Orbitozygomatic resection을 통한 변형된 transsylvian approach를 이용한 원위부 뇌저동맥 동맥류의 수술적 치료

심재홍,이선일 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Aneurysms arising from the distal basilar artery(BA) and relating to the origin of the superior cerebellar artery(SCA), posterior cerebral artery(PCA) account for more tran 15% of all intracranial aneurysms and more than one-half of all aneurysms occurring in the vertebrobasilar circulation. The anatomic complexity of the interpeduncular cistern is directly related to the dangers of surgical manipulation in this region and it is undoubtedly difficult to operate on a distal basilar aneurysm which located deep in a very narrow operative field restricted by unremovable neural and vascular architectures. Although we can not choose no single operative approach suitable to this area because the indivisual patient's vascular, neural and bony anatomy is widly variable, using the modified transsylvian approach with orbitozygomatic resection the distal basilar artery aneurysms could be seen and clipped easily by upward and oblique viewing from below through the wide operative space consisting of the less retracted intracarotid artery, middle cerebral artery and oculomotor nerve. We have operated 64 distal basilar artery aneuysms. Among them, 27 patients were approached using the modified transsylvian approach with orbitozygomatic resection. The operative procedure is presented in detail and compared with other surgical approaches.

LCD용 COF NCP 패키징 공정설계 및 분석

심재홍,차동혁,이종길 제어로봇시스템학회 2009 제어로봇시스템학회 국내학술대회 논문집 Vol.2009 No.9

교차종속관계하에서의 효율적인 퍼지 다기준의사결정법

심재홍,김정자 한국산업경영시스템학회 1998 한국산업경영시스템학회지 Vol.21 No.45

This paper presents a more efficient evaluation of alternatives by use of multi-criteria decision making methodlogy under fuzzy intersectional dependence relations. The performance evaluation of most systems such as weapons, enterprise systems etc. are multiple criteria decision making problems. The descriptions and judgements on these systems are usually linguistic and fuzzy. The traditional methods of Analytic Hierarchy Process(AHP) are mainly used in crisp(non-fuzzy) decision applications with a very unbalanced scale of judgements and rank reversal. To overcome these problems, we will propose a new, general decision making method for evaluation models using fuzzy AHP(FAHP) under fuzzy intersectional dependence relations. The T.M.S alternatives A, B and C will be evaluted by the Fuzzy Analytic Hierachy Process (FAHP) based on entropy weight in this study. We will use symmetric triangular fuzzy numbers to indicate the relative strength of the elements in the hierachy and degree of intersection between criteria. These problems are evaluated by five criteria : tactical criteria, technology criteria, maintenance criteria, economy criteria, advacement criteria.

인쇄회로기판의 통전검사를 위한 새로운 프로브 시스템

심재홍,조형석,김성권 제어로봇시스템학회 1995 제어로봇시스템학회 국내학술대회 논문집 Vol.1 No.2

뇌동맥류 수술 2,335례의 치험 : 2,335 Cases

심재홍,김수천,정용태,이선일,김무성,정영균,심홍보 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Objectives The principle role of treatment for ruptured aneurysm has been to obliterate the aneurysmal sac and secure the patient's life from the hazards of rebleeding and vasospasm. The present study was conducted to evaluate the overally surgical results in 2,335 patients with intracranial aneurysms operated in our institution from January 1980 to December 31th, 2001. ■ Patients and Methods Among these, 776 cases were anterior communicating artery aneurysms, 596 internal carotid artery aneurysms, 603 middle cerebral artery aneurysms, 63 anterior cerebral artery aneurysms and 80 cases of vertebro-basilar artery aneurysms, etc. The male to female ratio was 0.7 to 1. Surgical methods were 2,111 clippings, 182 coatings and wrappings, 23 aneurysmorraphy, 19 proximal ligations. ■ Results Incidence of the rebleeding was 5.6% of the early operation group. 17% of the late operation group. Incidence of the clinical vasospasm was 18.6% angiographic vasospasm was 26.2%. The percent of the multiple aneurysms was 9.3%, dissecting aneurysm ; 5 cases(0.2%), "De Novo" aneurysm ; 4 cases(0.17%), lobectomy cases ; 7 cases (0.3%), incidental aneurysms ; 117 cases(5.0%). Overall surgical result was favorable outcome in 86% and mortality in 7%. In early surgery group, favorable outcome was 88%, mortality was 6%. The calcium-channel blocker and "Triple-H" therapy does not improve the postoperative mortality but improve the post-operative morbidity significantly. In old age group, favorable outcome was 85.5% and 8.5% mortality rate, favorable outcome 69.8%, mortality 11.3% in late operation group. In old age group, early operation can reduce vasospasm, rebleeding, medical complications, etc. In complex artery aneurysm, the use of endovascular treatment is increasing. Intraoperative angiography reduced residual aneurysm or remained aneurysm in large, giant aneurysm, and complicated aneurysm, especially in A.com. a. aneurysm. ■ Conclusions In vascular surgery, it is important how we do it for the aneurysm from surgical treatment to postoperative management. The more aneurysm operations, the more difficult.

`82 민방위행정부문의 역점시책

심재홍 대한지방행정공제회 1982 地方行政 Vol.31 No.341

소성변형가능한 물체와 접촉하는 프로브 매니퓰레이터의 접촉제어

심재홍,조형석,김성권 제어로봇시스템학회 1996 제어로봇시스템학회 국내학술대회 논문집 Vol.1 No.10

뇌동맥류의 수술 중 뇌혈관 조영술의 역할

심재홍,Sim, Jae Hong 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : In the cerebral aneurysm surgery, the goal is complete circulatory exclusion of the aneurysm without compromise of normal vessels. In an operating room, an operator should confirm the completeness and precision of the surgical result, before closing the wound. Object of this study was to determine which cases require intraoperative angiography. Methods : We reported our experience with 48 intraoperative angiographic studies performed during the surgical treatment of cerebral aneurysm of these 48 cases. There were 5 giant(10.4%), 15 globular(1.5-2.5cm)(31.25%) and 28 saccular(58.3%) aneurysm. We recorded the incidence of unexpected findings, such as residual aneurysms, major vessel occlusions. Using Fischer's exact test, we assessed whether unexpected angiographic findings showed any correlation with aneurysm site, size and clinical findings. Results : In 5 cases(10.4%), we detected unexpected angiographic findings which resulted in clip adjustment. By means of clip adjustment, an operator could restore the flow of two major arterial occlusion(4.2%) and also obliterate three persistent filling aneurysms(6.3%). Globular aneurysm was the only factor to predict unexpected angiographic findings(p<0.05). The subgroup of globular and giant aneurysm has a high risk of occlusion of the parent artery and its branches and/or residual aneurysm. There were two minor complications related to this procedure. Conclusion : Intraoperative assessment makes it possible to recognize and correct the technical defect. Particularly in globular aneurysm, we were able to prevent both the chance for another operation and the risk of postoperative complications.

국가물류 정보화 추진방향

심재홍,Sim, Jae-Hong 한국물류협회 2005 물류혁신 컨퍼런스 Vol.13 No.1

뇌동맥류 재수술의 수술치험

심재홍 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Objectives: The goal of the aneurysm surgery is complete circulatory exclusion of the aneurysm without compromise of the normal vessels. Failure to obliterate intracranial aneurysm completely during initial surgery still occurs in spite of recent technical advances. Methods and Materials: Between 1980 and November. 18th 2002, we have performed 2,500 cases aneurysm surgery, Among these, we experienced 29 reoperated cases for the failed initial aneurysm surgery, including 7 intraoperative clip readjustment after intra-operative angiography. Results: Twenty-nine cases were reoperated for the failed surgery. Of them, 7 cases were performed intraoperative angiography and the others(22) were not. 3 cases were performed initial operation in other hospital. The number of location of aneurysm was 15 A-com, 7 ICA and 5 MCA. tec. The causes of operations were vessel occlusion(8, residual neck(7), rebleeding after coating(5), aneurismal filling(3), slipped clip(2) and others. Clinical outcomes were better than in readjustment group after intraoperative angiography; above favorable outcome in 6(85.7%), but 16(72.7%) in group without intraoperative angiography. Conclusion: Reoperative management for failed aneurysm surgery is very difficult because of scar tissue, coating material and previously placed clip etc. Preoperative and postoperative detailed radiological and clinical assessment should be performed to determine the success of surgical treatment. During operative procedure, the use of intraoperative angiography, endoscopy and doppler sonography etc. will reduce the need of another operation and decrease the risk of post operative complication.