Gradenigo씨증후군을 동반한 내경동맥 동맥류의 경험예

송장성,최덕영,송진언 최신의학사 1970 最新醫學 Vol.13 No.12

A 62-year-old female patient was admitted to Catholic Medical Center on Sept-15-1969, because of left hearing loss, paresthesia on the left face and diplopia. These symptoms had been progressive for about 2 years. Neurological examination revealed loss of corneal reflex, loss of pain and temperature sense at the distribution of the first and second branch of left trigeminal nerve and limitation of lateral gaze of the left eye ball. Left carotid angiogram showed a large round aneurysmal dilatation of the infraclinoid cavernous potion of the left internal carotid artery. Following identification of adequate circle of Willis and good cross filling in angiogram the left common carotid artery was ligated. Post-operatively the patient has shown improvement of the symptoms.

腦動靜脈畸形에 對한 臨床的觀察과 外科的 療法

宋鎭彦,李永根,崔昌洛,姜俊基,宋將成,李春章,河榮秀 대한신경외과학회 1972 Journal of Korean neurosurgical society Vol.1 No.1

We have experienced 19 patients of the cerebral arteriovenous malformations with subarachnoid hemorrhage, who were admitted to the Presbyterian Hospital, Daegu from January 1966 to July 1968, and to the Catholic Medical Center, Seoul from August 1968 to August 1971. All of the patients, who have the cerebral arteriovenous malformations, were proved by cerebral angiography. Since the site of lesions were considered to have close relation to the neurologic deficit and the result of surgery, various analysis of the clinical manifestations and the cerebral angiographic findings were attempted. Of the 19 patients, surgery was performed on 12 patients and its results were analysed correlating to various types of surgical procedure. Followings are the results, 1. From January 1966 to August 1971, there were 100 cases of cerebral vascular anomalies which were proved by cerebral angiography. Among the 100 cases, there were 71 intracranial aneurysms, 19 cerebral arteriovenous malformations, one cavernous angioma, 2 telangiectasis, 5 cerebral rete mirabile, and 2 Sturge Weber-Dimitris disease. The ratio of arteriovenous malformations to aneurysms was 1 : 3.7. 2. Age distribution of the bleeding arteriovenous malformations was ranged from 8 to 54, and 42 per cent of them were in the third decade. 73 per cent of the group had bleeding from the cerebral arteriovenous malformations before the age of 40. The ratio of male to female was 1.9 : 1. 3. The parietal region was most commonly involved by the malformations. There were 8 parietal lesions, 4 temoroparietal lesions, one temporal lesion, one occipital lesion, and one tela chorioidea lesion. Simultaneous involvement of the both hemispheres occurred in one case. In lesions involving the cerebral hemisphere, there was a predominance of the left side. 4. In the past history, convulsive seizure was recorded in two cases and recurrent hemorrhages were reported in two. One patient was recorded to have suffered fourth hemorrhage and the other have suffered third hemorrhage. 5. Meningeal irritation signs were most frequently observed in bleeding arteriovenous malformations. The incidence of weakness of extremities was higher in lesions involving the parietal area. Unconsciousness was occurred in 6 patients at the onset of symptom, of which transient loss of consciousness was seen in 3 patients. Transient hypertension at the onset was observed in two patients. 6. The feeding arteries of the malformations were most frequently seen from the middle cerebral artery and the draining veins from the malformations were into the superior sagittal sinus and internal cerebral vein in many cases. It was evident that the carotid artery of the site of arteiovenous malformations was markedly dilated in 5 patients. 7. Ligation of the vessels feeding the arteriovenous malformations was carried out in 8 patients. One patient had neurologic deficit after the operation. Evacuation of intracerebral hematoma, resection of the anomaly or carotid ligation were carried out in 4 patients. Of the 12 patients who underwent various types of surgery, there was one death after evacuation of a large intracerebral hematoma. 8. In our opinion, the ligation of feeding artery is a choice of procedure to reduce the incidence of rebleeding, if the resection of the lesion was considered to have operative risk by the location of malformations.

前交通動脈瘤에 對한 手術成績分析

宋鎭彦,李永根,崔昌洛,姜俊基,宋將成,河榮秀,李春章,金達洙,成台慶,安明洙,許春雄,朱文培,金英鎭 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

The authors attempted to analyse the factors influencing the mortality involved in aneurysm surgery based on 38 cases of intracranial surgery for anterior communicating aneurysms, and obtained the following conclusion. 1. The surgical results are much better when the aneurysm surgery is delayed over one week after the occurrence of aneurysmal rupture, if there is no evidence of intracerebral hematoma. Administration of a massive dosage of epsilon aminocaproic acid in the waiting period prior to aneurysm surgery seems to be effective for preventing recurrence of bleeding from the aneurysm. 2. The direction of the anterior communicating aneurysm should be clearly visualized on a cerebral angiogram so that the most effective aneurysmal approach can be selected in surgery. 3. Microsurgery and hypotension in aneurysm surgery minimize brain damage in the exposure of aneurysm and provide accurate isolation of the aneurysmal neck from the parent vessel in aneurysmal neck ligation. 4. Proximal ligation of the anterior cerebral artery is also an effective procedure to prevent recurrent hemorrhage from anterior communicating aneurysm.

腦動脈瘤에 對한 治療와 低血壓下의 動脈瘤 手術

宋鎭彦,李永根,崔昌洛,姜俊基,宋將成,河榮秀,李春章,金達洙,成泰慶,安明洙 대한신경외과학회 1973 Journal of Korean neurosurgical society Vol.2 No.1

Authors have experienced 104 cases of the intracranial aneurysms with subarachnoid hemorrhage, who were proved to have aneurysm by cerebral angiography for past 8 years. Aneurysm surgery under controlled hypotension has shown far better result than that of surgery under hypothermia, carotid ligation or conservative treatment. Of the 104 cases, the site distribution of aneurysms and the result of various treatment are analyzed. Followings are the results. 1. Anterior communicating aneurysm was 44 per cent of the cases and it was most common site of the intracranial aneurysm. 19 per cent of aneurysms located on internal carotid artery at the posterior communicating artery, and middle cerebral artery aneurysm was 16%. The site distribution of aneurysms in Korean has shown marked difference from the reports of other countries. 2. Of 40 cases, who received conservative therpy, 15 cases (37.5%) were expired, and most of them were dead due to rebleeding from aneurysms. 3. The direct attack of aneurysms through intracranial approach was performed under moderate hypothermia till 1970, and controlled hypotension was introduced thereafter. In 49 cases of intracranial aneurysm surgery, 7 (14.2%) were expired following surgery. 4. Mortality of the carotid ligation for 15 cases of the intracranial aneurysms was 40 per cent. Cerebral ischemia or rebleeding was cause of death. 5. Intracranial aneurysm surgery under hypotension was carried out in 16 cases, and one case (6.2%) was expired. Induced hypotension and careful identification of aneurysm and neighbouring structures by magnifying operating glasses promoted operative result in aneurysm surgery.