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김호재,이무섭,이우창,민경수,김영규,김동호 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.6
Objective : We proposed to study factors influencing the determination of operative side for easier and more successful clipping in the pterional approach to anterior communicating artery aneurysms and to determine the highest priority of factors in relation to the direction of the aneurysm. Methods : The present study was conducted retrospectively in 91 patients with anterior communicating artery aneurysm who were operated on between January 1996 and December 2002. A1 dominancy, the size and the direction of aneurysms, the configuration of the H-complex especially the relative locations of both A2 segments in the coronal plane and the presence or absence of accompanying aneurysms were determined by angiogram. The degree of operative difficulty and factors influencing difficulty were reviewed with operative records and videos. Results : In antero-inferior projecting aneurysms, when approached from the side of A1 dominancy, safe and easy clipping resulted(45/46cases). In superior projecting aneurysms, approaches from the side of the ipsilateral proximal A2 posterior to the contralateral A2 yielded favorable results(25/25cases), although the side was A1 non-dominant side. In some cases with posterior projecting aneurysms, approaches from the side of the posteriorly located A2 segment were inappropriate. Conclusion : In anterior communicating artery aneurysmal surgery, the A1 dominant side for antero-inferior projecting aneurysms and the side of the ipsilateral proximal A2 posterior to the contralateral A2 for superior projecting aneurysms should be considered prior to other factors. In posterior projecting aneurysms, angiographic analysis for the side where operator can observe the aneurysmal neck directly is required.
Cervical Intramedullary Neurenteric Cyst in an Elderly Patient
김호재,김영규,민경수,김동호 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.3
Intraspinal neurenteric cysts are rare congenital lesions that may occur either alone or in the context of a complex malformative disorder including vertebral, visceral and cutaneous abnormalities. Most of these lesions have an intradural extramedullary location. Rarely, intramedullary neurenteric cysts not associated with other malformations have been reported. A 72-year-old woman presented with a 5-year-history of progressive paraparesis(I/II), urinary retention. A magnetic resonance(MR) image revealed a C6-C7 intramedullary cystic lesion which was located ventrally to the spinal cord and no other spinal abnormalities. The cystic lesion were subtotally removed through posterior approach. On histopathological examination, fibrous connective tissue surrounded by cuboidal cells which contained mucin vacuoles were consistent with neurenteric cyst. Postoperative MR image showed the decompression of the spinal cord. Postoperatively, neurological deficits were improved. We report a case of neurenteric cyst occured in highly old age and unusual location.
김호재,유주영,정승민,송정식,박용범,이상원 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.2
Purpose: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitisactivity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Materials and Methods: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model. Results: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associatedwith the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulativerefractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). MultivariateCox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573). Conclusion: RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosisand predict refractory diseases during follow-up.