• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.500-506
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• 2000

뇌동정맥기형의 치료에 있어 술 전 색전술과 미세뇌수술을 병합함으로서 얼마나 치료효과를 높일 수 있는지를 알고자 후향적조사를 시행하였다. 조사군은 수술 전 초선택적 색전술후 수술을 시행하였던 10명의 뇌동정맥기형 환자를 대상으로 하였고, 대조군은 술 전 색전술 없이 수술만으로 치료하였던 27명의 환자를 대상으로 하였으며 각각의 환자군은 Spetzler-Martin grade, 뇌동정맥기형의 크기 그리고 Glasgow Outcome Scale을 이용한 술 후 추적관찰 결과에 따라 나누어 비교하였다. 조사대상 37명의 환자중 남자가 23명, 여자가 14명이었으며 나이는 11세부터 74세(평균 36세)였다. 뇌동정맥기형의 크기는 술 전 색전술과 수술적 치료를 병합하였던 조사군에서 평균 4.45cm로 수술만 시행하였던 군의 3.83cm에 비해 크게 나타났으며, Spetzler-Martin grade도 조사군에서는 3, 4, 5등급이 80%이었으나 대조군에서는 52%로 술 전 색전술과 수술을 병합한 군에서 높은 등급의 환자가 많았다. 수술 후 일주일째 평가한 Glasgow-Outcome Scale 점수는 조사군에서는 5점인 경우가 60%로 대조군의 44%보다 높았으며, 수술 후 6개월만에 평가한 점수도 조사군에서 5점인 경우가 80%이었고 대조군은 63%로 술 전 색전술과 수술을 병합하였던 환자에서 더 좋은 예후를 보였다. 결론적으로 수술 전 N-butyl cyanoacrylate를 이용한 초선택적 색전술을 시행한 후 수술 적으로 뇌동정맥기형을 제거함으로서 비교적 등급이 높은 환자에서 치료가 용이하였으며 이전의 수술적 치료만 하였던 경우에 비해 더 좋은 예후를 보임을 알 수 있었다.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.882-890
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• 2021

Objective : The aim of this study to investigate the benefits of patient-based 3-dimensional (3D) cerebral arteriovenous malformation (AVM) models for preoperative surgical planning and education. Methods : Fifteen patients were operated on for AVMs between 2015 and 2019 with patient-based 3D models. Ten patients' preoperative cranial angiogram screenings were evaluated preoperatively or perioperatively via patient-based 3D models. Two patients needed emergent surgical intervention; their models were solely designed based on their AVMs and used during the operation. However, the other patients who underwent elective surgery had the modeling starting from the skull base. These models were used both preoperatively and perioperatively. The benefits of patients arising from treatment with these models were evaluated via patient files and radiological data. Results : Fifteen patients (10 males and five females) between 16 and 66 years underwent surgery. The mean age of the patients was 40.0±14.72. The most frequent symptom patients observed were headaches. Four patients had intracranial bleeding; the symptom of admission was a loss of consciousness. Two patients (13.3%) belonged to Spetzler-Martin (SM) grade I, four (26.7%) belonged to SM grade II, eight (53.3%) belonged to SM grade III, and one (6.7%) belonged to SM grade IV. The mean operation duration was 3.44±0.47 hours. Three patients (20%) developed transient neurologic deficits postoperatively, whereas three other patients died (20%). Conclusion : Several technological innovations have emerged in recent years to reduce undesired outcomes and support the surgical team. For example, 3D models have been employed in various surgical procedures in the last decade. The routine usage of patient-based 3D models will not only support better surgical planning and practice, but it will also be useful in educating assistants and explaining the situation to the patient as well.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1406-1416
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• 2001

Objective : The goal of this study was to evaluate the effect of Gamma Knife radiosurgery(GKS) on cerebral arteriovenous malformation(AVM) and the factors associated with complete occlusion. Patients and Methods : A total of 369 radiosurgical procedures for 336 patients with cerebral AVMs were performed between December 1988 and June 2001. Three hundreds and twenty-four cases of 293 patients who were treated with GKS procedures from May 1992 to December 2000 were analyzed. Various clinical and radiologic parameters were evaluated. Results : The total obliteration rate for the cases with satisfactory radiological follow-up(more than 2 years) after GKS was 79.3%. In multivariate analysis, maximal diameter, angiographic form of AVM nidus, and number of draining veins significantly influenced the result of radiosurgery. In addition, marginal radiation dose, Spetzler-Martin grade, and flow pattern of AVM nidi also partly influenced the radiosurgical outcome. Conclusion : GKS on cerebral AVM is considered as an effective treatment modality. The risk of hemorrhage seems to decrease within the latency interval between GKS and complete occlusion of nidus. Along with the size, topography, or radiosurgical parameters of AVMs, it is necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

• Journal of Korean Neurosurgical Society
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• 제43권6호
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• pp.265-269
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• 2008

Objective : Outcome of gamma knife radiosurgery (GKS) in the consecutive 100 cases with cerebral arteriovenous malformations (AVMs) was analyzed. Methods : Data from initial 100 patients treated with GKS in the authors' institute were reviewed retrospectively. Spetzler-Martin grade at diagnosis were I in 18 patients, II in 27, III in 36, IV in 11, and V in 8. Thirty-five patients had experienced previous bleeding, 27 patients presented with seizure, and 31 patients presented with headache. The mean volume of the lesion was $4.3\;cm^3\;(0.1-29.3\;cm^3)$. The median radiation dose delivered to the margin was 20.0Gy (13-32Gy). Mean follow-up period was 37.5 months (5-63 months). Results : Angiographic follow-up was performed in 48 patients at least 2 years after GKS. Sixteen patients were lost in follow up following 2 years from GKS. Twenty-eight of 48 patients (58%) showed complete obliteration and 20 patients (42%) showed partial obliteration. Seven patients presented with post-GKS hemorrhage. Adverse radiation effect (ARE) was observed at follow-up MRI in 25 of 76 patients, and it was symptomatic in 5 patients. Complete obliteration was confirmed in 24 of 31 (77%) patients with volume less than $4\;cm^3$, meanwhile only 4 of 17 (24%) patients with volume of $4\;cm^3$ or more showed complete obliteration. Complete obliteration rate was 67% with 20Gy or higher marginal dose, 63% with 15-20 Gy, and 17% with less than 15Gy. Conclusion : GKS can provide high rates of obliteration with acceptable risk of morbidity in a subgroup of small AVMs. However, overall outcome in whole spectrum of AVMs, in which large proportion of cases have unfavorable characteristics for radiosurgery, is much worse. More effective therapeutic strategy needs to be developed for large AVMs that are difficult to be managed with current available treatment modalities.