• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.528-531
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• 2010

Ehlers-Danlos syndrome (EDS) type IV is characterized by its clinical manifestations, which are easy bruising, thin skin with visible veins, and rupture of arteries, uterus, or intestines. Arterial complications are the leading cause of death in vascular EDS because they are unpredictable and surgical repair is difficult due to tissue fragility. The authors report a case presented with cervical radiculopathy due to a segmental fusiform aneurysm of the cervical vertebral artery. Transfemoral cerebral angiography (TFCA) was done to verify the aneurysmal dilatation. However, during TFCA, bleeding at the puncture site was not controlled, skin and underlying muscle was disrupted and profound bleeding occurred during manual compression after femoral catheter removal. Accordingly, surgical repair of the injured femoral artery was performed. At this time it was possible to diagnose it as an EDS with fusiform aneurysm on cervical vertebral artery. Particularly, cervical fusiform aneurysm is rare condition, and therefore, connective tissue disorder must be considered in such cases. If connective tissue disorder is suspected, the authors suggest that a noninvasive imaging modality, such as, high quality computed tomography angiography, be used to evaluate the vascular lesion to avoid potential arterial complications.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.903-906
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• 1998

A 17-year-old-boy with a bilateral incomplete cervical rib, upon abduction of his left arm at 45 degrees, had immediately begun to show symptoms of severe tingling, claudication, pallor, and weakness of his left upper extremity. These symptoms were aggravated at 90 degrees, leaving him debilitated from his work in the printing office. Transfemoral positional subclavian arteriography revealed total occlusion of the subclavian artery immediately distal to a cervical rib during 90 degrees abduction. Resection of the anterior scalene and medial aspect of the middle scalene muscles, cervical and first ribs, and arteriolysis were performed via a combined supraclavicular and infraclavi cular approach. He has returned to work as a printer with marked relief of symptoms and has remained asymptomatic over follow-up periods of 10 months.

• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.175-182
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• 2019

Objective : Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography. Methods : CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA. Results : Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia. Conclusion : It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.

• Clinical Pain
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• v.19 no.1
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• pp.28-31
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• 2020

The incidence of heterotopic ossification (HO) was reported to be higher in combat-injured patients than in civilian trauma patients. HO is often considered a possible cause of residual limbs pain in amputee. Here, we report the case of a 21-year-old male, who underwent a traumatic right transfemoral and left transtibial amputation with two segments of painful HO around his left amputation site. We report the effect of extracorporeal shock wave therapy (ESWT) on size and pain associated with HO. After ESWT, the visual analog scale score decreased from 5~6 to 0~1 and the size of two masses decreased from 13.1 × 6.7 mm and 12.5 mm to 11.9 × 4.7 mm and 12.2 mm, respectively. To the best of our knowledge, this is the first case that has reported on the treatment of HO using ESWT for a traumatic transtibial amputation patient. The case suggests that ESWT could serve as a complementary treatment for HO in traumatic amputation patient.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.30-36
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• 2024

Objective: This study aims to investigate the efficacy of microsurgery with intraoperative indocyanine green (ICG) angiography as a treatment approach for ethmoidal dural arteriovenous fistula (DAVF). Methods: Between January 2010 and July 2021, our institution encountered a total of eight cases of ethmoidal DAVF. In each of these cases, microsurgical treatment was undertaken utilizing a bilateral sub-frontal interhemispheric approach, with the aid of intraoperative ICG angiography. Results: ICG angiography identified bilateral venous drainage with single dominance in four cases (50%) of ethmoidal DAVF, a finding that eluded detection during preoperative transfemoral cerebral angiography (TFCA). The application of microsurgical treatment, in conjunction with intraoperative ICG angiography, resulted in consistently positive clinical outcomes for all patients, as evaluated using the Glasgow Outcome Scale (GOS) at the 6-month postoperative follow-up assessment; six patients showed GOS score of 5, while the remaining two patients attained a GOS score of 4. Conclusions: The use of intraoperative ICG angiography enabled accurate identification of both dominant and non-dominant venous drainage patterns, ensuring complete disconnection of the fistula and reducing the risk of recurrence.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.71-78
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• 2024

Dural arteriovenous fistula (DAVF) is a rare condition affecting approximately 1.5% of 1,000,000 individuals annually. It frequently occurs in the transsigmoid and cavernous sinuses. An isolated sigmoid sinus is extremely rare and is treated by performing transfemoral transvenous embolization along the opposite transverse sinus. A 69-year-old woman presented with asymptomatic Borden type III/Cognard type III DAVF involving an isolated sigmoid sinus. She underwent a staged operation in which a navigation system was used to expose the sigmoid sinus in the operating room before transferring the patient to the angio suite for transvenous embolization. Various modalities have been used to treat DAVF, including surgical disconnection, transarterial embolization, transvenous embolization, and stereotactic radiosurgery. However, treating DAVF cases where the affected sinus is isolated can be challenging because an easily accessible surgical route may not be available. In this case, direct sinus cannulation and transvenous embolization were the most effective treatments.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.423-427
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• 2006

Objective : Postoperative brain swelling after resection of olfactory groove meningiomas by bifrontal interhemispheric transbasal approach is a knotty subject. Pathogenesis and predictive factors were investigated to prevent the problem. Methods : Eighteen patients of olfactory groove meningiomas who had undergone surgery were enrolled and retrospectively analyzed using their clinical and radiological data. Bifrontal inter hemispheric transbasal approach was used in all patients. Magnetic resonance imaging and transfemoral cerebral angiography were available for investigation in 18 and 14 patients respectively. Postoperative clinical course, tumor volume, peritumoral edema, tumor supplying vessels, and venous drainage patterns were carefully investigated in relation to postoperative brain swelling. Results : Seven patients [39%] developed clinically overt brain swelling after surgery. Among them, 4 patients had to undergo decompression surgery. In three patients, attempted bone flap removal was done by way of prevention of increased intracranial pressure resulted from intractable brain swelling and two of them eventually developed brain swelling which could be recovered without sequellae. Abnormal frontal base venous channel observed in preoperative angiography was significant predictive factor for postoperative brain swelling [p=0.031]. However, tumor volume, peritumoral edema, and existence of pial tumor supplying vessels from anterior cerebral arteries were failed to show statistical significances. Conclusion : To prevent postoperative brain swelling in olfactory groove meningioma surgery, unilateral approach to preserve frontal base venous channels or temporal bone flap removal is recommended when it is indicated.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.107-110
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• 2009

Infection of the both native and prosthetic vessels in the groin is a very serious disease because of recurrent arterial rupture and sepsis, and both these complications can cause death. The successful treatment of groin infection, including infection of the femoral artery, requires extensive excision of the infected tissues and restoration of the circulation. We experienced a case of obturator bypass in a patient with an infected femoral artery pseudoaneurysm and accompanying sepsis, and this occurred after performing a transfemoral angiogram in an A-V fistula of the carotid artery, and the patient also displayed intracranial hemorrhage.

• Journal of Biomedical Engineering Research
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• v.25 no.4
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• pp.243-251
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• 2004

This study was to quantitative analysis compare to dynamic characteristic change of the regional cerebral blood volume (rCBV) after development of cerebral fat embolism in cats using perfusion MR Imaging. Forty-four adult rats were used. Triolein (n = 15), oleic acid (n = 9) and linoleic acid (n = 11) were injected into the internal carotid artery using microcatheter through the transfemoral approach. Polyvinyl alcohol (Ivalon) (n = 9) was injected as a control group. Perfusion MR images were obtained at 30 minutes and 2 hours after embolization, based on T2 and diffusion-weighted images. The data was time-to-signal intensity curve and ΔR$_2$＊ curve were obtained continuously with the aid of home-maid image proc in.leased significantly at 2 hours compared with those of 30 minutes (P＜0.005). In conclusion, cerebral blood flow decreased in cerebral fat embolism immediately after embolization and recovered remarkably in time course. It is thought that clinically informations to dynamic characteristic change of the cerebral hemodynamics to the early finding in cerebral infarction by DWI and PWI

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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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].