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          • KCI등재후보

            고령환자군의 뇌동맥류에 대한 혈관내 수술의 치료결과

            이경규,우현진,강동훈,박재찬,김용선 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.2

            Objective : Subarachnoid hemorrhage (SAH) is known to have a high mortality rate and increase incidence by aging process. To old aged patients, treatment of cerebral aneurysm is controversial due to multiple factors, regarding underlying disease, life expectancy and treatment risk. We reviewed treatment outcome of the patients older than 65 years who had cerebral aneurysm (s) by using endovascular technique. Methods : Between 2000 and 2009, 177 patients who aged over 65 years were treated by endovascular management. Among them, 116 patients were presented with SAH and 61 patients were unruptured aneurysm. In SAH group, treatment outcome was evaluated by Glasgow Outcome Scale (GOS) at discharge and modified Rankin Scale (mRS) at 3 months. In unruptured aneurysm group, procedure complication and recurrence of the cerebral aneurysm were evaluated. Results : 177 patients harbored 209 aneurysms in total. GOS for the patients with SAH at discharge was good recovery (n=82, 71%), mild disability (n=7, 6%), severe disability (n=18, 15%), vegetative (n=3, 3%) and death (n=6, 5%). Three months mRS was good condition (mRS 0-2) in 83 patients, poor condition (mRS 3-5) in 26 and death in 1. Regarding the factors related with good recovery in SAH groups, initial Hunt and Hess grade showed statistical significance. In the group of unruptured aneurysm, only 1 patient (1.6%) had a procedure rupture and related in symptomatic intracerebral hemorrhage. Conclusion : Based upon our data, coil embolization of cerebral aneurysm was relatively safe and effective to older patients.

          • KCI등재후보

            침상돌기 주변 비파열성 뇌동맥류 결찰술의 결과 및 합병증에 대한 분석

            오선규,장인석,안재성,권도훈,권병덕 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3

            Objective : The study reports the clinical outcomes and complication rates of microsurgical clipping of unruptured paraclinoid aneurysms. Methods : From July 1997 to December 2008, 61 patients underwent microsurgical clipping for 61 unruptured paraclinoid aneurysms in our institute. Entire medical records, radiographic data, and operation records were reviewed retrospectively. Results : After the microsurgical clipping, complete obstruction was achieved in 56 patients (91.8%). Visual disturbance (nine cases, 14.8%) was the most frequent complication. Overall, 59 patients (96.7%) had a good long-term outcome (Glasgow outcome scale score of 4-5 3 months post-operatively). Conclusion : For patients with paraclinoid aneurysms, satisfactory outcomes can be achieved by microneurosurgical management. These results will be useful when considering treatment of an unruptured paraclinoid aneurysm. (Kor J Cerebrovascular Surgery 12(3):202-205, 2010)

          • KCI등재후보

            수두증 환자에서 복강경을 이용한 뇌실복강간 단락술

            최용수,김대원,강성돈 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3

            Objective : The ventriculoperitoneal (VP) shunt is the standard therapy for the management of hydrocephalus. Laparoscopic revision of distal shunt malfunction has become popular, but laparoscopic peritoneal shunt placements are not performed often. We present a series of 15 consecutive patients in which VP shunts were placed with laparoscopic assistance. Methods : From April 2007 to December 2009, 15 patients (aged 44-79 years) with hydrocephalus underwent laparoscopic VP shunt placement. Patients were followed postoperatively for signs and symptoms related to shunt malfunction, shunt infection, and procedure morbidity. Results : All patients tolerated this procedure well, and there were no complications. The benefits of this procedure included shunt placement under direct vision, and reduced risk of both abdominal trauma and intra-abdominal adhesions. Conclusion : Laparoscopic-assisted placement of the VP shunt is a good alternative treatment option for hydrocephalus patients. (Kor J Cerebrovascular Surgery 12(3):213-215, 2010)

          • KCI등재후보

            파열된 원위부 전대뇌동맥동맥류에 동반된 뇌실질내 출혈이 치료 결과에 미치는 영향

            최병삼,박인성,강동호,이철희,황수현,한종우 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3

            Objective : In this study, we analyzed the results of treating ruptured distal anterior cerebral artery (DACA) aneurysms surgically and reported the DACA aneurysms' characteristics and the influence of concomitant intracerebral hemorrhage (ICH) on the outcome. Methods : We retrospectively analyzed 24 patients with DACA aneurysms from among 430 patients who had received a diagnosis of, and undergone operations for, intracranial aneurysms in our hospital, from January 2003 to December 2008. We analyzed their age, gender, initial Glasgow coma scale (GCS) on admission, Hunt and Hess grading scale, and past medical history of hypertension or diabetes. We used computed tomography angiography (CTA) scans to investigate the location, size, multiplicity, ICH, and volume of each aneurysm and scored its surgical outcome according to the Glasgow Outcome Scale (GOS). Results : The 24 patients (8 men and 16 women) with DACA aneurysms were aged 5-73 years (mean, 52 years), and 6 had multiple aneurysms. Eleven patients had concomitant ICH, and these patients' mean hematoma volume was 15.2 cc. There were 4 patients with GCS scores from 14 to 15 and 7 patients with GCS scores below 13. Nine patients had GOS scores from 4 to 5, 1 patient had a GOS score of 3, and 1 patient, a GOS score of 1. Fisher's exact test revealed that initial GCS (P=0.03) and Hunt and Hess grade affected surgical outcomes. Concomitant ICH was not a statistically significant factor (P=0.7) Conclusions : We found DACA aneurysms were more common in women, multiple cerebral aneurysms were frequent, and these aneurysms were not large. Clinical outcomes were associated with initial GCS and Hunt and Hess grades. ICH was more frequent in DACA aneurysms, and ICH showed no correlation with either the clinical course or the final surgical outcome. (Kor J Cerebrovascular Surgery 12(3):165-168, 2010)

          • KCI등재

            하지 심부정맥혈전증 환자에서 폐색전증 발생에 미치는 인자

            윤상섭,최승혜,김상동,조항주,박순철,김기환,안창혁,김정수,문인성,유승진,임근우,김지일 대한뇌혈관외과학회 2008 대한뇌혈관외과학회지 Vol.24 No.2

            Purpose: Pulmonary embolism (PE) represents the most important and fatal complication of deep vein thrombosis (DVT), of which a dislodged thrombus is most commonly derived from the deep venous system of the lower extremity. The aim of this study is to define the incidence and risk factors of PE in DVT patients. Method: We retrospectively reviewed 248 patients with DVT in a lower extremity at Uijeongbu St. Mary's Hospital between January 2000 and August 2008 and they had received additional examinations for making the diagnosis of PE regardless of its symptoms. Result: There were 117 men and 131 women, and their mean age was 59 years old (range: 13∼91) at the time of diagnosis. There were 190 DVT-only patients and 58 patients with PE (the incidence rate of PE in the DVT patients: 23.8%). The gender ratio of the DVT only group was 1:1.3 (males: 83, female: 107) and the gender ratio of the DVT with PE group was 1:0.7 (males: 34, females: 24) (P<0.05). The risk factors of PE in the DVT patients were hypercoagulability (34%), cancer (23%), immobilization (17%), trauma/operation (10%), obesity (10%) and a past DVT history (7%). The idiopathic DVT patients had a relatively high cancer diagnosis rate (18.5%) and the majority of the newly detected cancer were from the chest or abdominal cavity. Conclusion: The incidence of DVT and PE is increasing and 23.8% of the DVT patients showed PE on their chest CT scan. The most significant risk factor for PE in the DVT patients was the male gender, yet an evaluation for cancer should be carefully done for idiopathic DVT patients because of their high rate of having cancer diagnosed.

          • KCI등재

            A Less Invasive Strategy for Ruptured Cerebral Aneurysms with Intracerebral Hematomas: Endovascular Coil Embolization Followed by Stereotactic Aspiration of Hematomas Using Urokinase

            김상흠,김태곤,공민호 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.2

            Objective:Aneurysm clipping and simultaneous hematoma evacuation through open craniotomy is traditionally recommended for ruptured cerebral aneurysms accompanied by intracerebral or intrasylvian hemorrhages. We report our experience of adapting a less invasive treatment strategy in poor-grade patients with intracerebral or intrasylvian hemorrhages associated with ruptured cerebral aneurysms, where the associated ruptured cerebral aneurysms were managed by endovascular coil embolization, followed by stereotactic aspiration of hematomas (SRH) using urokinase. Materials and Methods : We retrospectively analyzed 112 patients with ruptured cerebral aneurysms. There were accompanying intracerebral or intrasylvian hemorrhages in 36 patients (32.1%). The most common site for these ruptured aneurysms was the middle cerebral artery (MCA) (n = 15; 41.6%). Endovascular coil embolization followed by SRH using urokinase was performed in 9 patients (25%). Results : In these 9 patients, the most common site of aneurysms was the MCA (n = 3; 33.4%); the hematoma volume ranged from 19.24 to 61.68 mL. Four patients who were World Federation of Neurological Surgeons (WFNS) grade-IV on admission, achieved favorable outcomes (Glasgow Outcome Score [GOS] 4 or 5) at 6-months postoperatively. In the five patients who were WFNS grade-V on admission, one achieved a favorable outcome, whereas 4 achieved GOS scores of 2 or 3, 6-months postoperatively. There was no mortality. Conclusion : If immediate hematoma evacuation is not mandated by clinical or radiological signs of brain herniation, a less invasive strategy, such as endovascular coil embolization followed by SRH using urokinase, may be a good alternative in poor-grade patients with intracerebral or intrasylvian hemorrhages associated with ruptured cerebral aneurysms.

          • KCI등재

            Simultaneous Onset of Ischemic and Hemorrhagic Stroke Due To Intracranial Artery Dissection

            김종훈,장철훈,정영진 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.2

            Intracranial dissections commonly present as ischemic stroke and as hemorrhagic stroke. In general, while either ischemic stroke or hemorrhagic stroke may develop, the simultaneous onset of both may also occasionally occur. In this report, we present a case of simultaneous development of ischemic stroke and hemorrhagic stroke due to an intracranial artery dissection.

          • KCI등재

            Eyebrow Incision for Surgical Evacuation of a Lobar Intracerebral Hematoma with a Novel Endoport System

            Dale,Ding,Colin,J.,Przybylowski,Robert,M.,Starke,R.,Webster,Crowley,Kenneth,C.,Liu 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.2

            Large lobar intracerebral hemorrhages (ICHs) can cause rapid neurological deterioration, and affected patients have low rates of survival and functional independence. Currently, the role of surgical intervention in the management patients with lobar ICHs is controversial. Minimally invasive technologies have been developed which may potentially decrease the operative morbidity of ICH surgery. The aim of this case report is to describe the technical aspects of the use of a novel minimally invasive endoport system, the BrainPath (NICO, Indianapolis, IN, USA), through an eyebrow incision for evacuation of a large lobar hematoma. An 84-year-old female presented with a left frontal ICH, measuring 7.5 cm in maximal diameter and 81 cm3 in volume, secondary to cerebral amyloid angiopathy. Through a left eyebrow incision, a miniature modified orbitozygomatic craniotomy was performed, which allowed endoport cannulation of the hematoma from a lateral subfrontal cortical entry point. Endoport-assisted hematoma evacuation resulted in nearly 90% volume reduction and improvement of the patient's functional status at clinical follow-up. We found that minimally invasive endoport technology can be employed in conjunction with conventional neurosurgical skull base principles to achieve safe and effective evacuation of large lobar hematomas in carefully selected patients.

          • KCI등재

            Procedure-related Complications during Endovascular Treatment of Intracranial Saccular Aneurysms

            안재민,오재상,윤석만,심재현,오혁진,배학근 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.3

            Objective : We evaluate the rates and outcomes of major procedure-related complications during coiling. Materials and Methods : Between 2007 and 2015, 436 intracranial saccular aneurysms were treated. Complications are categorized as three types: intraprocedural aneurysm rupture (IAR), thromboembolism (TE), and post-procedural early rebleeding (PER). And we evaluated the risk factors of procedure related complications by multivariate analysis. Results : Complications occurred in 61 aneurysms (14%). The overall incidence of complications in subarachnoid hemorrhage (SAH) was significantly higher than in unruptured intracranial aneurysm (UIA) (20% vs. 6%). The incidence of IAR and TE were higher in SAH than in UIA (IAR 12% vs. 4%, TE 7% vs. 3%, p < 0.05). Five PER occurred only in SAH. In 34 UIA which were treated with balloon-assisted coiling (BAC), all these patients had good recovery despite 3 patients had the IAR. The incidence of IAR and TE were not different between BAC and non-BAC groups (p > 0.05). All 7 patients who had IAR during BAC had good recovery. In multiple logistic regression analysis, female gender, SAH, and intraventricular hemorrhage were associated with procedure related complication (p < 0.05). Conclusion : Endovascular coil embolization is a minimally invasive procedure, but incidence of its complication is not low, especially in SAH. BAC can be a good tool to avoid poor outcome from unexpected IAR during coiling. While IA tirofiban injection is a useful therapy in TE during coiling, sometimes we are aware of the risk of the early rebleeding in SAH patients.

          • KCI등재

            The Rupture Risk of Aneurysm in the Anterior Communicating Artery: A Single Center Study

            김명철,황승균 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.1

            Objective : The aim of this study was to evaluate the characteristics of ruptured aneurysms at anterior communicating artery (A com) with an analysis of clinical and morphological data, which could further our understanding of the risks of ruptured A com aneurysms. Materials and Methods : An analysis of data with 86 ruptured and 44 unruptured A com aneurysms were analyzed using a digital subtraction angiography or 3-dimensional computed tomography angiography between January 2010 and December 2015 in a single center. Results : Fifty-five percent of ruptured A com aneurysms were smaller than 4 mm in size. They had a smooth wall (44%), with a mean size ratio of 4.22 (range: 0.7-14.3) and mean height/width ratio of 1.48 (range: 0.5-2.9); 23 patients of A1 positive difference. Unruptured aneurysms were mostly 2-10 mm in size (94%) and had an irregular wall (43%), with a mean size ratio of 4.1 (range: 0.8-9.1) and mean height/width ratio of 1.2 (range: 0.1-2.6); 6 patients of A1 positive difference. In terms of the morphology of aneurysms, size of A com, maximum aneurysm size, neck width, aneurysm wall morphology, and size ratio were not different with statistical significance. However, dominance of A1 (p = 0.01) and height/width ratio (p = 0.03) were found to be a significant predictive factor for rupture of A com aneurysms. Conclusion : To better understand the rupture risk of A com aneurysms, a large, multicenter, collaborative, and prospective study should be performed in the future.

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