• Journal of Korean Neurosurgical Society
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• 제48권2호
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• pp.139-144
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• 2010

Objective : We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. Methods : We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. Results : Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. Conclusion : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.73-77
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• 2001

Object : To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. Method : Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. Result : Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. Conclusion : Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.447-453
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• 2005

The coverage of soft tissue defects around the knee joint or upper one third of lower leg presents a difficult challenge to the reconstructive surgeon. Various reconstructive choices are available depending on the location, size and depth of the defect. The authors present their clinical application of a medial sural artery perforator island flap as a useful alternative method for upper one third of lower leg and knee reconstruction. From 2002 to 2004, we operated total 4 patients (total 4 flaps) using the medial sural artey perforator island flap for coverage of the defect on upper one third of lower leg and knee, of 4 patients, 3 patients was men and one was woman. Average patient age was 54.6 years. The largest flap obtained was 10x8cm2. Postoperative follow up of the patients ranged from two to 33 months. In two cases, defects was located on upper one third of lower leg and in other two cases, defects were on the knee. All four cases had bone exposure open wound. In angiography, 2 cases had injured in the anterior tibial artery, 1 case had injured in the posterior tibial artery. There were no diabetes or other vascular disease. All 4 flaps were survived completely, without minor complications such as venous congestion and hematoma. Donor morbidity was restricted substantially to the donor linear scar. There were no functional impairment. As the main advantages of the medial sural perforator island flap, it ensures constant location and reliable blood supply without sacrificing any main source artery or damaging underlying muscle. This procedure is valuable extension of local flap for defect coverage with minimal functional deficit donor site and good aesthetic result on the defect. We consider it as one of the useful methods of the upper one third of lower leg and knee reconstruction.

• Journal of Chest Surgery
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• 제31권8호
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• pp.787-791
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• 1998

대상 및 방법: 가톨릭대학교 의과대학 흉부외과학 교실에서는 1979년 부터 1996년까지 27명의 원발성 심장 종양 환자를 수술하였으며, 환자의 연령은 21세부터 67세까지로 평균 45.1세이었다. 술후 병리학적 진단결과 24례는 점액종, 2례는 연골 육종, 1례는 혈관 육종이며, 가장 흔한 술전 증상은 심부전이었다. 진단은 심장초음파로 확진되었고 호발 부위는 난원와였다. 종양 주위를 세심히 관찰후 심방 중격을 포함하여 완전 절제를 시행하였으며 술후 대부분의 환자 에서 증상 호전이 있었다. 결과: 1례에서 수술 직후 저심박출증으로 사망하였고, 2례에서 국소 재발로 인해 만기 사망하였다. 결론: 결론적으로, 수술시 완전 절제가 중요하며 술전 심장 초음파 검사상 양성으로 보일지라도 악성의 가능성을 배제해서는 안되며 CT나 MRI가 진단에 도움이 되며 수술시에 악성이 의심되면 광범위한 절제와 더불어 술후 항암제및 방사선 요법이 도움이 되리라 생각된다.

• Clinical and Experimental Pediatrics
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• 제46권3호
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• pp.302-307
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• 2003

환아는 3개월된 영아로 발병 10일째에 본원에 내원하여 초기에 적절한 진단과 치료를 받지 못했으며 발병 2주에 시행한 심초음파상 거대 관상동맥류를 보였다. 이에 정맥용 면역글로불린 투여와 aspirin과 dipyridamole로 치료 중 발병 24일째 혈전증이 동반되어 urokinase와 heparin의 IV 투여를 통한 혈전용해 치료로 혈전을 완전히 제거할 수 있었다. 이후 5년간 aspirin, dipyridamole, coumadin을 투여하면서 심전도와 심초음파검사를 반복하며 외래 추적 관찰 중 점차 좌측관상동맥내 혈전이 증가하고 내경이 점차 좁아지는 소견과 함께 협착이 의심되었다. 발병 5년 후 시행한 관상동맥 혈관조영술상 관상동맥 좌측 전하지가 완전 폐색되고 우측관상동맥으로부터 발달한 측부순환에서 혈류를 공급받고 있었고, 핵의학 검사상 좌심실의 전벽과 중격, 일부 외벽에 완전 가역적 관류 결손을 보였던 가와사끼병 환아 1례를 경험하여 보고한다.

• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.547-549
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• 2015

Acute subdural hematoma (SDH) of arterial origin is rare, especially SDH associated with an arteriovenous malformation (AVM) is extremely rare. The authors report a case of acute spontaneous SDH due to rupture of a tiny cortical AVM. A 51-year-old male presented with sudden onset headache and mentality deterioration without a history of trauma. Brain CT revealed a large volume acute SDH compressing the right cerebral hemisphere with subfalcine and tentorial herniation. Emergency decompressive craniectomy was performed to remove the hematoma and during surgery a small (5 mm sized) conglomerated aciniform mass with two surrounding enlarged vessels was identified on the parietal cortex. After warm saline irrigation of the mass, active bleeding developed from a one of the vessel. The bleeding was stopped by coagulation and the vessels were removed. Histopathological examination confirmed the lesion as an AVM. We concluded that a small cortical AVM existed at this area, and that the cortical AVM had caused the acute SDH. Follow up conventional angiography confirmed the absence of remnant AVM or any other vascular abnormality. This report demonstrates rupture of a cortical AVM is worth considering when a patient presents with non-traumatic SDH without intracerebral hemorrhage or subarachnoid hemorrhage.

• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.42-47
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• 2012

Objective : The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia. Methods : The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings. Results : The sex of the patient, the patient's age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). Conclusion : These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.5-10
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• 2009

Objective : Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms. Methods : From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively. Results : After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5. Conclusion : Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms.

• Tuberculosis and Respiratory Diseases
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• 제79권3호
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• pp.179-183
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• 2016

A 59-year-old man presented with acute dyspnea following sudden productive cough and expectoration of a full cup of "blood-tinged" sputum. He had been diagnosed with hepatitis B virus-related hepatocellular carcinoma and had received transarterial chemoembolization 5 years ago for a 20-cm hepatic mass; he denied any history of hematemesis and the last esophagogastroduodenoscopy from a year ago showed absence of varix. Chest computed tomography (CT) with angiography showed new appearance of right basal lung consolidation but no bleeding focus. Despite the use of systemic antibiotics, the patient developed respiratory failure on day 7 of hospitalization. After intubation, a massive amount of brown sputum with anchovy-paste-like consistency was suctioned via the endotracheal tube. Bronchoscopic toileting was performed and the patient was extubated. In the ward, he continued to expectorate the brown sputum. On day 25 of hospitalization, a repeat CT scan showed simultaneous disappearance of the pneumonic consolidation and the necrotic fluid within the hepatic mass, suggesting the presence of a fistula. He has continued to receive systemic antibiotics, sorafenib, and entecavir, and follow up by respiratory and hepato-oncology specialists.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.92-97
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• 2004

저자들은 간 이식 후 지속적 비기능 항진에 발생된 내과적 치료에 반응하지 않는 림프세포증식성질환의 6세된 남아에서 부분적 비동맥 색전술을 치료의 한 방법으로 선택하였다. 비기능항진의 억제 효과로 면역력 증강을 통해 혈액학적 호전을 유도하고자 하였으며 치료 후 PTLD의 호전을 보인 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.