Quantitative Analysis of Intraoperative Indocyanine Green Video Angiography in Aneurysm Surgery

손영제,양희진,김정은,박성배,이상형,정영섭 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.2

Objective:Indocyanine green (ICG) videoangiography (VA) is being used in assessment of blood flow during cerebrovascular surgery. However, data collected during ICG angiography are usually interpreted qualitatively. In this study, quantitative analysis of ICG angiogram was attempted. Materials and Methods:ICG VA, performed during aneurysm surgery was analyzed retrospectively. The angiogram was captured serially in regular time interval. The stacked images were then fed into an image analysis program, ImageJ. The selected areas of interest were as follows: parent and branch vessels, and dome of aneurysm. Changes of signals of measurement points were plotted. The time to peak, washout time, and the peak intensity between areas were compared. Results:Among the 16 cases enrolled in this study, five cases were anterior communicating artery aneurysms, and 11 cases were middle cerebral artery bifurcation aneurysms. There was no signal intensity of aneurysm dome in our series. No difference in time to peak or maximum signal intensity was observed between vessels in each case. The average time to peak was 9.0 and washout time was 31.3 seconds. No significant difference in time profile was observed between anterior communicating artery aneurysms and middle cerebral artery bifurcation aneurysms. Conclusion :Findings of this study demonstrate that quantitative analysis is possible using a personal computer and common video capture and analysis software. It can be a good adjunctive to evaluation of vascular status during aneurysm surgery. It displays time profiles of multiple points of interest over time, and is helpful in objective evaluation of changes of blood flow over time. It might be helpful in various fields of cerebrovascular surgery.

림프구성 누두신경뇌하수체염 : 증례 보고 및 문헌고찰

손영제,왕규창,최기영,지제근,조병규,Son, Young-Je,Wang, Kyu-Chang,Choe, Gheeyoung,Chi, Je Keun,Cho, Byung-Kyu 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Lymphocytic infundibuloneurohypophysitis is a rare inflammatory disorder, which may be caused by autoimmune response, affecting the infundibulum and the posterior lobe of the pituitary gland. The authors present a 15-year-old man with central diabetes insipidus, whose sellar magnetic resonance imaging (MRI) showed a focal thickening of the infundibulum and loss of high signal of the normal neurohypophysis on T1-weighted images. The histopathological diagnosis was lymphocytic infundibuloneurohypophysitis. When a patient presents with central diabetes insipidus and infundibular thickening on brain MRI, this entity should be included in the differential diagnosis though it is very rare. The significance of this entity in treatment is that it is basically not a surgical one, and surgery is needed only for tissue diagnosis. Symptomatic treatment and observation make it regress spontaneously.

소아의 원발성 악성 연수막 흑색종 - 증 례 보 고 -

손영제,왕규창,김연미,신상훈,지제근,조병규,Son, Young-Je,Wang, Kyu-Chang,Kim, Youn Mee,Shin, Sang-Hoon,Chi, Je G.,Cho, Byung-Kyu 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Primary malignant leptomeningeal melanoma is very rare, accounting for less than 0.1 percent of tumors in the central nervous system. Patients with primary intracranial malignant melanoma tend to be younger than metastatic intracranial melanoma, most commonly in the fourth decade of life. This tumor is extremely rare and the biologic behavior is aggressive especially in children. The authors report a case of primary malignant leptomeningeal melanoma in a twelve-year-old boy which was initially diagnosed as meningitis. On autopsy, associated extensive leptomeningeal melanosis was confirmed and believed to be the origin of the tumor. This case emphasizes the pattern of clinical presentation and the significance of leptomeningeal melanosis in primary leptomeningeal melanoma.

Trans-obturator tape로 치료한 복압성요실금 80예에 관한 임상적 고찰

송치훈 ( Chi Hun Song ),손영제 ( Young Je Son ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6

목적: 여성의 복압성 요실금에 대한 치료에 다양한 수술적 방법이 이용되고 있다. 저자는 Trans-obturator tape (TOT)를 이용하여 치료한 환자들을 대상으로 TOT의 안정성과 효용성을 평가하고자 한다. 연구 방법: 2004년 8월부터 2005년 9월까지 복압성 요실금 (순수 혹은 복합성)을 가진 여자 환자들 중 TOT를 이용하여 치료하고 3개월 이상 추적 관찰한 80명을 대상으로 치료 결과 및 예후를 임상적으로 분석하였다. 결과: 환자의 연령분포는 28세에서 74세였고, 평균연령은 42.8세였다. 전체 환자 중 복압성 요실금은 74명 (92.5%)에서 완전 회복이 되었고 4명 (5%)에서 부분회복이 되었으며 2명 (2.5%)에서는 효과가 없었다. 복합성 요실금 환자에서 절박뇨는 36명 중 30명 (83.3%)에서 호전되었고 빈뇨는 27명 중 20명 (62.9%)에서 호전되었다. 평균 수술시간은 14.3±3.8분이었고, 입원에서 퇴원까지의 시간은 평균 6±2.4시간이었다. 수술 후 창상출혈이 한 명에서 나타났고 수술 중 방광천공이 의심된 환자가 한 명 발생하였다. 수술 전에 없었던 절박뇨가 1명 나타났고 빈뇨가 세 명에서 나타났으나 일시적이었고 두 명은 요속이 약해졌다고 호소하였지만 치료가 필요한 정도는 아니었다. 결론: TOT를 이용한 수술은 복압성 요실금 치료에 있어서 안전하고 효과적인 방법이고 절박뇨나 빈뇨에도 효과가 있어 복합성 요실금의 1차적인 치료방법으로서 외래에서 쉽게 시술할 수 있는 수술 방법의 하나로 생각된다. Objective: This study was performed to evaluate the efficacy and safety of Trans-obturator tape (TOT) in the surgical treatment of stress incontinence and analyze the postoperative clinical outcome. Methods: Between August 2004 and September 2005, females diagnosed as having stress incontinence (pure or mixed) were operated on using TOT. Eighty cases with more than three-month follow-up period were included for this study. Results: Patient age ranged from 28 to 74 years (mean, 58). After surgical treatment using TOT, 74 cases (92.5%) of stress incontinence showed complete recovery, 4 cases (5%) showed partial recovery, and 2 cases (2.5%) were unchanged without further functional deterioration. Urgency in the mixed incontinence was improved in 30 in 36 cases (83.3%) and frequency was changed for the better in 20 of 27 cases (62.9%). The mean operation time was 14.3 minutes and the mean hospital stay was six hours. Postoperative evaluation with cystoscope was unnecessary. The postoperative complication rate was 10% (8/80). Postoperative wound bleeding occurred in one case and intraoperative bladder perforation happened in one case. Postoperative transient urgency was developed in one case and postoperative transient frequency developed in three cases. Two patients complained of weak urinary stream. Conclusion: The surgical treatment using TOT is thought to be a safe and efficient means for the outpatient management of stress incontinence. And also, this method appears to have an effect on urgency and frequency.

Carpal Tunnel Syndrome Diagnosed by Carpal Tunnel Pressure Measurement

안성열,정영섭,이상형,양희진,손영제 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Carpal tunnel syndrome (CTS), the most common compressive neuropathy, is usually diagnosed by clinical features and nerve conduction test (NCS). However, NCS might show no abnormal finding. Ultrasonography (USG), known as helpful adjunctive in diagnosis of CTS, also might show false negative finding. A 33-year-old woman presented with complaints of pain and numbness in median nerve area on her right hand for 4 years. Despite typical clinical features of CTS, neither NCS nor USG showed abnormal finding. Because of persistent symptom, without significant improvement on conservative management, endoscopic carpal tunnel release (ECTR) was performed with carpal tunnel pressure (CTP) measurement. The measured CTP was 27.9 mmHg before ECRT, which was reduced to 5.9 mmHg after operation. The pain and numbness subsided after operation. Our case showed the usefulness of CTP measurement in diagnosis of CTS. The measurement of CTP might be an important diagnosis modality for some patients having CTS, especially in cases without definitive findings in NCS and USG. Carpal tunnel syndrome (CTS), the most common compressive neuropathy, is usually diagnosed by clinical features and nerve conduction test (NCS). However, NCS might show no abnormal finding. Ultrasonography (USG), known as helpful adjunctive in diagnosis of CTS, also might show false negative finding. A 33-year-old woman presented with complaints of pain and numbness in median nerve area on her right hand for 4 years. Despite typical clinical features of CTS, neither NCS nor USG showed abnormal finding. Because of persistent symptom, without significant improvement on conservative management, endoscopic carpal tunnel release (ECTR) was performed with carpal tunnel pressure (CTP) measurement. The measured CTP was 27.9 mmHg before ECRT, which was reduced to 5.9 mmHg after operation. The pain and numbness subsided after operation. Our case showed the usefulness of CTP measurement in diagnosis of CTS. The measurement of CTP might be an important diagnosis modality for some patients having CTS, especially in cases without definitive findings in NCS and USG.

Large Spinal Meningioma with Hemorrhage after Selective Root Block in the Thoraco-Lumbar Spine

이희승,이상형,정영섭,양희진,손영제,박성배 대한척추신경외과학회 2013 Neurospine Vol.10 No.4

Spinal meningioma accounts for 25% of all spinal cord tumors and occurs mostly in the thoracic region. Spontaneous intraspinal bleeding associated with spinal meningioma has rarely been reported. Most cases of hemorrhage associated with meningiomas are extratumoral and subarachnoid, whereas subdural and intratumoral hemorrhage cases have been reported to occur rarely. We experienced a case of a 58-year-old woman with thoracolumbar spinal meningioma accompanied by intraspinal subdural hematoma. She presented with progressively worsened back pain and newly developed weakness in the right lower extremity after a selective nerve root block in the lumbar spine. She underwent the operation and progressively showed neurological recovery during the postoperative course. We report a thoracolumbarspinal meningioma with subdural and intratumoral hemorrhage after a spinal procedure that caused a sudden neurological deterioration.

Metal Artifact Reduction for Orthopedic Implants: Brain CT Angiography in Patients with Intracranial Metallic Implants

선우준,박선원,임정효,강연아,정영섭,손영제,김수진 대한의학회 2018 Journal of Korean medical science Vol.33 No.21

Background: The purpose of this study was to qualitatively and quantitatively evaluate the effects of a metal artifact reduction for orthopedic implants (O-MAR) for brain computed tomographic angiography (CTA) in patients with aneurysm clips and coils. Methods: The study included 36 consecutive patients with 47 intracranial metallic implants (42 aneurysm clips, 5 coils) who underwent brain CTA. The computed tomographic images with and without the O-MAR were independently reviewed both quantitatively and qualitatively by two reviewers. For quantitative analysis, image noises near the metallic implants of non-O-MAR and O-MAR images were compared. For qualitative analysis, image quality improvement and the presence of new streak artifacts were assessed. Results: Image noise was significantly reduced near metallic implants (P < 0.01). Improvement of implant-induced streak artifacts was observed in eight objects (17.0%). However, streak artifacts were aggravated in 11 objects (23.4%), and adjacent vessel depiction was worsened in eight objects (17.0%). In addition, new O-MAR-related streak artifacts were observed in 32 objects (68.1%). New streak artifacts were more prevalent in cases with overlapping metallic implants on the same axial plane than in those without (P = 0.018). Qualitative assessment revealed that the overall image quality was not significantly improved in O-MAR images. Conclusion: In conclusion, the use of the O-MAR in patients with metallic implants significantly reduces image noise. However, the degree of the streak artifacts and surrounding vessel depiction were not significantly improved on O-MAR images.

뇌 관련 신경외과 수술 시 Mobile CT의 임상적 적용과 유용성 평가

김희정(Hee Jeong Kim),전진수(Jin Sue Jeon),이숙희(Suek Hee Lee),박성배(Sung Bae Park),손영제(Young Je Son),양희진(Hee Jin Yang),정영섭(Young Seob Chung),이상형(Sang Hyung Lee) 대한CT영상기술학회 2012 대한CT영상기술학회지 Vol.14 No.2

목적 두부전용 이동형 CT인 Mobile CT scan을 pre., intra., postoperative imaging scan으로 분류하고 이를 뇌 관련 신경외과 수술에 선택적으로 적용하여 Mobile CT scan의 그 적용성과 임상적인 유용성에 관하여 알아보고자 한다. 대상 및 방법 보라매병원 신경외과에 내원하여 2010년 8월부터 2011년 12월까지 뇌 관련 신경외과 수술을 받은 환자 총 296명을 대상으로 수술 및 환자의 상태에 따라 Mobile CT scan을 pre., intra., postoperative imaging scan으로 분류하고 scan protocol은 brain noncontrast와 contrast를 이용하여 선택적으로 시행하였으며 신경외과 전문의의 자문을 얻어 실제적으로 획득되는 임상적 가치 및 유용성을 평가하였다. 결과 Mobile CT의 preoperative imaging scan은 환자의 수술 직전 뇌 상태 확인과 응급수술을 요하는 환자의 수술 계획을 위한 base image를 획득할 수 있었고, intraoperative imaging scan은 intraoperative events를 monitoring하고 병변 및 brain의 새로운 위치와 병변의 제거 정도 등의 수술 진행 정보를 제공하였다. Postoperative imaging scan에서는 수술 직후 수술 부위의 이상 소견 여부를 확인할 수 있었다. 결론 뇌 관련 신경외과 수술 시 적용한 Mobile CT의 pre., intra., postoperative imaging scan은 수술 계획의 진행 정도 확인과 뇌 및 환자 상태를 실시간으로 monitoring할 수 있어 효과적으로 환자 안전 및 수술의 정확성과 성공률을 높이는데 유용할 것으로 사료된다. I. Purpose Portable Computed Tomography, Mobile CT scan is classified into pre., intra., postoperative imaging scan. It would be applied selectively to discoverits application and clinically usability. II. Object and Method The subject of this experiment was based en 296 patients who visited department of neurosurgery, Boramae Medical Center from August 2010 to December 2011. I classified Mobile CT scan into pre., intra., postoperative imaging scan and conducted scan protocol by using noncontrast and contrast selectively and they were evaluated by advice of neurosurgical specialist. III. Result Preoperative imaging scan of Mobile CT could obtain brain status and base image of patients, who need emergency operation, before operation. Intraoperative scan could monitor intraoperative events with offering progressive information of brain and also could shaw removal degrees of lesions, In postoperative case, it could confirm abnormality opinion of surgery areas, IV. Conclusions Pre., intra. and postoperative imaging scan of Mobile CT are useful for confirming progress of operation plan, monitoring of brain with patients’ status in neurosurgical operation associated with brain. In my opinion, selective application of Mobile CT scan could be used effectively for caring patients, raising accuracy and success rate of operations.

The Effect of Cervical Radiculopathy on the Outcome of Carpal Tunnel Release in a Patient with Carpal Tunnel Syndrome

Lee Heui Seung,박성배,Lee Sang Hyung,Young Seob Chung,Hee-Jin Yang,손영제 대한말초신경학회 2015 The Nerve Vol.1 No.1

Objective The aim of this cross-sectional study was to elucidate the incidence of cervical radiculopathy among patients who have been diagnosed with carpal tunnel syndrome (CTS) and to evaluate the outcome of carpal tunnel release (CTR) in CTS patients with clinically diagnosed cervical radiculopathy. Methods Eighty-five patients who underwent CTR for their electrophysiologically and ultrasonographically diagnosed CTS from January 2013 to July 2015 were evaluated according to the presence of cervical radiculopathy or any condition proven by a radiological assessment of the cervical region. The outcome of CTR was graded from 1 to 4 by the degree of pain relief and evaluated according to clinical factors including cervical radiculopathy. Results CTR was shown to be effective in 70 (82.4%) patients, whereas 14 (16.5%) were categorized as a non-effective group. The outcome of CTR was significantly different in the presence of ipsilateral cervical radiculopathy, which was documented by an electrophysiological assessment (p=0.05). However, there was no significant difference in the outcome of CTR between patients with normal and abnormal findings in the cervical region in the radiological assessments. Conclusion CTR seemed less effective for the patients who had cervical radiculopathy. An electrophysiological study to identify cervical radiculopathy before performing a CTR is necessary to increase the success rate of the treatment by selecting the most appropriate patients.

The Effect of Medial Branch Block for Low Back Pain in Elderly Patients

Lee Heui Seung,Sung Bae Park,Lee Sang Hyung,Young Seob Chung,Hee-Jin Yang,손영제 대한말초신경학회 2015 The Nerve Vol.1 No.1

Objective The aim of this cross-sectional study was to evaluate the outcome of a medial branch block (MBB) in elderly patients to determine the factors associated with the degree of pain relief. Methods Fifty-six patients 75 years or older with MBB from January 2013 to July 2015 were classified into two groups by the degree of pain relief. The outcome of the MBB was evaluated according to clinical factors. Results A MBB was shown to be effective for 39 (69.6%) patients. Seventeen (30.4%) were categorized in the non-effective group. The two groups were significantly different in the history of previous lumbar spine surgery but had similar ages represented (p=0.019). Conclusion A MBB can be an effective minimally invasive intervention in elderly patients. Because the MBB seemed less effective for the patients who had a lumbar surgery, careful selection of the patients before performing a MBB is necessary to provide a higher success rate of pain relief.