• Archives of Plastic Surgery
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• v.36 no.4
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• pp.512-515
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• 2009

Purpose: Neurofibromatosis(NF) is an autosomal - dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop - shaped ligation before removal of the giant NF in both buttocks. And then we could successfully reduce the amount of hemorrhage during the operation. Methods: A 46 - year - old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about $30{\times}20cm$ in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop - shaped suture ligation(weaving the thread up and down in a loop - shaped pattern, leaving a space of 2 cm between each loop) with a straight needle and prolene 2 - 0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged - shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop - shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. Results: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscense did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow - up, the functional and cosmetic result was excellent. Conclusion: A continuous loop - shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.600-612
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• 2021

Purpose To evaluate the long-term radiologic and clinical outcomes of stent-graft placement for the treatment of post-pancreaticoduodenectomy arterial hemorrhage (PPAH) based on the imaging findings of stent-graft patency and results of liver function tests. Materials and Methods We retrospectively reviewed the medical records of nine consecutive patients who underwent stent-graft placement for PPAH between June 2012 and May 2017. We analyzed the immediate technical and clinical outcomes and liver function test results. Stent-graft patency was evaluated using serial CT angiography images. Results All stent-grafts were deployed in the intended position for the immediate cessation of arterial hemorrhage and preservation of hepatic arterial blood flow. Technical success was achieved in all nine patients. Eight patients survived after discharge, and one patient died on postoperative day 28. The median follow-up duration was 781 days (range: 28-1766 days). Follow-up CT angiography revealed stent-graft occlusion in all patients. However, serum aspartate aminotransferase or alanine aminotransferase levels in all patients were well below those observed in hepatic infarction cases. Conclusion Stent-graft placement is a safe and effective treatment method for acute life-threatening PPAH. Liver function and distal hepatic arterial blood flow were maintained postoperatively despite the high incidence of stent-graft occlusion observed on follow-up CT.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.746-752
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• 1985

A retrospective clinical observation was made of 40 patients with postoperative cerebral dysfunction among 2634 patients who underwent open-heart operations in Severance Hospital. Yonsei University between 1962, the year the first successful open heart operation was done, and June 1985. Suspected causes of brain damage were reviewed. Brain CT findings were evaluated in 24 patients. There were 15 cerebral infarcts, 4 intracerebral bleedings, 3 ischemic brain damages, 1 infarction with intracerebral hemorrhage and 1 diffuse cortical atrophy from unknown cause. The most frequent site of cerebral infarction was the middle cerebral artery area with no predilection on the right of left.

• Journal of Chest Surgery
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• v.15 no.1
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• pp.15-20
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• 1982

During the past ten years from 1972 to 1981, a total of 100 cases of bronchiectasis were treated by pulmonary resection at C.A.F.G.H. Pulmonary tuberculosis and frequent U.R.I. were the most frequent associated disease and encountered in 54% in this series. Various types of pulmonary resection were performed on 100 patients; left lower lobectomy in 40 cases, left lower lobectomy and lingular segmentectomy In 29 cases, right lower lobectomy in 12 cases, right middle and lower lobectomy in 12 cases, lingular segmentectomy in 3 cases, left pneumonectomy in 3 cases and both lower lobectomy in 1 case. Complications developed in 9 cases and 1 case among them died of sepsis following secondary opera-tion. Among complications of 9 cases, postoperative atelectasis showed in 4 cases, hemorrhage in 2 cases, bronchopleural fistula in 2 cases, pulmonary edema in 1 case. Complications were treated by conservative and secondary operative management with satisfactory result except one death. Remainders without complication showed good result without symptom in postoperative and follow-up periods.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.318-322
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• 2007

Regarding the bilateral vertebral artery [VA] dissecting aneurysms, treatment strategy remains controversial because there have not been enough cases to reach a conclusion on the best treatment. We present a patient underwent staged microsurgical trapping and endovascular coiling for each dissecting aneurysm of bilateral VA presenting subarachnoid hemorrhage [SAH]. The ruptured side was managed by VA trapping procedure without any neurological deficit. Postoperative cerebral angiography revealed patent right PICA without filling of previous right dissecting aneurysm and spontaneous occlusion of the left dissecting aneurysm one month after trapping procedure. However, follow-up angiography revealed recanalization and growing of the left VA dissecting aneurysm one year after the operation. The patient underwent endovascular embolization using GDC for the proximal occlusion of the left VA and postoperative course was uneventful.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.2
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• pp.189-195
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• 2023

Subarachnoid hemorrhage secondary to rupture of an aneurysm is a severe condition, associated with a high rate of morbidity and mortality. There are few cases in the literature of rupture of an aneurysm of the persistent trigeminal artery. This is the case of a 62-year-old female who has suffered multiple ruptures of aneurysms, in different decades of her life, with the development of de novo aneurysm, been this the presented case, a rupture of aneurysm of the persistent trigeminal artery. This patient has survival to these conditions and remain without important morbidity. The case manifested with a clinical picture of third and seventh cranial nerve deficit, which this last one, there are not previous publications of cases with this deficit. This aneurysm was embolized with coils, and the postoperative condition was satisfactory, been discharged at 4 postoperative days.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.2
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• pp.210-215
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• 2024

Cerebral ischemic complications after pituitary surgery are not frequently reported. Multiple mechanisms have been proposed, including vasospasm, and delayed cerebral ischemia resulting from postoperative subarachnoid bleeding. Given the unknown etiology of vasospasm following these situations, little is known about its prevention. Through a case report and bibliographic review, the authors warn about the importance of recognizing key signs postoperatively that could indicate increased risk for cerebral vasospasm and must be recognized in a timely manner, with appropriate treatment strategies implemented once these symptoms present.

• Journal of Korean Neurosurgical Society
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• v.46 no.2
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• pp.93-98
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• 2009

Objective: Although prophylactic antiepileptic drug (AED) use in patients with aneurysmal subarachnoid hemorrhage (SAH) is a common practice, lack of uniform definitions and guidelines for seizures and AEDs rendered this prescription more habitual instead of evidence-based manner. We herein evaluated the incidence and predictive factors of seizure and complications about AED use. Methods: From July 1999 to June 2007, data of a total of 547 patients with aneurysmal SAH who underwent operative treatments were reviewed. For these, the incidence and risk factors of seizures and epilepsy were assessed, in addition to complications of AEDs. Results: Eighty-three patients (15.2%) had at least one seizure following SAH. Forty-three patients (79%) had onset seizures, 34 (6.2%) had perioperative seizures, and 17 (3.1%) had late epilepsy. Younger age (< 40 years), poor clinical grade, thick hemorrhage, acute hydrocephalus, and rebleeding were related to the occurrence of onset seizures. Cortical infarction and thick hemorrhage were independent risk factors for the occurrence of late epilepsy. Onset seizures were not predictive of late epilepsy. Moreover, adverse drug effects were identified in 128 patients (23.4%) with AEDs. Conclusion: Perioperative seizures are not significant predictors for late epilepsy. Instead, initial amount of SAH and surgery-induced cortical damage should be seriously considered as risk factors for late epilepsy. Because AEDs can not prevent early postoperative seizures (< 1 week) and potentially cause unexpected side effects, long-term use should be readjusted in high-risk patients.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.441-446
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• 2012

Objective : Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH. Methods : Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and ${\geq}70$ years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and ${\geq}70$ years of age). Results : Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (${\geq}70$ years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus. Conclusion : In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.

• Journal of Korean Neurosurgical Society
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• v.46 no.3
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• pp.215-220
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• 2009

Objective : Intraoperative ventriculostomy is widely adopted to make the slack brain. However, there are few reports about hemorrhagic or parenchymal injuries after ventriculostomy. We tried to analyze and investigate the incidence of these complications in a consecutive series of patients with aneurysmal subarachnoid hemorrhage (SAH). Methods : From September 2006 to June 2007, 43 patients underwent surgical clipping for aneurysmal SAH at our hospital. Among 43 patients, we investigated hemorrhagic or parenchymal injuries after intraoperative ventriculostomy using postoperative computed tomographic scan in 26 patients. After standard pterional craniotomy, ventriculostomy catheter was inserted perpendicular to the cortical surface along the bisectional imaginary line from Paine's point. Results : Hemorrhagic injuries were detected in 12 of 26 patients (46.2%). Mean systolic blood pressure during anesthesia was with in statistically significant parameter related to hemorrhage (p=0.006). On the other hand, parenchymal injuries were detected in 11 of 26 patients (42.3%). Female and the amount of infused mannitol during anesthesia showed statistically significant parameters related to parenchymal injury (p=0.005, 0.04, respectively). However, there were no ventriculostomy-related severe complications. Conclusion : In our series, hemorrhagic or parenchymal injuries after intraoperative ventriculostomy occurred more commonly than previously reported series in aneurysmal SAH patients. Although the clinical outcomes of complications are generally favorable, neurosurgeon must keep in mind the frequent occurrence of brain injury after intraoperative ventriculostomy in the acute stage of aneurysmal SAH.