• Journal of Trauma and Injury
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• v.35 no.4
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• pp.277-281
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• 2022

Craniocerebral gunshot injuries is gradually increasing in the civilian population with a worse prognosis than closed head trauma. We experienced a case of craniocerebral gunshot injury which a bullet penetrating from the submandibular area into the clivus of a patient. The patient did not show any symptom. However, serial laboratory findings showed an increase in blood lead level. We removed foreign bodies without any problems using an endoscopic transnasal transclival approach. Due to the extremely low frequency, guidelines for definitive management of gunshot injuries have not been presented in Korea yet. We introduce our surgical experience of a craniocerebral gunshot injury with an unusual approach for removing intracranial foreign bodies.

• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.524-533
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• 2021

Objective : When treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. Methods : Twenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. Results : The pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. Conclusion : For high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.

• Journal of Chest Surgery
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• v.28 no.12
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• pp.1167-1173
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• 1995

We evaluated fifty three cases of traumatic diaphragmatic injuries that we have experienced from Jan.1973 to Oct.1994. The age distribution of the pateint was ranged from 1 to 74 years. Sex ratio is 39:14 with male dominence. The traumatic diaphragmatic injuries were due to blunt trauma in 37[Left 22, Right 15 cases and penetrating trauma in 16[Left 9, Right 7 cases. In blunt trauma, Preoperative diagnosis of the diaphragmatic injuries was possible in 27 patients[72% , and in penetrating trauma, 14 patients[88% . Among 37 in blunt traumas, 22[58% cases, and among 16 in penetrating traumas, 13[88% cases were operated within 24 hours. The most common herniated abdominal organ in the thorax was stomach[14/53 . The traumatic diaphragmatic repair of 50 cases were performed by thoracic approach in 23 cases, thoracoabdominal approach in 8 cases and abdominal approach in 19 cases, and in 3 cases, not operated. Hospital mortality [including not operated patients[3 was 17%[9/53 and the causes of death were intracranial hematoma[1 , hypertensive encephalopathy[1 and asphyxia[1 , and among operated patients[6 , combined head injury[2 , multiorgan failure[2 , hypovolemic shock[1 , and pulmonary edema & renal failure[1 . All deaths had related to the severity of associated injuries.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.4
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• pp.429-433
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• 2023

84 years old gentle man with past medical history of hypertension and diabetes presented with sudden onset right sided weakness and aphasia for two hours. Initial neurological assessment revealed National Institute of Health Stroke Scale (NIHSS) 17. Computed tomography (CT) scan demonstrated minimal early ischemic changes along left insular cortex with occlusion of left middle cerebral artery (MCA). Based on clinical and imaging findings, decision was made to perform mechanical thrombectomy procedure. Initially, right common femoral artery approach was utilized. However, due to unfavorable type-III bovine arch, left internal carotid artery could not be engaged via this approach. Subsequently, access was switched to right radial artery. Angiogram revealed small caliber radial artery, with larger caliber ulnar artery. Attempt was made to advance the guide catheter through the radial artery, however significant vasospasm was encountered. Subsequently, ulnar artery was accessed and successful thrombolysis in cerebral infarction (TICI) III left MCA reperfusion was achieved with a single pass of mechanical thrombectomy via this approach. Post procedure neurological examination demonstrated significant clinical improvement. Doppler ultrasound 48 hours after the procedure demonstrated patent flow in radial and ulnar arteries with no evidence of dissection.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.8-14
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• 2017

Objective : The purposes of this study were to introduce a superficial temporal artery (STA)-sparing mini-pterional approach for the treatment of cerebral aneurysms and review the surgical results of this approach. Methods : Between June 2010 and December 2015, we performed the STA-sparing mini-pterional approach for 117 patients with 141 unruptured intracranial aneurysms. We analyzed demographic, radiologic, and clinical variables including age, sex, craniotomy size, aneurysm location, height of STA bifurcation, and postoperative complications. Results : The mean age of patients was 58.4 years. The height of STA bifurcation from the superior border of the zygomatic arch was $20.5mm{\pm}10.0$ (standard deviation [SD]). The craniotomy size was $1051.6mm^2{\pm}206.5$ (SD). Aneurysm neck clipping was possible in all cases. Intradural anterior clinoidectomy was performed in four cases. Contralateral approaches to aneurysms were adopted for four cases. Surgery-related complications occurred in two cases. Permanent morbidity occurred in one case. Conclusion : Our STA-sparing mini-pterional approach for surgical treatment of cerebral aneurysms is easy to learn and has the advantages of small incision, STA sparing, and a relatively wide surgical field. It may be a good alternative to the conventional pterional approach for treating cerebral aneurysms.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.592-599
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• 2001

Objective : The anterior communicating artery(ACoA) is known to be the most frequent location of intracranial aneurysms, but the complex arterial anatomy of the ACoA region makes this aneurysm among the most difficult one to treat. In the treatment of ACoA aneurysms, the direction of aneurysmal fundus is known to be very important in the surgical tactics. All ACoA aneurysms in our series were classified according to its direction, and analyzed the clinical features in order to investigate the prognostic factors influencing upon the surgical outcome. Methods : The authors reviewed 236 cases of ruptured ACoA aneurysms that were operated from 1990 to 1997, were classified according to Pia's classification. Results : The incidence rate of the ACoA aneurysm was 35.1%(236/672). Ventral group was more common than dorsal group, especially in ventro-caudal projection subgroup(36.0%). Poor preoperative clinical grade(Hunt-Hess grade IV and V) patients were more common in dorsal group(13.1%) than ventral group(2.6%). Rebleeding and intracerebral hematoma were more commonly seen in ventral group. However, vasospasm, hydrocephalus, hyponatremia, and intraventricular hemorrhage were observed more frequently in dorsal group. Worse outcome was more common in dorsal group than ventral group, especially in dorso-caudal projection subgroup. Also, poor outcome was identified in patients with intracerebral hematoma, intraventricular hemorrhage, hyponatremia, and hypertension, although statistically insignificant. In cases with the A1 dominancy, there was no difference in surgical outcome between the right and left side approach. The higher the aneurysmal neck from the planum sphenoidale, the worse outcome via pterional approach. Conclusion : It seems that the preoperative clinical grade, aneurysmal direction, and the height of aneurysmal neck, especially in the pterional approach, would be the major prognostic factors, and that intracerebral hematoma, intraventricular hemorrhage, hyponatremia, hydrocephalus and the intraoperative aneurysmal rupture would be the minor prognostic factors.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.340-345
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• 2009

Objective : We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. Methods : A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. Results : Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. Conclusion : The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1063-1068
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• 2000

Objectives : To determine the contribution of cranial magnetic resonance angiography(MRA) for the evaluation of patients with ischemic cerebrovascular accident. Methods : Magnetic resonance image(MRI) and MRA studies performed on 34 patients with ischemic stroke were retrospectively reviewed with the clinical records. Results : There were 9 transient ischemic attacks and 25 completed strokes in our series. Twenty-three of 34 MRA examinations(68%) were positive for stenosis or occlusion. The distribution of stenotic or occlusive vascular lesions were correlated with the location of infarction in 22 of the 23 positive cases(96%). MRA provided additional information not obtained from the MRI in 19 cases(56%). Conclusions : Vascular lesions demonstrated on intracranial MRA show a high correlation with infarct distribution. MRA provided information adjunctive to conventional MRI in a majority of cases. We conclude that MRA is an important noninvasive component of the complete evaluation of ischemic stroke.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.44-50
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• 2000

Objective : A few anecdotal cases of mesenchyme-derived tumors which grow into a cranial cavity have been reported that disclosed a dismal prognosis, due to their critical location, aggressive biological behavior, and high rate of surgical morbidity. The aim of this study is to search clinical factors related to these tumors. Methods : Eight patients who underwent surgical removal of intracranial mesenchymal tumors between January 1993 and December 1997 were studied retrospectively. The tumors included are three chordomas, two chondrosarcomas, two rhabdomyosarcomas, and one hemangiopericytoma. Authors compared clinical features, treatment, and results of our cases with reported cases. The mean follow-up period was 20.5 months. Results : All cases showed nonspecific, location-related clinical findings and arose from sphenopetroclival region. Single stage operation was performed in 4 cases, and skull base approaches in 3 cases. Adjuvant therapies were done in 2 cases. Recurrence was seen in 3 cases(37.5%), and 3 patients died. Interdisciplinary approach with otologic surgeon was done in 2 cases. Conclusion : Recent advancement of refined tactics has made these tumors amenable and provides prolongation of progression-free survival. These are modified skull base approaches, multi-modality treatment options, and inter-disciplinary team approaches. Good results may be expected for these mesenchymal tumors by aggressive resection and adjuvant therapies according to their biological nature.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.518-527
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• 2015

Objective : The treatment of complex intracranial aneurysms remains challenging. One approach is the application of surgical flow alteration to treat aneurysms that are neither clippable, trappable, or coilable. The efficacy and limitations of surgical flow alteration have not yet been established. Methods : Cases of complex aneurysms treated with surgical flow alteration (proximal occlusion with or without bypass, distal occlusion with or without bypass and bypass only) were included in this retrospective study. Results : Among a total of 16 cases, there were 7 giant aneurysms (${\geq}25mm$ diameter) and 9 large aneurysms (>10 mm diameter); 15 of 16 aneurysms were unruptured. There were 8 aneurysms located in the anterior circulation, while the other 8 were in the posterior circulation. Aneurysms were treated with proximal occlusion in 10 cases and distal occlusion in 5 cases; in 1 case, the aneurysm occluded spontaneously after bypass without parent artery occlusion. All but 2 cases underwent prior or concurrent bypass surgery. Complete obliteration of the aneurysm at the latest imaging follow-up was shown in 12 of 16 cases (75.0%). Bypass patency was confirmed in 13 of 15 cases (86.7%). Surgery-related morbidity developed in 3 cases (18.8%, Glasgow outcome scale of 4) and all were perforator infarctions. There were no mortalities. Conclusion : Surgical flow alteration resulted in a high rate of aneurysmal obliteration with acceptable morbidity. Although several limitations remained, it could represent an alternative method for treating complex aneurysms.