Intra-arterial Thrombolysis for Central Retinal Artery Occlusion: Two Cases Report

황교준,우세준,박규형,황정민,권오기 대한의학회 2010 Journal of Korean medical science Vol.25 No.6

Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.

척추유합술 후 발생한 창상감염의 치료

황교준,구성욱,진동규,조용은,김영수 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.1

Objective:This study is performed to evaluate the risk factors, clinical manifestations, treatments, and prognostic factors among patients with postoperative wound infection after spinal instrumentation. Methods : The records and radiologic data of 28 patients diagnosed as postoperative wound infection from Jan. 1991 to Oct. 2002 who had underwent spinal instrumentation initially were retrospectively evaluated. Results : All patients(mean age, 50.4 yrs) diagnosed as postoperative wound infection and subsequently received IV antibiotics and continuous irrigation system. The 13 among 28 cases had significant preoperative risk factors(for example, diabetes mellitus, obesity, alcoholism, long-term corticosteroid usage, and chronic renal failure). Infection was diagnosed at an average of 15.9 days after operation. The most common presenting features were local heating, fever, and wound discharge. All patients could be discharged after infection control. At follow up evaluation, 21 case(75%) have not shown recurrence but, the recurrence was developed among 7 cases. The C-reactive protein(CRP) was more correlated with clinical outcomes than other laboratory findings and the recurred group exhibited significant(p<0.05) higher CRP level, compared with the non-recurred group, from 7 days to 21 days after operation. Conclusion : Without removal of instruments, surgical removal of infective tissues and continuous irrigation with susceptible antibiotics can be effective in the treatment of postoperative wound infection after spinal instrumentation. CRP level can be an effective parameter of infection treatment and prognosis. Key words:Spine;Wound infection.

Total Spondylectomy for Giant Cell Tumor of Cervical Spine

황교준,Keung-Nyun Kim,Do-Heum Yoon,Woo-Ik Yang 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.34 No.3

Giant cell tumor which is arisen at vertebra is rare and this tumor of the cervical vertebra has been very rarely reported tumor which is less than 1% of all giant cell tumor. When the treatment option is considered, the curretage is often selected rather than total resection because the anatomic relationship of adjacent structures is complicated and there are major vessels and organs around the cervical vertebra. The prognosis of this tumor is decided by degree of resection so, total sponylectomy should be considered as primary surgical option. We report a case of cervical giant cell tumor in which the total spondylectomy was performed successfully and discuss the feasibility of this procedure at cervical region. Key words:Giant cell tumor;Cervical spine;Total spondylectomy.

Extracorporeal Membrane Oxygenation for Acute Life-Threatening Neurogenic Pulmonary Edema following Rupture of an Intracranial Aneurysm

황교준,황성미,이재준,신승훈,김형수,이희성,이태헌,김기호 대한의학회 2013 Journal of Korean medical science Vol.28 No.6

Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.

Unity 엔진을 활용한 MDA (Model Driven Architecture) 기반 게임 설계 방법

황교준(Kyojun Hwang),김형락(Hyunglak Kim),이욱진(Scott Uk-Jin Lee) 한국정보과학회 2017 한국정보과학회 학술발표논문집 Vol.2017 No.06

A retrieval thrombectomy technique with the Solitaire stent - two case reports -

박현,황교준,방재승,박인성,오창완,권오기 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.4

Two male patients who presented with altered mental states and hemiparesis were treated by retrieval thrombectomy. The occlusion sites were M1 in both patients. During each thrombectomy, a self-expanding and fully retrievable Solitaire stent was partially deployed to cover the whole intra-arterial clot and then was retrieved slowly while occluding the internal cerebral artery with a balloon-guiding catheter. Complete recanalization (defined as thrombolysis of cerebral infarction grade 2b or 3) was achieved in both patients. The procedural time from groin puncture to recanalization was 17 min and 30 min, respectively. Immediate post-operative National Institutes of Health Stroke scores improved to 17 from 22 in one patient and to 19 from 24 in the other patient. There were no procedure-related complications including distal embolisms or post-operative intracranial hemorrhages. We suggest that this technique may be a simple, rapid, and safe thrombolytic method for acute ischemic stroke patients with large artery occlusions. (Kor J Cerebrovascular Surgery 12(4):240-4, 2010)

Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report

김택균,방재승,황교준,권오기,오창완,남경한 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.3

We report a rare case of an idiopathic pseudoaneurysm causing intraventricular hemorrhage (IVH). A 28-year-old man presented with sudden onset of severe headache. He underwent external ventricular drainage for an isolated IVH in the right lateral ventricle. Digital subtraction angiography (DSA) revealed that the aneurysm (7.5×4.5 mm) arose from the distal part of the medial lenticulostriate artery. Following removal of the external ventricular drainage catheter, the aneurysm decreased in size (4.0×2.3 mm). However, follow-up DSA revealed a slightly enlarged aneurysm (4.2×3.2 mm) with morphologic change. The aneurysm was clipped via the interhemispheric transcallosal approach, but postoperative DSA revealed a residual aneurysm sac beside the clips. Given the risk of rebleeding, a second operation was planned for complete resection of the aneurysm. After revised craniotomy and careful dissection of the caudate nucleus, the aneurysm sac was completely resected. Histopathological examination revealed that the aneurysm was a pseudoaneurysm. The patient recovered without any neurological sequel and was discharged. To the best of our knowledge, this is the first reported case of an idiopathic lenticulostriate artery pseudoaneurysm protruding into the right lateral ventricle and causing an IVH that was successfully treated with microsurgical resection.

Hemodynamic Instability during Carotid Angioplasty and Stenting-Relationship of Calcified Plaque and Its Characteristics

전진수,신승훈,황교준 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.2

Purpose: During carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque. Materials and Methods: Thirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque. Results: Nineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively). Conclusion: The calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.

The Usefulness of the Frontolateral Approach as a Minimally Invasive Corridor for Clipping of Anterior Circulation Aneurysm

양제열,오창완,권오기,황교준,김택균,문종언,안성열,김준학,김진성,방재승 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3

Objective : Several studies have reported on the effectiveness of frontolateralcraniotomy in reducing the operating time and post-operativecomplications. However, no study has practically evaluated this methodfrom the cosmetic point of view. Materials and Methods : We designed this study for comparison of theclinical differences and cosmetic outcomes between the frontolateral craniotomyand the conventional pterional craniotomy for clipping of unrupturedintracranial aneurysms. We performed a retrospective analysis ofthe two groups based on their medical records and radiologic findingsjuxtaposed with their length of hospital stay, intensive care unit day andoperation time, and the emergence of postoperative complication, meansize of aneurysm, and temporal depression. Results : After careful comparison of the thickness of temporalis musclebetween the craniotomy side and the contralateral side, the results clearlyshowed that the conventional pterional craniotomy group was asymmetricby a p value of 0.152 and the frontolateral craniotomy group was symmetricby a p value of 0.002. Conclusion : Frontolateral craniotomy could be a practical alternative forpatients with an unruptured intracranial aneurysm in the anterior circulationincluding the posterior communicating artery, particularly thosewho are in a medically poor state or who highly demand minimal aestheticmutilation.

Clinicoepidemiological Features of Asymptomatic Moyamoya Disease in Adult Patients

양제열,홍주철,오창완,권오기,황교준,김정은,강현승,조원상,김택균,문종언,안성열,김준학,방재승 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3

Objective : The aim of this study was to document the natural course ofasymptomatic adult moyamoya disease (MMD) and the factors related todisease progression to aid in treatment decisions. Materials and Methods : Among 459 adult MMD patients (aged ≥ 20 years),42 patients were included in this retrospective cohort study. Clinical records ofadult asymptomatic MMD patients (n = 42) and follow-up data from September2013 were reviewed to determine the factors related to disease progression. Results : The mean age of patients at the time of diagnosis was 41.2years (range, 23-64 years), and the mean follow-up period was 37.3 months(range, 7.4-108.7 months). Of the 42 patients and 75 hemispheres, therewere 12 patients (28.6%) and 13 hemispheres (17.3%) with disease progression. There were four hemispheres (5.3%) with symptomatic progression (threehemorrhage, one transient ischemic attack) and nine hemispheres (12.0%)with asymptomatic radiographic progression. There were no relationshipswith sex, diabetes, hypertension, thyroid disease, family history of MMD,or family history of stroke. However, reduced initial cerebrovascular reservecapacity was observed in seven hemispheres (9.3%) in patients withdisease progression. A relationship was found between disease progressionand initial cerebrovascular reserve capacity (p = 0.05). None of the patientsunderwent bypass surgery during the follow-up period. Conclusion : It appears that asymptomatic adult MMD is not a permanentstable disease. In particular, reduced cerebrovascular reserve capacityis an indication of MMD progression, so close regular observation is needed.