• Journal of Chest Surgery
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• 제32권7호
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• pp.665-667
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• 1999

좌관상 동맥동에서 발생하여 좌심실로 파열된 발살바동 동맥류에 기인한 울혈성 심부전을 주소로 내원한 48세 남자 환자의 수술적 체험 1례를 보고 하고자 한다. 술 전 심 초 싣캥\ulcorner좌 관상동맥동에서 시작하여 좌 심실에 이르는 머리핀 모양의 낭(sac)이 관찰 되는 발살바동 동맥류의 파열이 관찰되었고, 대동맥 좌심실 터 널(aorto-left ventricle tunnel)을 감별 진단에 범주에 두었다. 수술 소견상 좌 관상동맥동에서 시작하여 좌심실 내의 승모판 전엽 하방에 여러개의 누공을 보이는 직경 7mm, 길이 20mm의 동맥류가 관찰되었다. 수술은 파 열동맥류의 대동맥측 근위부는 우심낭으로 첨포봉합 하였고, 좌심실내의 원위부는 spaghetti를 이용해 직접 봉합하였다. 환자는 술 후 14일째 퇴원하였고, 술 후 8개월 동안 별다른 문제없이 외래 추적 관찰 중이다. 이에 저자들은 본 질환의 희귀성과 함께 수술적 방법을 알리고자 증례 보고 하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.80-84
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• 2012

Objective : This study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment. Methods : Enrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale. Results : Age and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway. Conclusion : Even if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.

• Journal of Korean Neurosurgical Society
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• 제39권2호
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• pp.120-124
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• 2006

Objective : This study is aimed to assess the clinical outcome in early and minimally invasive surgery using incision for the patients with poor grade aneurysm. Methods : The authors retrospectively reviewed all 46 poor grade patients of Hunt and Hess[H-H] grade IV and V who suffered aneurysmal subarachnoid hemorrhage[SAH] between 1999 and 2004. All 35 patients harboring 43 aneurysms who underwent early surgery within 72 hours were included in this study. Clinical outcome was assessed by Glasgow outcome scale[GOS] and compared with that of conventional pterional approach. Results : Twenty four patients were operated with conventional pterional approach and 11 with eyebrow approach within 72 hours after SAH. Seven multiple aneurysm patients harbor 15 aneurysms, Forty one aneurysms were treated with clippings. All 11 patients of eyebrow surgery group[ESG] were in H-H grade IV, 3 in Fisher grade III and 8 in Fisher grade IV. Among 24 patients of pterional approach group[PAG]. 20 were in H-H grade IV and 4 in H-H grade V, 3 were in Fisher grade III and 21 in Fisher grade IV. Overall favorable outcome was achieved in 41.7% and 54.5% in PAG and ESG, respectively. Favorable outcome of H-H grade IV in PAG showed 45.0%. Overall mortality rate was 14.3%. Conclusion : It is concluded that the clinical outcome of early and minimally invasive aneurysmal surgery using eyebrow incision in the selected poor grade aneurysm patients can be compatible with that of conventional pterional surgery.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.158-160
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• 2010

The authors present a case of multiple intracranial calcifications after the procedure of external ventricular drain placement in a 50-year-old man with pericallosal artery aneurysm. We believe that calcifications formed dust that had fallen into the track during the external ventricular drain procedure. The clinical features and radiological findings are presented with review of literature.

• Journal of Chest Surgery
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• 제47권2호
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• pp.167-170
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• 2014

Herein, we present a case of a successful treatment of persistent type 2 endoleaks associated with aneurysmal sac enlargement after endovascular aneurysm repair in an elderly patient. We confirmed the diagnosis by abdominal computed tomography and selective angiography revealing an 11.0-cm aneurysm sac with type 2 endoleaks. An attempt for the endovascular embolization of collateral arteries was unsuccessful due to anatomic variations and their multiple complex communications. Instead, transperitoneal sacotomy and direct suturing on the feeding target vessels was successfully performed without any endograft damage. In conclusion, sacotomy appears to be a feasible therapeutic substitute where endovascular or other techniques have a high risk of failure and lead to unsuccessful results.

• 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.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.81-88
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• 2011

Objective : The purpose of this study was to analyze the clinical and anatomic features involved in determining treatment modalities for anterior communicating artery (AcoA) aneurysms. Methods : The authors retrospectively evaluated 112 AcoA aneurysms with pretreatment clinical features including age, Hunt and Hess grade, medical or neurological comorbidity, and anatomical features including aneurysm size, neck size, dome-to-neck ratio, vessel incorporation, multiple lobulation, and morphologic scoring system. Post-treatment clinical results were classified according to the Glasgow Outcome Scale, and anatomic results in coiled patients were classified according to the modified Raymond scale. Using multivariate logistic regression, the probabilities for decision making between surgical clipping and coil embolization were calculated. Results : Sixty-seven patients (60%) were treated with surgical clipping and 45 patients (40%) with endovascular coil embolization. The clinical factor significantly associated with treatment decision was age (${\geq}$65 vs. <65 years) and anatomical factors including aneurysm size (small or large vs. medium), dome-to-neck ratio (<2 vs. ${\geq}$2), presence of vessel incorporation, multiple lobulation, and morphologic score (${\geq}$2 vs. <2). In multivariate analysis, older patients (age, 65 years) had significantly higher odds of being treated with coil embolization relative to clipping (adjusted OR=3.78; 95% CI, 1.39-10.3; p=0.0093) and higher morphological score patients (${\geq}$2) had a higher tendency toward surgical clipping than endovascular coil embolization (OR=0.23; 95% CI, 0.16-0.93; p=0.0039). Conclusion : The optimal decision for treating AcoA aneurysms cannot be determined by any single clinical or anatomic characteristics. All clinical and morphological features need to be considered, and a collaborative neurovascular team approach to AcoA aneurysms is essential.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.258-260
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• 2007

Multiple aneurysms at the same cerebral arterial branching site are rare, and have been mainly described in a few case reports in comparison with other intracranial multiple aneurysms. Most reported locations of the same artery where multiple aneurysms developed were internal carotid artery and anterior communicating artery. We experienced a very rare case of multiple aneurysms arising at the same bifurcation site of the middle cerebral artery. Only one case like this has been reported previously in the literature. We discussed the preoperative diagnosis and surgical management of such condition.

• Journal of Chest Surgery
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• 제30권7호
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• pp.724-728
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• 1997

68세된 남자로 좌측과 후측 흉부에 통증을 주소로 내원하였다. 술전 시행한 흉복부 W scan에서 대동맥류는 좌측 쇄골하동맥에서 횡격막까지 연결되었고 긴박성 파열의 소견도 보였다. 또한 술전 관동맥조영술에서는 좌회선동맥에 95%, 좌전하행지에 50%의 협착소견을 보였다. 수술은 고동맥-고정맥 우회술을 하면서 좌측 제 4늑간을 통하여 측후방 개흉절개를 하여 수술시야를 확보하였고 대동맥을 차단한뒤 대동맥류를 절개하고 인조혈관으로 대치하였다. 그리고 심박동하에서 대복제정 맥을 이용하여 좌회선동맥의 두번째 둔각변연동맥과 좌측 쇄골하동맥 기시부에 관상동맥 우회술을 하였다. 술후 환자는 술중 저혈압성 쇼크와 저산소증으로 다발성 뇌경색의 합병증을 보였다.

• Tuberculosis and Respiratory Diseases
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• 제43권1호
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• pp.96-101
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• 1996

저자들은 과거력상 반복되는 구강내 아프타성 궤양 및 결절홍반양 피부병변이 있었고, 객혈을 주소로 내원한 37세 남자환자에서 혈관조영술상 다발성 폐동맥류, 심부 정맥의 협착 및 폐색소견이 관찰되었고, 조직학적으로는 폐혈관염 소견을 보여, Hughes-Stovin 증후군으로 진단하였으며, 코일을 이용한 폐동맥색전술로 폐동맥류를 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다.