• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.1
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• pp.50-61
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• 2023

Objective: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. Methods: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. Results: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. Conclusions: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.

• Investigative Magnetic Resonance Imaging
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• v.20 no.3
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• pp.152-157
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• 2016

Purpose: Operating room management is the serious and complex task for hospital managers and the common approach is to develop relevant standard operational procedures. From patient and staff safety perspective, operating room management should be well-studied and hospital should identify and address any potential risks. Simultaneous usage of different imaging and less-invasive treatment technologies demands strong management control. Materials and Methods: We have formed the multidisciplinary expert panel (surgeons, anesthesiologists, radiologists, healthcare managers etc.) for hybrid theater management standard operational procedure development. On the first stage the general concept of hybrid room design and patient routing was developed. The second stage included the technical details discussion. For patient safety improvement we modified the Surgical Safety Check-list in accordance with potential MRI-related safety challenges and concerns. Results: WHO Surgical Safety Checklist is a simple and easy-to use tool which includes three blocks of question (grouped by the surgery process). We have developed two additional blocks of questions for the intraoperative magnetic resonance investigation. It is very important to have a special detailed routing with a strong control of ferromagnetic devices and anesthesiology care. Conclusion: High-energy MRI (1.5-3.0T) is characterized by potential influence on patient and staff safety in case of hybrid surgery. It is obvious to have a strong managerial control of ferromagnetic devices and anesthesiology care. Surgical Safety Checklist is the validated tool for improving patient safety. Modification and customization of this check-list potentially provides the opportunity for surgery processes improving.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.35-45
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• 2019

Objective : To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Methods : A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. Results : Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using $XperGuide^{(R)}$ system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. Conclusion : Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.4
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• pp.468-472
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• 2023

Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.

• Proceedings of the SAREK Conference
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• 2009.06a
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• pp.1418-1423
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• 2009

This study describes experimental study on the performance characteristics with load condition in hybrid solar heating system during spring season. The room temperatures, the hot water conditions and the lower part temperatures of heat storage tank were changed to analyze the system performances. As a results, the hot water was significantly affected by the ambient temperature. The indoor setting temperature affected the solar fraction. When the low part temperature of the storage tank increased, the temperature of the hot water rose and the temperature of the hot water in morning was affected by the ambient temperature.

• Tunnel and Underground Space
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• v.27 no.3
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• pp.161-171
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• 2017

Demand for high-grade limestone is increasing, but the production in the domestic mines has been limited due to the lack of systematic development plans and efforts to develop mining technology to improve the recovery ratio, transition to high-cost underground mining due to increasing social awareness of environmental protection, and the smallness of the domestic mining industry, etc. In this study in connection with this issue, an analysis on the recovery change by improvement of mining method was executed. 3D modeling technique was used to construct a 3D model. 3D model includes the geological structure, the limestone ore body and the underground pits and tunnels excavated at the Daepyeong District of Daesung MDI Donghae District. By using the 3D model, measured resources, reserves and ore recovery were evaluated from the results of pilot operation of the room and pillar hybrid mining method, which is a variant of room and pillar mining method. These results were compared with those obtained from the conventional mining method. The ore recovery obtained by hybrid mining method was found to be up to 71.6%, showing about 26%p. increase compared with the case of conventional mining method.

• Korean Journal of Air-Conditioning and Refrigeration Engineering
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• v.26 no.10
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• pp.491-496
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• 2014

In general, the entire air supply of a bio-safety laboratory (BSL) should be exhausted on the outside to ensure bio-safety, and the air conditioning system should always be operated to maintain a difference in the room pressure. As a result, the annual energy consumption of such a building is approximately five or ten times higher than that of an office building of the same magnitude. Thus, this study applies an actual operating system that targets BSL. The energy consumption is analyzed using the Energy Plus V8.0 program (an energy analysis program), and five kinds of cases that depend on the energy consumption of the basic BSL system are also analyzed. As a result, the energy consumption in Case 1 (basic system) is of 324.95 GJ. When the basic system of Case 1 is compared to that in Case 2 (basic system+passive design with exterior envelopes), an annual energy savings of is 6.9% is achieved. For Case 3 (basic system+Photovoltaic, PV) 12.7% is achieved, and for Case 4 (Solar Geothermal Hybrid System of renewable energy, SGHS) 49.5% is achieved. If a passive design with exterior envelopes and renewable energy system (PV+SGHS) is combined, as in Case 5, the energy consumption would be 118.15 GJ. Therefore, when this last system is compared to a basic system, the passive design with exterior envelopes and renewable energy system (PV+SGHS) can reduce energy consumption by 63.6%.

• Journal of Korean Society of Environmental Engineers
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• v.38 no.12
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• pp.676-682
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• 2016

In this study, rainwater-greywater hybrid system was installed and operated for 1 year in order to evaluate its water quantity, water quality, and economic efficiency in building no. 39. This system was expected to overcome each disadvantages of and maximize each advantages. Low-greywater that was washed up from shower room was treated by MBR (Membrane Bioreactor) and ozone oxidation. Rainwater that was collected from the rooftop was stored in a reservoir, and then transferred to the storage tank that was mixed with treated greywater. After 1 year operating in building no. 39, rainwater and greywater was used to supply $2,599m^3$ of toilet flushing water. In terms of water quality, rainwater was satisfied far the greywater reuse standards except for E.coli. Moreover, low greywater quality was acceptable except for E. coli, BOD, SS, and turbidity. In addition, economic analysis was obtained from benefit-cost ratio (B/C) with 1.11. It implies that the feasibility of the project was reasonable. Furthermore, various research and policy to improve the economic efficiency of water recycling facilities is required to expand the use of water recycling facilities.

• Journal of Korean Neurosurgical Society
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• v.61 no.4
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• pp.478-484
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• 2018

Objective : Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). Methods : This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent's opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. Results : Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. Conclusion : Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.891-900
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• 2021

Objective : Vertebral artery dissecting aneurysm (VADA) is a very rare subtype of intracranial aneurysms; when ruptured, it is associated with significantly high rates of morbidity and mortality. Despite several discussions and debates, the optimal treatment for VADA has not yet been established. In the last 10 years, flow diverter devices (FDD) have emerged as a challenging and new treatment method, and various clinical and radiological results have been reported about their safety and effectiveness. The aim of our study was to evaluate the clinical and radiological results with the use of FDD in the treatment of unruptured VADA. Methods : We retrospectively evaluated the data of all patients with unruptured VADA treated with FDD between January 2018 and February 2021 at our hybrid operating room. Nine patients with unruptured VADA, deemed hemodynamically unstable, were treated with FDD. Among other parameters, the technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcomes were evaluated. Results : Successful FDD deployment was achieved in all cases, and the immediate follow-up angiography showed intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of facial numbness and palsy was noted in one patient; however, the symptoms had completely disappeared when followed up at the outpatient clinic 2 weeks after the procedure. The 3-6 months follow-up angiography (n=9) demonstrated complete/near-complete obliteration of the aneurysm in seven patients, and partial obliteration and segmental occlusion in one patient each. In the patient who achieved only partial obliteration, there was a sac 13 mm in size, and there was no change in the 1-year follow-up angiography. In the patient with segmental occlusion, the cause could not be determined. The clinical outcome was modified Rankin Scale 0 in all patients. Conclusion : Our preliminary study using FDD to treat hemodynamically unstable unruptured VADA showed that FDD is safe and effective. Our study has limitations in that the number of cases is small, and it is not a prospective study. However, we believe that the study contributes to evidence regarding the safety and effectiveness of FDD in the treatment of unruptured VADA.