Endovascular Treatment in Post-Surgiclal Cerebral Aneurysms

강현승,한문희,권배주,장기현,오창완,한대희 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.1

Objective : The authors present the result of endovascular treatment in cases of residual or recurrent cerebral aneurysms after surgery. Methods : 370 cases harboring 410 aneurysms underwent endovascular coil embolization over the past eight years. We selected 13 cases that underwent coil embolization in the post-surgical condition with residual or recurrent aneurysms. Radiologic and clinical data were reviewed to determine reasons of referral, outcomes, and technical problems of postsurgical endovascular treatment. Results : The mean interval from surgery to endovascular treatment was 23 months (range 0 day to 121 months). The reasons of postsurgical endovascular treatment were : 1) incomplete clipping (n=6); 2) failed clipping (n=3); and 3) rehemorrhage (n=4). Among the 4 cases of rehemorrhage, 3 cases presented with recurrent aneurysms after clipping; one case had undergone aneurysm wrapping. At time of endovascular treatment three patients were classified as Hunt- Hess Grade 0, two Grade I, three Grade II, and five Grade III. In all 13 cases, treatments by endovascular coil embolization were successful, resulting in total or near total occlusion of aneurysms, with no procedure-related morbidity or mortality. Clinical outcome at time of the last clinical evaluation was; Glasgow Outcome Scale (GOS) 5 in ten patients, GOS 4 in one, and GOS 3 in one. Mean duration of follow-up was 17 months. No subarachnoid hemorrhage or aneurysm regrowth was noted during the follow-up period. Conclusion : Endovascular coil embolization is a good alternative treatment modality in cases of postoperative residual or recurrent aneurysms.

뇌동맥 조영술을 위한 이오파미돌 250 조영제의 유효성과 안전성: 이오파미돌 300과 비교한 다기관, 무작위배정, 이중맹검 연구

서효빈,한문희,권배주,임소향,정철규,김성현,김재형 대한영상의학회 2007 대한영상의학회지 Vol.57 No.6

Purpose: To evaluate and compare the safety, tolerance and the image quality of cerebral angiography images with the use of the nonionic monomeric contrast agent, iopamidol at 250 mgI/mL or 300 mgI/mL. Materials and Methods: This study was approved by the institutional review board and was performed from December 2005 to March 2006. A total of 90 patients undergoing an elective cerebral angiography were studied during a phase III clinical trial to compare the safety and diagnostic efficacy of iopamidol at 250 mgI/ml and 300 mgI/ml. The overall quality of cerebral angiography images was independently graded into three categories: good, bad and nondiagnostic by two radiologists. Results: The image quality of the cerebral angiography was good in 100% of the patients in both groups. A total of 4.44% of the patients experienced adverse events (4.44% in the iopamidol 250 group and 4.44% in the iopamidol 300 group). No statistically significant differences were observed between the two studied groups for either the proportion of patients with one or more adverse events or the intensity of the adverse events. Conclusion: The safety and efficacy (quality of the radiographic diagnostic visualization) of Iopamidol at 250 and 300 mg I/ml did not reveal any significant differences and thus are comparable. 목적: 비이온성 수용성 요오드 조영제인 이오파미돌(iopamidol) 250 mgI/mL과 이오파미돌 300 mgI/mL을 이용하여 얻어진 뇌동맥혈관조영술에서 영상의 질과 조영제의 안전성을 비교하여 저농도 이오파미돌의 비열등성을 입증하고자 하였다. 대상과 방법: 의학연구윤리심의위원회의의 승인을 받았으며, 환자들에게 임상시험에 참가한다는 동의를 얻었다. 진단을 목적으로 뇌동맥혈관조영술을 필요로 하는 총 90명의 환자를 무작위 배분하여 2005년 12월부터 2006년 3월까지 이중맹검법으로 시험약과 대조약을 이용해 뇌동맥혈관조영술을 시행하였다. 2명의 영상의학과 전문의가 이중맹검법으로 독립적으로 영상의 질을 평가하였고, 조영술 후 28시간까지 대상 환자들을 관찰하여 내약성, 이상반응, 임상병리검사, 활력징후결과를 비교하였다. 결과: 영상의 질은 시험군과 대조군에서 두 영상의학과 전문의 모두‘우수’로 조사되었으며, 평가의 유효율은 두 시험군 모두에서 100%였다. 부작용 발현율은 두 군에서 각각 4.44%(2/45, 2/45)였다. 내약성, 이상반응의 발현율과 그 정도에서 두 군간의 유의한 차이는 없었으며, 기타 투약 후 활력 징후나 신체진찰 결과 특이 변화는 없었다. 모든 결과에서 통계적으로 유의한 차이를 보이지 않았다. 결론: 뇌동맥혈관조영술에 의한 진단이 필요한 뇌혈관 질환자를 대상으로 저농도 이오파미돌을 이용한 검사는 영상의 질이나 약제의 안전성이 300 mgI/mL의 이오파미돌과 다르지 않음을 확인하였다.

와우이식술 시 발생한 뇌척수액 분출

김종선,임윤성,장선오,권배주,오승하,김영호,이효정,최병윤 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.12

Background and Objectives:A cerebrospinal fluid (CSF) gusher during cochlear implantation can produce surgical difi-culties and postoperative life threatening morbidities such as meningitis. Authors reviewed cases of CSF gushers during cochlear implantation, and assesed the radiologic characteristics of CSF gushers. Subjects and Method:From November 198 to March 2004, 72 congenital deaf children with inner ear malformation underwent cochlear implantation in Seoul National Uni-bone HRCT and IAC MRI were reviewed retrospectively. Results:Eighty percent (12/15) of CSF gushers had cochlear malformation. One case with a common cavity (100% ), 6 of 15 cases of cochlear hypoplasia (32% ) and 5 of 27 cases of in-complete partition (18.5%) showed CSF gush. The total or a partial defect of the modiolus significantly increased the risk of CSF gush. During the surgery, promontory mucosa around the cochleostomy opening was removed by electrocauterization and Some aditional procedures such as mastoid or midle ear obliteration were performed in two patients with intractable CSF gush. No lumbar drains were used. Postoperative meningitis developed in one case 7 months after cochlear implantation without a history of CSF leak. However, there were no evidences of CSF leak in all cases during the postoperative folow-up period (3- 49 months, mean 24 months). Conclusion:Cochlear implant surgeons should be prepared to cope with CSF gusher during the evidence of modiolar defect.

Concurrent Hypertensive Intracerebral Hemorrhage and Rupture of a Previously Clipped Intracranial Aneurysm

조원상,강현승,권현조,권배주,한문희,김정은 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.1

Simultaneous occurrence of remote intracerebral hemorrhage (ICH) and intracranial aneurysmal subarachnoid hemorrhage is very rare. We report on a case of concurrent hypertensive ICH at the left thalamus and rupture of an intracranial aneurysm at the bifurcation of the single A2 segment of the anterior cerebral artery in a 64-year-old woman, which was clipped previously, with review of the literature. To our knowledge, this is the first case report demonstrating bleeding of previously clipped aneurysm with simultaneous hypertensive ICH. Hypertensive crisis following ICH seems to have provoked rupture of the residual aneurysm. (KorJCerebrovascularSurgery12(1):13-8, 2010)

Bilateral Approach for Stent-assisted Coiling of Posterior Inferior Cerebellar Artery Aneurysms - Two Cases

Se-Il Jeon,권배주,서대희,강희인,박성춘,최일승 대한뇌혈관외과학회 2012 Journal of Cerebrovascular and Endovascular Neuros Vol.14 No.3

Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding. PICA preservation is the key to a successful endovascular treatment, based on the premise that a PICA origin aneurysm is well occluded. To secure PICA flow, stenting into the PICA would be the best method, however, it is nearly impossible technically via the ipsilateral vertebral artery (VA) if the PICA arose at an acute angle from the sac. In such a case, a bilateral approach for stent-assisted coiling can be a creative method for achievement of two goals of both aneurysm occlusion and PICA preservation: ipsilateral approach for coil delivery and contralateral cross-over approach for stent delivery via a retrograde smooth path into the PICA.

Comparison of 1.5T and 3T 1H MR Spectroscopy for Human Brain Tumors

Ji-hoon Kim,장기현,나동규,송인찬,김승자,권배주,한문희 대한영상의학회 2006 Korean Journal of Radiology Vol.7 No.3

Objective: We wanted to estimate the practical improvements of 3T proton MR spectroscopy (1H MRS) as compared with 1.5T 1H MRS for the evaluation of human brain tumors. Materials and Methods: Single voxel 1H MRS was performed at both 1.5T and 3T in 13 patients suffering with brain tumors. Using the same data acquisition parameters at both field strengths, the 1H MRS spectra were obtained with a short echo time (TE) (35 msec) and an intermediate TE (144 msec) with the voxel size ranging from 2.0 cm3 to 8.7 cm3. The signal to noise ratios (SNRs) of the metabolites (myoinositol [MI], choline compounds [Cho], creatine /phosphocreatine [Cr], N-acetyl-aspartate [NAA], lipid and lactate [LL]) and the metabolite ratios of MI/Cr, Cho/Cr, Cho/NAA and LL/Cr were compared at both TEs between the two field strengths in each brain tumor. The degrees of spectral resolution between the Cho and Cr peaks were qualitatively compared between the two field strengths in each brain tumor. Results: The SNRs of the metabolites at 3T demonstrated 49 73% increase at a short TE (p < 0.01) and only 2 12% increase at an intermediate TE (p > 0.05) compared with those of 1.5T. The SNR of inverted lactate at an intermediate TE decreased down to 49% with poorer inversion at 3T (p < 0.05). There was no significant difference in the metabolite ratios between the two field strengths. The degrees of the spectral resolution at 3T were slightly superior to those of 1.5T at a short TE. Conclusion: As compared with 1.5T, 3T 1H MRS demonstrated 49 73% SNR increase in the cerebral metabolites and slightly superior spectral resolution only at a short TE, but little at an intermediate TE, in the brain tumors. There was no significant difference in the metabolite ratios between the two field strengths. Objective: We wanted to estimate the practical improvements of 3T proton MR spectroscopy (1H MRS) as compared with 1.5T 1H MRS for the evaluation of human brain tumors. Materials and Methods: Single voxel 1H MRS was performed at both 1.5T and 3T in 13 patients suffering with brain tumors. Using the same data acquisition parameters at both field strengths, the 1H MRS spectra were obtained with a short echo time (TE) (35 msec) and an intermediate TE (144 msec) with the voxel size ranging from 2.0 cm3 to 8.7 cm3. The signal to noise ratios (SNRs) of the metabolites (myoinositol [MI], choline compounds [Cho], creatine /phosphocreatine [Cr], N-acetyl-aspartate [NAA], lipid and lactate [LL]) and the metabolite ratios of MI/Cr, Cho/Cr, Cho/NAA and LL/Cr were compared at both TEs between the two field strengths in each brain tumor. The degrees of spectral resolution between the Cho and Cr peaks were qualitatively compared between the two field strengths in each brain tumor. Results: The SNRs of the metabolites at 3T demonstrated 49 73% increase at a short TE (p < 0.01) and only 2 12% increase at an intermediate TE (p > 0.05) compared with those of 1.5T. The SNR of inverted lactate at an intermediate TE decreased down to 49% with poorer inversion at 3T (p < 0.05). There was no significant difference in the metabolite ratios between the two field strengths. The degrees of the spectral resolution at 3T were slightly superior to those of 1.5T at a short TE. Conclusion: As compared with 1.5T, 3T 1H MRS demonstrated 49 73% SNR increase in the cerebral metabolites and slightly superior spectral resolution only at a short TE, but little at an intermediate TE, in the brain tumors. There was no significant difference in the metabolite ratios between the two field strengths.

Intra-Arterial Therapy for Cardioembolic Internal Carotid Artery Terminus Occlusion: The Past and Present Status in Real Practice

정승욱,정철규,김재형,최병세,김범준,한문구,배희준,권배주,차상훈 대한영상의학회 2015 대한영상의학회지 Vol.73 No.4

Purpose: There is little data on the effect of intra-arterial therapy (IAT) in acute cardioembolic internal carotid artery terminus (ICAT) occlusion that has poor prognosis. We determined procedural and clinical outcomes in patients with acute cardioembolic ICAT occlusion treated with different methods of IAT. Materials and Methods: On retrospective review of our registry, patients with cardioembolic ICAT occlusion were categorized as thrombolytic-based IAT group (TLG) and thrombectomy-based IAT group (TEG) according to the primary endovascular technique. Subsequently, procedural and clinical outcomes were compared. Results: Fifty-five patients had cardioembolic ICAT occlusion and 18 patients were assigned to TLG and 37 patients to TEG. The rate of complete reperfusion was significantly higher and the groin puncture to reperfusion time was significantly shorter in TEG than those in TLG. There was a trend towards functional outcome at 3 months in the TEG group; however, it was not statistically significant (p = 0.06). Age, baseline Albert Stroke program early CT score and puncture to reperfusion time were factors affecting unfavorable outcome at 3 months, on multivariable analysis. Conclusion: Thrombectomy-based IAT has advantages over thrombolytic-based IAT in terms of the reduction of groin puncture to reperfusion time and improvement of the rate of complete reperfusion.

The Susceptibility Vessel Sign of the Middle Cerebral Artery on the T2*-Weighted Gradient Echo Imaging: Semi-quantification to Predict the Response to Multimodal Intra-Arterial Thrombolysis

윤성원,정철규,최병세,김재형,권오기,한문구,배희준,권배주,한문희 대한영상의학회 2011 대한영상의학회지 Vol.64 No.1

Purpose: We wanted to determine whether or not the “susceptibility asymmetry index” (SAI) of acute stroke on the T2*-weighted image is related with successful recanalization using multimodal intra-arterial thrombolysis (IAT). Materials and Methods: The 81 patients who underwent multimodal IAT for middle cerebral artery (MCA) territory acute stroke were included in this retrospective study. The multimodal IAT included intra-arterial urokinase infusion, clot disruption by a microwire, microcatheter and balloon manipulation, and balloon angioplasty and/or stenting for the flow-limiting stenosis. The diameter of the susceptibility vessel sign was measured on the T2*-weighted gradient echo imaging (GRE), and the diameter of the contralateral normal MCA at the corresponding level was measured on magnetic resonance angiography (MRA); the ratio between these two diameters was defined as the susceptibility asymmetry index. The relation between the TICI (Thrombolysis In Cerebral Infarction) score of 2-3 after multimodal IAT and the SAI was assessed. The receiver operating characteristic (ROC) curve analysis was performed on the SAI to predict a TICI score of 2-3 after multimodal IAT. Results: The mean SAI of 81 patients was 1.66 ± 0.66. Seventy nine percent of the patients had a TICI of 2-3 after multimodal IAT. According to the ROC curve analysis, an SAI less than 1.3 was optimal for predicting the presence of stenotic lesion after recanalization (area under the curve: 0.821, sensitivity: 88.2%, specificity: 69.8%, p=0.0001), and the SAI ≤1.61 (area under the curve: 0.652, sensitivity: 60.9%, specificity: 70.6%, p=0.0226) could predict a TICI score of 2-3. The TICI score of 2-3 after multimodal IAT was achieved in 88.6% of the cases with a SAI ≤ 1.61 and in 67.6% of the cases with a SAI >1.61 (p=0.028). Conclusion: The lower SAI on T2*-GRE could predict stenotic lesion and successful recanalization after performing IAT.

Unusual MR Features of Extravasation of Contrast Material in Hyperacute Intracerebral Hemorrhage

최승홍,장기현,전우선,김지훈,강현승,권배주,나동규,김재형,한문희 대한자기공명의과학회 2005 Investigative Magnetic Resonance Imaging Vol.9 No.1

초급성 두개내 출혈에 있어서 조영제의 혈관외 누출은 급성 출혈을 의미하며, 혈종의 크기 증가를 예견하는 소견이다. 또한, 임상 의사들에게는 적절한 치료 방침 결정에 있어 중요한 소견이다. 우리는 세 명의 초급성 두개내 출혈 환자에서 비전형적인 조영제의 혈관외 누출을 보인 자기공명 영상을 보고하고자 한다. 첫 번째 증례는 우측 기저핵과 좌측 측뇌실에 동시에 발생한 조영제 혈관외 누출의 예이며, 두 번째 증례는 혈관염이 의심되는 환자에서 조영증강을 보이는 종양이나 혈관 질환을 감별하였던 비교적 다량의 조영제의 혈관외 누출을 보인 증례이다.마지막으로, 세 번째 증례는 고혈압 환자에서 자기공명 영상을 얻는 중에 발생한 급성 출혈의 예이다.