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남택균,변준수,최현호,정미선,이은정 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.11
Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performedwith coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via directpuncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrogradesuperior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs wereoccluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterialembolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncturethe TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserteda 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheterto support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week,time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor andmarkedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effectiveand feasible method for the treatment of DAVF when other approaches seem difficult.
남택균,박승원,박용숙,권정택,민병국,황성남 대한신경외과학회 2015 Journal of Korean neurosurgical society Vol.58 No.3
Objective : This study investigates the role of a burr hole and calvarial bone marrow-derived stem cells (BMSCs) in a transient ischemic brain injury model in the rat and postulates a possible mechanism for the efficacy of multiple cranial burr hole (MCBH) surgery in moyamoya disease (MMD). Methods : Twenty Sprague-Dawley rats (250 g, male) were divided into four groups : normal control group (n=5), burr hole group (n=5), ischemia group (n=5), and ischemia+burr hole group (n=5). Focal ischemia was induced by the transient middle cerebral artery occlusion (MCAO). At one week after the ischemic injury, a 2 mm-sized cranial burr hole with small cortical incision was made on the ipsilateral (left) parietal area. Bromodeoxyuridine (BrdU, 50 mg/kg) was injected intraperitoneally, 2 times a day for 6 days after the burr hole trephination. At one week after the burr hole trephination, brains were harvested. Immunohistochemical stainings for BrdU, CD34, VEGF, and Doublecortin and Nestin were done. Results : In the ischemia+burr hole group, BrdU (+), CD34 (+), and Doublecortin (+) cells were found in the cortical incision site below the burr hole. A number of cells with Nestin (+) or VEGF (+) were found in the cerebral parenchyma around the cortical incision site. In the other groups, BrdU (+), CD34 (+), Doublecortin (+), and Nestin (+) cells were not detected in the corresponding area. These findings suggest that BrdU (+) and CD34 (+) cells are bone marrow-derived stem cells, which may be derived from the calvarial bone marrow through the burr hole. The existence of CD34 (+) and VEGF (+) cells indicates increased angiogenesis, while the existence of Doublecortin (+), Nestin (+) cells indicates increased neurogenesis. Conclusion : Based on these findings, the BMSCs through burr holes seem to play an important role for the therapeutic effect of the MCBH surgery in MMD.
환축추관절에 발생한 활액낭종의 편측 후측방 접근법을통한 외과적 감압술- 증 례 보 고 -
남택균,김영백,박승원,황성남 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.33 No.6
The authors report a patient with synovial cyst of the atlantoaxial joint with cord compression located posteriorly to the dens. Subtotal resection of the cyst was performed through unilateral posterior approach, hemilaminectomy of C1 and C2, which provided adequate and stable decompression. The clinical and magnetic resonance imaging features and the surgical approach are discussed with review of literatures. Key words:Synovial cyst;Atlantoaxial joint;Spinal cord compression;Posterolateral decompression.
남택균,박용숙,변준수,박승원,권정택 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.1
Purpose: The purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction(MPR) images for sylvian dissection during microsurgical treatment of middle cerebral artery (MCA) aneurysms. Materials and Methods: Forty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MDTM imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings. Results: Utilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicularimages to the sylvian surface in the same orientation as the surgeon’s view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs. Conclusion: In addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms.
박용숙,남택균 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.2
We describe a technique to clip a large internal carotid artery (ICA) aneurysm via a retrograde suction decompression (RSD). A large aneurysm in the right distal ICA involving the bifurcation region measuring 1.2×1.1×0.7 cm with posterior projection was managed with assisted RSD technique. The anterior choroidal artery emerged from the side wall of the aneurysm. An Inahara shunt was inserted into the ICA with neck dissection, and RSD was applied after completely clipping the aneurysm. RSD with an Inahara carotid shunt is useful for complete visualization of the aneurysm, including its surrounding structures, and for proximal control of the parent vessels, subsequently achieving satisfactory clip placement.
김재욱,남택균,박기수,박용숙,권정택 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.2
Unruptured cerebral aneurysms sometimes present with visual symptomsdue to compression of the visual pathways. However, until now, unruptured anterior communicating artery (ACoA) aneurysms presenting visual field defects have been extremely rare. The authors report the case of a 51-year-old woman who presented with left homonymous hemianopsia. Radiological findings demonstrated an ACoA aneurysm filled with thrombus, that was compressing the optic chiasm and post-chiasmal tract. The patient underwent clipping of the aneurysm, which resolved the visual field defect. In cases of visual field defects, an ACoA aneurysm should be included in the differential diagnosis.
Multiple Spontaneous Simultaneous Intracerebral Hemorrhages
서진석,남택균,권정택,박용숙 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.2
Simultaneous occurrence of intracerebral hemorrhage (ICH) in different arterialterritories is an uncommon event. We report on two cases of multiplespontaneous simultaneous ICH for which we could find no specificcause. A 73-year-old man, with no related medical history, was admittedto the hospital with simultaneous bithalamic ICH, and subsequently diedof recurrent pneumonia. Second patient was a 60-year-old man who presentedwith simultaneous ICH in the pons and thalamus; he died of recurrentbleeding. We review the possible pathological mechanisms, clinicaland radiologic features of simultaneous multiple ICH.
이신헌,남택균,박용숙,권정택 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2
A 43-year-old man was admitted for head trauma after falling backward. The patient complained of diplopia. Unilateral internuclear ophthalmoplegia (INO) was diagnosed during the neurologic examination. Initially, no specific finding was shown on T2-weighted, T1-weighted, and fluid attenuated inversion recovery brain magnetic resonance image (MRI) or brain computed tomography (CT). However, susceptibility-weighted imaging (SWI) definitively demonstrated a tiny hemorrhage at the midline of the pontomesencephalic junction. The patient’s symptom improved after 12 weeks. We discuss the clinical significance of SWI when traumatic INO due to a tiny hemorrhage is suspected.