직접성 목동맥해면정맥동루에 의한 치명적인 지연성 비출혈 : 증례 보고 : Delayed life-threatening epistaxis due to direct CCF : a case report

고준경 부산대학교 병원 암연구소 2014 부산대병원학술지 Vol.- No.36

Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

고준경,Hwan Soo Kim,Hyuk Jin Choi,이태홍,윤은영,최창화 대한신경외과학회 2015 Journal of Korean neurosurgical society Vol.58 No.3

Objective : Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods : From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results : Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0–2, and the other 12 were either dependent or had expired (mRS score, 3–6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion : Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome.

Multiple Spinal Tumors with Meningiomas and Schwannomas

고준경,김위현,최병관,최창화 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.34 No.6

We report a case of suspicious neurofibromatosis associated with multiple spinal tumors with dual pathology. The patient was a 16-year-old girl who had developed progressive paraparesis for 6 months. She had cafe-au-lait spots and multiple subcutaneous nodule. Magnetic resonance(MR) imaging of the lumbar spine had shown dumbbell-shape spinal tumor at L1-2. The tumor had been removed successfully at the local hospital. But, she had got worse to paraplegia. Postoperative MR image of the whole spine had revealed multiple spinal tumors at T3-4, T6-7, C2-3, C7-T1. She underwent 3 additional operations to remove the compressive lesions. Histopathologic findings documented 3 schwannomas and 2 meningiomas. She improved dramatically and was discharged from the hospital. Subsequent MR images of the whole spine revealed numerous small spinal tumors around the spinal cord and cauda quina. Key words:Multiple spinal tumors;Meningioma;Schwannoma;Neurofibromatosis.

Communicating Hydrocephalus Accompanied by Arachnoid Cyst in Aneurismal Subarachnoid Hemorrhage

최재영,고준경,차승헌,조원호 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.4

The authors describe a case of communicating hydrocephalus accompanied by an arachnoid cyst in an aneurismal subarachnoid hemorrhage. A 69-year-old female was referred to our clinic due to the sudden onset of a headache. A head computed tomography scan demonstrated an arachnoid cyst in the right middle fossa with a mass effect and diffuse subarachnoid hemorrhage. Digital subtraction angiography then revealed a left internal carotid-posterior communicating artery aneurysm. The neck of the aneurysm was clipped successfully and the post-operative period was uneventful. However, two months after discharge, the patient reported that her mental status had declined over previous weeks. A cranial computed tomography scan revealed an interval increase in the size of the ventricle and arachnoid cyst causing a midline shift. Simultaneous navigation guided ventriculoperitoneal shunt and cystoperitoneal shunt placement resulted in remarkable radiological and clinical improvements.

Contralateral Transverse Sinus Occlusion After Treatment of Transverse-Sigmoid Sinus Dural Arteriovenous Fistula: A Case Report

이정환,이재일,고준경,이태홍,최창화 대한신경손상학회 2022 Korean Journal of Neurotrauma Vol.18 No.1

A dural arteriovenous fistula (DAVF) is a pathologic arteriovenous shunt located within the dural wall of a venous sinus. In addition, DAVFs are associated with sinus thrombosis. Consequently, sinus occlusion may occur near DAVF lesions, making treatment challenging. However, there are few reports of sinus occlusion unrelated to lesions. In this study, we present a rare case of contralateral transverse sinus occlusion in a patient who underwent endovascular treatment and stereotactic radiosurgery for DAVF in the transverse-sigmoid sinus with ipsilateral sigmoid sinus occlusion.

A Case of Intradural Epidermoid Tumor in Lumbar Region

김경기,최창화,고준경 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.1

The authors describe a case of intradural epidermoid tumor in which the patient presented with low back pain and weakness of right lower extremity. The magnetic resonance imaging study showed intraspinal mass lesion at L2-3. The patient had no history of previous lumbar puncture. It was removed totally through laminectomy of L2 and L3 without any injury of the neural structure. The pathological findings were compatible with epidermoid tumor. The postoperative course was uneventful without any neurologic deficit. Characteristics of this lesion with a pertinent literature is reviewed.

전교통동맥류의 방향에 따른 임상분석

조원호,최창화,이재일,고준경 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.3

Objective : It has been known that the prognosis of aneurysm rupture is depend on the preoperative clinical state, presence of rebleeding, vasospasm, hydrocephalus, but the direction of aneurysm might be one of the important prognostic factors in the anterior communicating artery (ACOM) aneurysm. Methods : One hundred forty three cases of ACOM aneurysms, operated from 1996 to 2005, were analysed retrospectively according to the surgical outcomes and directions of aneurysms. Result : The results of analysis were summarized as follows 1) The direction of ACOM aneurysms were as follows; anterior-superior direction in 33.6%, anterior-inferior 30.1%, posterior-superior 10.5%, anterior 7.7%, superior 7.0%, inferior 7.0% and posterior-inferior in 4.2%. 2) There was no significant relationship between the direction of aneurysm and the preopertive clinical state, but the incidence of Hunt-Hess grade Ⅳ and Ⅴ was high in the posterior-superior and anterior-superior direction groups. 3) Intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) was accompanied in 28.7%. In posterior-superior and anterior-superior direction group, there is statistically significance between direction and IVH or ICH (p < 0.05). 4) Vasospasm was observed in 23.8% and cerebral infarction in 17.5%. The incidence was increased in the posterior-superior group. 5) Superior and posterior-superior direction group showed high mortality rate (20.0%). Conclusion : Although there was no statistic significance, we found that the direction of aneurysm might affect the clinical characteristics and prognosis in the patients underwent clipping surgery of ACOM aneurysm. Especially, posterior-superior and anterior-superior direction groups revealed the high incidence of ICH, IVH, vasospasm and cerebral infarction. Therefore, we should pay more careful attention to the patients with the superi-orly directed ACOM aneurysms.

페녹시계 제초제 MCPA를 분해하는 토양세균의 분리 및 특성 연구

김영진,차민석,오계헌,고준경,김영훈 순천향대학교 기초과학연구소 1997 순천향자연과학연구 논문집 Vol.3 No.1

A pure culture that can utilize 4-chloro-2-methylphenoxyacetic acid(MCPA) as a sole carbon and energy source was isolated from soil samples. Initially, clear zone formation on thin-layered MCPA agar plates was observed around spot inoculum of the isolate. As the results of various physiological and biochemical tests, the isolate was identified as Pseudomonas aeruginosa. The bacterium was able to degrade MCPA(300㎎/L) completely within 7 days of incubation as determined by UV-spectrophotometric analysis.

Unusual Magnetic Resonance Imaging Findings Contrast-induced Encephalopathy following Cerebral Angiography

조원호,이정환,이태홍,최창화,고준경 고신대학교(의대) 고신대학교 의과대학 학술지 2021 고신대학교 의과대학 학술지 Vol.36 No.1

Contrast-induced encephalopathy (CIE) following cerebral angiography has similar clinical presentations to ischemic complications of cerebral angiography. Neurologic deficits in CIE are mostly transient, but those caused by acute cerebral infarction (ACI) as ischemic complications of cerebral angiography may be permanent. Therefore, distinguishing CIE from ACI is important. Diffusion restriction on magnetic resonance imaging (MRI) implies ACI, while hyperintensity on diffusion weighted imaging (DWI) without correlation on the apparent diffusion coefficient (ADC) map implies CIE. We reported a rare case of CIE with diffusion restriction on MRI following cerebral angiography that mimicked MRI findings of ACI. The mechanism of this phenomenon remains unknown and requires further investigation.

Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms

Jae Young Choi,최창화,고준경,이재일,Chae Wook Huh,이태홍 영남대학교 의과대학 2019 Yeungnam University Journal of Medicine Vol.36 No.3

Background: The anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms. Methods: From January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed. Results: Aneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only three aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, five (6.9%) remnant neck, and one (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of eight asymptomatic and two symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included one major and three minor recanalizations. Conclusion: Coiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.