• Korean Journal of Anesthesiology
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• 제71권6호
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• pp.483-485
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• 2018

A 34-year-old man who previously underwent a craniotomy due to oligodendroglioma was admitted with a diagnosis of recurrent brain tumor. An awake craniotomy was planned. Approximately 15 minutes after completing the scalp nerve block, his upper torso suddenly moved and trembled for 10 seconds, suggesting a generalized clonic seizure. He recovered gradually and fully in 55 minutes without any neurological sequelae. The emergency computed tomography scan revealed a localized fluid collection and small intracerebral hemorrhage nearby in the temporoparietal cortex beneath the skull defect. He underwent surgery under general anesthesia at 8 hours after the seizure and was discharged from the hospital after 10 days. This report documents the first case of generalized seizure that was caused by the accidental intracerebral injection of local anesthetics. Although the patient recovered completely, the clinical implications regarding the scalp infiltration technique in a patient with skull defects are discussed.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.410-418
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• 2014

Objective : The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes. Methods : From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis. Results : Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation. Conclusion : EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.

• 대한두개안면성형외과학회지
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• 제21권5호
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• pp.309-314
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• 2020

Reconstructions of extensive composite scalp and cranial defects are challenging due to high incidence of postoperative infection and reconstruction failure. In such cases, cranial reconstruction and vascularized soft tissue coverage are required. However, optimal reconstruction timing and material for cranioplasty are not yet determined. Herein, we present a large skull defect with a chronically infected wound that was not improved by repeated debridement and antibiotic treatment for 3 months. It was successfully treated with anterolateral thigh (ALT) free flap transfer for wound salvage and delayed cranioplasty with a patient-specific polyetheretherketone implant. To reduce infection risk, we performed the cranioplasty 1 year after the infection had resolved. In the meantime, depression of ALT flap at the skull defect site was observed, and the midline shift to the contralateral side was reported in a brain computed tomography (CT) scan, but no evidence of neurologic deterioration was found. After the surgery, sufficient cerebral expansion without noticeable dead-space was confirmed in a follow-up CT scan, and there was no complication over the 1-year follow-up period.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.174-183
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• 2022

Management of traumatic skull base fractures and associated complications pose a unique reconstructive challenge. The goals of skull base reconstruction include structural support for the brain and orbit, separation of the central nervous system from the aerodigestive tract, volume to decrease dead space, and restoration of the three-dimensional appearance of the face and cranium with bone and soft tissues. An open bicoronal approach is the most commonly used technique for craniofacial disassembly of the bifrontal region, with evacuation of intracranial hemorrhage and dural repair performed prior to reconstruction. Depending on the defect size and underlying patient and operative factors, reconstruction may involve bony reconstruction using autografts, allografts, or prosthetics in addition to soft tissue reconstruction using vascularized local or distant tissues. The vast majority of traumatic anterior cranial fossa (ACF) injuries resulting in smaller defects of the cranial base itself can be successfully reconstructed using local pedicled pericranial or galeal flaps. Compared with historical nonvascularized ACF reconstructive options, vascularized reconstruction using pericranial and/or galeal flaps has decreased the rate of cerebrospinal fluid (CSF) leak from 25 to 6.5%. We review the existing literature on this uncommon entity and present our case series of n = 6 patients undergoing traumatic reconstruction of the ACF at an urban Level 1 trauma center from 2016 to 2018. There were no postoperative CSF leaks, mucoceles, episodes of meningitis, or deaths during the study follow-up period. In conclusion, use of pericranial, galeal, and free flaps, as indicated, can provide reliable and durable reconstruction of a wide variety of injuries.

• 전자공학회논문지SC
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• 제47권5호
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• pp.18-23
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• 2010

본 논문은 유발전위(evoked potential) 뇌파인 P300에 기반한 뇌-기계 인터페이스의 실시간 구현을 위한 효율적인 알고리즘을 제안한다. P300 뇌파는 외부 시각 자극이 인간의 의지와 일치할 경우, 100-300ms 부근에서 negative pick를 갖는 특성이 있다. 이러한 특성에 기초하여 P300 뇌파의 포텐셜(potential) 감소를 감지하여 인간의 의도를 역으로 추론할 수 있으며, 이를 뇌-기계 인터페이스에 활용할 수 있다. 연구에서 P300 뇌파는 인간의 두개골 외부에 부착된 전극을 통해 얻어졌으며, 시각적 자극으로는 2차원 알파벳 신호를 사용하였다. P300 뇌파의 포텐셜 감소 검출을 위하여 뇌파 포텐셜을 자극과 연계하여 확률적으로 모델링하였다. 확률적 모델은 피실험자가 의도하는 신호의 모델(target model)과 의도하지 않는 신호의 모델(non-target model)로 구성된다. 이러한 확률적 모델에 기반하여 피실험자의 의도를 추론하기 위해서 최우추정법(maximum likelihood estimation)을 사용하였다. 실험에는 신체 건강한 성인 남자 3명이 참가하였으며, 'A'와 'E' 실험에 대한 피실험자 k의 평균 성공률은 98%, 피실험자 j의 평균 성공률 90%, 그리고 피실험자 h의 성공률은 79.8%였다.

• Radiation Oncology Journal
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• 제37권1호
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• pp.22-29
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• 2019

Purpose: The aim of this study is to evaluate the efficacy and feasibility of four-field box whole brain radiotherapy (FB-WBRT) with tilting baseplate by comparing bilateral WBRT (B-WBRT). Methods and Materials: Between March 2016 and September 2018, 20 patients with brain metastases underwent WBRT using the four-field box technique. WBRT is performed with a dose of 30 Gy in 10 fractions daily. Two computed tomography simulations per person were performed. One was in the traditional supine position for B-WBRT and the other by applying the tilting acrylic supine baseplate to elevate the head by 40° for FB-WBRT. The B-WBRT used the field-in-field technique, which is the most commonly used method in our institution. The FB-WBRT comprised anterior, posterior, and bilateral beams. A wedge was applied in anterior and posterior fields to compensate for skull convexity. Results: The average of Dmean of both parotid glands was 10.2 Gy (range, 3.8 to 17.8 Gy) in B-WBRT and 5.4 Gy (range, 2.0 to 11.7 Gy) in FB-WBRT (p < 0.05). Compared to B-WBRT, FB-WBRT reduced the mean dose of the right and left parotid glands from 10.1 Gy to 4.9 Gy and from 10.4 Gy to 5.8 Gy, respectively (p < 0.05). Further, V₅, V₁₀, V₁₅, V₂₀, and V₂₅ for the parotid gland decreased significantly in FB-WBRT (p < 0.05). The Dmax and Dmean of lens decreased according to the dose-volume histogram. Conclusion: Compared to B-WBRT, FB-WBRT with a tilting baseplate is a simple and effective method that takes feature of noncoplanar beam to protect the parotid gland.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.38-42
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• 2010

Purpose: The clinical utility of brain computed tomography (CT) in detecting temporal bone fracture is not well established. We performed this study to determine the utility of brain computed tomography (CT) in detecting fractures of the temporal bones in correlation with fracture patterns. We used high resolution computed tomography (HRCT) as the gold standard for diagnosing temporal bone fracture and its pattern. Methods: From January 2007 to December 2009, patients who underwent both brain CT and HRCT within 10 days of head trauma were investigated. Among them, 58 cases of temporal bone fracture confirmed by HRCT were finally included. Fracture patterns (transverse or non-transverse, otic capsule sparing or otic capsule violating) were determined by HRCT. Brain CT findings in correlation with fracture patterns were analyzed. Results: Among 58 confirmed cases of temporal bone fracture by HRCT, 14 cases (24.1%) were not detected by brain CT. Brain CT showed a significantly lower ability to detect temporal bone fracture with transverse component than without transverse component (p=0.020). Moreover, brain CT showed lower ability to detect otic capsule violating pattern than otic capsule sparing pattern (p=0.015). Among the 14 cases of temporal bone fracture that were not detected by brain CT, 4 cases lacked any objective physical findings (facial palsy, hemotympanum, external auditory canal bleeding) suggesting fractures of the temporal bones. Conclusion: Brain CT showed poor ability to detect temporal bone fracture with transverse component and otic capsule violating pattern, which is associated with a poorer clinical outcome than otic capsule sparing pattern. Routine use of HRCT to identify temporal bone fracture is warranted, even in cases without evidence of temporal bone fracture on brain CT scans or any objective physical findings suggestive of temporal bone fracture.

• 대한두개안면성형외과학회지
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• 제18권1호
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• pp.21-24
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• 2017

Background: In evaluation of craniosynostosis patients in terms of neurodevelopmental delay, positron emission tomography computed tomography (PET-CT) scan can be used to assess brain abnormalities through glucose metabolism. We aimed to determine the unnecessity of PET-CT in this study. Methods: Thirty-eight patients diagnosed with craniosynostosis who underwent distraction osteogenesis from October, 2010 to November, 2013 were reviewed. Magnetic resonance imaging (MRI) and PET-CT scan were carried out for evaluation of the brain structure and function, whereas X-ray and CT scan were taken for evaluation of the skull. Results: Nine patients reported abnormal MRI findings which were not significant, and five patients showed local problem on brain on PET-CT scan. No correlation was found among them. Conclusion: PET-CT evaluation of possible abnormal brain findings do not affect surgical planning or require additional therapy. Preoperative PET-CT scan is not the essential study to get any etiologic information of the disease consequences or to establish the treatment plan.

• 한국임상수의학회지
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• 제27권5호
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• pp.579-583
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• 2010

18년 령의 수컷 포메라니언견이 낙상으로 인한 외상성 머리 손상으로 내원하였다. 신체검사 및 신경검사 후 뇌손상이 의심되었다. 두부 방사선 쵤영에서 우측 후두골 부위에 골절로 인한 뼈조각이 관찰되었다. 전산화 단층촬영상에서 두개 내 출혈 소견이 확인되었다. 두부 외상에 대한 처치에도 불구하고 환자는 내원 수 시간 후 폐사하였고 부검을 실시하였다. 육안 검사 상 대뇌 피질의 출혈 소견과 부종이 확인되었으며 이는 전산화 단층 촬영 결과와 일치하였다. 본 증례보고는 개에서 발생한 심한 외상성 뇌손상의 임상적 특성, 전산화 단층촬영 영상적 특징, 부검 소견, 그리고 조직학적 변화를 잘 보여주고 있다.

• International Journal of Computer Science & Network Security
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• 제24권2호
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• pp.43-52
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• 2024

Medical imaginings assume a important part in the analysis of tumors and cerebrospinal fluid (CSF) leak. Magnetic resonance imaging (MRI) is an image segmentation technology, which shows an angular sectional perspective of the body which provides convenience to medical specialists to examine the patients. The images generated by MRI are detailed, which enable medical specialists to identify affected areas to help them diagnose disease. MRI imaging is usually a basic part of diagnostic and treatment. In this research, we propose new techniques using the 4D-MRI image segmentation process to detect the brain tumor in the skull. We identify the issues related to the quality of cerebrum disease images or CSF leakage (discover fluid inside the brain). The aim of this research is to construct a framework that can identify cancer-damaged areas to be isolated from non-tumor. We use 4D image light field segmentation, which is followed by MATLAB modeling techniques, and measure the size of brain-damaged cells deep inside CSF. Data is usually collected from the support vector machine (SVM) tool using MATLAB's included K-Nearest Neighbor (KNN) algorithm. We propose a 4D light field tool (LFT) modulation method that can be used for the light editing field application. Depending on the input of the user, an objective evaluation of each ray is evaluated using the KNN to maintain the 4D frequency (redundancy). These light fields' approaches can help increase the efficiency of device segmentation and light field composite pipeline editing, as they minimize boundary artefacts.