• The Journal of Korean Medicine
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• v.18 no.1
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• pp.337-343
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• 1997

With the purpose of producing easily the basal ganglia infarction into Chen's, scerebral ischemic model which is almost cortical infarct made by the ligation of distal part of MCA and 1 hr obliteration of both common carotid arteries in rat, the MCA obstruction was extended between rhinal fissure and olfactory tract with electrocauterization in place of 10-0 silk suture ligation of distal part of MCA. Both original Chen's model and modified Chen's have shown the cortical infarction in dorsolateral & lateral frontoparietal cortex, but not any infarction in basal ganglia. However, the modified Chen's model have shown the effect of average 12% increase in cortical infarct than that of original Chen's model. This experimental results suggest the modified Chen's model can not reduce the blood flow of the lateral lenticulostriatal artery enough to make the basal ganglia infarction and that blood circulation of basal gagglia under its condition is probably being kept partly through the posterior cerebral artery via vertebral artery. Therefore, The follow-up observation on ischemic time lapse would be needed.

• Proceedings of the KSMRM Conference
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• 2002.11a
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• pp.89-89
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• 2002

Purpose： To report initial experience and evaluate feasibility of cervical carotid artery contrast-enhanced MR angiography (CEMRA) using whole body coil at 3.0T Method： Twenty-eight patients (14 male, ages 41-80, mean age 63) underwent CEMRA at the 3.0T using whole body coil and 3D-FSPGR (TR/TE 6.6/l.3 msec, FA 30, thickness 1.3mm), and thirty patients (17 male, ages 30-80, mean age 57) underwent CEMRA at the 1.5T using Helmholtz neck coil and 3D FLASH sequence (TR/TE 3.8/l.4msec, FA 35, thickness 1mm). At both 1.5 and 3.0T, a power injector (Spectris) injected 20m1 of gadolinium to the right or left antecubital vein at a rate of 3mL/s. All CEMRA cases were accepted by one neuroradiologiest. We measured the signal intensities at the bifurcation of common carotid artery (CCA), vertebral artery (V2) and two surrounding tissues (ST) and noise at the background in all patients, and also compared contras-to-noise ratios (CNR) of CCA/ST and V2/ST at 3.0 and 1.5T

• Journal of Veterinary Clinics
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• v.36 no.4
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• pp.207-211
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• 2019

This study was performed to compare the radiographic and echocardiographic features of cardiovascular changes between small and large dogs with heartworm diseases. Total of 49 dogs from two institutions were included in this study. The dogs were diagnosed with heartworm infestation and underwent thoracic and echocardiography. On thoracic radiographs, vertebral heart scale, reverse D shape, main pulmonary artery dilation, peripheral pulmonary artery dilation, and evidence of right heart failure were evaluated. On echocardiographs, visibility of worms, main pulmonary artery to aortic root (MPA/Ao) ratio, right to left ventricular basal diameter (RVD/LVD) ratio, and pulmonary hypertension were evaluated and analyzed between small and large dogs. The proportion of reverse D shape of the heart and accuracy for right ventricular hypertrophy in small dogs were lower than those of the large dogs. For echocardiographic parameter, the MPA/Ao and RVD/LVD ratio in the small dogs were significantly lower than those of the large dogs. As the results, thoracic radiography have a tendency to underestimate the severity of HWD in small dogs and should be used with echocardiography.

• Journal of Korean Neurosurgical Society
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• v.49 no.6
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• pp.351-354
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• 2011

Objective : This investigation was conducted to evaluate a new, safe entry point for the C2 pedicle screw, determined using the anatomical landmarks of the C2 lateral mass, the lamina, and the isthmus of the pars interarticularis. Methods : Fifteen patients underwent bilateral C1 lateral mass-C2 pedicle screw fixation, combined with posterior wiring. The C2 pedicle screw was inserted at the entry point determined using the following method : 4 mm lateral to and 4 mm inferior to the transitional point (from the superior end line of the lamina to the isthmus of the pars interarticularis). After a small hole was made with a high-speed drill, the taper was inserted with a 30 degree convergence in the cephalad direction. Other surgical procedures were performed according to Harm's description. Preoperatively, careful evaluation was performed with a cervical X-ray for C1-C2 alignment, magnetic resonance imaging for spinal cord and ligamentous structures, and a contrast-enhanced 3-dimensional computed tomogram (3-D CT) for bony anatomy and the course of the vertebral artery. A 3-D CT was checked postoperatively to evaluate screw placement Results : Bone fusion was achieved in all 15 patients (100%) without screw violation into the spinal canal, vertebral artery injury, or hardware failure. Occipital neuralgia developed in one patient, but this subsided after a C2 ganglion block. Conclusion : C2 transpedicular screw fixation can be easily and safely performed using the entry point of the present study. However, careful preoperative radiographic evaluation, regardless of methods, is mandatory.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.7
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• pp.239-244
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• 2018

Both arterial dissection and atherosclerosis are major causes of cerebral infarction and appear to be occlusion or stenosis in magnetic resonance angiography(MRA) and computed tomographic angiography(CTA). But there are differences in treatment because they have different mechanisms. Recently, as high resolution magnetic resonance image(HR-MRI) develops, the image of blood vessel wall can be confirmed non-invasively. Though HR-MRI has become a very useful method for patients with suspected arterial dissection, differential diagnosis of the two diseases has not yet been fully established due to differences in the findings according to stages of arterial dissection and atherosclerosis. We investigated the differences between vertebral artery dissection and atherosclerosis through HR-MRI in two patients and confirmed the diagnosis by CTA follow-up. In addition to the previously established diagnostic criteria, we determined that the long and severe stenosis and recanalization suggest arterial dissection. Characteristics of arterial dissection confirmed by HR-MR and additional studies will be helpful for the treatment.

• Journal of Korean Neurosurgical Society
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• v.57 no.6
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• pp.460-464
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• 2015

Objective : Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. Methods : Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. Results : Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. Conclusion : Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.114-119
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• 2012

Objective : The purpose of this study was 1) to analyze clinically-executed cervical lateral mass screw fixation by the Kim's technique as suggested in the previous morphometric and cadaveric study and 2) to examine various complications and bicortical purchase that are important for b-one fusion. Methods : A retrospective study was done on the charts, operative records, radiographs, and clinical follow up of thirty-nine patients. One hundred and seventy-eight lateral mass screws were analyzed. The spinal nerve injury, violation of the facet joint, vertebral artery injury, and the bicortical purchases were examined at each lateral mass. Results : All thirty-nine patients received instrumentations with poly axial screws and rod systems, in which one hundred and seventy-eight screws in total. No vertebral artery injury or nerve root injury were observed. Sixteen facet joint violations were observed (9.0%). Bicortical purchases were achieved on one hundred and fifty-six (87.6%). Bone fusion was achieved in all patients. Conclusion : The advantages of the Kim's technique are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known techniques. The Kim's technique can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.193-198
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• 2010

Objective : The purpose of this study is to compare the incidence of possible complications of cervical lateral screw fixation and the achievements of bicortical purchase using the Roy-Camille, Magerl and the modified methods. Methods : Six fresh-frozen cervical spine segments were harvested. The Roy-Camille technique was applied to C3 and C4, and the Magerl technique was applied to C5, C6, and C7 of one side of each cadaver. The modified technique was applied to the other side of each cadaver. The nerve root injury, violation of the facet joint, vertebral artery injury, and the bicortication were examined at each screwing level. Results : No vertebral artery injury was observed in any of the three methods. One nerve root injury was observed in each cervical spine segment using the Roy-Camille method (8.3%), the Magerl method (5.6%), and the modified method (3.3%). Facet joint injuries were observed in two cervical spinal segments using the Roy-Camille method (16.7%) and three with the Magerl method (16.7%), while five facet joint violations occurred when using the modified method (16.7%). Bicortical purchases were achieved on ten cervical spinal segments with the Roy-Camille method (83.3%) and Magerl method (55.6%), while twenty bicortical purchases were achieved in the modified method (66.7%). Conclusion : The advantages of the modified method are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known methods. This modified method can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.164-168
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• 2009

Objective : Bilateral C1-2 transarticular screw fixation (TAF) with interspinous wiring has been the best treatment for atlantoaxial instability (AAI). However, several factors may disturb satisfactory placement of bilateral screws. This study evaluates the usefulness of unilateral TAF when bilateral TAF is not available. Methods : Between January 2003 and December 2007, TAF was performed in 54 patients with AAI. Preoperative studies including cervical x-ray, three dimensional computed tomogram, CT angiogram, and magnetic resonance image were checked. The atlanto-dental interval (ADI) was measured in preoperative period, immediate postoperatively, and postoperative 1, 3 and 6 months. Results : Unilateral TAF was performed in 27 patients (50%). The causes of unilateral TAF were anomalous course of vertebral artery in 20 patients (74%), severe degenerative arthritis in 3 (11%), fracture of C1 in 2, hemangioblastoma in one, and screw malposition in one. The mean ADI in unilateral group was measured as 2.63 mm in immediate postoperatively, 2.61 mm in 1 month, 2.64 mm in 3 months and 2.61 mm in 6 months postoperatively. The mean ADI of bilateral group was also measured as following; 2.76 mm in immediate postoperative, 2.71 mm in 1 month, 2.73 mm in 3 months, 2.73 mm in 6 months postoperatively. Comparison of ADI measurement showed no significant difference in both groups, and moreover fusion rate was 100% in bilateral and 96.3% in unilateral group (p=0.317). Conclusion : Even though bilateral TAF is best option for AAI in biomechanical perspectives, unilateral screw fixation also can be a useful alternative in otherwise dangerous or infeasible cases through bilateral screw placement.

• Journal of Korean Neurosurgical Society
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• v.54 no.1
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• pp.25-29
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• 2013

Objective : To clarify the landmark for deciding the entry point for C1 lateral mass screws via the posterior arch by using 3-dimensional (3D) computed images. Methods : Resnick insisted that the C1 posterior arch could be divided into pure posterior and lateral lamina (C1 pedicle). Authors studied where this transition point (TP) is located between the posterior lamina and the C1 pedicle and how it can be recognized. The 3D computed images of 86 cadaver C1s (M : F=45 : 41) were used in this study. Results : The superior ridge of the C1 posterior arch had 2 types of orientation. One was in the vertical direction in the C1 posterior lamina and the other was in the horizontal direction in the C1 pedicle. The TP was located at the border between the 2 areas, the same site as the posterior end of the groove of the vertebral artery. On posterior-anterior projection, the posterior arch was sharpened abruptly at TP. We were unable to identify the TP in 6.4% of specimens due to complete or partial osseous bridges. A total of 93.8% of the TP were located between the most enlarged point of the spinal canal and the medial wall of the vertebral artery. Conclusion : The anatomic entry zone of C1 lateral laminar screws was clarified and identified based on the TP by using preoperative 3D computed images.