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토끼의 만성 뇌혈관연축 모델에서 혈관확장제에 의한 비가역적 혈관수축의 발현시기와 혈관벽의 전자현미경소견상 이상소견이 발현되는 시기와의 시간관계
정천기,조병규,김하영,지제근,김종재,한대희 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.11
One of the characteristics of the cerebral vasospasm is its irreversibility with the vasodilators.Under the hypothesis that the irreversibility with vasodilators might be caused by the structural change in the arterial wall, authors examined the chronological relationships between the irreversibility and the electron microscopic findings of the arterial wall in the rabbit chronic vasospasm model. The development of the vasospasm and the irreversibility of the vasospasm with the intra-arterial papaverine were defined angiographically. After the second angiography done in one to 30 days after subarachnoid hemorrhage(SAH), eighteen rabbits were sacrificed, and the basilar artery was examined with electron microscope. Arterial narrowing was the severest one day after SAH(54.1% of the pre-SAH diameter), and was maintained up to 30 days afer SAH. The irreversibility of the arterial constriction with the papaverine developed 5 days after SAH, which had a tendency to recover 6 to 9 days after SAH. However the irreversibility was noted again 16 days after SAH. Electron microscopy revealed the endothelial wrinkling, disorganization of muscle fiber, myonecrosis, thickening of smooth muscle fibers, and increase of connective tissue in the tunica media. These structural changes were severest one day after SAH, and gradually diminished up to 30 days after SAH. These data show that there are no chronological relationships between the irreversibility and the structural change per se. However the fact that the irreversibility developed during the reparative phase of the arterial wall injury by SAH suggests that the chronic vasospasm is not a primary event but a secondary phenomenon following an injury to the cerebral arterial wall.
정천기,박인성,한대희 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12
This study analyzed the long-term outcome of 23 consecutive patients with giant intracranial aneurysms during the past 10 years. Age ranged from 5 to 73, and male to female ratio was 6 to 17. The internal carotid artery(ICA) was the most frequent site(56.5 percent), and the posterior circulation(34.8 percent) next. Thirteen presented with mass effect, and six with bleeding. Direct neck clipping was done on three ; proximal artery clipping on five trapping. wrapping and thrombectomy each on one. Detachable balloon occlusion of the parent artery was performed on five. Seven were cared for conservatively. Mean follow-up period was 33.2 months(2.0 to 110). Overall mortality rate was 17 percent and morbidity rate was 26 percent. Survival analysis with Kaplan-Meier method and log-rank test for comparison were used. There was no statistically significant difference on the survival rate between ICA and posterior circulation(p>0.l), between presentations with mass effect and bleeding(p>0.l), and between the treated and the not-treated(p>0.l). Only the completeness of exclusion from the circulation had a significant effect on survival(p=0.0286). The most frequent complication was infarction in the parent artery territory in 7 patients(44% of treatment group). but these patients improved (mean Karnofsky performance score 61 on discharge, 83 on the last follow-up). Magnetic resonance imaging(MRI) was useful. One aneurysm that had a persistent signal void on MRI one month postoperatively, continued to grow. In this study, the only significant factor in survival was the completeness of exclusion from the circulation. And MRI was useful for follow-up.
뇌동맥류 환자의 뇌전산화단층촬영소견과 뇌동맥연축과의 관계에 대한 연구
정천기,한대희 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1
Authors reviewed the relationship between the cerebral vasospasm in the cerebral angiograms and CT findinge in the 41 cases of subarachnoid hemorrhage due to intracranial aneurysmal rupture during the period from July 1982 to February 1984. This study was based upon the CT scans performed within the first 5 days and angiograms obtained between 7 and 17 days after subarachnoid hemorrhage. Conclusions were as following: 1) No relationship between the site of aneurysm and the amount of subarachnoid blood. 2) No relationship between the site of aneurysm and the development of vasospasm. 3) No definite additional influence of the intracerebral or intraventricular clots on the development of vasospasm. 4) High incidence of severe vasospasm with clot or thick layer in subarachnoid space.