• Journal of Yeungnam Medical Science
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• 제10권2호
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• pp.475-484
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• 1993

두개강내 정맥동 주위의 수술시 일시적으로 또는 영구히 정맥동을 결찰해야 할 경우 안전한 결찰부위 및 결찰시간을 알기 위해 30마리의 고양이를 각각 5마리씩 6군으로 나누어 시상정맥동의 전방 1/3, 중앙 1/3, 후방 1/3과 Torcular Herophili 및 좌, 우 횡행정맥동을 폐쇄시켜 전신동맥압, 뇌관류압, 두개강내압 및 정맥동내압의 폐쇄 전과 폐쇄후 시간경과에 따른 변화를 관찰하여 다음과 같은 결론을 얻었다. 시상 정맥동의 경우 전방 1/3폐쇄군에서는 폐쇄후 시간 경과에 따른 유의한 변화는 없었다. 중앙 1/3폐쇄군에서는 폐쇄후 시간별로는 전신동맥압이 폐쇄후 2분, 4분에 유의한 상승이 있었고 두개강내압이 폐쇄후 l분에서 3분에 걸쳐, 정맥동내압이 1분에서 4분에 증가하였다. 후방 1/3폐쇄군에서는 폐쇄후 시간경과에 따라 전신동맥압의 경우는 폐쇄후 2분, 4분, 6분에 유의한 증가를 보였으며 6분에 가장 현저한 증가(p<0.05)를 보였고 두개강내압은 2분에서 7분간 계속 유의한 증가를 보였고 폐쇄후 3분에 가장 현저한 증가(p<0.01)를 보였다. 정맥동내압은 1분에서 3분에 유의한 증가를 보였고 폐쇄후 1분에 가장 현저한 증가(p<0.01)를 보였다. Torcular Herophili 폐쇄군에서는 폐쇄후 시간 별로는 전신동맥압의 경우는 폐쇄후 1분에서 2분, 4분에서 6분까지 유의한 증가를 보였으며 폐쇄후 2분에 각각 가장 현저한 증가(p<0.01)를 보였고 뇌관류압은 폐쇄후 5분, 6분, 7분에 유의한 감소(p<0.05)를 실험군중 처음으로 보였다. 두 개강 내압은 3-6분간 유의한 증가를 보였고 폐쇄후 6분에 가장 유의한 증가를 보였다(p<0.01). 정맥동내압은 7분간 계속 유의한 상승이 있었고 폐쇄후 2분에 가장 현저한 증가(p<0.01)를 보였다. 우측 횡행정맥동 폐쇄군에서는 폐쇄후 시간별로는 전신동맥압이 폐쇄후 5분에 유의한 상승을 보였고 두개강 내압이 7분간 계속 유의한 상승을 보여 가장 민감한 반응을 보였으며 폐쇄후 6분에 가장 현저한 상승(p<0.01)을 보였다. 정맥동내압도 계속 유의한 증가를 보였고 폐쇄후 2분에 가장 유의 한 증가(p<0.01)를 나타냈다. 좌측 횡행정맥 폐쇄군에서는 폐쇄후 시간경과에 따라 유의한 변화는 없었다.

• 대한방사선기술학회지:방사선기술과학
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• 제46권5호
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• pp.427-433
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• 2023

This study aimed to quantitatively compare the diameters measured directly from the coronal plane or sagittal plane of 2D digital subtraction angiography (DSA) and the cross-sectional area-converted diameters calculated from contrast-enhanced MR (CE-MR) imaging. A retrospective analysis was conducted on 20 patients who underwent both 2D DSA and CE-MR imaging. Firstly, the venous diameters of the superior sagittal sinus (SSS) and transverse sinus (TS) were directly measured from 2D DSA. Subsequently, the axial planes for SSS diameter and the sagittal plane for TS in CE-MR imaging were utilized to calculate cross-sectional area-based converted diameters. The numerical values obtained from 2D DSA and CE-MR imaging were compared pairwise at each location. For SSS, the diameter measured by 2D DSA was 27% larger than the conversion-based diameter from CE-MR imaging (9.8±1.4 mm vs. 7.1±1.3 mm, P<0.05). Similarly, for the right TS, the difference was 16% (8.8±3.2 mm vs. 7.4±2.0 mm, P<0.05), and for the left TS, the difference was 22% (8.4±2.8 mm vs. 6.6±1.3 mm, P<0.05). In conclusion, the diameter measured directly in conventional 2D DSA may be larger than the diameter converted based on the cross-sectional area. Therefore, when selecting the size of the stent, it is crucial to make precise determinations while keeping this fact in mind.

• Journal of Korean Neurosurgical Society
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• 제67권5호
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• pp.578-585
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• 2024

Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalize obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy can be an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction.

• 대한두개안면성형외과학회지
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• 제21권2호
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• pp.109-113
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• 2020

Sinus pericranii is a rare vascular anomaly characterized by abnormal venous communication between the inner and outer regions of the cranial cavity. Here, we report a case of sinus pericranii and venous malformations in the right periorbital region of a 2-year-old girl. Radiologic findings showed venous malformations in the right parietal region communicating with the superior sagittal sinus in the intracranial region. There were notable improvements following surgical resection for the abnormal venous lesions and several sclerotherapies. Presence of a bluish and pulsating mass on the scalp, which showed bruit on auscultation, may indicate sinus pericranii, which should be included in the differential diagnosis.

• Journal of Korean Neurosurgical Society
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• 제66권6호
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• pp.735-742
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• 2023

Nephrotic syndrome (NS) is associated with cerebral venous sinus thrombosis (CVST), which is a rare cerebrovascular disorder in children. Systemic anticoagulation with heparin is the standard therapy for CVST, and mechanical thrombectomy (MT) has been described as a salvage treatment for adult anticoagulant refractory CVST, However, it has never been reported in children. We describe a case of MT for refractory CVST in a child with NS. A 13-year-old boy with newly diagnosed NS presented to an emergency department with acute headache. A head computed tomography showed acute thrombus in the superior sagittal sinus, straight sinus and transverse sinus. The child was started on heparin therapy, but clinically deteriorated and became unresponsive. In view of the rapid deterioration of the condition after anticoagulation treatment, the patient received intravascular treatment. Several endovascular technologies, such as stent retriever and large bore suction catheter have been adopted. After endovascular treatment, the patient's neurological condition was improved within 24 hours, and magnetic resonance venography of the head demonstrated that the CVST was reduced. The child recovered with normal neurological function at discharge. This case highlights the importance of considering MT for refractory CVST, and we suggest that MT may be considered for refractory CVST with NS in children.

• Childhood Kidney Diseases
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• 제10권2호
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• pp.238-243
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• 2006

Nephrotic syndrome in childhood is known to be associated with a hypercoagulable state and thromboembolic complications, among which cerebral venous thrombosis is a very rare and serious one, with only a few isolated reports in the literature. A 9-year-old boy with known nephrotic syndrome was admitted due to a relapse with massive proteinuria and generalized edema. He complained of a prolonged frontal headache. The enhanced brain magnetic resonance imaging(MRI) showed a high signal in the region of the superior sagittal sinus and right transverse sinus consistent with a thrombus. He was managed with steroids, cyclosporine and warfarin. His headache subsided 2 weeks later and proteinuria resolved 1 month later. An MRI 2 months later was normal. We describe this case and review the literature to emphasize the importance of recognizing this potentially life threatening complication and initiating anticoagulation therapy.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.244-249
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• 2001

Dural arteriovenous malformations(AVM) are not uncommon. Reports of intracranial dural AVM have been increasing but most of them deal with dural AVM in the region of the cavernous sinus, posterior fossa and tentorium, but those of the anterior cranial fossa are very rare. Recently, we experienced two cases of right frontal dural arteriovenous malformation fed mainly by both ethmoidal arteries. The angiographic appearance in these two cases is quite uniform. The nidus was located in the frontal dura, although their main feeders were dural arteries. They were drained through an intracerebral cortical vein associated with aneurysmal dilatation of proximal portion into superior sagittal sinus. Spontaneous intracerebral hematoma was the cause of the clinical symptoms. We report two cases of intracerebral hematoma, caused by dural AVM, which was successfully managed by surgical treatment.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.17-25
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• 2016

Objective : Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods : Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results : All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ${\geq}2$ times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion : Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.

• 대한두개안면성형외과학회지
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• 제21권2호
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• pp.114-118
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• 2020

Adenoid cystic carcinoma (ACC) in the lacrimal gland is a very rare disease with poor overall prognosis. Its primary treatment is surgical excision, including orbital exenteration and radical orbitectomy, which is combined with radiotherapy and chemotherapy. Age, histopathologic type, bone invasion, and tumor extent are known factors that affect the prognosis of ACC. Furthermore, perineural invasion is highly associated with local tumor recurrence and tumor base invasion. Here, we report a rare case of ACC in the lacrimal gland with superior sagittal sinus invasion that repeatedly recurred after the surgical excision.

• Journal of Korean Neurosurgical Society
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• 제48권4호
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• pp.357-359
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• 2010

While a delayed intracerebral hemorrhage at the site of a ventricular catheter has occasionally been reported in literature, a delayed hemorrhage caused by venous infarction secondary to ventriculoperitoneal shunting has not been previously reported. In the present case, a 68-year-old woman underwent ventriculoperitoneal shunting through a frontal burr hole, and developed a hemorrhagic transformation of venous infarction on the second postoperative day. This massive venous infarction was caused by bipolar coagulation and occlusion of a large paramedian cortical vein in association with atresia of the rostral superior sagittal sinus. Thus, to eliminate the risk of postoperative venous infarction, technical precautions to avoid damaging surface vessels in a burr hole are required under loupe magnification in ventriculoperitoneal shunting.