• Journal of Korean Neurosurgical Society
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• 제64권3호
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• pp.427-436
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• 2021

Objective : The fate of partially thrombosed intracranial aneurysms (PTIAs) is not well known after endovascular treatment. The authors aimed to analyze the treatment outcomes of PTIAs. Methods : We retrospectively reviewed the medical records of 27 PTIAs treated with endovascular intervention between January 1999 and March 2018. Twenty-one aneurysms were treated with intraluminal embolization (ILE), and six were treated with parent artery occlusion (PAO) with or without bypass surgery. Radiological results, clinical outcomes and risk factors for major recurrence were assessed. Results : The initial clinical status was similar in both groups; however, the last status was better in the ILE group than in the PAO group (p=0.049). Neurological deterioration resulted from mass effect in one case and rupture in one after ILE, and mass effect in two and perforator infarction in one after PAO. Twenty cases (94.2%) in the ILE group initially achieved complete occlusion or residual neck status. However, 13 cases (61.9%) showed major recurrence, the major causes of which included coil migration or compaction. Seven cases (33.3%) ultimately achieved residual sac status after repeat treatment. In the PAO group, all initially showed complete occlusion or a residual neck, and just one case ultimately had a residual sac. Two cases showed major recurrence, the cause of which was incomplete PAO. Aneurysm wall calcification was the only significantly protective factor against major recurrence (odds ratio, 36.12; 95% confidence interval, 1.85 to 705.18; p=0.018). Conclusion : Complete PAO of PTIAs is the best option if treatment-related complications can be minimized. Simple fluoroscopy is a useful imaging modality because of the recurrence pattern.

• Journal of Korean Neurosurgical Society
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• 제53권4호
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• pp.235-240
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• 2013

Fusiform aneurysms on the basilar artery (BA) trunk are rare. The microsurgical management of these aneurysms is difficult because of their deep location, dense collection of vital cranial nerves, and perforating arteries to the brain stem. Endovascular treatment is relatively easier and safer compared with microsurgical treatment. Selective occlusion of the aneurysmal sac with preservation of the parent artery is the endovascular treatment of choice. But, some cases, particularly giant or fusiform aneurysms, are unsuitable for selective sac occlusion. Therefore, endovascular coiling of the aneurysm with parent vessel occlusion is an alternative treatment option. In this situation, it is important to determine whether a patient can tolerate parent vessel occlusion without developing neurological deficits. We report a rare case of fusiform aneurysms in the BA trunk. An 18-year-old female suffered a headache for 2 weeks. Computed tomography and magnetic resonance image revealed a fusiform aneurysm of the lower basilar artery trunk. Digital subtraction angiography revealed a $7.1{\times}11.0$ mm-sized fusiform aneurysm located between vertebrovasilar junction and the anterior inferior cerebellar arteries. We had good clinical result using endovascular coiling of unruptured fusiform aneurysm on the lower BA trunk with parent vessel occlusion after confirming the tolerance of the patient by balloon test occlusion with induced hypotension and accompanied by neurophysiologic monitoring, transcranial Doppler and single photon emission computed tomography. In this study, we discuss the importance of preoperative meticulous studies for avoidance of delayed neurological deficit in the patient with fusiform aneurysm on lower basilar trunk.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.141-145
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• 2014

Vertebral artery (VA) injuries usually accompany cervical trauma. Although these injuries are commonly asymptomatic, some result in vertebrobasilar infarction. The symptoms of VA occlusion have been reported to usually manifest within 24 hours after trauma. The symptoms of bilateral VA occlusions seem to be more severe and seem to occur with shorter latencies than those of unilateral occlusions. A 48-year-old man had a C3-4 fracture-dislocation with spinal cord compression that resulted from a traffic accident. After surgery, his initial quadriparesis gradually improved. However, he complained of sudden headache and dizziness on the 5th postoperative day. His motor weakness was abruptly aggravated. Radiologic evaluation revealed an infarction in the occipital lobe and cerebellum. Cerebral angiography revealed complete bilateral VA occlusion. We administered anticoagulation therapy. After 6 months, his weakness had only partially improved. This case demonstrates that delayed infarction due to bilateral VA occlusion can occur at latencies as long as 5 days. Thus, we recommend that patients with cervical traumas that may be accompanied by bilateral VA occlusion should be closely observed for longer than 5 days.

• 구강회복응용과학지
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• 제26권1호
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• pp.1-12
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• 2010

총의치가 잔존치조제에 가하는 응력은 지지골의 흡수를 야기할 수 있으며, 이는 하악골에서 더 흔히 발생한다. 이러한 응력은 측방력과 관련이 있고, 이는 총의치의 교합력에 따라 차이를 보이게 된다. 그러므로 본 연구의 목적은 총의치의 교합양식(양측성 균형교합-33도 해부학적 치아, C군 ; 무교두교합-0도 비해부학적 치아, M군 ; 설측교두교합,-상악은 33도 해부학적 치아와 하악은 0도 비해부학적 치아, L군)에 따른 하악잔존치조제에 미치는 응력의 크기를 중심위, 측방위, 전방위 상태에서 비교하는 것이다. 기성 아크릴릭 무치악 모델을 이용하여 양측성 균형교합, 무교두교합, 설측교두교합 양식을 갖는 총의치를 제작하여 이를 T-ScanII(Tekscan, Boston, U.S.A)를 이용해 기록했다. 하악 무치악 아크릴 모형을 1.5 mm 일정하게 삭제한 뒤 실리콘으로 점막을 재현하여 제1소구치와 제1대구치 부위에 각각 $4{\times}6$의 linear strain gauge를 부착했다. 교합기에 모형을 부착한 상태에서 Universal Testing Machine(instron$^{(R)}$ 5567, Bluehill 2.0 software ,U.S.A.)으로 50 N과 150 N의 힘을 중심위, 측방위, 전방위 상태에서 일정하게 가하여 교합양식에 따른 응력값을 측정했다. 중심위와 전방위 상태에서는 전방과 후방의 응력값을 교합양식에 따라 비교하고, 측방위에서는 작업측과 비작업측에서의 응력값을 비교하였다. 이상과 같은 실험으로 양측성 균형교합에서의 응력값이 비작업측을 제외하고는 모든 위치에 서 설측교두교합과 무교두교합보다 더 컸으며, 비작업측과의 차이값과 비작업측에서의 응력 변화율도 가장 컸다. 그러나, 측방운동시 비작업측의 응력은 양측성 균형교합에서 가장 작은 것으로 나타났다.

• Journal of Korean Neurosurgical Society
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• 제46권1호
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• pp.71-73
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• 2009

In surgical planning of the parasagittal meningioma, invasion and occlusion of the superior sagittal sinus are important factors. When tumor is located within anterior 1/3, or when angiographic finding shows total occlusion of superior sagittal sinus, it is regarded that the ligation of superior sagittal sinus is safe. We report a case of parasagittal meningioma in 59-year-old male patient with complete occlusion of superior sagittal sinus which was confirmed by preoperative angiography, who developed temporary neurologic deterioration after superior sagittal sinus ligation and resection.

• Journal of Chest Surgery
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• 제54권5호
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• pp.383-388
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• 2021

Background: Achieving external access to and manual occlusion of the left atrial appendage (LAA) during minimally invasive mitral valve surgery (MIMVS) through a small right thoracotomy is difficult. Occlusion of the LAA using an epicardial closure device seems quite useful compared to other surgical techniques. Methods: Fourteen patients with atrial fibrillation underwent MIMVS with concomitant surgical occlusion of the LAA using double-layered endocardial closure stitches (n=6, endocardial suture group) or the AtriClip Pro closure device (n=8, AtriClip group) at our institution. The primary safety endpoint was any device-related adverse event, and the primary efficacy endpoint was successful complete occlusion of blood flow into the LAA as assessed by transthoracic echocardiography at hospital discharge. The primary efficacy endpoint for stroke reduction was the occurrence of ischemic or hemorrhagic neurologic events. Results: All patients underwent LAA occlusion as scheduled. The cardiopulmonary bypass and aortic cross-clamp times in the endocardial suture group and the AtriClip group were 202±39 and 128±41 minutes, and 213±53 and 136±44 minutes, respectively (p=0.68, p=0.73). No patients in either group experienced any device-related serious adverse events, incomplete LAA occlusion, early postoperative stroke, or neurologic complication. Conclusion: Epicardial LAA occlusion using the AtriClip Pro during MIMVS in patients with mitral valve disease and atrial fibrillation is a simple, safe, and effective adjunctive procedure.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.644-653
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• 2017

Objective : Paraclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms. Methods : Data of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups : simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results. Results : Complete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005-0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106-9.302). Conclusion : Use of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.

• 구강회복응용과학지
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• 제16권3호
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• pp.171-185
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• 2000

The treatment objectives of the complete oral rehabilitation are : (1) comfortably functioning temporomandibular joints and stomatognathic musculature, (2) adherence to the basic principle of occlusion advocated by Schuyler, (3) anterior guidance that is in harmony with the envelope of function, (4) restorations that will not violate the patient's neutral zone. There may be many roads to achieving these objectives, but they all convey varing degrees of stress and strain on the dentist and patient. There are no "easy" cases of oral rehabilitation. Time must be taken to think, time must be taken to plan, and time must be taken to perform, since time is the critical element in both success and failure. Moreover, a systematized and integrated approach will lead to a prognosis that is favorable and predictable. This approach facilitates development of optimum oral function, comfort, and esthetics, resulting in a satisfied patient. Such a systematized approach consists of four logical phase : (1) patient evaluation, (2) comprehensive analysis and treatment planning, (3) integrated and systematic reconstruction, and (4) postoperative maintenance. Firstly, we must evaluate the mandibular position. The results of a repetitive, unstrained, nondeflective, nonmanipulated mandibular closure into complete maxillomandibular intercuspation is not so much a "centric" occlusion as it is a stable occlusion. Accordingly, we ought to concern ourselves less with mandibular centricity and more with mandibular stability, which actually is the relationship we are trying to establish. The key to this stability is intercuspal precision. Once neuromuscular passivity has been achieved during an appropriate period of occlusal adjustment and provisionalization, subsequent intercuspal precision becomes the controlling factors in maintaining a stable mandibular position. Secondly, we must evaluate the planned vertical dimension of occlusion in relationship to what may now be an altered(generally diminished), and avoid the hazard of using such an abnormal position to indicate ultimate occlusal contacting points. There are no hard and fast rules to follow, no formulas, and no precise ratios between the vertical dimension of occlusion. Like centric relation, it is an area, not a point.

• 대한치과보철학회지
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• 제55권4호
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• pp.451-457
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• 2017

벨마비는 원인이 명확하지 않은 급성 말초성 안면 신경마비로 주로 편측으로 나타난다. 일부에서는 완전히 회복되지 못하여 안면 근육의 불완전 마비, 구축 등의 후유증으로 인해 하악의 편측 변위 또는 편측 저작 습관 및 부조화가 나타나며, 따라서 만약 무치악 환자에서 총의치로 수복한다면 더욱 세심한 주의가 필요하다. 본 증례에서는 벨마비의 후유증과 불안정한 하악 운동으로 인해 술자에 의한 중심위 채득이 어려운 무치악 환자에서 고딕아치 묘기법으로 재현성 있는 중심위를 채득하고, 중심위와 환자의 습관적인 하악 기능 운동 범위 간의 자유도 부여를 위해 설측 교합을 이용하여 총의치를 제작함으로써 기능 및 심미적으로 양호한 결과를 얻었기에 보고하는 바이다.

• 대한치과보철학회지
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• 제50권4호
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• pp.311-317
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• 2012

총의치 장착시, 환자는 생리적으로 안정된 범위 내에서 자연스럽게 기능하기를 원하며 이를 위해서는, 안모의 회복(심미적 효과), 생물학적으로 안정된 인공치 배열과 외형, 의치 동요가 없는 교합접촉이 반드시 필요하다. 이에 본 증례보고에서는 총의치를 제작하기에 불리한 조건을 가진 환자를 대상으로 인상면, 연마면, 교합면에 있어서의 의치의 안정을 증대시키기 위해, 기능적 변연 형성을 통한 인상채득, 중립대 확인, 생리적 중심위 재확립, 안정된 교합을 형성시켜 주었으며, 임상적으로 기능과 심미적인 측면에 있어서 만족할 만한 결과를 얻었기에 이를 보고하고자 한다.