surgical excision, decreased blood loss, and diminished the time required for resection. The review of literatures revealed a few cases of the carotid body tumor with papillary carcinoma of the thyroid. We report a case of the huge carotid body tumor with papillary carcinoma of the thyroid, which was removed by 4 times of preoperative embolization and transcervical approach.

• Journal of Yeungnam Medical Science
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• v.12 no.2
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• pp.260-268
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• 1995

Ischemia results when the decrease in tissue perfusion exceeds the tissues ability to increase an oxygen extraction from the blood. Brain edema has been defined as an abnormal accumulation of fluid within brain parenchyma associated with a volumetric enlargement of the brain tissue. In most instances, the labelling of edema as vasogenic or cytotoxic is only relative. For cerebral protection, there were many possible techniques which could increase or maintain cerebral perfusion and reduce cerebral metabolic demand for oxygen. This study was carried out the effect of mild brain hypothermia which was induced by infusion with cold saline into the carotid artery, during brief episodes of transient global ischemia on postischemic brain edema in rabbit. Eight rabbits were anesthetized with halothane and mechanically ventilated with oxygen. For isolated cerebral perfusion, polyethylene catheter was inserted left carotid artery for infusion of cold saline, external carotid artery was ligated, vertebral arteries were cautherized, right carotid artery was snared for ischemia and femoral artery and vein were also canulated for monitoring and drug treatment. At 3 hours After transient global ischemia, specific gravity of cerebral cortex and hippocampus was compared with no-perfusion group , perfusion with cold saline group and normal group. There was no significant differences in physiologic variables among the groups before transient global ischemia. But during transient global ischemia, brain temperature of perfusion group was decreased when compared to no perfusion group. Specific gravity of cerebral cortex and hippocampus of no-perfusion group and perfusion group was statistically significant when compared to normal group (p<0.01). The results of this study suggested that mild brain hypothermia with intracarotid cold saline infusion during brief episodes of transient global ischemia had decreased postischemic brain edema in rabbit.

• Journal of Radiation Industry
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• v.12 no.4
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• pp.325-332
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• 2018

Carotid angiography covering the aortic arch includes contrast-enhanced magnetic resonance angiography (CEA), which is applied to a large region and usually employs contrast media. However, the use of contrast media can be dangerous in infants, pregnant women, and patients with chronic renal failure (CRF). Follow-up patients informed of a lesion may also want to avoid constant exposure to contrast media. We aimed to apply time-of-flight (TOF) angiography to a large region and compare its usefulness with that of CEA. Ten patients (mean age, 58 years; range, 45~75 years) who visited our hospital for magnetic resonance angiography (MRA) participated in this study. A 3.0 Tesla Achieva magnetic resonance imaging (MRI) system (Philips, Netherland) and the SENSE NeuroVascular 16-channel coil were employed for both methods. Both methods were applied simultaneously to the same patient. Three TOF stacks were connected to cover the aortic arch through the circle of Willis, and CEA was applied in the same manner. For the quantitative assessment, the acquired images were used to set the regions of interest (ROIs) in the common carotid artery (CCA) bifurcation, internal carotid artery, external carotid artery, middle cerebral artery, and vertebral artery, and to obtain the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) for the soft tissues. Three radiologists and one radiological resident performed the qualitative assessment on a 5-point scale - 1 point, "very bad"; 2 points, "bad"; 3 points, "average"; 4 points, "good"; and 5 points, "very good" - with regard to 4 items: (1) sharpness, (2) distortion, (3) vein contamination, and (4) expression of peripheral vessels. For the quantitative assessment, we estimated the mean SNR and CNR in each of the 5 ROIs. In general, the mean SNR was higher in TOF angiography (166.1, 205.2, 154.39, 172.23, and 161.95) than in CEA(92.05, 95.43, 84.76, 73.69, and 88.3). Both methods had a similar mean CNR: 67.62, 106.71, 55.9, 73.74, and 63.46 for TOF angiography, and 67.82, 71.19, 60.52, 49.45, and 64.07 for CEA. In all ROIs, the mean SNR was statistically significant (p<0.05), whereas the mean CNR was insignificant (p>0.05). The mean values of TOF angiography and CEA for each item in the qualitative assessment were 4.2 and 4.28, respectively for item 1; 2.93 and 4.55, respectively, for item 2; 4.6 and 3.13, respectively, for item 3; and 2.88 and 4.65, respectively, for item 4. Therefore, TOF angiography had a higher mean for item 3, and CEA had a higher mean for items 2 and 4; there was no significant difference between the two methods for item 1. The results for item 1 were statistically insignificant (p>0.05), whereas the results for items 2~4 were statistically significant (p<0.05). Both methods have advantages and disadvantages and they complement each other. However, CEA is usually applied to a large region covering the aortic arch. Time-of-flight angiography may be useful for people such as infants, pregnant women, CRF patients, and followup patients for whom the use of contrast media can be dangerous or unnecessary, depending on the circumstance.