• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.120-123
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• 2012

Objective : Percutaneous vertebroplasty (PVP) is usually carried out under three-dimensional (2D) fluoroscopic guidance. However, operative complications or bone cement distribution might be difficult to assess on the basis of only 2D radiographic projection images. We evaluated the feasibility of performing an intraoperative and postoperative examination in patients undergoing PVP by using three-dimensional (3D) reconstructive C-arm. Methods : Standard PVP procedures were performed on 14 consecutive patients by using a Siremobil Iso-$C^{3D}$ and a multidetector computed tomography machine. Post-processing of acquired volumetric datasets included multiplanar reconstruction (MPR) and surface shaded display (SSD). We analyzed intraoperative and immediate postoperative evaluation of the needle trajectory and bone cement distribution. Results : The male : female ratio was 2 : 12; mean age of patients, 70 (range, 77-54) years; and mean T score, -3.4. The mean operation time was 52.14 min, but the time required to perform and post-process the rotational acquisitions was 7.76 min. The detection of bone cement distribution and leakage after PVP by using MPR and SSD was possible in all patients. However, detection of the safe trajectory for needle insertion was not possible. Conclusion : 3D rotational image acquisition can enable intra- or post-procedural assessment of vertebroplasty procedures for the detection of bone cement distribution and leakage. However, it is difficult to assess the safe trajectory for needle insertion.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.91-94
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• 2010

Purpose: The purpose of this study is to describe the usefulness of intraoperative mobile CT scans in the reduction of zygomatic arch fracture. Method: Two patients with zygomatic arch fractures were selected who were indications of closed reduction by Gilles' approach. After the reduction was done in the operating room with zygomatic arch elevator, intraoperative CT scan was done to check the extent of reduction. Additional reduction was performed according to the obtained images from the intraoperative mobile CT scan. Examination of the preoperative CT, intraoperative CT after the reduction, and postoperative plain X-ray films were done for documentation and analysis. Results: Reduction was carried out successfully to the patients without any complications. Both patients were satisfied with the postoperative cosmetic and functional outcome. Revisional surgery was not necessary during the 6 months follow up. Conclusion: The advantage of this method is that it is easier to obtain three dimensional relationships of the fracture site. Furthermore, the operator is less exposed to radiation hazards compared to other methods that obtain intraoperative images such as the C-arm. In conclusion, intraoperative mobile CT scan can be a useful surgical aid in the reduction of zygomatic arch fractures.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.322-327
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• 2001

Objectives : There are many kinds of method to evaluate neural decompression during operation. They are direct visual and manual inspection, intraoperative ultrasound, endoscope, intraoperative computed tomography and intraoperative myelography. We used intraoperative myelography to evaluate the proper decompression of neural elements during the decompressive surgery. Methods : We injected 10-20cc of nonionic water-soluble contrast materials through direct puncture site of exposed dura during operation or lower lumbar level or lumbar drain inserted preoperatively. 12 patients were included in this study. They were 7 patients of centrally herniated lumbar disc disease, 1 patient of multiple lumbar spinal stenosis, 2 patients of thoracic extradural tumor and 2 cervical fracture & dislocations. Results : 5 of 12 patients showed remained neural compression through intraoperative myelography, so they were operated further through other approach. Myelographic dye is heavier than CSF, so the dependent side of subarachnoid space was visualized only. In one case, CSF leakage through hemovac was detected, but it was treated only bed rest for 5 days after hemovac removal. Conclusion :Intraoperative myelography is an effective method to evaluate neural decompression during spinal surgery. This technique is easy and familiar to us, neurosurgeons.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.424-429
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• 2017

Background: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.687-696
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• 2013

Background Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. Methods Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. Results The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18- hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. Conclusions In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.

• Journal of Gastric Cancer
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• v.10 no.4
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• pp.188-195
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• 2010

Purpose: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. Materials and Methods: The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. Results: Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. Conclusions: Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.

• Journal of Trauma and Injury
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• v.37 no.2
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• pp.166-169
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• 2024

Stab wounds, particularly those affecting multiple body regions, present considerable challenges in trauma care. This report describes a case of sustained self-inflicted stab injuries to the abdomen and thighs of a 23-year-old male patient. Although the patient's vital signs were stable and bleeding was minimal from thigh wounds without overt signs of vascular injury, the patient experienced a sudden, profound hemorrhage from the right thigh, leading to cardiac arrest. Successful resuscitation was followed by surgical repair of a right superficial femoral arterial injury accompanying a resuscitative endovascular balloon of the aorta. Subsequent lower extremity computed tomography angiography revealed no additional vascular abnormalities. The patient was discharged in stable condition on the 12th postoperative day. This case underscores the unpredictability of stab wound trajectories and the potential for hidden vascular injuries, even in the absence of immediate life-threatening signs. It also emphasizes the critical role of advanced imaging modalities, such as computed tomography angiography, in identifying concealed injuries, and the importance of strategic intraoperative techniques, including resuscitative endovascular balloon occlusion of the aorta, in achieving favorable patient outcomes.

• Journal of Gastric Cancer
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• v.13 no.4
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• pp.266-272
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• 2013

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwent surgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computed tomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.140-146
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• 2009

Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

• Imaging Science in Dentistry
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• v.51 no.1
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• pp.35-40
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• 2021

Purpose: This study was conducted to evaluate the accuracy of cone-beam computed tomography (CBCT) in detecting the posterior superior alveolar(PSA) artery canal in a sample of the Egyptian population. Materials and Methods: CBCT images of 600 maxillary sinuses of patients were examined for the presence or absence of the PSA artery along the lateral wall of the maxillary sinus, and for the diameter and type of the canal in relation to age and sex. The distances from the canal to the alveolar crest and sinus floor were also measured. Each canal was assessed to determine whether it was bifid. Results: The PSA artery canal could be detected in 92.0% of the sinuses. The mean distance from the inferior border of the PSA artery canal to the sinus floor was 8.2±2.2 mm (range, 3.2-13.6 mm) in males and 7.3±2.1 mm (range, 3.0-13.1 mm) in females. The mean distance from the inferior border of the PSA artery canal to the alveolar crest was 18.2±2.7 mm (range, 11.0-23.9 mm) in males and 17.4±2.3 mm (range, 10.8-23.5 mm) in females. The mean diameter of the PSA artery canal was larger in male subjects. The PSA artery canal was bifid in 8.7% of cases. The most frequently observed location of the PSA artery canal was intraosseous(82.2%). Conclusion: CBCT was confirmed to be a valuable tool for evaluation and localization of the PSA artery before maxillary sinus lift surgery to avoid intraoperative bleeding.