• Journal of Trauma and Injury
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• 제25권1호
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• pp.1-6
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• 2012

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

• Journal of Chest Surgery
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• 제36권10호
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• pp.734-740
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• 2003

관상동맥우회술 시 내흉동맥의 장기개통률이 복재정맥의 경우보다 높은 것으로 보고되면서 동맥이식편에 대한 관심과 사용이 증가되고 있으며 그중의 하나로 요골동맥의 사용이 증가하고 있다. 이에 저자들은 좌내흉동맥과 요골동맥을 사용하여 시행한 관상동맥우회술의 성적을 좌내흉동맥과 복재정맥만을 사용한 경우와 비교하여 그 조기결과를 분석하였다. ,대상 뜻 방법: 2000년 1월부터 2002년 12월까지 시행한 관상동맥우회술 165예 중 요골동맥군 45예와 나이, 성별, NYHA, 좌심실박출계수, 수술 전 관상동맥조영술 소견이 유사한 복재정맥군을 수술 전 위험인자와 수술결과에 대해 비교분석하였다. 결과: 수술 사망률과 합병증(중풍, IABP삽입, 수술 중 심근경색) 각각의 발생률은 두군 간에 통계학적 차이가 없었으나 이들의 총발생률은 요골동맥군에서 복재정맥군보다 적었으며(p<0.05), 중환자실 재원기간은 요골동맥군이 2.93$\pm$0.62일로 복재정맥군의 3.55$\pm$0.95일에 비해 더 짧았다(p<0.001). 수술 후 7∼14일 사이에 요골동맥군에서 시행한 관상동맥조영술상 좌내흉동맥과 요골동맥의 개통률은 100%, 복재정맥은 94.9%였다. 걸론: 관상동맥우회술 시 내흉동맥과 요골동맥을 사용한 군에서 내흉동맥과 복재정맥만을 사용한 군보다 우수한 조기 수술 성적을 얻었다.

• 한국의학물리학회지:의학물리
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• 제21권3호
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• pp.274-280
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• 2010

선형가속기를 이용하여 single-fraction stereotactic radiosurgery (SRS)를 시행하였던 뇌동맥 기형 치료 환자 25예 중 13예의 임상결과와 혈관조영술 소견에 대해 알아보고자 하였다. 2002년부터 2009년까지 뇌동정맥 기형으로 SRS를 시행하였던 25명 중 추적 혈관조영술이 시행된 기간이 12개월 이상인 환자 15명(남자 6명, 여자 9명)을 대상으로 하였으며 후향적으로 MRI와 혈관조영술에서 동정맥기형 핵의 크기와, 위치, 파열유무, 추적기간 동안의 합병증 유무, 혈관조영술에서의 변화를 분석하였다. 평균 30개월(12~89개월) 동안 추적 혈관조영술이 시행되었던 15명의 환자 (평균나이 33세, 14~56세) 중 모든 환자에서(100%) 동정맥기형이 완전 소실되었고 3명(20%)에서 유출정맥만이 동맥기 촬영에서 확인되었다. 추적기간 중 1명에서 경련이 있었으며 출혈이나 뇌부종에 의한 임상증상이 있었던 환자는 없었다. 동정맥기형 핵의 부피는 평균 4.3 cc (SD 3.7 cc, 범위 0.69~11.7 cc)였으며 방사선 조사 선량은 평균 17 Gy (12~20 Gy)였다. 동정맥기형의 위치는 대엽이 11예, 기저핵이 1예, 뇌교가 1예, 소뇌가 2예였다. 9예는 파열, 나머지 6예는 비 파열 예였다. 선형가속기를 이용한 뇌동정맥기형 방사선 치료의 성적은 추적기간을 4년 이상으로 할 때 높은 완치율을 보이며 동맥기에 유출정맥이 남아 있을 경우 유출정맥이 완전히 소멸될 때까지 추적 관찰이 요구된다.

• Journal of Korean Neurosurgical Society
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• 제45권4호
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• pp.224-230
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• 2009

Objective : We aimed to analyze clinical and radiological outcomes retrospectively in patients with basilar apex aneurysms treated by coiling or clipping. Methods : Outcomes of basilar bifurcation aneurysms were assessed retrospectively in 77 consecutive patients (61 women, 16 men), ranging in age from 25 to 79 years (mean, 53.7 years) from 1999 to 2007. Results : Forty-nine patients out of 77 patients (63.6%) presented with subarachnoid hemorrhages of the 49 patients treated with coiling, 27 (55.1 %) showed complete occlusion of the aneurysm sac. Of these, 13 patients (26.5%) developed coil compaction on angiographic or MRI follow-up, with recoiling required in 9 patients (18.4%). Procedural complications of coiling were acute infarction in nine patients and the bleeding of the aneurysms in six patients. The remaining 28 patients underwent microsurgery : twenty-six of these (92.9%) with microsurgery followed up with conventional angiography. Complete occlusion of the aneurysm sac was achieved in 19 patients (73.1%). Operation-related complications of microsurgery were thalamoperforating artery injuries in three patients, retraction venous injury in two, postoperative epidural hemorrhage (EDH) in one, and transient partial or complete occulomotor palsy in 14 patients. Glasgow Outcome Scores (GOS) were 4 or 5 in 21 of 28 (75%) patients treated with microsurgery at discharge, and at 6 month follow-up, 20 of 28 (70.9%) maintained the same GOS. In comparison, GOS of four or 5 was observed in 36 of 49 (73.5%) patients treated with coiling at discharge and at 6 month follow-up, 33 of 49 patients (67.3%) maintained the GOS from discharge. Conclusion : Basilar top aneurysms were still challenging lesions based on our series. Endovascular or microsurgery endowed with its inborn risks and procedural complications for the treatment of basilar apex aneurysms individually. Microsurgery provided better outcome in some specific basilar apex aneurysms. For reaching the most favorable outcome, endovascular modality as well as microsurgery was inevitably considered for each specific basilar apex aneurysm.

• Journal of Chest Surgery
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• 제38권1호
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• pp.67-71
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• 2005

상대정맥증후군의 원인은 악성과 비악성 두 가지로 나눌 수 있다. 항암 화학요법이나 방사선 치료에 반응이 없는 악성 종양에 의한 상대정맥증후군의 경우, 수술보다는 방사선학적 중재적 시술로 치료하는 것이 일반적이다. 그러나 비악성 원인에 의한 경우 수술과 중재적 시술 중 어느 것이 우수한지 아직 정립되어 있지 않다. 저자들은 혈액 투석용 카테터에 의한 상대정맥증후군 환자 2명에 대해 수술적 치료를 시도하였다. 2명 모두 중재적 시술이 불가능하거나 실패한 경우였다. 첫 번째 환자는 expanded polytetrafluoroethylene를 이용하여 무명정맥-우심방 단락술을 시행하였고, 다른 한 환자는 혈전 제거술과 함께 자가 심막을 이용하여 상대정맥과 무명정맥의 첩포 확장술을 시행하였다. 두 환자 모두 증상의 현저한 호전이 있었으며, 수술 후 시행한 혈관 조영술에서 우회혈관의 현저한 저하가 관찰되었다.

• Journal of Korean Neurosurgical Society
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• 제43권6호
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• pp.265-269
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• 2008

Objective : Outcome of gamma knife radiosurgery (GKS) in the consecutive 100 cases with cerebral arteriovenous malformations (AVMs) was analyzed. Methods : Data from initial 100 patients treated with GKS in the authors' institute were reviewed retrospectively. Spetzler-Martin grade at diagnosis were I in 18 patients, II in 27, III in 36, IV in 11, and V in 8. Thirty-five patients had experienced previous bleeding, 27 patients presented with seizure, and 31 patients presented with headache. The mean volume of the lesion was $4.3\;cm^3\;(0.1-29.3\;cm^3)$. The median radiation dose delivered to the margin was 20.0Gy (13-32Gy). Mean follow-up period was 37.5 months (5-63 months). Results : Angiographic follow-up was performed in 48 patients at least 2 years after GKS. Sixteen patients were lost in follow up following 2 years from GKS. Twenty-eight of 48 patients (58%) showed complete obliteration and 20 patients (42%) showed partial obliteration. Seven patients presented with post-GKS hemorrhage. Adverse radiation effect (ARE) was observed at follow-up MRI in 25 of 76 patients, and it was symptomatic in 5 patients. Complete obliteration was confirmed in 24 of 31 (77%) patients with volume less than $4\;cm^3$, meanwhile only 4 of 17 (24%) patients with volume of $4\;cm^3$ or more showed complete obliteration. Complete obliteration rate was 67% with 20Gy or higher marginal dose, 63% with 15-20 Gy, and 17% with less than 15Gy. Conclusion : GKS can provide high rates of obliteration with acceptable risk of morbidity in a subgroup of small AVMs. However, overall outcome in whole spectrum of AVMs, in which large proportion of cases have unfavorable characteristics for radiosurgery, is much worse. More effective therapeutic strategy needs to be developed for large AVMs that are difficult to be managed with current available treatment modalities.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1188-1194
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• 2000

Objective : Internal carotid-posterior communicating artery(IC-PC) aneurysms can be clipped easily without any special preparations. Occasionally, however, it is difficult to clip the low-lying IC-PC aneurysms without some kinds of additional procedures. Clinical Material and Methods : We experienced four cases of low-lying IC-PC aneurysms, which the intradural anterior clinoidectomy and/or anterior petroclinoid fold(APF) resection was essential to expose the proximal side of the aneurysmal neck and/or proximal control. One patient harbored two low-lying IC-PC aneurysms bilaterally. The patients were divided into two groups according to the necessity of anterior clinoidectomy : Group I(n=4) that needed an intradural clinoidectomy and/or APF resection and Group II(n=29) that had IC-PC aneurysms, easily clipped without any special preparation. Also, various radiometric parameters were measured through the preoperative angiograms. Results : The incidence of such aneurysms was 12% among a total of thirty-three surgically treated IC-PC aneurysms during lasr 3 years. Among four cases, three cases presented with subarachnoid hemorrhage and all aneurysmal sac projected to postero-inferior direction. In our study, We initially considered the necessity of intraoperative anterior clinoid process(ACP) removal and/or resection of APF in cases of shorter distance less than 5.6mm between the proximal aneurysmal sac and tip of the ACP(p<0.001), and the proximal portion of aneurysmal neck has located below the interclinoid line(p=0.001). Conclusion : Through a careful preoperative evaluation, some radiometric parameters can be used to determine whether the ACP should be removed in clipping of the low-lying IC-PC aneurysms. Unlike to total removal of the ACP, the intradural partial anterior clinolidectomy and/or APF resection, which are more familiar to surgeons, reduce the risks of the premature rupture, operative time, and also contribute a more precise clip placement with proximal control than the extradural clinoidectomy.

• Journal of Korean Neurosurgical Society
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• 제38권2호
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• pp.89-95
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• 2005

Objective : The purpose of this study is to analyze aneurysm morphology and define limitations and feasibility in endovascular Gugliemi detachable coil[GDC] embolization for anterior communicating artery [ACoA] aneurysms. Methods : From January 2000 through October 2003, 123patients were treated with endovascular coil embolization for ACoA aneurysms. There were 75women and 48men, with a mean age of 63years. All ruptured aneurysms were treated within 15days of rupture. Aneurysm morphology was classified according to neck size and projection of aneurysm dome as follows-A : neck of aneurysm <4mm & anterior projection, B : neck of aneurysm [4mm & anterior projection, C : neck of aneurysm<4mm & posterior [superior] projection, D : neck of aneurysm [4mm & posterior [superior] projection, E : neck of aneurysm<4mm & inferior projection, and F : neck of aneurysm [4mm & inferior projection. Endovascular procedures were categorized as either "successful" or "unsuccessful". Clinical follow-up was estimated at discharge and at 6months, post treatment results were classified according to Glasgow Outcome Scale[GOS]. Results : Successful embolization for ACoA was performed in 86patients of 123patients [69.9%]. Complete or near complete aneurysm occlusion was observed in 102patients [82.9%]; a neck remnant was observed in 6patients [4.9%]; partial embolization was done in 3patients [2.4%]; and embolization was attempted in 12patients [9.8%]. Among 55patients with follow-up angiographic results, 18patients [32.7%] were defined as recanalization of the aneurysm sac. Morphological analysis demonstrated that anterior projecting aneurysms and morphological classifications [morphological classifications worsens [A - D] chances of successful coil occlusion significantly decrease] were major factors in successful embolization, and, inferiorly projecting and wide neck [${\ge}4mm$] aneurysms are highly related to recanalization of aneurysms. Conclusion : Endovascular coil embolization of ACoA aneurysms shows good outcome in our study. Nevertheless, there is a limitation in the endovascular approach to ACoA, even though advanced modern techniques evolve rapidly. Compensatory surgical approach with the endovascular approach is required for successful treatment of ACoA aneurysms.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.342-349
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• 2015

Background : Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system. Method : A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes ($mRS{\leq}2$) at 3 month were compared across the three method. Results : Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331). Conclusion : Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.

• Journal of Chest Surgery
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• 제41권6호
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• pp.718-723
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• 2008

배경: 최근 20년간 수술적인 기법, 마취 기술, 심폐기 운용, 중환자실 관리의 발전으로 심장수술의 사망률과 합병증은 상당히 감소하였지만 심장수술이 중추신경계에 상당한 위험 요소가 되는 것은 널리 알려진 바이다. 이 연구는 두경부 MRA를 통해 심장 수술 대상자에서 불현성 뇌혈관계 질환의 유병률과 두경부 MRA 상에서 비정상적인 소견을 보인 환자의 치료 방침의 변화를 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2008년 6월까지 두경부 MRA 촬영에 동의한 107명의 심장수술 예정자(21세에서 83세까지의 연령분포를 보인 남자 71명과 여자 36명)를 대상으로 하였다. 이 환자들 중에서 신경학적인 고위험군의 비율과 그 환자들의 치료 방침의 변화를 관찰하였다. 결과: 신경학적으로 고위험군 환자의 비율은 15.7% (17예)였으며, 이중 11예는 허혈성 심질환, 6예는 판막 질환이였으며, 이 중 2예의 환자만이 이전에 신경학적인 병력이 있었다. 14명(13.1%)의 환자에서 치료 방침에 변화가 있었다. 결론: 심장수술 대상자에 있어 불현성 뇌혈관계 질환은 비교적 높은 것으로 생각되며, 이를 밝히는 데 있어 두경부 MRA가 의미 있는 것으로 생각된다.