• Archives of Plastic Surgery
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• 제32권2호
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• pp.175-182
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• 2005

Skull base tumors have been determined inoperable because it is difficult to accurately diagnose the extent of the involvement and to approach and excise the tumor safely. However, recently, the advent of sophisticated diagnostic tools such as computed tomography and magnetic resonance imaging as well as the craniofacial and neurosurgical advanced techniques enabled an accurate determination of operative plans and safe approach for tumor excision. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amenable to local tissue closure. The purpose of this study is to analyze experiences of skull base reconstruction and to evaluate long term survival rate and complications. All cranial base reconstructions performed from July 1993 to September 2000 at Department of Plastic and Reconstructive Surgery of the Seoul National University Hospital were observed. The medical records were reviewed and analysed to assess the location of defects, reconstruction method, existence of the dural repair, history of preoperative radiotherapy and chemotherapy, complications and causes of death of the expired patients. There were 12 cases in region II, 8 cases in region I and 1 case in region III according to the Irish classification of skull base. Cranioplasty was performed in 4 patients with a bone graft and microvascular free tissue transfer was selected in 17 patients to reconstruct the cranial base and/or mid-facial defects. Among them, 11 cases were reconstructed with a rectus abdominis musculocutaneous free flap, 2 with a latissimus dorsi muscluocutaneous free flap, 1 with a fibular osteocutaneous free flap, 2 with a scapular osteocutaneous free flap, and 1 with a forearm fasciocutaneous free flap, respectively. During over 3 years follow-up, 5 patients were expired and 8 lesions were relapsed. Infection(3 cases) and partial flap loss(2 cases) were the main complications and multiorgan failure(3 cases) by cancer metastasis and sepsis(2 cases) were causes of death. Statistically 4-years survival rate was 68%. A large complex defects were successfully reconstructed by one-stage operation and, the functional results were also satisfactory with acceptable survival rates.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.701-705
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• 2000

Solitary plasmacytomas are rare and account for 5-10% of all plasma cell disorders. These tumors are categorized as solitary plasmacytomas of bone(osseous) or extramedullary plasmacytomas(non-osseous). About a half of solitary plasmacytomas of bone occur in the spine but rarely in the skull. We report a case of solitary plasmacytoma of the skull presented with a painless palpable left parietal calvarial mass in an otherwise asymptomatic 38- year-old man. Skull radiographs showed a large radiolucent lesion with well defined non-sclerotic margins. Computed tomograph scan demonstrated a markedly enhancing mass extending from the epidural to the subcutaneous space. The patient underwent surgery and tumor was completely excised. Pathological examination showed tumor to be a plasmacytoma synthesizing IgG. Postoperatively, the patient received radiotherapy. There was no evidence of systemic involvement on postoperative laboratory wokups. Our recommended treatment is a complete surgical excision combined with postoperative radiation therapy. The patient should be follwed carefully for more than 10 years because of either local recurrence or possible progression to multiple myeloma.

• 한국제4기학회지
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• 제21권1호
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• pp.37-45
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• 2007

머리뼈 밑면의 높이는 영양상태와 건강조건에 크게 영향을 받는다. 귀밑점-으뜸점(Porion-basion)의 길이로 알려진 머리뼈 밑면의 높이는 캘리퍼(coordinate caliper)나 머리깊이(subtraction)를 계산하는 방법 등으로 쉽게 측정된다. 이 연구에서는 조선후기(17-18세기)와 6.25전쟁을 수행한 한국인의 영양상태와 건강상태를 알고자 하였다. 이를 위해 6.25전사자와 조선후기(17-18세기) 인골을 자료로 머리뼈 밑면높이의 변화정도를 살펴보고 변화에 영향을 끼친 요인이 무엇인지를 밝히고자 한다. 17-18세기 조선시대 회곽묘에서 출토된 인골모음과 6.25전사자 유해모음을 자료로 하였으며 비교는 미국에서 시기를 달리한 테리 인골모음과 법의학 인골모음을 사용하였다. 한국 인골모음의 경우 백인들과 비슷하거나 약간 낮으나 흑인보다는 건강상태가 좋은 것으로 관찰되는데 이는 민간계층가정에서 어린아이 성장에 필요한 영양을 효과적으로 공급하는 민간 재래적 방법 때문인 것으로 가늠된다. 그러나 조선 후기시대후기 인골의 영양상태는 일제하에서 성장한 6.25전사자와 별로 차이가 없다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.144-145
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• 2002

Stereotactic radiotherapy is required to irradiate a small tumor accurately. The radiotherapy showing improves when making an accidental error little boundlessly. It is performed according to treatment planning that is established by the outside landmark of head. At present, when stereotactic radiotherapy for a head is done, the Leksell Flame is fixed on the head, and positioning based on the point and so on which it is in that fixed implement is performed. However, there are problems on the method done at present in the point such as reappearance when the fractionated irradiation method in which the Leksell Flame is removed and installed at every treatment is done because there are landmarks outside the head. Landmarks in the skull were decided, and that precision was examined for the purpose of the improvement of the radiation therapeutic gain. Linac-graphy with longitudinal and lateral view were taken with 6 MV photon beams. A distance to base point inside the skull, each film measured the angle from a center of the small irradiation field, and comparison was done. From the results, a large accidental error wasn't seen as a result of the measurement by every film. Stereotactic radiotherapy for a head treatment had an accidental error of about several millimeters when treatment positioning was done. Therefore, it was thought that there was no problem about an accidental error to arise by putting a landmark in the skull. And, because an accidental error was easy to discover, we thought that modification could be done easily. It was suggested that a landmark in the skull on thus study were useful for improvement of stereotactic radiotherapy.

• Investigative Magnetic Resonance Imaging
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• 제9권1호
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• pp.57-61
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• 2005

골육종은 주로 장골의 골간단 (metaphysic) 에 생기는 악성도가 매우 높은 종양으로 두개골에는 매우 드물게 생긴다. 저자들은 두개기저부에 생겨 접형골을 파괴시키면서 약 2개월 만에 재발한 골육종 1예를 보고하고자 한다. 두통과 어지러움증 그리고 오른족 볼쪽의 감각이 저하된 28세 남자의 전산화단층촬영과 자기공명영상소견에서 이 종양은 약 3cm 의 크기로 균일하게 조영증강이 잘 되면서 내부에 낭성변화가 동반된 소견을 보였다. 종양은 완전히 절제되었고 한달간의 항암요법을 시행하였다. 약 두 달후에 다시 시행한 자기공명영상 소견에서 처음 수술한 같은 부위에 다시 처음보다 크기가 더 큰 종양이 발견되었고 제 2차 수술후 병리소견에서 처음과 같은 골육종으로 확진되었다.

• Journal of Korean Biological Nursing Science
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• 제22권1호
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• pp.45-52
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• 2020

Purpose: The purpose of this study was to investigate the risk factors of intracranial hemorrhage in children with skull fractures from head trauma. Methods: The retrospective study included 205 patients diagnosed with a skull fracture in a pediatric emergency room. Data were analyzed using 𝓍²-test, Fisher's exact test, t-test, and logistic regression analysis with the SPSS/WIN24.0 program. Results: Intracranial hemorrhage was diagnosed in 71 patients. There were statistically significant differences between the hemorrhagic group and non-hemorrhagic group in age group, places of accident, type of accident, location of the fracture, and symptoms. Intracranial hemorrhage by age group was higher in school-age and adolescence than in infancy. The places of accidents of hemorrhage were higher in street and school than in the home. The types of an accident of bleeding were higher in the case of knock and traffic accident than in fall. Symptoms of nausea, headache, and loss of consciousness were associated with higher intracranial hemorrhage. Multivariable logistic regression analysis showed that knock (OR= 3.29, 95% CI= 1.50-7.22), traffic accident (OR= 4.78, 95% CI= 1.31-17.43), nausea (OR= 4.18, 95% CI= 1.42-12.31), and loss of consciousness (OR= 3.29, 95% CI= 1.41-9.50) were risk factors for intracranial hemorrhage. Conclusion: In this study, the risk factors of intracranial hemorrhage were identified in pediatric patients with skull fractures caused by head trauma. It is recommended that the results of this study be used to manage and educate patients, caregivers, and medical staff after head trauma hemorrhage.

• 대한치과기공학회지
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• 제23권1호
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• pp.95-106
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• 2001

The purpose of this study was to show the method of three-dimensional morphometry developed recently and to compare the accuracy of three-dimensional morphometry with those of PA cephalometry, The three-dimensional morphometry analysis program and device were developed. Steel balls (1.2mm in diameter) were attached in twenty five landmarks of artificial human skull. This artificial human skull was used as experimental materials. From three-dimensional morphometry and PA cephalometry of artificial human skull. eleven linear measurements were acquired and made into asymmetry index. Right-left differences of measurements were used as asymmetry index. These measurements and asymmetry index were compared respectively with those of actual. The results were as follows: 1. Mean difference between three-dimensional morphometry and actual artificial human skull in linear measurements was $1.99{\pm}0.37mm$, and mean difference between PA cephalometry and actual was $21.12{\pm}0.45mm$. Both of all were reduced more than those of actual. 2. Mean difference between three-dimensional morphometry and actual artificial human skull in asymmetry index was $0.07{\pm}0.42$, and mean difference between PA cephalometry and actual was $3.63{\pm}0.60$. Three-dimensional morphometry was reduced while PA cephalometry was magnified more than that of actual. 3. Each eleven asymmetry index of three-dimensional morphometry was the same negative sign as those of actuals while only N-Z, ANS-J, Tr-Go, Tr-ANS asymmetry index were the same in PA cephalometry. These results suggest that the method of three-dimensional morphometry is more accurate than those of PA cephalometry in asymmetry analysis.

• 한국정보통신학회논문지
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• 제2권1호
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• pp.3-10
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• 1998

슈퍼임포즈는 개인식별 방법으로 신원 미상의 두개골의 발견 시, 두개골의 사진과 용의자 생전 사진의 동일 비율로 확대, 축소 후 두 영상을 중첩하므로서 동일인 여부를 비교, 판별하는 기법으로 삼풍백화점 붕괴사고와 Quam KAL기 추락사고와 같이 대형사건에서의 개인식별은 매우 중요한 문제이다 기존의 방법은 렌즈와 거울 및 사진기술에 의존하는 수작업으로 2주정도의 시간이 소요되는 반면 본 연구의 결과로 컴퓨터 영상처리 기술과 주변기기의 활용을 이용하여 슈퍼임포즈 영상의 실시간 처리와 보다 다양하고 자세한 영상처리 정보에 의한 상세한 슈퍼임포즈 영상정보를 얻을 수 있다. 본 연구는 비디오 카메라로 입력한 두개골 영상과 스캐너로 입력한 생전 사진의 중첩을 위한 영상시스템의 구축과 영상처리 기법을 응용한 다양한 응용 프로그램을 개발하였다. 슈퍼임포즈의 영상처리 기법으로는 두개골 및 생전 사진의 윤곽선 추출, 중첩점 조정, 상,하,좌,우 각도조정, 윤곽선보정, Hue 조정, 히스토그램 조정 등 다양한 영상처리 기법을 응용하고, 보다 자세한 감정문 형식을 도입하였다. 또한, 본 슈퍼임포즈 영상시스템은 국립과학수사연구소의 슈퍼임포즈 영상자료의 처리기술 및 축적 기술의 발전으로, 두개골 영상과 생전 사진을 이용한 생전의 3차원 영상의 복원 연구도 가능하리라 사려된다.

• 대한방사선기술학회지:방사선기술과학
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• 제45권6호
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• pp.483-489
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• 2022

This study proposes a new skull lateral examination, and provides an improved examination environment for patients and radiologists. The study was divided into three groups. One group was divided into the SID (source to image receptor distance) 110 ㎝ and 180 ㎝ in the skull lateral posture, the other group The other group was divided into an position in contact with the detector and an position without contact with the detector, and the other group was divided into male and female groups, considering that the difference in shoulder width between adult males and females would affect the dose and image quality. For dose evaluation, the ESD (entrance surface dose) was measured at the EAM (external auditory meatus), and the conditions were applied equally at 70 ㎸p, 200 ㎃, and 10 ㎃s. For image quality evaluation, SNR (signal to noise ratio) and CNR (contrast to noise ratio) were measured in frontal sinus, EAM, and sella turcica. As a result of ESD comparison, when sid 110 ㎝ to sid 180 ㎝ was changed among the three groups, ESD values decreased the most to 729.18±4.62 μ㏉ and 224.18±0.74 μ㏉ at 180 ㎝ (p<0.01). The values of SNR and CNR were statistically significant (p<0.01), but there was no qualitative difference. This shows that when the SID is 180 ㎝, it is possible to reduce the dose without lowering the image quality. So, It is suggested that the SID 180 ㎝ is used without contacting the detector when examining the skull lateral.

• Journal of Korean Neurosurgical Society
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• 제66권1호
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• pp.53-62
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• 2023

Objective : Deep learning is a machine learning approach based on artificial neural network training, and object detection algorithm using deep learning is used as the most powerful tool in image analysis. We analyzed and evaluated the diagnostic performance of a deep learning algorithm to identify skull fractures in plain radiographic images and investigated its clinical applicability. Methods : A total of 2026 plain radiographic images of the skull (fracture, 991; normal, 1035) were obtained from 741 patients. The RetinaNet architecture was used as a deep learning model. Precision, recall, and average precision were measured to evaluate the deep learning algorithm's diagnostic performance. Results : In ResNet-152, the average precision for intersection over union (IOU) 0.1, 0.3, and 0.5, were 0.7240, 0.6698, and 0.3687, respectively. When the intersection over union (IOU) and confidence threshold were 0.1, the precision was 0.7292, and the recall was 0.7650. When the IOU threshold was 0.1, and the confidence threshold was 0.6, the true and false rates were 82.9% and 17.1%, respectively. There were significant differences in the true/false and false-positive/false-negative ratios between the anterior-posterior, towne, and both lateral views (p=0.032 and p=0.003). Objects detected in false positives had vascular grooves and suture lines. In false negatives, the detection performance of the diastatic fractures, fractures crossing the suture line, and fractures around the vascular grooves and orbit was poor. Conclusion : The object detection algorithm applied with deep learning is expected to be a valuable tool in diagnosing skull fractures.