• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.127-130
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• 2009

Purpose: In an amputated auricle, a microvascular anastomosis is the best treatment of choice. But, the neartotally amputated auricle which is connected by very narrow tissue pedicle to the head, can survive by simple attachment without a microvascular anastomosis owing to the rich vascular network through the superficial temporal artery and posterior auricular artery. In cases of venous congestion resulting from a lack of vein anastomosis, medical leeches (Hirudo medicinalis) can solve the problem. We are reporting the case of a 6-year-old boy who had a neartotally amputated auricle with successful results by simple closure and medical leech treatment without a microvascular anastomosis. Methods: A 6-year-old male patient had an left auricular injury by an escalator accident. The left auricle was neartotally amputated from the temporal head with connection only by very narrow skin and subcutaneous pedicle (about 1 cm in width) at the helical root of upper and anterior part of auricle. Marginal bleeding from the avulsed auricle was noted and the arterial blood was supplied from a branch of upper auricular branch of the superficial temporal artery. The auricle was repaired by simple closure including cartilage and skin without any vascular anastomosis. After simple closure, the auricle showed good circulation with pink color. But on the 2nd day after the operation, there was a venous congestion with severe swelling, which resulted in a purplish colored auricle. The venous congestion disappeared after using medical leeches by the 5th day after the operation. Results: The repaired auricle showed aesthetically and functionally satisfactory result with normal development at the 9 months follow-up check after the operation. Conclusion: In cases of neartotally amputated auricles of children or crushing injury in which microsurgery is difficult, we can try simple closure with the use of medical leeches in treating a of venous congestion for a successful result.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.20-26
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• 2007

Objective : We present the difference of histopathologic changes of the internal elastic lamina (IEL) and collagen III in the superficial temporal artery (STA) between aneurysmal patients and non-aneurysmal patients. Also, the pathologic data with clinical features by comparative methods to validate the risk factor of the intracranial aneurysm are presented. Methods : Samples of the STA were harvested form 38 patients including aneurysmal and non-aneurysmal patients undergoing craniotomy. Paraffin-embedded sections were examined, using hematoxylin and eosin, van Giebson and mouse anti-collagen III staining techniques. Histopathological observations were ana lysed and correlated with clinical features such as presence of aneurysm, hypertension, age, and sex. Results : Twenty-seven patients had the intracranial aneurysm. Of these 24 patients were 50 years old or older. Nineteen patients had a history of hypertension. Twenty patients were female. Histopathological study demostrated the derangement of IEL and the deficiency of type III collagen were prominent in aneurysmal patients (p < 0.05). Fifty years old or older patients did not show correlation with the deficiency of type III collagen, but with the derangement of IEL (p < 0.05). The female sex was not correlated with the derangement of IEL but with the deficiency of type III collagen (p < 0.05). However, Hypertension was not correlated with these pathologic data. Conclusion : Patients with intracranial aneurysms have severe histopathologic changes of the arterial wall showing the derangement of IEL and the deficiency of type III collagen. In the clinico-pathologic study, the advanced age and female sex were considered as risk factors of the intracranial aneurysm.

• The Journal of the Korea Contents Association
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• v.10 no.3
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• pp.215-221
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• 2010

To assess the clinical value of time resolved imaging of contrast kinetics(TRICKS) MRA by comparison with conventional time of flight(TOF) MR angiography. Both TOF-MRA and TRICKS-MRA were performed in 17 patients with cerebrovascular disease and in 6 patients with brain tumor. Among 17 cerebraovascular patients, digital subtraction angiography(DSA) data were also obtained in 11 patients. TOF-MRA showed good spatial resolution but short in temporal resolution. Although TRICKS-MRA showed somewhat low spatial resolution, it showed superior temporal resolution by distinguishing vessel and tumor in all patients. Also, from the analysis of vessel-tumor relationship, TRICKS-MRA showed better performance than TOF-MRA. TRICKS-MRA makes it possible to image arterial, capillary and venous phase sequentially with very speedy manner and therefore, the clinical use of this method is highly suggestive for future use.

• Proceedings of the Korea Contents Association Conference
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• 2009.05a
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• pp.1105-1110
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• 2009

To assess the clinical value of time resolved imaging of contrast kinetics(TRICKS) MRA by comparison with conventional time of flight(TOF) MR angiography. Both TOF-MRA and TRICKS-MRA were performed in 17 patients with cerebrovascular disease and in 6 patients with brain tumor. Among 17 cerebraovascular patients, digital subtraction angiography(DSA) data were also obtained in 11 patients. TOF-MRA showed good spatial resolution but short in temporal resolution. Although TRICKS-MRA showed somewhat low spatial resolution, it showed superior temporal resolution by distinguishing vessel and tumor in all patients. Also, from the analysis of vessel-tumor relationship, TRICKS-MRA showed better performance than TOF-MRA. TRICKS-MRA makes it possible to image arterial, capillary and venous phase sequentially with very speedy manner and therefore, the clinical use of this method is highly suggestive for future use.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.54-57
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• 2015

A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

• Journal of Trauma and Injury
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• v.27 no.2
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• pp.33-37
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• 2014

Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.

• Proceedings of the KSME Conference
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• 2001.11b
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• pp.529-532
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• 2001

The purposes of the present study are to investigate hemodynamic characteristics and to define shear-sensitive remodeling in the stenosed coronary models. Two models for the compensatory remodelling used for this research are a pre-stenotic dilation and a post-stenotic dilation models for the computer simulation. The peak wall shear stress on the post-stenotic model is higher than that of the pre-stenotic model. Two recirculation zones are generated in the pre-stenotic model, and the zones in the pre-stenotic model are smaller than those in the post-stenotic model. Variation of the wall shear stress in the pre-stenotic model is lower than that in the post-stenotic model. In computer simulation with the post-stenotic model, higher temporal and spatial shear fluctuation and stress suggested shear-sensitive remodeling. Shear-sensitive remodeling may be associated with the increased risk of plaque rupture, the underlying cause of acute coronary syndromes, and sudden cardiac death.

• Journal of Biomedical Engineering Research
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• v.17 no.1
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• pp.79-84
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• 1996

A number of experimental evidences suggest that the rnun ventrolateral medulla(RVLM) is the final common pathway in the regulation of arterial blood pressure. A Voup of neurons in the RVLM, called the cardiovascular neurons (UN), show spontaneous activity temporally synchronized with the periodic cardiac cycle. These neurons affect the sympathetic nerve discharge(SND), thus are believed to be responsible for blood pressure control. The present experiment identified 98 UVNs in 42 cats based on the temporal relationships between each neuron's activity with both the cardiac cycle and SWD. In 20 UWL changes of spontaneous firing rate(FR) during the somatosympathetic reflex(SSR) were studied Five different firing patterns were observed during the pressor and depressor responses of SSR, implying that they form an interconnected neuronal circuit interacting with one another to generate efferent signals for blood pressure regulation. In the following companion paper, the firing patterns of CVN are analyzed to develop a minimal neuronal circuit model explaining the present experimental outcome.

• Journal of Biomedical Engineering Research
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• v.17 no.1
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• pp.71-80
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• 1996

A number of experimental evidences suggest that the rnun ventrolateral medulla(RVLM) is the final common pathway in the regulation of arterial blood pressure. A Voup of neurons in the RVLM, called the cardiovascular neurons (UN), show spontaneous activity temporally synchronized with the periodic cardiac cycle. These neurons affect the sympathetic nerve discharge(SND), thus are believed to be responsible for blood pressure control. The present experiment identified 98 UVNs in 42 cats based on the temporal relationships between each neuron's activity with both the cardiac cycle and SWD. In 20 UWL changes of spontaneous firing rate(FR) during the somatosympathetic reflex(SSR) were studied Five different firing patterns were observed during the pressor and depressor responses of SSR, implying that they form an interconnected neuronal circuit interacting with one another to generate efferent signals for blood pressure regulation. In the following companion paper, the firing patterns of CVN are analyzed to develop a minimal neuronal circuit model explaining the present experimental outcome.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.2
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• pp.196-203
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• 2024

Isolated middle cerebral artery dissection (MCAD) is rare but increasingly recognized as a significant clinical entity, particularly in younger adults. Ischemic stroke is the most common manifestation in symptomatic cases but symptoms can vary in severity from headaches to severe neurologic deficits. Due to its rarity and unpredictable clinical course, there is no established treatment strategy for isolated MCAD. Through two case reports, we reviewed the post-operative clinical course of MCAD under different treatment modalities. Case 1 was a 21-year-old woman who presented to the emergency department with headaches and left-side hemiparesis. Isolated MCAD was diagnosed and she was successfully treated with the placement of a self-expandable stent and subsequent chemical angioplasty for post-stent vasospasm. Case 2 was a 35-year-old woman who presented to the emergency department with left-side hemiparesis and dysarthria. Isolated MCAD was diagnosed and she was successfully treated with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis.