• Anatomy and Cell Biology
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• 제56권4호
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• pp.575-578
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• 2023

Anterior cerebral arteries are paired and supply the major portion of the medial surface of the brain. They are branches of the intracranial part of the internal carotid artery and form the anterior portion of the circle of Willis (CW) which is situated in the interpeduncular fossa. During routine dissection in the department of anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, a rare variation had been observed in the CW, azygos anterior cerebral artery associated with hypoplastic A1 fragment of the right anterior cerebral artery in a 63-year-old female cadaver. It is important to identify and study this kind of rare variation for surgeons, anatomists, and radiologists during dissection, surgical, radiological, and diagnostic interventions.

• Journal of Korean Neurosurgical Society
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• 제59권3호
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• pp.204-213
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• 2016

Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis. Although sufficient spontaneous reshaping of the cranium can be expected by expansive cranioplasty, keeping the cranial bone flap expanded sufficiently is often difficult when the initial expansion is performed during infancy. So far distraction osteogenesis (DO) is the only method to make it possible and to provide low rates of re-expansion of the cranial vault. DO is quite beneficial for both FOA and posterior cranial vault expansion, compared with the conventional methods. Associated hydrocephalus and chronic tonsillar herniation due to lambdoid synostosis can be surgically treatable. Abnormal venous drainages from the intracranial space and air way obstruction should be always considered at any surgical procedures. Neurosurgeons have to know well about the managements not only of the deformed cranial vault and the associated brain lesions but also of other multiple skeletal lesions associated with syndromic craniosynostosis, to improve treatment outcome.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.343-346
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• 2007

Hypoplasia of the internal carotid artery is a rare congenital anomaly. Agenesis, aplasia, and hypoplasia of the internal carotid artery [ICA] are frequently associated with cerebral aneurysms in the circle of Willis. Authors report two cases with congenital hypoplasia of the ICA accompanying with the aneurysms. Transfemoral cerebral angiography [TFCA] in one patient identified nonvisualization of the left ICA. Bilateral anterior cerebral artery [ACA] and middle cerebral artery [MCA] were supplied from the right ICA accompanying with two aneurysms at anterior communicating artery [AcoA] and A1 portion of the left ACA. TFCA in another patient demonstrated hypoplastic left ICA and left ACA filled from the right ICA accompanying with AcoA aneurysm. Left MCA was filled from basilar artery via posterior communicating artery [PcoA]. Skull base computed tomography [CT] in two patients showed hypoplastic carotid canal. Authors performed direct aneurysmal neck clipping. Follow up CT angiography [CTA] at one year after surgery did not show regrowth or new development of the aneurysm. In patients with hypoplastic ICA, neurosurgeons should be aware of the possibility of development of the aneurysms, presumably because of hemodynamic process. Direct aneurysmal neck clipping is a good treatment modality. After operation, regular CTA, magnetic resonance angiography [MRA] or TFCA is needed to find progressive lesion and to prevent cerebrovascular attack [CVA].

• Journal of Chest Surgery
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• 제43권2호
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• pp.161-163
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• 2010

좌심형성부전 증후군을 진단 받은 여자 아이가 생후 12일에 Norwood 수술을 받았다. 수술 중 우연히 발견된 좌상대정맥은 수술 시야를 확보하기 위해 절단하였다. 수술 후 점진적인 저박출증을 보인 환아는 수술 후 7시간 째 사망하였다. 부검 결과 관상정맥동 유입부가 폐쇄되어 있고, 관상정맥동과 심방 사이에 교통이 없었으며, 좌상대정맥이 관상정맥동 혈류의 유일한 통로였다. 수술 중 우연히 좌상대정맥이 발견된 환자에서, 좌상대정맥이 심장 정맥혈류의 유일한 통로일 수 있으므로 좌상대정맥을 보존해야 한다.

• 대한소아치과학회지
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• 제23권3호
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• pp.601-608
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• 1996

저자는 전반적인 치아우식증을 주소로 개인 의원에서 경희대학교병원 소아치과에 의뢰된 10세 여아에서 Robinow syndrome 의 드문 증례의 치료를 시행하고 문헌을 고찰하여 다 음과 같은 결론을 얻었다. 1. 전신소견으로 전두부 돌출, 양안격리, 넓은 안검렬, 들창코 등을 보이는 태아모습의 특정적 안모와 작은키, 짧은 팔, 굽은 손가락, 생식기의 미발육 등이 관찰되었고 전반적인 발육지연이 있었다. 2. 구내소견으로 치아우식, 치아총생, 구개수의 미발육, 수술받은 구개열, 구호흡이 관찰되었다. 3. 이 증후군에서 드물게 보여지는 정신지체, 청각장애, 삼출성 중이염을 동반하였다. 4. 가족력은 발견할수 없었다. 5. 전신마취하에 전반척인 치과치료와 이비인후과치료를 함께 시행하였다. 6. Robinow 증후군은 여러 합병증을 수반할 수 있으므로 타과와의 협력하에 전반적인 검사를 시행하고 포괄적인 협력진료가 요구된다.

• 대한치과마취과학회지
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• 제13권4호
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• pp.221-224
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• 2013

Despite the laryngeal mask airway (LMA) has been widely used in anesthesia, its use is rare in the field of dentistry. Placing LMA in the oral cavity may interrupt dental treatment. However, there are some circumstances in which LMA is more advantageous than tracheal intubation for managing the airway. Especially, the reinforced LMA has a flexible tube shaft, rendering it more accessible for dental treatment. We report a case of dental treatment of a 3-year-old patient with hypoplastic left heart syndrome combined with pulmonary hypertension using reinforced LMA for airway management under general anesthesia. We also discuss the considerations of utilizing the reinforced LMA for dental treatment.

• Journal of Chest Surgery
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• 제42권1호
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• pp.9-13
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• 2009

서론: 좌심형성부전증후군은 사망률이 높은 질환이다. 이번 연구는 노우드(Norwood) 수술을 거쳐 최종적으로 폰탄 수술을 시행한 좌심형성부전증후군 환자에서 외과적 치료 및 폰탄 수술 후 결과를 알아 보기 위한 것이다. 대상 및 방법: 1997년 10월부터 2005년 5월까지 좌심형성부전증후군으로 노우드 수술을 시행한 21명의 환자 중 최종적으로 폰탄(Fontan) 수술을 시행한 6명의 환자를(M : F=4 : 2) 대상으로 역행적 조사를 하였다. 노우드 수술 시 평균 나이는 $17.3{\pm}10.8$일(9~36일)이었고, 양방향성 글렌수술은 $8.9{\pm}7.1$개월(4.6~23.3개월), 그리고 폰탄 수술은 $32.4{\pm}9.8$개월(20.9~43.9개월)에 시행하였다. 한 명의 환자에서 삼첨판 역류가 보여, 2차 수술 시 판막 성형술을 시행하였다. 모든 환자에서 고어텍스 도관을 이용한 심장외 폰탄 수술(20 mm 2명, 18 mm 4명)을 하였으며 1명에서 개방창(fenestration)을 두었다. 결과: 노우드 수술 사망률은 30% (7/21)이며, 4명의 중간단계사망이 있어, 10명만이 양방향성 글렌수술을 시행 하였다. 10명의 환자 중 1명의 만기 사망과 1명의 외래 관찰 누락이 있었으며, 6명의 환자는 현재 폰탄 수술을 시행한 후 외래 관찰 중이고, 2명은 폰탄 수술을 위해 대기 중이다. 폰탄 수술 후에는 1명에서 출혈로 재수술을 한 이외의 합병증은 없었다. 모든 환자가 정상 동성 리듬을 보였다. 수술 후 시행한 초음파에서 모든 환자에서 좋은 심실기능을 관찰할 수 있었으며, 삼첨판 역류는 2명에서만 Grade I으로 관찰되었다. 환자들은 현재 평균 $19.6{\pm}14.9$개월(1.5~39.1개월)간 외래 관찰 중이며, 현재 모든 환자에서 항 혈소판제(아스피린) 및 심장약을 투약하고 있으며, 모두 NYHA functional class I의 상태이다. 결론: 좌심형성부전증후군으로 Norwood 술식을 거쳐 최종적으로 폰탄 수술을 시행한 환자에서 1차 수술 후 높은 사망률을 보임에도 불구하고 만족할만한 혈류역학과 임상상태를 확인할 수 있었고, 단계적 수술 교정법은 이 질환에서, 보다 적극적으로 고려되어야 된다고 사료된다.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1042-1052
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• 2018

Objective: To determine the utility of computed tomography (CT) ventricular volumes and morphometric parameters for deciding the treatment strategy in children with a hypoplastic left ventricle (LV). Materials and Methods: Ninety-four consecutive children were included in this study and divided into small LV single ventricle repair (SVR) (n = 28), small LV biventricular repair (BVR) (n = 6), disease-matched control (n = 19), and control (n = 41) groups. The CT-based indexed LV volumes, LV-to-right-ventricular (LV/RV) volume ratio, left-to-right atrioventricular valve (AVV) area ratio, left-to-right AVV diameter ratio, and LV/RV long dimension ratio were compared between groups. Proportions of preferred SVR in the small LV SVR group suggested by the parameters were evaluated. Results: Indexed LV end-systolic (ES) and end-diastolic (ED) volumes in the small LV SVR group ($6.3{\pm}4.0mL/m^2$ and $14.4{\pm}10.2mL/m^2$, respectively) were significantly smaller than those in the disease-matched control group ($16.0{\pm}4.7mL/m^2$ and $37.7{\pm}12.0mL/m^2$, respectively; p < 0.001) and the control group ($16.0{\pm}5.5mL/m^2$ and $46.3{\pm}10.8mL/m^2$, respectively; p < 0.001). These volumes were $8.3{\pm}2.4mL/m^2$ and $21.4{\pm}5.3mL/m^2$, respectively, in the small LV BVR group. ES and ED indexed LV volumes of < $7mL/m^2$ and < $17mL/m^2$, LV/RV volume ratios of < 0.22 and < 0.25, AVV area ratios of < 0.33 and < 0.24, and AVV diameter ratios of < 0.52 and < 0.46, respectively, enabled the differentiation of a subset of patients in the small LV SVR group from those in the two control groups. One patient in the small LV biventricular group died after BVR, indicating that this patient might not have been a good candidate based on the suggested cut-off values. Conclusion: CT-based ventricular volumes and morphometric parameters can suggest cut-off values for SVR in children with a hypoplastic LV.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.599-602
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• 2019

We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.

• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.132-137
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• 1998

환자 및 아버지의 cafe-au-leit반점으로 유전적 소인을 인정할 수 있는, 쇄골의 저성장 및 미란성 변화를 동반한 신경섬유종증 1례를 치험한 바, 상기 환자의 골격계의 변형이 신경섬유종증의 골막침범에 의한 압박 및 그로 인한 영양효과(trophiceffect)로 인한 것임을 확인할 수 있었다.