뇌동정맥기형의 외과적 수술합병증과 그 처치

임만빈,김일만,Yim, Man-Bin,Kim, Il-Man 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objectives : The goal of surgical management of cerebral arteriovenous malformation(AVM) is elimination of the lesion without development of new neurological deficits. To improve the management results of cerebral AVMs in the future, this article discusses about surgical complications of the AVM and their management. Material and Methods : During the past 18 years, 116 patients with cerebral AVMs were managed by surgery. Among these cases, 7 cases died, 7 cases developed new neurological deficits, 11 cases residual AVM and 5 cases intracerebral hematoma(ICH) after surgery. The author analyzes the causes of those complications and investigates the methods to minimized those complications based on the review of the literatures. Results : One stage removal of AVM and ICH in the poor neurological state were performed in 5 of 7 death cases. Subtotal removal of ICH followed by delayed AVM surgery after recovery is regard as one method to improve the outcome of patient with large ICH. Postoperative new neurological deficits developed owing to normal perfusion pressure breakthrough(NPPB) in 3, judgement error in 2, preoperative embolization in 1 and cortical injury in 1 case(s). Proper management of NPPB, accurate anatomical knowledge and physiological monitoring during operation, and well trained skill for embolization are regard as methods to minimize those complications. Residual AVMs after surgery were noticed in 11 cases, in which unintended 6 cases due to inaccurate dissection of peripheral margin of AVM, and intended 3 cases due to massive brain swelling during operation, 1 cases due to diffuse type and 1 case due to multiple type of AVM. Accurate dissection of peripheral margin of AVM and mild hypotension during operation may help to avoid this complication. Postoperative hemorrhage occurred in 3 cases due to rupture of the residual AVM and in 2 cases due to oozing from the AVM bed. Complete resection of AVM, complete control of bleeding points at AVM bed and mild hypotension during early postoperative period are the methods to avoid this complication. Conclusion : A precise but flexible therapeutic strategy and refined skill for endovascular, radiosurgical and microsurgical techniques are required to successful treatment of cerebral AVM. Adequate timing of AVM resection, accurate anatomical knowledge, proper management of NPPB and accurate dissection of peripheral margin of AVM are the key points for avoiding complications of the AVM surgery.

기저동맥 분기부 동맥류와 기저동맥-상소뇌동맥 분기부 동맥류에 대한 측두엽하 접근

임만빈,김상열,손은익,김동원,이정교,김인홍,배정인 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

The pterional(Transsylvian) and subtemporal approaches are main surgical route for direct clipping of basilar bifurcation and basilar-superior cerebellar artery aneurysms. In general, the pterional approach has the advantage for high placed aneurysm and the subtemporal approach has the advantage for low placed and posterior directed aneurysm of basilar bifurcation. The authers has been performed surgery for 5 cases of basilar bifurcation and basilar-superior cerebellar artery aneurysms through subtemporal route during 1.5 years with good results in 3 cases, fair result in 1 case, and death in 1 case. We described about this 5 cases detaily and discussed the subtemporal approach for these lesions.

대 뇌동맥류 및 거대 뇌동맥류의 수술적 가료

임만빈,이창영,김일만,손은익,김동원,Yim, Man-Bin,Lee, Chang-Young,Kim, Ill-Man,Son, Eun-Ik,Kim, Dong-Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objectives : The goal of the surgical management of large and giant aneurysm is complete extirpation of the aneurysms with preservation or reconstruction of the parent artery. To improve the surgical management results of those aneurysms in the future, we review our experience and discuss technical maneuvers and strategies used to avoid potential complications of those aneurysm surgery. Material and Methods : During the past 12 years, thirty six cases of large and giant aneurysms(diameter>19mm) were managed by surgery. The clinical characteristics, treatment methods, surgical complications and outcome of those cases were analyzed and, based on the review of the literatures, the preventive methods of surgical complication related to the clipping of those aneurysms were discussed. Results : The locations of those aneurysms were anterior circulation in 34 cases and posterior circulation in 2 cases. The most frequent site of aneurysmal location was a paraclinoidal region of the anterior circulation. The aneurysms were managed surgically by direct clipping of aneurysmal neck in 31 cases, aneurysmal trapping followed by extracranial-intracranial bypass in 2 cases, proximal clipping of parent artery, aneurysmorrhaphy, and excision of aneurysm followed by end to end anastomosis of parent artery in each one case. Surgical complications occurred in 13 cases. A parent vessel occlusion by thrombus formation and parent vessel stenosis after clipping of aneurysm were the main complications. We obtained good outcome in 27, fair 5, poor 1 and dead in 3 case(s). Conclusion : We conclude that selection of suitable management method for each case, high quality of surgical technique and prevention of complication during operation are important key points for the successful treatment of large and giant aneurysm. The heparinization prior to application of temporary clip on parent vessels, aneurysmal decompression during dissection and clipping of aneurysm, complete closing of the aneurysmal neck and avoiding the narrowing of parent vessel after clipping of aneurysm were the main technical maneuvers used to avoid complications of those aneurysm surgery.

폐쇄성 뇌혈관 질환의 외과적 치료

임만빈,손은익 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.4

The main pathophysiology of cerebral ischemia caused by occlusive cerebrovascular disease(CVD) are hemodynamic low perfusion and embolic mechanism. The main objects of surgical method for occlusive CVD are improvement of low perfusion and elimination of embolic source with surgical procedure. The causes of occlusive CVD can be devided as a atheromatous and non-atheromatous occlusion. The frequent sites of occlusion in atheromatous origin are carotid bifurcation, carotid siphon and middle cerebral artery (MCA), proximal subclavian and vertebral artery origin, vertebral artery proximal to origin of posterior inferior cerbellar artery (PICA), vertebral artery distal to origin of PICA and mid-basilar artery. The lesions of non-atheromatous occlusive disease are extracranial internal carotid artery (ICA) aneurysm, traumatic dissection with or without false aneurysm of ICA, loops and kinks of ICA, osteophytic or traumatic vertebral artery compression, traumatic dissection with or without false aneurysm of vertebral artery and Moya Moya disease. Depend on occlusion site and disease, the surgical procedures are different. The main surgical procedures for occlusive CVD are carotid endarterectomy, extracranial-intracranial (EC-IC) bypass surgery, vertebral artery endarterectomy, vertebral artery to common carotid artery transposition, resection and end-to-end or interposition vein graft of ICA, indirect revascularization for Moya Moya disease and unroof the transverse foramen of cervical vertebra. The author reviews the surgical indication and procedure of occlusive CVD briefly.

뇌졸중의 수술적 치료

임만빈 메디메디아코리아(주) 2004 심장과 혈관 Vol.6 No.2

척수종양과 척수를 압박하는 전이성 종양의 임상적 고찰

임만빈,정혁인,김인홍 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.1

The author have presented 58 cases with tumors in spinal canal who were admitted to the department of neurosurgery, Presbyterian Medical Center. Keimyung university school of medicine from March 1975 to September 1979. Of these, 35 cases had spinal metastasis causing cord or cauda equina compression and 23cases had spinal cord tumors. We attempted to analyse these cases clinically and discussed with the review of the literatures. The results were summarized as follows: 1) In the age distribution, The common incidence of age was between first and second decade in spinal cord tumors and fifth decade in metastatic epidural tumors. The ratio of male to female was about 2:1 in both cases. 2) The most common complaint was weakness of extremities (33 cases: 94%) in metastatic epidural tumor and pain in back and extremities (23 cases: 100%) in spinal cord tumors. The sphincter disturbance was somewhat more common in metastatic epidural tumors (25 cases: 71%) than in spinal cord tumors (11 cases: 48%). 3) The duration of symptomes from onset to admission in the patients with metastatic epidural tumors were shorter than in those with spinal cord tumors. The majorities of the duration of symptomes were some monthes in both cases. 4) Motor weakness, reflex change and sensory impairment were the most frequent physical findings. 5) The thoracic region was the most common site of spinal cord tumors and metastatic epidural tumors. 6) Plain spine X-ray was abnormal in 13 cases (56%) of spinal cord tumors, 25 cases (71%) in the metastatic epidural tumors. Twenty three cases in the spinal cord tumors and twenty five cases in the metastatic epidurae tumors had done myelography, and it showed intradural convexity in 23 cases (100%) of spinal cord tumors, complete obstruction (serrated or transverse) in 23 cases (91%) of metastatic epidural tumors. 7) The most frequent pathology of spinal cola tumors was schwannoma (16 cases) and the most frequent primary site of metastatic epidural tumors was lung (4 cases). 8) The prognosis was relatively excellent in spinal cord tumors and poor in metastatic epidural tumors in spite of treatment with decompression and radiation therapy.

뇌동맥류 1216례의 수술 경험

임만빈 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.4

The author analysed the age and sex distribution of the patients, seasonal variations of and predisposing factors to aneurysmal rupture, the size of ruptured aneurysm, sites of aneurysms, surgical and medical complications, surgical results and causes of death and morbidity of the 1216patients with cerebral aneurysm operated on from September 1982 to August 1999 at the Department of Neurosurgery, Dongsan Medical Center. The male-to-female was 1 : 1.9. Prior to the age of 50 years, male was preponderant and female was preponderant thereafter. The incidence of aneurysmal rupture was higher in winter and spring than summer and autumn. The onset of aneurysmal rupture occurred during house work or job working(17.5%), defecation and/or urination(10.3%), rest and/or playing(9.0%), and bathing and/or washing up(8.9%). Based on angiography, 79% of the aneurysms were within 4 to 11 mm in diameter. Posterior circulation aneurysms were noted in 7% of the patients. Of the anterior circulation aneurysms, anterior communicating/anterior cerebral artery aneurysm was the most frequent site. Multiple aneurysms were found in 20% of the cases. The surgical complications included intraoperative aneurysmal rupture including minor leakage in 17%, intracerebral hematoma in 5%, cerebral vessel occlusion or injury in 3%, cranial nerve injury in 2%, epidural hematoma in 1%, and incomplete clipping in 1%. Medical complications occurred during hospitalization included vasospasm in 17%, shunt requiring hydrocephalus in 10%, respiratory complication in 7%, gastrointestinal complication in 2%, cardiovascular complication in 1%, and endocrine complication in 1%. The surgical outcome was good in 81%, fair in 6%, poor in 4%, and dead in 9%. The leading causes of death and disability resulted from direct effect of initial hemorrhage, vasospasm, surgical complications, rebleeding and medical complications. There was no definite difference between our cases and those of other literatures in age and sex distribution, the size of ruptured aneurysms and sites of aneurysms. Regarding the surgical results, there is some room for improvement. The opportunities for improvement will be related to decreasing the rate of surgical and medical complications and proper management of ischemia related to the vasospasm.

좌측 측뇌실에 발생한 거대한 수막종 : 1례 보고 Case Report

임만빈,변인수,김인홍 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.1

The authors present a case of huge intraventricular meningioma in a 45 year-old female located in the left lateral ventricle. Meningiomas occurs only rarely in the ventricles of the brain. The diagnosis of choice is CT scanning to determine the site, size, density, and vascularity of the lesion. Surgical morbity and motality are low despite the deep location of the lesion, and the prognosis is favorable. Literature concerned were reviewed.

뇌동맥류 파열의 계절적, 주간적 변동과 소인 인자

임만빈,이장철,손은익,김동원,김인홍 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.5

본원에 입원하였던 766례의 뇌지주막하 출혈 환자를 대상으로 뇌지주막하 출혈의 소인 인자와 계절적, 주간적 변동을 조사하였다. 주도적 소인인자로써는 배변 및 배뇨가 12.3%, 직업적 일을 하다가 11.8%, 가사일을 하다가 10.3%였고, 하루 중 오전 6시부터 10시까지가 21.8%, 오후 5시부터 8시까지에 18.3%가 출혈하였으며, 계절적으로는 겨울에 호발하였나 다른 계절과 비교하여 통계학적으로 유의한 차이는 없었다. 결론적으로 뇌지주막하 출혈은 혈압의 주간적 생리적 변동에 영향은 받으나 이 이외에도 혈압을 갑자기 상승시키는 활동이나 뇌압에 영향을 미치는 일들도 뇌동맥류 파열에 중요한 역할을 할 것으로 생각된다. In order to determine the predisposing factors to cerebral aneurysm rupture and to examine the relationship between circadian periodicity of blood pressure change and the rupture of an aneurysm. the authors investigated activities of the patients or events as well as diurnal and seasonal variations in the onset of subarachnoid hemorrhage(SAH) in 766 consecutive patients. The authors also compared the difference of these data between patients with a history of hypertension and patients without a history of hypertension. The results showed that the onset of SAH was associated with defecation and/or urination in 12.3%, working on the jab in 11. 8%, housework including washing clothes in 10.3%, sleeping in 7.4% and bathing and/or washing up in 7.2%. The incidence of the onset of SAH associated with defecation and/or urination was higher in patients with a history of hypertension than in patients without a history of hypertension(p<0.05). The diurnal variation of the onset of SAH showed two broad peak times from 6 to 10 a.m. (21.8%) and from 5 to 8 p.m. (18. 3%). The seasonal variation of the onset of SAH showed the incidence to be slightly higher in winter than in any other seasons. In spring. autumn and winter, the leading activities of the patients or events in the onset of SAH was defecation and/or urination and, in summer, it was job performing. We concluded that the onset of the SAH is related not only to the physiological circadian periodicity of blood pressure change but also to the activities or events which induced a sharp rising blood pressure and changing the venous and cerebrospinal fluid pressure.

중대뇌동맥 동맥류의 수술적 가료

임만빈,이창영 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12