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Kim M, Kim JH, Park W, Park JC, Ahn JS, Kwun BD, Lee SG, Hwang S, Kim M, Lee S. Risk of Cerebral Aneurysm Rupture After Liver Transplantation: Development and Validation of a Hemorrhagic Stroke Scoring Model. J Korean Med Sci 2024; 39:e88. [PMID: 38469964 PMCID: PMC10927392 DOI: 10.3346/jkms.2024.39.e88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) patients appear to be more prone to neurological events compared to individuals undergoing other types of solid-organ transplantation. The aims of the present study were to analyze the prevalence of unruptured intracranial aneurysms (UIAs) in patients undergoing liver transplantation (LT) and to examine the perioperative occurrence of subarachnoid hemorrhage (SAH). Also, it intended to systematically identify the risk factors of SAH and hemorrhagic stroke (HS) within a year after LT and to develop a scoring system which involves distinct clinical features of LT patients. METHODS Patients who underwent LT from January 2012 to March 2022 were analyzed. All included patients underwent neurovascular imaging within 6 months before LT. We conducted an analysis of prevalence and radiological features of UIA and SAH. The clinical factors that may have an impact on HS within one year of LT were also reviewed. RESULTS Total of 3,487 patients were enrolled in our study after applying inclusion and exclusion criteria. The prevalence of UIA was 5.4%. The incidence of SAH and HS within one year following LT was 0.5% and 1.6%, respectively. We developed a scoring system based on multivariable analysis to predict the HS within 1-year after LT. The variables were a poor admission mental status, the diagnosis of UIA, serum ammonia levels, and Model for End-stage Liver Disease (MELD) scores. Our model showed good discrimination among the development (C index, 0.727; 95% confidence interval [CI], 0.635-0.820) and validation (C index, 0.719; 95% CI, 0.598-0.801) cohorts. CONCLUSION The incidence of UIA and SAH was very low in LT patients. A poor admission mental status, diagnosis of UIA, serum ammonia levels, and MELD scores were significantly associated with the risk of HS within one year after LT. Our scoring system showed a good discrimination to predict the HS in LT patients.
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Affiliation(s)
- Minwoo Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kim HB, Park JC, Ahn JS, Lee S, Yang K, Park W. The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm. J Cerebrovasc Endovasc Neurosurg 2024:jcen.2024.E2023.08.001. [PMID: 38389227 DOI: 10.7461/jcen.2024.e2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Objective We evaluated the role of subgaleal closed suction drains in postoperative epidural hematoma (EDH) and wound complications following pterional craniotomy for cerebral aneurysm. Methods We reviewed 5,280 pterional craniotomies performed on 5,139 patients between January 2006 and December 2020. A drain was placed subgalealy and tip of drain was positioned between the bone flap and the deep temporalis. 1,637 cases (31%) had a subgaleal suction drain. We analyzed demographic and clinical variables related to EDH requiring evacuation and wound complications in patients with and without drains. Univariate and multivariate logistic regression analyses were performed to determine the associated risk factors. Results Fourteen cases (0.27%) of EDH requiring evacuation and 30 cases (0.57%) of wound complications were identified. Univariate analysis found that drain insertion, subarachnoid hemorrhage (SAH), and operation time were associated with EDH, while drain insertion, SAH, male gender, older age, and longer operation time were associated with wound complications. Multivariate analysis found no significant association between drain use and EDH (OR=1.62, p=0.402) or wound complications (OR=1.45, p=0.342). Conclusions Routine use of subgaleal closed suction drains may not be necessary after pterional craniotomy, as drain insertion was not associated with a reduced risk of EDH requiring evacuation or wound complications.
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Affiliation(s)
- Hong Bum Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kuhyun Yang
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim JH, Jeon H, Kim M, Byun J, Chung Y, Lee SU, Park W, Park JC, Ahn JS, Lee S. Chemical and perfusion markers as predictors of moyamoya disease progression and complication types. Sci Rep 2024; 14:56. [PMID: 38167529 PMCID: PMC10762200 DOI: 10.1038/s41598-023-47984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
To investigate the association between chemical markers (triglyceride, C-reactive protein (CRP), and inflammation markers) and perfusion markers (relative cerebral vascular reserve (rCVR)) with moyamoya disease progression and complication types. A total of 314 patients diagnosed with moyamoya disease were included. Triglyceride and CRP levels were assessed and categorized based on Korean guidelines for dyslipidemia and CDC/AHA guidelines, respectively. Perfusion markers were evaluated using Diamox SPECT. Cox proportional hazard analysis was performed to examine the relationship between these markers and disease progression, as well as complication types (ischemic stroke, hemorrhagic stroke, and rCVR deterioration). Elevated triglyceride levels (≥ 200) were significantly associated with higher likelihood of end-point events (HR: 2.292, CI 1.00-4.979, P = 0.03). Severe decreased rCVR findings on Diamox SPECT were also significantly associated with end-point events (HR: 3.431, CI 1.254-9.389, P = 0.02). Increased CRP levels and white blood cell (WBC) count were significantly associated with moyamoya disease progression. For hemorrhagic stroke, higher triglyceride levels were significantly associated with end-point events (HR: 5.180, CI 1.355-19.801, P = 0.02). For ischemic stroke, severe decreased rCVR findings on Diamox SPECT (HR: 5.939, CI 1.616-21.829, P < 0.01) and increased CRP levels (HR: 1.465, CI 1.009-2.127, P = 0.05) were significantly associated with end-point events. Elevated triglyceride, CRP, and inflammation markers, as well as decreased rCVR, are potential predictors of moyamoya disease progression and complication types. Further research is warranted to understand their role in disease pathophysiology and treatment strategies.
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Affiliation(s)
- Jae Hyun Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hanwool Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, Republic of Korea
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Medical Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, Republic of Korea.
- Bio-Medical Institute of Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Choi JH, Kim M, Park W, Park JC, Kwun BD, Ahn JS. Superficial temporal artery interposition bypass for the treatment of complex intracranial aneurysms: Flexible and creative options for flow preservation bypass. Clin Neurol Neurosurg 2023; 235:108019. [PMID: 37979563 DOI: 10.1016/j.clineuro.2023.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE Flow-preservation bypass is a treatment option for complex intracranial aneurysms (IAs) that cannot be managed with microsurgical clipping or endovascular treatment. Various bypass methods are available, including interposition grafts such as the radial artery or saphenous vein. Size discrepancy, invasiveness, and procedure complexity must be considered when using interposition grafts. We describe our experience of treating complex IAs using a superficial temporal artery (STA) interposition bypass. METHODS We retrospectively reviewed the medical records and operative videos of all patients who were treated for complex IAs at our center from January 2009 to December 2021 using cerebral revascularization. Clinical, radiological, and surgical findings of the cases that underwent STA interposition bypass were investigated. RESULTS Seventy-six bypass procedures were performed of which seven (9.2%) complex IAs were managed using STA interposition bypass. Of these 5 cases were of anterior cerebral artery, 1 of middle cerebral artery, and 1 of posterior inferior cerebellar artery aneurysm. There were no postoperative ischemic complications. Revision surgery for postoperative pseudomeningocele was performed in one case. The long-term bypass patency rate was 85.7% (6 out of 7) and good long-term aneurysm control was achieved in all cases, with a mean follow-up of 64 months. CONCLUSIONS When treating complex IAs, creative revascularization strategies are needed in selective cases for favorable outcomes. STA interposition graft bypass which can reduce the size discrepancy between the donor and recipient may be a less invasive, flexible, and practical option for treating complex IAs.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minwoo Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Duk Kwun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Moon E, Park W, Song Y, Lee DH, Ahn JS, Park JC. Mass Effect After Flow Diversion for Unruptured Large and Giant Cavernous or Paraclinoid Internal Carotid Artery Aneurysm. World Neurosurg 2023; 180:e108-e116. [PMID: 37690582 DOI: 10.1016/j.wneu.2023.08.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The mass effect associated with large or giant intracranial aneurysms is difficult for traditional endovascular treatment. This study investigated whether flow diverters can relieve the aneurysmal mass effect caused by aneurysmal compression symptoms. METHODS Fifty-five patients with unruptured large and giant intracranial aneurysms treated by a flow diverter at our institution from January 2014 to February 2022 were retrospectively evaluated. RESULTS In this study, 53 patients were included. Initially, 27 patients (51.9%), including 10 with compressive optic neuropathy, 12 with third nerve palsy, 2 with facial hyperesthesia, and 11 with sixth nerve palsy, were symptomatic. The symptom duration was shorter in the improved group (n = 2.2 ± 4.0 vs. n = 3.1 ± 3.9, P = 0.49). Thrombus formation following the flow diversion procedure was typically observed on magnetic resonance imaging (MRI) performed immediately and was not significantly associated with symptomatic improvement (OR = 0.395; 95% CI (0.058-2.698), P = 0.343). However, symptomatic improvement was seen in most patients when the aneurysm size decreased on MRI. A reduction in the aneurysm size on the MRI at the 3-month follow-up was correlated with symptomatic improvement in the multivariate analysis (OR = 0.08, 95% CI (0.013-0.485), P < 0.05). CONCLUSIONS A flow diverter might help alleviate compression symptoms caused by large or giant intracranial aneurysms. Shrinkage of the aneurysm within 3 months postoperatively and a shorter duration of symptoms contribute to the favorable outcomes of mass effect. Ultimately, prompt treatment is crucial for improving symptomatic intracranial artery aneurysms.
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Affiliation(s)
- Eunji Moon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Choi JH, Park W, Park JC, Kwun BD, Ahn JS. Clipping of Unruptured Anterior Choroidal Artery Aneurysms Together with Small Branches: Safety Confirmation Using Intraoperative Indocyanine Green Video-Angiography and Intraoperative Neurophysiological Monitoring. World Neurosurg 2023; 180:e19-e29. [PMID: 37331470 DOI: 10.1016/j.wneu.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND In treating anterior choroidal artery (AChA) aneurysms, preserving the AChA main trunk is of course necessary to prevent postoperative ischemic complications. However, in practice, complete occlusions are often limited by small branches. OBJECTIVE We aimed to demonstrate that even in cases where complete occlusion of the AChA aneurysm is complex due to small branches, complete occlusion can be safely achieved using indocyanine green video-angiography and intraoperative neurophysiological monitoring (IONM). METHODS We performed a retrospective review of all unruptured AChA aneurysms surgically treated at our institution from 2012 to 2021. All available surgical videos were reviewed to find AChA aneurysms clipped with small branches; clinical and radiological data were collected for these cases. RESULTS Among 391 cases of unruptured AChA aneurysms treated surgically, 25 AChA aneurysms were clipped with small branches. AChA-related ischemic complications occurred in 2 cases (8%) without retrograde indocyanine green filling to the branches. These 2 cases had changes in IONM. There were no ischemic complications in the remaining cases with retrograde indocyanine green filling to the branches and no change in IONM. During an average follow-up of 47 months (12-111 months), a small residual neck was observed in 3 cases (12%) and recurrence or progression of the aneurysm was observed in only 1 case (4%). CONCLUSIONS The surgical treatment of AChA aneurysms carries the risk of devastating ischemic complications. Even in cases where complete clip ligation seems impossible due to small branches associated with AChA aneurysms, complete occlusion can be safely achieved using indocyanine green video-angiography and IONM.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Koh JS, Hwang G, Park JC, Lee CY, Chung J, Lee SW, Kwon HJ, Kim SR, Kang DH, Kwon SC, Kim ST, Chang CH, Jang DK, Choi JH, Kim YW, Kim BT, Shin BG, You SH, Chung SY, Ko J, Kim TG, Yoon SM, Lee JY, Park H, Park JH, Cho JH, Koo HW, Sung JH, Rhee J, Shin HG. Tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms: a nationwide registry study. J Neurointerv Surg 2023; 15:1095-1104. [PMID: 36596671 DOI: 10.1136/jnis-2022-019571] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Antiplatelet therapy, where regimens are tailored based on platelet function testing, has been introduced into neurointerventional surgery. This nationwide registry study evaluated the effect and safety of tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms compared with conventional therapy using a standard regimen. METHODS This study enrolled 1686 patients in 44 participating centers who received stent assisted coiling for unruptured aneurysms between January 1, 2019 and December 31, 2019. The standard regimen (aspirin and clopidogrel) was used for all patients in the conventional group (924, 19 centers). The regimen was selected based on platelet function testing (standard regimen for clopidogrel responders; adding cilostazol or replacing clopidogrel with other thienopyridines (ticlopidine, prasugrel, or ticagrelor) for clopidogrel non-responders) in the tailored group (762, 25 centers). The primary outcome was thromboembolic events. Secondary outcomes were bleeding and poor outcomes (increase in modified Rankin Scale score). Outcomes within 30 days after coiling were compared using logistic regression analysis. RESULTS The thromboembolic event rate was lower in the tailored group than in the conventional group (30/762 (3.9%) vs 63/924 (6.8%), adjusted OR 0.560, 95% CI 0.359 to 0.875, P=0.001). The bleeding event rate was not different between the study groups (62/762 (8.1%) vs 73/924 (7.9%), adjusted OR 0.790, 95% CI 0.469 to 1.331, P=0.376). Poor outcomes were less frequent in the tailored group (12/762 (1.6%) vs 34 (3.7%), adjusted OR 0.252, 95% CI 0.112 to 0.568, P=0.001). CONCLUSION Tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms reduced thromboembolic events and poor outcomes without increasing bleeding.
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Affiliation(s)
- Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea (the Republic of)
| | - Gyojun Hwang
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung Universtity Dongsan Medical Center, Daegu, Korea (the Republic of)
| | - Joonho Chung
- Department of Neurosurgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea (the Republic of)
| | - Sang-Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Korea (the Republic of)
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea (the Republic of)
| | - Seong-Rim Kim
- Department of Neurosurgery, The Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Gyeonggi, Korea (the Republic of)
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea (the Republic of)
| | - Sung-Tae Kim
- Department of Neurosugery, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Chul Hoon Chang
- Department of Neurosurgery, Yeungnam University Medical Center, Daegu, Korea (the Republic of)
| | - Dong-Kyu Jang
- Department of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea (the Republic of)
| | - Jae Hyung Choi
- Department of Neurosurgery, Dong-A University Hospital, Busan, Korea (the Republic of)
| | - Young Woo Kim
- Department of Neurosurgery, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Gyeonggi, Korea (the Republic of)
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Gyeonggi, Korea (the Republic of)
| | - Byoung Gook Shin
- Department of Neurosurgery, Dongeui Medical Center, Busan, Korea (the Republic of)
| | - Seung Hoon You
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea (the Republic of)
| | - Seung Young Chung
- Department of Neurosurgery, Daejeon Eulji University Hospital, Daejeon, Korea (the Republic of)
| | - Junkyeung Ko
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea (the Republic of)
| | - Tae Gon Kim
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medine, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Seok-Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Chungnam, Korea (the Republic of)
| | - Jong Young Lee
- Department of Neurosurgery, Hallym University Gangdong Sacred Heart hospital, Seoul, Korea (the Republic of)
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Gyeongnam, Korea (the Republic of)
| | - Jung Hyun Park
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi, Korea (the Republic of)
| | - Jae-Hoon Cho
- Department of Neurosurgery, Pohang SM Christianity Hospital, Pohang, Gyeongbuk, Korea (the Republic of)
| | - Hae-Won Koo
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi, Korea (the Republic of)
| | - Jae Hoon Sung
- Department of Neurosurgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Gyeonggi, Korea (the Republic of)
| | - Jinnie Rhee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (the Republic of)
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (the Republic of)
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Chung J, Cheong JH, Kim JM, Lee DH, Yi HJ, Choi KS, Ahn JS, Park JC, Park W. Is Fetal-Type Posterior Cerebral Artery a Risk Factor for Recurrence in Coiled Internal Carotid Artery-Incorporating Posterior Communicating Artery Aneurysms? Analysis of Conventional Statistics, Computational Fluid Dynamics, and Random Forest With Hyper-Ensemble Approach. Neurosurgery 2023; 93:611-621. [PMID: 37057916 DOI: 10.1227/neu.0000000000002458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/20/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The fetal-type posterior cerebral artery (FPCA) has been regarded as the risk factor for recurrence in coiled internal carotid artery-incorporating posterior communicating artery (ICA-PCoA) aneurysm. However, it has not been proven in previous literature studies. OBJECTIVE To reveal the impact of FPCA on the recurrence of ICA-PCoA aneurysms using conventional statistical analysis, computational fluid dynamics (CFD) simulation, and random forest with hyper-ensemble approach (RF with HEA). METHODS Vascular parameters and clinical information from patients who underwent coil embolization ICA-PCoA aneurysms from January 2011 to December 2016 were obtained. Conventional statistical analysis was applied to a total of 95 cases obtained from patients with a follow-up of more than 6 months. For CFD simulation, 3 sets of three-dimensional models were used to understand the hemodynamical characteristics of various FPCAs. The RF with HEA was applied to reinforce the clinical data analysis. RESULTS The conventional statistical analysis fails to reveal that FPCA is a risk factor. CFD analysis shows that the diameter of FPCA alone is less likely to be a risk factor. The RF with HEA shows that the impact of FPCA is also minor compared with that of the packing density in the recurrence of coiled ICA-PCoA aneurysms. CONCLUSION The gathered results of all 3 analyses show more clear evidence that FPCA is not a risk factor for coiled ICA-PCoA aneurysms. Hence, we may conclude that FPCA itself is doubtful to be the major risk factor in the recurrence of coiled ICA-PCoA aneurysms.
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Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, Dankook University, Cheonan, Republic of Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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9
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Choi JH, Park JC, Ahn JS, Park W. Treatment of Dural Arteriovenous Fistula with Intradural Draining Vein at the Craniocervical Junction: Case Series with Special Reference to the Anatomical Considerations. World Neurosurg 2023; 175:e1226-e1236. [PMID: 37427702 DOI: 10.1016/j.wneu.2023.04.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas at the craniocervical junction (CCJ DAVFs) are a rare vascular disease. Endovascular treatment (EVT) and microsurgery are the primary treatment modalities for CCJ DAVFs. However, incomplete treatment or complications may occur after treatment because of the anatomical complexity. OBJECTIVE We analyzed the neurosurgical treatment experiences of CCJ DAVFs to recommend suitable classification and treatment options. METHODS CCJ DAVFs were anatomically classified into three types according to the feeding arteries and their relationships with the anterior spinal (ASAs) and lateral spinal arteries (LSAs). Type 1 was fed by the radiculomeningeal artery from the vertebral artery and was not associated with the ASA or LSA. Type 2 was fed by the radiculomeningeal artery, and the radicular artery supplied the LSA near the fistula point. Type 3 had the characteristics of type 1 or type 2 CCJ DAVFs, except the ASA also contributed to the fistula. RESULTS There were 5, 7, and 4 cases of type 1, type 2, and type 3 CCJ DAVFs, respectively. EVT was attempted in 12 patients, of whom only 1 (type 1) was completely cured without complications. Nine cases had residual lesions after EVT, and two had spinal cord infarction due to occlusion of the LSA. Fourteen patients underwent microsurgical treatment. In all 14 cases, CCJ DAVFs were completely obliterated after microsurgery. CONCLUSION In cases of type 1 CCJ DAVF, both microsurgical treatment and EVT may be considered. However, for type 2 and 3 CCJ DAVFs, microsurgery may be a superior treatment modality.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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10
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Kim M, Jeon H, Chung Y, Lee SU, Park W, Park JC, Ahn JS, Lee S. Efficacy of Acetylcysteine and Selenium in Aneurysmal Subarachnoid Hemorrhage Patients: A Prospective, Multicenter, Single Blind Randomized Controlled Trial. J Korean Med Sci 2023; 38:e161. [PMID: 37270916 DOI: 10.3346/jkms.2023.38.e161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/16/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) patients have oxidative stress results in inflammation, tissue degeneration and neuronal damage. These deleterious effects cause aggravation of the perihematomal edema (PHE), vasospasm, and even hydrocephalus. We hypothesized that antioxidants may have a neuroprotective role in acute aneurysmal SAH (aSAH) patients. METHODS We conducted a prospective, multicenter randomized (single blind) trial between January 2017 and October 2019, investigating whether antioxidants (acetylcysteine and selenium) have the potential to improve the neurologic outcome in aSAH patients. The antioxidant patient group received antioxidants of acetylcysteine (2,000 mg/day) and selenium (1,600 µg/day) intravenously (IV) for 14 days. These drugs were administrated within 24 hours of admission. The non-antioxidant patient group received a placebo IV. RESULTS In total, 293 patients were enrolled with 103 patients remaining after applying the inclusion and exclusion criteria. No significant differences were observed in the baseline characteristics between the antioxidant (n = 53) and non-antioxidant (n = 50) groups. Among clinical factors, the duration of intensive care unit (ICU) stay was significantly shortened in patients who received antioxidants (11.2, 95% confidence interval [CI], 9.7-14.5 vs. 8.3, 95% CI, 6.2-10.2 days, P = 0.008). However, no beneficial effects were observed on radiological outcomes. CONCLUSION In conclusion, antioxidant treatment failed to show the reduction of PHE volume, mid-line shifting, vasospasm and hydrocephalus in acute SAH patients. A significant reduction in ICU stay was observed but need more optimal dosing schedule and precise outcome targets are required to clarify the clinical impacts of antioxidants in these patients. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0004628.
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Affiliation(s)
- Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanwool Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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11
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Lee JM, Lee S, Park W, Park JC, Ahn JS, Kim JH, Byun J. Necessity of Mandatory Postoperative Intensive Care Unit Management after Clipping Surgery for Unruptured Intracranial Aneurysms. Clin Neurol Neurosurg 2023; 228:107703. [PMID: 37058770 DOI: 10.1016/j.clineuro.2023.107703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Many neurosurgeons routinely perform postoperative intensive care unit (ICU) management after clipping of unruptured intracranial aneurysms (UIAs). However, whether routine postoperative ICU care is necessary remains a clinical question. Therefore, we investigated which factors acted as risk factors that actually required ICU care after microsurgical clipping of unruptured aneurysms. METHODS We included a total of 532 patients who underwent clipping surgery for UIA between January 2020 and December 2020. The patients were divided into two groups: those who really required ICU care (41 patients, 7.7%) and those who did not (491 patients, 92.3%). A backward stepwise logistic regression model was used to identify factors that were independently associated with ICU care requirement. RESULTS The mean hospital stay duration and the operation time were significantly longer in the ICU requirement group than in the no ICU requirement group (9.9 ± 10.7 vs. 6.3 ± 3.7 days, p = 0.041), (259.9 ± 128.4 vs. 210.5 ± 46.1 min, p = 0.019). The transfusion rate was significantly higher (p = 0.024) in the ICU requirement group. Multivariable logistic regression analysis identified male sex (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.15-4.76; p = 0.0195), operation time (OR, 1.01; 95% CI, 1.00-1.01; p = 0.0022), and transfusion (OR, 2.35; 95% CI, 1.00-5.51; p = 0.0500) as independent risk factors for requiring ICU care after clipping. CONCLUSIONS Postoperative ICU management may not be mandatory after clipping surgery for UIAs. Our results suggest that postoperative ICU management may be more required in the male sex, patients with longer operation times, and those who received a transfusion.
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12
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Eun C, Lee SJ, Park JC, Ahn JS, Kwun BD, Park W. Efficacy of intraoperative neuromonitoring (IONM) and intraoperative indocyanine green videoangiography (ICG-VA) during unruptured anterior choroidal artery aneurysm clipping surgery. J Cerebrovasc Endovasc Neurosurg 2023:jcen.2023.E2022.10.008. [PMID: 36693397 DOI: 10.7461/jcen.2023.e2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Objective The aim of this study was to investigate the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) and intraoperative neuromonitoring (IONM) to prevent postoperative ischemic complications during microsurgical clipping of unruptured anterior choroidal artery (AChA) aneurysms. Methods We retrospectively reviewed the clinical and radiological records of all patients who had undergone microsurgical clipping for unruptured AChA aneurysms at our institution between April 2001 and December 2019. We compared the postoperative complication rate of the group for which intraoperative ICG-VA and IONM were utilized (group B; n=324) with that of the group for which intraoperative ICG-VA and IONM were not utilized (group A; n=72). Results There were no statistically significant differences in demographic data between the two groups. Statistically significant differences were observed in the rate of overall complications (p=0.014) and postoperative ischemic complications related to AChA territory (p=0.039). All the cases (n=4) in group B who had postoperative infarctions related to AChA territory showed false-negative results of intraoperative ICG-VA and IONM. Conclusions Preserving the patency of the AChA is essential to minimize postoperative complications. Intraoperative monitoring tools including ICG-VA and IONM can greatly contribute to lowering complication rates. However, their pitfalls and false-negative results should always be considered.
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Affiliation(s)
- Chanbo Eun
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Joo Lee
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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13
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Choi JH, Park W, Park JC, Ahn JS. Cerebral Myxomatous Aneurysms: Case Series and Systematic Review of Literature with Adequate Follow-Up Periods and Aneurysmal Wall Biopsy Results. World Neurosurg 2022; 172:e107-e119. [PMID: 36566979 DOI: 10.1016/j.wneu.2022.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cerebral myxomatous aneurysms (CMA) are intracranial aneurysms caused by cardiac myxoma. The exact mechanism underlying their development has not yet been elucidated. And an optimal treatment method has not yet been established because of rarity of the disease. In addition, most existing reports have had a short follow-up period or lack of follow-up imaging test results. The aim of this study was to provide better insights into the course and treatment options of CMAs. METHODS We describe 4 CMA patients treated in our hospital and literature search was performed using PubMed and Embase databases. Keywords used were as follows: "cerebral myxomatous aneurysm", "myxomatous aneurysm", "cardiac myxoma", and "intracranial aneurysm". Only publications in English and related to this disorder with adequate follow-up periods and aneurysmal wall biopsy results were included. Clinical, radiological, pathological, and treatment characteristics were analyzed. RESULTS A total of 134 CMA cases were managed conservatively that included 5 enlargements, 6 regressions, and 120 stable aneurysms, which were identified for a total of 453.33 aneurysm years (1.76% per aneurysm year, 1.32% per aneurysm year, and 26.47% per aneurysm year, respectively). Poor outcome rate was high in cases with hemorrhage (either parenchymal or subarachnoidal hemorrhage) due to rupture of the CMA (46.67%, 7 out of 15). Thirteen cases had aneurysm biopsy results of which 11 showed tumor invasion on the aneurysm wall. CONCLUSIONS Even though the natural course of unruptured, benign-looking CMAs appears to be favorable, the presence or absence of viable tumor cells in the aneurysm may promote an unfavorable disease course. In the case of large, symptomatic, and enlarging CMAs, surgical, endovascular, or combined treatment should be considered as the mortality and morbidity due to rupture might be high.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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14
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Seo D, Yoon BH, Byun J, Park W, Park JC, Ahn JS. Pseudoaneurysm formation or dural arteriovenous fistula formation at the middle meningeal artery following revascularization surgery in Moyamoya disease. J Cerebrovasc Endovasc Neurosurg 2022; 25:87-92. [PMID: 36153860 PMCID: PMC10073767 DOI: 10.7461/jcen.2022.e2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Moyamoya disease (MMD) is a rare progressive steno-occlusive cerebrovascular disorder. Currently, revascularization surgery is used as optimal treatment to overcome MMD. However, revascularization for MMD has reported several complications. Also, iatrogenic complications such as pseudoaneurysms formation or dural arteriovenous fistulas (dAVFs) formation-has been identified in rare cases after the surgical intervention for revascularizations. We describe two cases. In first case, the patency of the anastomosis site was good and saccular type pseudoaneurysm formation was found at parietal branch of posterior middle meningeal artery (MMA) in transfemoral cerebral angiography (TFCA) performed on the twelfth day after surgery. We decided to treat pseudoaneurysm by endovascular embolization the next day, but the patient was shown unconsciousness and anisocoria during sleep at that day. Computed tomography showed massive subdural hemorrhage at the ipsilateral side, thus we performed decompressive craniectomy and hematoma evacuation. In second case, the patency of the anastomosis site was good and dAVF formation at right MMA was found in TFCA performed on the sixth day after surgery. We performed endovascular obliteration of the arteriovenous fistula under local anesthesia. Pseudoaneurysm formation or dAVF formation after revascularization surgery is an exceptional case. If patients have such complications, practioner should carefully screen the patients by implementing digital subtraction angiogram to identify anatomic features; as well as consider immediate treatment in any way, including embolization or other surgery.
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Affiliation(s)
- Dongok Seo
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Byul Hee Yoon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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15
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Deniwar MA, Kwon B, Song Y, Park JC, Lee DH. Use of a Rigid-Tipped Microguidewire for the Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistulas with an Occluded Inferior Petrosal Sinus. J Korean Neurosurg Soc 2022; 65:688-696. [PMID: 35853478 PMCID: PMC9452388 DOI: 10.3340/jkns.2021.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Transvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire.
Methods In this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated.
Results Despite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications.
Conclusion The use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe.
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Affiliation(s)
- Mohamed Adel Deniwar
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Neurosurgery, Mansoura University Hospitals, Mansoura, Egypt
| | - Boseong Kwon
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institutue of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Hong CK, Byun J, Park W, Kim YH, Park JC, Ahn JS, Kim JH. Management of Internal Carotid Artery Injury During Transsphenoidal Surgery: A Case Series and Suggestion for Optimal Management. World Neurosurg 2022; 163:e230-e237. [PMID: 35364296 DOI: 10.1016/j.wneu.2022.03.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Internal carotid artery (ICA) injury during transsphenoidal surgery is a rare but serious complication. We analyzed a series of ICA injuries that occurred during a transsphenoidal approach to suggest an optimal management strategy. METHODS Between January 2015 and May 2020, we enrolled 10 cases of ICA injury at our institution. RESULTS Among the 10 patients enrolled, 5 had pituitary adenoma, 2 had craniopharyngioma, and 1 each had skull base chondrosarcoma, tuberculum sellae meningioma, and nasopharyngeal cancer; 4 were revision surgery cases. The cavernous segment of the ICA was the most commonly injured area. The most common reason for ICA injury was a drill injury at the sellar floor opening. A direct repair was performed using a clip in only 1 patient. In the others, bleeding control of the injured ICA was achieved by packing multiple cotton pads. After angiography, 6 patients underwent immediate endovascular sacrifice of the injured ICA. In 3 patients who showed poor collateral flow from the anterior communicating and posterior communicating arteries, revascularization surgery was performed before endovascular trapping. After 6 postoperative months, 6 patients showed favorable functional outcomes, and 4 patients showed poor functional outcomes. CONCLUSIONS Prompt control of bleeding, endovascular management of injured ICA, and consideration of revascularization surgery based on collateral flow may prevent catastrophic neurological sequelae.
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Affiliation(s)
- Chang Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neuro-intervention, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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17
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Ban SP, Kwon OK, Kim YD, Kim BT, Oh JS, Kim KM, Kim CH, Kim CH, Choi JH, Kim YW, Lim YC, Byoun HS, Park SQ, Chung J, Park KY, Park JC, Kwon HJ. Optimal duration of dual antiplatelet therapy after stent-assisted coil embolization of unruptured intracranial aneurysms: A prospective randomized multicenter trial. J Korean Neurosurg Soc 2022; 65:765-771. [PMID: 35707971 DOI: 10.3340/jkns.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Stent-assisted coil embolization (SAC) has been increasingly used to treat various types of intracranial aneurysms. Delayed thromboembolic complications are major concerns regarding this procedure, so dual antiplatelet therapy with aspirin and clopidogrel is needed. However, clinicians vary the duration of dual antiplatelet therapy after SAC, and no randomized study has been performed. This study aims to compare the safety and efficacy of long-term (12 months) dual antiplatelet therapy and short-term dual antiplatelet therapy (6 months) after SAC for patients with unruptured intracranial aneurysms (UIAs). Methods This is a prospective, randomized and multicenter trial to investigate the optimal duration of dual antiplatelet therapy after SAC in patients with UIAs. Subjects will receive dual antiplatelet therapy for 6 months (short-term group) or 12 months (long-term group) after SAC. The primary endpoint is the assessment of thromboembolic complications between 1 and 18 months after SAC. We will enroll 528 subjects (264 subjects in each group) and perform 1:1 randomization. This study will involve 14 top-performing, high-volume Korean institutions specializing in coil embolization. Results The trial will begin enrollment in 2022, and clinical data will be available after enrollment and follow-up. Conclusion This article describes that the aim of this prospective randomized multicenter trial is to compare the effect of short-term (6 months) and long-term (12 months) dual antiplatelet therapy on UIAs in patients undergoing SAC, and to find the optimal duration.
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Affiliation(s)
- Seung Pil Ban
- Departments of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Departments of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Departments of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Departments of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Deok Kim
- Departments of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Departments of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Bum-Tae Kim
- Departments of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Sang Oh
- Departments of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kang Min Kim
- Departments of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Departments of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chang Hyeun Kim
- Departments of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang-Hyun Kim
- Departments of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jai Ho Choi
- Departments of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Woo Kim
- Departments of Neurosurgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Yong Cheol Lim
- Departments of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Hyoung Soo Byoun
- Departments of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sukh Que Park
- Departments of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joonho Chung
- Departments of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Young Park
- Departments of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Departments of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyon-Jo Kwon
- Departments of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
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Lu G, Chung J, Park JC, Ahn JS, Kwun BD, Lee DH. Comparison of Visual Outcomes of Ophthalmic Artery Aneurysms Treated with Microsurgical Clipping and Endovascular Coiling. Neurointervention 2022; 17:18-27. [PMID: 35045591 PMCID: PMC8891588 DOI: 10.5469/neuroint.2020.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Post-treatment visual deficit is a major concern associated with both microsurgical clipping and endovascular coiling for the treatment of ophthalmic artery (OphA) aneurysms of the internal carotid artery. We aimed to compare the safety and effectiveness of the 2 modalities. MATERIALS AND METHODS We retrospectively reviewed and compared the baseline characteristics and postoperative visual and angiographic outcomes of OphA aneurysms treated by clipping or coiling between January 2010 and August 2018 at our hospital. In addition, the balloon occlusion test was performed to evaluate the safety of OphA occlusion. RESULTS This study included 56 aneurysms treated by clipping and 82 aneurysms treated by coiling. Both the immediate and follow-up rates of incomplete aneurysm occlusion were comparable between the 2 groups (21.4% vs. 22.0%; 24.4% vs. 23.6%). The incidence of post-treatment visual deficits was higher in the clipping group than in the coiling group (16.1% vs. 2.4%; P=0.010). We observed total ipsilateral OphA occlusion in 6 patients and near occlusion in 3 patients during endovascular coiling; however, only 1 patient with near OphA occlusion showed a post-treatment visual field defect. CONCLUSION OphA aneurysms treated by endovascular coiling exhibited an aneurysm occlusion rate similar to that of microsurgical clipping with fewer post-treatment visual deficits. The total occlusion of OphA with adequate collaterals did not cause post-treatment visual deficits.
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Affiliation(s)
- Guangdong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jaewoo Chung
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoon BH, Byun J, Kim M, Lee S, Park JC, Ahn JS, Park W. The Influence of Neurological Disorders Before Cardiac Myxoma Surgery on the Rate of Postoperative Recurrences: Analysis of 317 Patients in a Single Center. World Neurosurg 2021; 158:e128-e137. [PMID: 34710580 DOI: 10.1016/j.wneu.2021.10.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac myxoma is a very rare disease for which resection is the gold standard treatment. Many neurological manifestations are associated with this disease, including embolic infarctions, arterial aneurysms, and brain metastatic myxomas, but few large-scale studies have addressed this. The aim of this study was to retrospectively analyze the incidence, type, and prognosis of these neurological disorders. METHODS We enrolled 317 patients who underwent a cardiac myxoma resection between 2004 and 2019 at our institution. A retrospective review of medical records and radiological imaging was performed for each patient, and clinical factors were compared and analyzed with regard to clinical outcomes and the incidence of adverse events. RESULTS Patients with a neurological disorder before surgery were found to be more likely to develop new postoperative neurological complications (P = 0.003). Patients with a neurological disorder arising at any time before or after surgery had poorer outcomes (P < 0.001). CONCLUSIONS The clinical management of cardiac myxoma must take account of neurological sequelae independently of the surgical intervention to remove the lesion. Patients with cardiac myxoma and any neurological disorder should undergo both neurosurgical follow-up and cardiac surgical follow-up, even if myxoma removal surgery has been performed. We recommend active neuroimaging during long-term follow-up as essential in these cases.
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Affiliation(s)
- Byul Hee Yoon
- Department of Neurosurgery, Uijeongbu Eulji Medical Center, Uijeongbu city, Gyeonggi-do, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Cho SH, Denewar M, Park W, Ahn JS, Kwun BD, Lee DH, Park JC. Corrigendum to "Intraprocedural Rupture of Unruptured Cerebral Aneurysms During Coil Embolization: A Single-Center Experience" [World Neurosurgery 105 (2017) 177-183]. World Neurosurg 2021; 149:511. [PMID: 33744167 DOI: 10.1016/j.wneu.2021.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Su Hee Cho
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Mohammed Denewar
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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21
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Kim M, Byun J, Chung Y, Lee SU, Park JE, Park W, Park JC, Ahn JS, Lee S. Reactive Oxygen Species Scavenger in Acute Intracerebral Hemorrhage Patients: A Multicenter, Randomized Controlled Trial. Stroke 2021; 52:1172-1181. [PMID: 33626901 DOI: 10.1161/strokeaha.120.032266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Moinay Kim
- Department of Neurosurgery (M.K., J.B., W.P., J.C.P., J.S.A., S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joonho Byun
- Department of Neurosurgery (M.K., J.B., W.P., J.C.P., J.S.A., S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.C.)
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Republic of Korea (S.U.L.)
| | - Ji Eun Park
- Department of Radiology (J.E.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery (M.K., J.B., W.P., J.C.P., J.S.A., S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery (M.K., J.B., W.P., J.C.P., J.S.A., S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery (M.K., J.B., W.P., J.C.P., J.S.A., S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery (M.K., J.B., W.P., J.C.P., J.S.A., S.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Byun J, Park W, Park JC, Ahn JS. Clinical Outcomes of Large (>10 mm) Unruptured Posterior Circulation Aneurysms and Their Predictors. J Korean Neurosurg Soc 2020; 64:39-50. [PMID: 33353291 PMCID: PMC7819800 DOI: 10.3340/jkns.2020.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022] Open
Abstract
Objective The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation.
Methods This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018.
Results There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Posttreatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status.
Conclusion Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.
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Affiliation(s)
- Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yim Y, Jung SC, Kim JY, Kim SO, Kim BJ, Lee DH, Park W, Park JC, Ahn JS. Added diagnostic values of three-dimensional high-resolution proton density-weighted magnetic resonance imaging for unruptured intracranial aneurysms in the circle-of-Willis: Comparison with time-of-flight magnetic resonance angiography. PLoS One 2020; 15:e0243235. [PMID: 33270756 PMCID: PMC7714200 DOI: 10.1371/journal.pone.0243235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/17/2020] [Indexed: 01/18/2023] Open
Abstract
Background Advanced imaging methods can enhance the identification of aneurysms of the infundibula, which can reduce unnecessary follow-ups or further work-up, fear, and anxiety in patients. Purpose This study aimed to evaluate the added diagnostic value of three-dimensional proton density-weighted vessel wall magnetic resonance imaging (3D-PD MRI) in identifying aneurysms from index lesions refer to vascular bulging lesions without vessels arising from the apex, observed using volume-rendered TOF-MRA in the circle-of-Willis compared with time-of-flight magnetic resonance angiography (TOF-MRA). Study type Retrospective. Population A total of 299 patients who underwent 3D-PD MRI, digital subtraction angiography (DSA), and TOF-MRA between January 2012 and December 2016 were retrospectively enrolled in this study. Field strength/sequence 3 Tesla, 3D-PD MRI. Assessment Three neuroradiologists independently evaluated TOF-MRA and 3D-PD MRI combined with TOF-MRA for the determination of intracranial aneurysms in patients with index lesions within the circle of Willis. Final diagnoses were made by another neuroradiologist and neurointerventionist in consensus using DSA as the reference standard. The diagnostic performance and proportions of undetermined lesions on TOF-MRA and 3D-PD MRI with TOF-MRA were assessed based on the final diagnoses. Statistical tests The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of unruptured intracranial aneurysms were calculated for each imaging modality. Results Of 452 lesions identified on volume-rendered TOF-MRA images, 173 (38%) aneurysms and 276 (61%) infundibula were finally diagnosed on DSA. 3D-PD MRI with TOF-MRA showed superior diagnostic performance (p = .001; accuracy, 85.5% versus 95.4%), superior area under the receiver operating characteristic curve over TOF-MRA (p = .001; 0.837 versus 0.947), and a lower proportion of undetermined lesions than TOF-MRA (p = .001; 25.1% versus 2.3%). Data conclusion For unruptured intracranial aneurysms in the circle of Willis, 3D-PD MRI can complement TOF-MRA to improve diagnostic performance and lower the proportion of undetermined lesions.
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Affiliation(s)
- Younghee Yim
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - Jung Youn Kim
- Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Jun Kim
- Department of Radiology, University of Korea College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kang DU, Park JC, Hwang SW, Park SH, Yang DH, Kim KJ, Ye BD, Myung SJ, Yang SK, Byeon JS. Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasia with or without the hybrid technique. Colorectal Dis 2020; 22:2008-2017. [PMID: 32866340 DOI: 10.1111/codi.15339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/04/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
AIM The main aim of this study was to compare the long-term outcome of a conventional colorectal endoscopic submucosal dissection (ESD) in which submucosal dissection was continued throughout until the completion of resection (ESD-T) to hybrid endoscopic submucosal dissection (ESD-H) in the colorectum. METHOD Medical records of 836 colorectal neoplasia patients treated by ESD-T or ESD-H were reviewed. ESD-H was defined as colorectal ESD with additional snaring in the final stage of the procedure. Primary outcomes were the overall and metastatic recurrence rates. Secondary outcomes were short-term outcomes such as the en bloc resection rate, procedure time and adverse events. RESULTS The overall recurrence rate was higher in the ESD-H than in the ESD-T group (5.7% vs 0.7%, P = 0.001). The metastatic recurrence rate showed no significant difference between these groups (1.4% vs 1.4%, P = 1.000). Multivariate analysis revealed that a failed en bloc resection (hazard ratio 24.097; 95% CI 5.446-106.237; P < 0.001) and larger tumour size (hazard ratio 1.042; 95% CI 1.014-1.070; P = 0.003) were independently associated with overall recurrence. The ESD-H group showed a lower en bloc resection rate (56.8% vs 96.5%, P < 0.001), shorter procedure time (45.6 vs 54.3 min, P < 0.001) and higher perforation rate (10.3% vs 6.0%, P = 0.029). CONCLUSION Although long-term outcomes in terms of overall recurrence are inferior following ESD-H, a failed en bloc resection and large tumour size are the only independent risk factors for recurrence. Further investigations are warranted to improve the long-term outcomes of ESD-H.
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Affiliation(s)
- D U Kang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J C Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S W Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S H Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D H Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - K J Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - B D Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S J Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S K Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J S Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoon BH, Byun J, Park YS, Kim M, Lee JS, Park W, Park JC, Ahn JS. Clinical Interrogation of Mandatory Insertion of Central Venous Catheter for Clipping Surgery of Unruptured Intracranial Aneurysm: A Propensity Score Matched Study. World Neurosurg 2020; 146:e405-e412. [PMID: 33250188 DOI: 10.1016/j.wneu.2020.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Microsurgical clipping, along with endovascular treatment, has evolved in the treatment of unruptured intracranial aneurysms (UIA), and these developments have resulted in a reduction of the complication rate. We discuss the need for a central venous catheter (CVC) insertion as an anesthetic preparation for microsurgical clipping. METHODS Between January 2019 and September 2019, 722 patients with UIA were treated at our institution. We excluded patients with a history of endovascular treatment or bypass surgery, recurrent aneurysms after coil embolization, brain tumors, or subarachnoid hemorrhages. A total of 272 patients were enrolled. Eighty-four patients underwent CVC insertion, and 188 patients underwent clipping surgery without CVC insertion. Outcome-related factors were compared between the 2 groups. We performed propensity score matching of the 2 groups to increase comparability. RESULTS There were no significant differences in outcome, sex, aneurysm location, aneurysm multiplicity, aneurysm size, or comorbid disease between the 2 groups. The mean age at the time of surgery was higher in the non-CVC insertion group than in the CVC insertion group. There were no meaningful differences in primary outcomes, including premature rupture and intraoperative motor evoked potential/somatosensory evoked potential change, and secondary outcomes, including estimated blood loss, duration of intensive care unit stay, duration of hospitalization, and Glasgow Outcome Scale score at discharge. CONCLUSIONS CVC insertion for clipping surgery for UIA is not mandatory. Considering the possible complications associated with CVCs, we cautiously suggest aneurysm surgery with CVC insertion in patients with serious medical comorbidities, aneurysm sizes >10 mm, and difficult proximal parent artery control.
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Affiliation(s)
- Byul Hee Yoon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yong Seok Park
- Department of Anesthesiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim DJ, Park W, Park JC, Ahn JS, Lee DH, Byun J. Microsurgical treatment of lateral cavernous sinus wall dural arteriovenous fistula with large venous aneurysm: A case report. J Cerebrovasc Endovasc Neurosurg 2020; 23:41-48. [PMID: 33017880 PMCID: PMC8041508 DOI: 10.7461/jcen.2020.e2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
We report a case of lateral cavernous sinus wall dural arteriovenous fistula (DAVF) accompanied large venous aneurysm which is presented intracerebral hemorrhage (ICH). A 58-year-old male patient came to emergency department for acute onset of headache and dysarthria. In brain computed tomography scan, large left temporal lobe ICH was noted. In transfemoral cerebral angiography, multiple arteries from external carotid artery and left internal carotid artery (ICA) fed arteriovenous shunt. This shunt was drained through cavernous sinus with enlarged multiple cortical veins. One large venous aneurysm was estimated as bleeding focus for ICH. Considering ICH and high flow shunt, we planned urgent treatment to reduce flow of arteriovenous shunt. However, transvenous embolization was failed due to tortuous venous anatomy. Therefore, we planned craniotomy and microsurgical treatment. There was engorged small vessel in lateral wall of cavernous sinus and vascular trunk which is fistulous connection was noted. Fistula connection was obliterated and disconnected after coagulation. In postoperative image, fistula was completely disappeared and there was no cortical venous reflux, also large venous aneurysm was disappeared. Patient recovered very well without new neurological deficits. We reported successfully treated lateral cavernous sinus wall DAVF by combined endovascular and transcranial-microsurgical treatment.
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Affiliation(s)
- Dong Jin Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Chung J, Lee S, Park JC, Ahn JS, Park W. Scalp thickness as a predictor of wound complications after cerebral revascularization using the superficial temporal artery: a risk factor analysis. Acta Neurochir (Wien) 2020; 162:2557-2563. [PMID: 32691266 DOI: 10.1007/s00701-020-04500-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cerebral revascularization using the superficial temporal artery diverts some of the blood supply from the scalp to the brain. This may compromise the blood supply to the scalp and could result in more wound complications. OBJECTIVE This retrospective chart review aimed to identify the incidence of, and independent risk factors for, wound complications after cerebral revascularization using the superficial temporal artery. METHODS Patients who underwent cerebral revascularization using the superficial temporal artery between January 2003 and February 2017 were studied. Minor wound complications included superficial skin necrosis, and mild wound dehiscence, while major wound complications included full-thickness skin necrosis, deep infection, and osteomyelitis that required additional surgical treatment. RESULTS A total of 482 cerebral revascularization procedures using the superficial temporal artery were included. Wound complications developed in 32 cases (6.6% of the total), including 7 classified as major in severity (1.5% of the total). The multivariate analysis revealed diabetes mellitus (odds ratio 4.058, p = 0.001), low body mass index (odds ratio 1.21, p = 0.009), and thin scalp (odds ratio 1.82, p < 0.001) as the main risk factors for wound complications. Every 1-mm increase in scalp thickness was associated with a protective effect on wound complications (odds ratio 0.549). CONCLUSION Cerebral revascularization using the superficial temporal artery was associated with a relatively high incidence of wound complications. Diabetes mellitus, low body mass index, and thin scalp were found to be independent risk factors for wound complications. The thickness of the scalp could be a useful predictor of wound complications.
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Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, Dankook University Hospital, Cheonan, South Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Kim DJ, Heo Y, Byun J, Park JC, Ahn JS, Lee DH, Kwun BD, Park W. Role of microsurgery for treatment of posterior circulation aneurysms in the endovascular era. J Cerebrovasc Endovasc Neurosurg 2020; 22:141-155. [PMID: 32971573 PMCID: PMC7522389 DOI: 10.7461/jcen.2020.22.3.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Dong Jin Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Yeon Heo
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Kyunghee University School of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Byun J, Kim M, Park W, Park JC, Ahn JS. Middle Cerebral Artery-to-Middle Cerebral Artery Bypass with Superficial Temporal Artery Interposition Graft for the Treatment of Recurrent Thrombosed Middle Cerebral Artery Aneurysm. World Neurosurg 2020; 143:17. [PMID: 32659358 DOI: 10.1016/j.wneu.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Abstract
Microsurgical treatment of thrombosed middle cerebral artery (MCA) aneurysm is very complicated, especially in recurrent cases. A 48-year-old man presented with a recurrent thrombosed right MCA aneurysm. We performed MCA-to-MCA bypass using a superficial temporal artery (STA) interposition graft and proximal trapping. Initially, an STA-to-MCA bypass with aneurysm trapping was planned because 1 MCA branch of the superior trunk of the M2 segment needed flow replacement after aneurysm trapping. However, the blood flow from the proximal STA was insufficient because of the previous surgical trauma and redo clipping was not feasible. As the backflow from the distal STA segment was good, we used it as an interposition graft for the MCA-to-MCA bypass. The patient recovered well without any neurologic deficits. In this case, the recurrent aneurysm was a fusiform MCA-M2 segment aneurysm with clip slippage. Our initial surgical plan could not be executed. We changed our surgical plan to an MCA-interposition graft-MCA bypass considering the mobility of the M3 arteries. The options for interposition grafts included radial artery, saphenous vein, or ipsilateral or contralateral STA. The caliber discrepancy in the radial artery or saphenous vein grafts makes them less suitable. Further, harvesting the contralateral STA is time-consuming and tedious. Thus the ipsilateral STA interposition graft was used and showed promising results. We recommend this surgical technique in cases in which good STA backflow is guaranteed. In conclusion, revision surgery performed for a recurrent thrombosed MCA aneurysm with an MCA-STA interposition graft-MCA bypass with proximal trapping was successful. This technique is safe and effective for complex aneurysms with suboptimal condition of the STA, which could be due to reduced blood flow, previous surgery, or trauma.
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Affiliation(s)
- Joonho Byun
- Department of Neurosurgery, Medical College of the University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Medical College of the University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Medical College of the University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Medical College of the University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Medical College of the University of Ulsan, Asan Medical Center, Seoul, Korea.
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Park YH, Lee YS, Seo YM, Seo H, Park JS, Bae HS, Park JC. Midkine Promotes Odontoblast-like Differentiation and Tertiary Dentin Formation. J Dent Res 2020; 99:1082-1091. [PMID: 32442055 DOI: 10.1177/0022034520925427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Autophagy is an intracellular self-degradation process that is essential for tissue development, cell differentiation, and survival. Nevertheless, the role of autophagy in tooth development has not been definitively identified. The goal of this study was to investigate how autophagy is involved in midkine (MK)-mediated odontoblast-like differentiation, mineralization, and tertiary dentin formation in a mouse tooth pulp exposure model. In vitro studies show that MK and LC3 have similar expression patterns during odontoblast-like cell differentiation. Odontoblast-like cell differentiation is promoted through MK-mediated autophagy, which leads to increased mineralized nodule formation. Subcutaneous transplantation of hydroxyapatite/tricalcium phosphate with rMK-treated human dental pulp cells led to dentin pulp-like tissue formation through MK-mediated autophagy. Furthermore, MK-mediated autophagy induces differentiation of dental pulp cells into odontoblast-like cells that form DSP-positive tertiary dentin in vivo. Our findings may provide 1) novel insight into the role of MK in regulating odontoblast-like differentiation and dentin formation in particular via autophagy and 2) potential application of MK in vital pulp therapy.
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Affiliation(s)
- Y H Park
- Laboratory for the Study of Regenerative Dental Medicine, Department of Oral Histology-Developmental Biology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Y S Lee
- Laboratory for the Study of Regenerative Dental Medicine, Department of Oral Histology-Developmental Biology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Y M Seo
- Laboratory for the Study of Regenerative Dental Medicine, Department of Oral Histology-Developmental Biology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - H Seo
- Laboratory for the Study of Regenerative Dental Medicine, Department of Oral Histology-Developmental Biology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - J S Park
- Department of Dental Hygiene, Seoyeong University, Gwang-ju, Republic of Korea
| | - H S Bae
- Department of Oral Hygiene, Namseoul University, Cheonan, Republic of Korea
| | - J C Park
- Laboratory for the Study of Regenerative Dental Medicine, Department of Oral Histology-Developmental Biology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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Byun J, Kwon DH, Lee DH, Park W, Park JC, Ahn JS. Radiosurgery for Cerebral Arteriovenous Malformation (AVM) : Current Treatment Strategy and Radiosurgical Technique for Large Cerebral AVM. J Korean Neurosurg Soc 2020; 63:415-426. [PMID: 32423182 PMCID: PMC7365281 DOI: 10.3340/jkns.2020.0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/29/2020] [Indexed: 11/27/2022] Open
Abstract
Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system. AVM harbors 2.2% annual hemorrhage risk in unruptured cases and 4.5% annual hemorrhage risk of previously ruptured cases. Stereotactic radiosurgery (SRS) have been shown excellent treatment outcomes for patients with small- to moderated sized AVM which can be achieved in 80–90% complete obliteration rate with a 2–3 years latency period. The most important factors are associated with obliteration after SRS is the radiation dose to the AVM. In our institutional clinical practice, now 22 Gy (50% isodose line) dose of radiation has been used for treatment of cerebral AVM in single-session radiosurgery. However, dose-volume relationship can be unfavorable for large AVMs when treated in a single-session radiosurgery, resulting high complication rates for effective dose. Thus, various strategies should be considered to treat large AVM. The role of pre-SRS embolization is permanent volume reduction of the nidus and treat high-risk lesion such as AVM-related aneurysm and high-flow arteriovenous shunt. Various staging technique of radiosurgery including volume-staged radiosurgery, hypofractionated radiotherapy and dose-staged radiosurgery are possible option for large AVM. The incidence of post-radiosurgery complication is varied, the incidence rate of radiological post-radiosurgical complication has been reported 30–40% and symptomatic complication rate was reported from 8.1% to 11.8%. In the future, novel therapy which incorporate endovascular treatment using liquid embolic material and new radiosurgical technique such as gene or cytokine-targeted radio-sensitization should be needed.
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Affiliation(s)
- Joonho Byun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kwon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Heui Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim M, Park W, Chung Y, Lee SU, Park JC, Kwon DH, Ahn JS, Lee S. Development and validation of a risk scoring model for postoperative adult moyamoya disease. J Neurosurg 2020; 134:1505-1514. [PMID: 32384266 DOI: 10.3171/2020.2.jns193221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current grading system for moyamoya disease (MMD) is focused on angiographic studies with limited clinical application. The authors aimed to determine relevant factors that may impact postoperative outcome and establish a scoring system to predict the functional outcome. METHODS Adult patients with MMD who underwent treatment between 1998 and 2016 were included. Factors such as age, sex, comorbidity, smoking, MMD family history, initial presentation, multimodal imaging modalities, and types of surgical revascularization were thoroughly reviewed. These factors were analyzed to determine possible risk factors related to unfavorable 6-month postoperative outcomes using the modified Rankin Scale (mRS) (unfavorable: mRS score ≥ 3). A scoring system was developed using these independent risk factors to predict the outcome and validated using prospectively collected data from multiple centers between 2017 and 2018. RESULTS Of 302 patients for whom applications were submitted, 260 patients (321 hemispheres) met the diagnostic criteria. In multivariate analysis, hyperlipidemia, smoking, cerebral infarction on preoperative CT or MRI, and moderately to severely reduced regional cerebrovascular reserve results from Diamox SPECT were significantly related to unfavorable outcome. The authors developed a scoring system and stratified patients into risk groups according to their scores: low-risk (score 0-3), intermediate-risk (score 4-6), and high-risk (score 7-9) groups. This model demonstrated both good discrimination and calibration using C-statistics and the Hosmer-Lemeshow goodness-of-fit test showing 0.812 (95% CI 0.743-0.881) (p = 0.568) for the development and 0.954 (95% CI 0.896-1) (p = 0.097) for the temporal and external validation cohort. CONCLUSIONS The authors' scoring system is readily adoptable to predict the postoperative outcome for MMD. Their data revealed the importance of smoking and hyperlipidemia, which were the only modifiable factors included in the scoring system. The authors validated their scoring system both internally and externally and maintained good performance, highlighting the system's generalizability and reliability.
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Affiliation(s)
- Moinay Kim
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Wonhyoung Park
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Yeongu Chung
- 2Department of Neurosurgery, Kangbuk Samsung Medical Center Hospital, Seoul; and
| | - Si Un Lee
- 3Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Cheol Park
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Do Hoon Kwon
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Jae Sung Ahn
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Seungjoo Lee
- 1Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Song Y, Sheen JJ, Kim JG, Lee SH, Cho SH, Park JC, Choi CG, Lee DH. Alpha Stent for Coiling of Unruptured, Wide-Necked, Distal Internal Carotid Artery Aneurysms: Safety and Effectiveness at 6 Months. Korean J Radiol 2020; 21:228-235. [PMID: 31997598 PMCID: PMC6992434 DOI: 10.3348/kjr.2019.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/17/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Alpha stent (CGBio), a new intracranial stent featuring a re-sheathable mesh design with improved wall apposition at the curved segment, was clinically evaluated. We report the 6-month follow-up results from a prospective, single-center study in which the stent was used for coiling of wide-necked distal internal carotid artery (ICA) aneurysms. MATERIALS AND METHODS Between April 2016 and 2018, 50 patients (mean age, 56.5 years, 45 females [90%]) with 54 unruptured distal ICA aneurysms (average diameter: 5.6 ± 1.7 mm) were enrolled. The primary endpoint for effectiveness was successful coil embolization with the Alpha stent, and subsequent complete or near-complete occlusion at the 6-month magnetic resonance angiography assessment. The primary safety endpoint was the absence of serious adverse events (SAEs) up to 6 months from the procedure. RESULTS The primary effectiveness endpoint was observed in 94.4% (51/54) aneurysms. In one patient with technical failure, the stent could not be deployed because of parent artery tortuosity; therefore, a different type of stent was used. Of the 53 aneurysms treated with the Alpha stent, complete occlusion was achieved in 64.1% (34/53) cases, and near-complete occlusion was achieved in 32.0% (17/53) cases by the 6-month follow-up. Two cases (3.7%) required retreatment because of major recurrence. In 4% (2/50) patients, SAEs, i.e., retinal artery thromboembolism and corona radiata lacunar infarction, were reported after the procedure. CONCLUSION For endovascular treatment of unruptured, wide-necked, distal ICA aneurysms, coil embolization using the newly developed Alpha stent showed excellent procedural and mid-term clinical follow-up results in terms of effectiveness and safety.
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Affiliation(s)
- Yunsun Song
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Jon Sheen
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joong Goo Kim
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Sang Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Su Hee Cho
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong Gon Choi
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Lee D, Lee DH, Park JC, Shin JH, Song Y, Chung J, Sheen JJ, Suh DC. Timing of Thrombosis in Embolization of Unruptured Intracranial Aneurysms : Tirofiban as Rescue Treatment. Clin Neuroradiol 2020; 31:125-133. [PMID: 31970464 DOI: 10.1007/s00062-019-00873-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Thrombosis is one of the main complications of endovascular treatment for unruptured intracranial aneurysms (UIA). This article reports the timing and initial location of thrombosis and prognosis after the use of tirofiban for performing coil embolization for UIA. METHODS This study retrospectively collected 1686 cases of intracranial aneurysms treated with coil embolization from January 2013 to February 2018. Ruptured cases were excluded. The presumed causes and timing of thrombosis, the response after tirofiban administration and the modified Rankin scale (mRS) score at 3 months were reviewed. RESULTS Of the 26 patients 76% were female and middle cerebral artery and basilar artery aneurysms accounted for 7 cases. The initial location of thrombosis was related to the stent (n = 14, 53.8%) or coil (n = 12, 46.2%). Of the patients 19 (73.1%) developed thrombosis during the procedure, and 5 patients (19.2%) developed it within 1 day of the procedure. Median duration between the thrombotic procedure and initial thrombosis was 38.5 min, 12 patients were symptomatic but more than half completely recovered after using tirofiban. Good clinical outcome (mRS 0-2) was seen in 92.3%. In the subgroup analysis, median time from the first thrombotic procedure to initial thrombosis within 1 day was 38.0 min (stent-related group) and 35.0 min (coil-related group, p = 0.651). CONCLUSION In most cases of embolization for UIA, thrombosis requiring the use of tirofiban occurs intraprocedurally or on the first day after the procedure. Careful observation of thrombosis during the procedure is important and tirofiban should be used for a better outcome even if the infarction progresses.
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Affiliation(s)
- Dongwhane Lee
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea (Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, Korea (Republic of).
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - Jae Ho Shin
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea (Republic of)
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, Korea (Republic of)
| | - Jaewoo Chung
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea (Republic of)
| | - Jae Jon Sheen
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea (Republic of)
| | - Dae Chul Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, Korea (Republic of)
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Chung J, Park W, Hong SH, Park JC, Ahn JS, Kwun BD, Lee SA, Kim SH, Jeon JY. Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases. J Neurosurg 2019; 130:936-948. [PMID: 29570008 DOI: 10.3171/2017.8.jns17791] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Somatosensory and motor evoked potentials (SEPs and MEPs) are often used to prevent ischemic complications during aneurysm surgeries. However, surgeons often encounter cases with suspicious false-positive and false-negative results from intraoperative evoked potential (EP) monitoring, but the incidence and possible causes for these results are not well established. The aim of this study was to investigate the efficacy and reliability of EP monitoring in the microsurgical treatment of intracranial aneurysms by evaluating false-positive and false-negative cases. METHODS From January 2012 to April 2016, 1514 patients underwent surgery for unruptured intracranial aneurysms (UIAs) with EP monitoring at the authors' institution. An EP amplitude decrease of 50% or greater compared with the baseline amplitude was defined as a significant EP change. Correlations between immediate postoperative motor weakness and EP monitoring results were retrospectively reviewed. The authors calculated the sensitivity, specificity, and positive and negative predictive values of intraoperative MEP monitoring, as well as the incidence of false-positive and false-negative results. RESULTS Eighteen (1.19%) of the 1514 patients had a symptomatic infarction, and 4 (0.26%) had a symptomatic hemorrhage. A total of 15 patients showed motor weakness, with the weakness detected on the immediate postoperative motor function test in 10 of these cases. Fifteen false-positive cases (0.99%) and 8 false-negative cases (0.53%) were reported. Therefore, MEP during UIA surgery resulted in a sensitivity of 0.10, specificity of 0.94, positive predictive value of 0.01, and negative predictive value of 0.99. CONCLUSIONS Intraoperative EP monitoring has high specificity and negative predictive value. Both false-positive and false-negative findings were present. However, it is likely that a more meticulously designed protocol will make EP monitoring a better surrogate indicator of possible ischemic neurological deficits.
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Affiliation(s)
| | | | | | | | | | | | | | - Sung-Hoon Kim
- 3Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Park H, Kim M, Jeong HK, Kim KH, Cho JY, Yoon HJ, Park JC. P1526Pre-dialysis left atrial function assessed by two-dimensional speckle tracking echocardiography as a predictor of upcoming heart failure in hemodialysis patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial global longitudinal strain (LA GLS) by 2-dimensional speckle tracking echocardiography is a useful tool to assess LA function and left ventricular (LV) diastolic function. The authors assessed prognostic value of LA GLS, and other diastolic functional parameters in patients undergoing hemodialysis.
Methods
A total of 78 (49 male) patients undergoing hemodialysis who checked echocardiography due to heart failure (HF) symptoms were included for this analysis. Echocardiography wasperformed at the same day of, and before hemodialysis session. Besides conventional echocardiographic measurements, GLS of the LA and the LV were checked and compared. Incidence of rehospitalization due to HF symptoms during mean follow up duration of 381.4±197.5 days was investigated and echocardiographic parameters were compared between patients who experienced rehospitalization and who did not.
Results
16 (20.1%) patients experienced rehospitalization due to HF. HF rehospitalization group had significantly low baseline LV ejection fraction (55.7±7.2 vs. 61.3±7.1%, p=0.006) and LV GLS (14.7±3.4 vs. 18.2±3.9%, p=0.002), while LV geometry (LV end-diastolic volume index and LV wall thickness) did not show significant differences. In HF rehospitalization group, baseline LA function and diastolic function were significantly impaired as reflected by LA GLS (18.8±2.6 vs. 23.8±3.6%, p<0.001), E/E' ratio (20.8±3.3 vs. 15.8±4.6%, p<0.001), and right ventricular systolic pressure (61.4±9.6 vs. 53.4±12.8%, p=0.022). LA end-systolic volume index was not significantly different between the 2 groups. Among various echocardiographic parameters, receiver operation characteristic curve analysis revealed that LA GLS had the strongest power (cutoff value 20.6%, sensitivity 0.813 and specificity 0.790, area under curve 0.849) in prediction of future rehospitalization due to HF.
Predictor of future HF: ROC analysis
Conclusions
The present study demonstrated that functional changes of the LA as measured by LA GLS before hemodialysis session can be used as an echocardiographic parameter to predict future rehospitalization due to HF. Further studies are required to evaluate prognostic value of LA function in predicting other cardiovascular events in hemodialysis patients.
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Affiliation(s)
- H Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - M Kim
- Chonnam National University Hospital, Nephrology, Gwangju, Korea (Republic of)
| | - H K Jeong
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - K H Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - J Y Cho
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - H J Yoon
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - J C Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
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Park H, Kim M, Jeong HK, Kim HY, Kim KH, Cho JY, Yoon HJ, Park JC. P688Cardiac dysfunction as a predictor of hepatic sinusoidal obstruction syndrome after hematopoietic cell transplantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hepatic sinusoidal obstruction syndrome (HSOS) is a well-known fatal complication of hematopoietic cell transplantation (HCT), but the impact of cardiac abnormalities on the occurrence of HSOS has been poorly evaluated. Therefore, the authors investigated whether the structural changes or dysfunction of the heart before HCT is associated with the future occurrence of HSOS.
Methods
A total of 92 patients who underwent HCT were divided into 2 groups; HSOS group (n=11, 6 males, 53.8±15.9 years) vs no HSOS group (n=81, 51 males, 48.6±14.7 years). According to the modified Seattle criteria, HSOS was defined as otherwise unexplained occurrence of 2 or more of the following events within 20 days of HCT; serum total bilirubin >2 mg/dL, hepatomegaly or right upper quadrant pain, sudden weight gain due to fluid accumulation (>2% of baseline body weight). Echocardiography examinations were performed 1 month before HCT, and echocardiographic findings were compared between the groups.
Results
HSOS was developed in 11 patients (12.0%). HSOS group had significantly larger left ventricular end-diastolic volume index (LVEDVI) (65.2±4.9 vs 53.2±6.9 ml/m2, p<0.001) and relatively worse systolic function than no HSOS group (LV ejection fraction: 56.4±3.4 vs 65.1±5.9%, p<0.001, LV global longitudinal strain: −17.9±1.4 vs −20.1±2.0%, p=0.001). LV diastolic functional parameters were also significantly worse in HSOS group than in no HSOS group (E/E' ratio: 11.3±1.8 vs 9.1±2.0, p=0.002, left atrial global longitudinal strain: 27.7±3.3 vs 34.9±5.9%, p<0.001). However, left atrial volume index was not different between the groups (30.8±2.8 vs 29.0±3.3 ml/m2, p=0.078). By receiver operation characteristic curve analysis, among significantly different variables, LVEDVI was the most powerful predictor for HSOS, and the optimal cutoff value was 59.25 mL/m2. (81.8% sensitivity and 77.8% specificity, AUC 0.909).
Predictor of HSOS: ROC analysis
Conclusions
The present study demonstrated that structural changes or dysfunction of the heart are more prevalent in patients with HSOS after HCT and larger LVEDVI, among them, can be a useful predictor of upcoming HSOS. Routine echocardiographic study before HCT would be useful to identify high risk group for HSOS, and the development of HSOS should be carefully monitored in HCT patients with cardiac structural changes or dysfunction on echocardiography.
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Affiliation(s)
- H Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - M Kim
- Chonnam National University Hospital, Nephrology, Gwangju, Korea (Republic of)
| | - H K Jeong
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - H Y Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - K H Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - J Y Cho
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - H J Yoon
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
| | - J C Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea (Republic of)
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Lee HS, Ahn JS, Park JC, Lee S, Kim M, Park W. Dominance of the Anterior Cerebral Artery as a Predictor of Vasospasm-Related Cerebral Infarction After Surgical Treatment of Ruptured Blood Blister-Like Aneurysm in the Internal Carotid Artery. World Neurosurg 2019; 130:e513-e524. [DOI: 10.1016/j.wneu.2019.06.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
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Bae SA, Yoon HJ, Kim KH, Kim HY, Park HJ, Cho JY, Jeong MH, Park JC. P671Impacts of echocardiography-defined pulmonary hypertension on clinical outcome in patients with multiple myeloma. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is a rarely reported complication of multiple myeloma (MM). PH of MM is usually mild to moderate and can be secondary to a variety of conditions, including left ventricular dysfunction, diastolic dysfunction, chronic heart failure, treatment-related toxicity, thrombophilic condition and precapillary involvement. However, only few reports regarding PH in MM incidence and prognosis exist up to now.
Purpose
The purpose of this study was to investigate the risk factors of transthoracic echocardiography-defined PH and its impact on clinical outcome in patients with MM.
Methods
A total of 277 MM patients was included and divided into 2 groups–those non-pulmonary hypertension (PH) or those with PH, based on the results of the transthoracic echocardiography (TTE); PH group (n=143, 60.9±9.2 years, 68 males) versus non-PH group (n=134, 55.9±11.5 years, 72 males). We analyzed propensity score matching and multiple imputation method were used to deal with the missing data in echocardiographic characteristics.
Results
During the follow-up period (median 618 days), all-cause death occurred in 79 (28.5%) patients and 41 patients (14.8%) died from cardiovascular causes (including acute decompensated heart failure, fatal MI, sudden cardiac arrest). In the Kaplan-Meier survival analysis of crude population and propensity-matched population, cumulative overall survival and cardiovascular death (CVD)-free survival were significantly lower in the PH group than in the non-PH group (p<0.001). In propensity-matched population, estimated pulmonary artery pressure >35mmHg in TTE, congestive heart failure, and DM were significant independent predictors of all-cause death.
KM curves in MM stratified by PH
Conclusion
This study demonstrates that the presence of PH, congestive heart failure, and DM is an independent prognostic factor for all-cause death in MM patients with MM. These results highlight the risk associated cardiovascular disease in MM patients and emphasize that management strategies that prevent deterioration of cardiac function are essential.
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Affiliation(s)
- S A Bae
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - H J Yoon
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - K H Kim
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - H Y Kim
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - H J Park
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - J Y Cho
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
| | - J C Park
- Chonnam National University Medical School, Department of Cardiovascular Medicine, Gwangju, Korea (Republic of)
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Ameri AH, Mooradian MJ, Emerick KS, Park JC, Wirth LJ, Asgari MM, Tsao H, Lawrence D, Sullivan RJ, Demehri S. Immunotherapeutic strategies for cutaneous squamous cell carcinoma prevention in xeroderma pigmentosum. Br J Dermatol 2019; 181:1095-1097. [PMID: 31102460 DOI: 10.1111/bjd.18144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- A H Ameri
- Center for Cancer Immunology and Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A.,Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - M J Mooradian
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - K S Emerick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 02114, U.S.A
| | - J C Park
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - L J Wirth
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - M M Asgari
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - H Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - D Lawrence
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - R J Sullivan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
| | - S Demehri
- Center for Cancer Immunology and Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A.,Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, U.S.A
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Chung Y, Park W, Park JC, Chung J, Ahn JS. Intra-Aneurysmal Rupture of an Atheroma during the Clipping of Large Atherosclerotic Aneurysm of the Middle Cerebral Artery: A Case Report with Video Demonstration. J Neurol Surg A Cent Eur Neurosurg 2019; 80:391-395. [PMID: 31140180 DOI: 10.1055/s-0039-1677826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ischemic complications including silent or symptomatic events are known to occur during the clipping of intracranial aneurysms, although at a relatively lower rate than during endovascular treatment. An atherosclerotic or calcified neck is one of the major contributors to postoperative ischemic sequelae from a surgically treated aneurysm. Atherosclerotic changes in intracranial vessels or within an aneurysm wall or neck area are often seen during surgery. However, we were not previously able to detect any showering of atheromatous emboli during temporary or permanent clipping procedures. We describe a case of an intra-aneurysmal rupture of a squeezed atheroma observed after permanent clipping of an atherosclerotic large middle cerebral artery aneurysm. After tentative clipping to treat the severe atherosclerotic aneurysm in this patient, we applied supplementary clipping to the atherosclerotic area of the aneurysmal sac. The resulting squeezing of the intra-aneurysmal atheroma caused a leakage into the subadventitial layer of the aneurysmal sac. We also discuss the potential ischemic complications of aneurysmal clipping surgery. We conclude that the surgical techniques used to treat these specific aneurysms require circumspect planning through a review of preoperative images.
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Affiliation(s)
- Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jaewoo Chung
- Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
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Lee HS, Park W, Kim YH, Park JC, Ahn J, Kim JH. Follow-Up and Treatment of Patients with Coexisting Brain Tumor and Intracranial Aneurysm. World Neurosurg 2019; 129:e73-e80. [PMID: 31082556 DOI: 10.1016/j.wneu.2019.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The association of primary brain tumors with coexisting unruptured intracranial aneurysms (UIAs) has been debated, and treatment strategies have not yet been established. We evaluated the flow association between brain tumors and coexisting UIAs and the outcomes of patients with brain tumor who did not receive treatment of coexisting UIAs. METHODS The medical records of patients with coexisting UIAs and brain tumors who had undergone surgical tumor resection were retrospectively analyzed to evaluate the incidence of UIAs according to tumor type, association of arterial feeder vessels and coexisting UIAs, and the occurrence of subarachnoid hemorrhage during the follow-up period for patients who had not receive treatment for the UIAs. RESULTS Of the 55 patients, 21 (38.9%) had undergone treatment of UIAs and 33 (61.1%) had received regular follow-up examinations without UIA treatment. Two patients (6.1%) developed subarachnoid hemorrhage. Of the 33 patients with astrocytic or oligodendroglial tumors who had not undergone treatment of UIAs, 2 had experienced an interval increase. Flow-related UIAs were found to be significantly more common in patients with astrocytic or oligodendroglial tumors than in those with tumors of other histological types (P = 0.01). CONCLUSIONS The incidence of UIAs among patients with primary brain tumors appears to be greater than that in the general population. An interval increase in aneurysm size and aneurysmal rupture was observed in 2 patients with astrocytic or oligodendroglial tumors. We would recommend perioperative treatment of flow-related UIAs in patients with astrocytic or oligodendroglial tumors and noninvasive evaluations such as magnetic resonance angiography if coexisting UIAs remain untreated.
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Affiliation(s)
- Heui Seung Lee
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jaesung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Chung J, Park W, Park JC, Kwun BD, Ahn JS. Characteristics of Peri-Internal Carotid Artery Bifurcation Aneurysms According to a New Anatomic Classification: How to Overcome Difficulties in the Microsurgical Treatment of Posteroinferiorly Projecting Carotid-A1 Junctional Aneurysms. World Neurosurg 2019; 126:e1219-e1227. [PMID: 30885871 DOI: 10.1016/j.wneu.2019.02.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Based on our clinical experience, posteroinferiorly projecting carotid-A1 junctional aneurysms are often difficult to treat microsurgically. Our objective was to classify peri-internal carotid artery (ICA) bifurcation aneurysms according to their location and analyze their characteristics. METHODS From January 2008 to October 2017, microsurgical or endovascular treatment of 6777 aneurysms were performed at our hospital. We identified 199 peri-ICA bifurcation aneurysms (2.94%) classified into true ICA bifurcation aneurysm, carotid-A1 junctional aneurysm, and carotid-M1 junctional aneurysm according to the anatomic location. Medical records including patient characteristics, aneurysm location, surgical method, any neurologic deficits, clinical outcomes, medical history, and radiologic findings were retrospectively reviewed. The anatomic position of the aneurysm was defined from the virtual surgical, anteroposterior, and lateral views, and the degree of agreement was calculated. RESULTS There were 103 true ICA bifurcation aneurysms, 92 carotid-A1 junctional aneurysms, and 4 carotid-M1 junctional aneurysms. Carotid-A1 junctional aneurysms tended to be smaller, elongated, and more often posteroinferiorly projecting than true ICA bifurcation aneurysms. Posteroinferiorly projecting carotid-A1 junctional aneurysms tended to require complex aneurysm surgery. The virtual surgical view had an almost perfect degree of agreement with the actual surgical view. CONCLUSIONS The characteristics of carotid-A1 junctional aneurysms and true ICA bifurcation aneurysms differ. In particular, carotid-A1 junctional aneurysms tend to have a posteroinferior projection and that causes difficulty in surgical treatment. We recommend the virtual surgical view for preoperative planning. Furthermore, an adequate Sylvian fissure opening and a strategic approach using appropriate devices to inspect blind spots should be considered for a successful treatment outcome.
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Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, KyungHee University College of Medicine, KyungHee University Medical Center, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Kim M, Lee HS, Lee S, Park JC, Ahn JS, Kwon DH, Kwun BD, Park W. Pediatric Intracranial Aneurysms: Favorable Outcomes Despite Rareness and Complexity. World Neurosurg 2019; 125:e1203-e1216. [PMID: 30794975 DOI: 10.1016/j.wneu.2019.01.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric intracranial aneurysms (IAs) are rare and differ from their adult counterparts in terms of their aneurysmal characteristics, presentation, treatment, and outcomes. Their treatment is often more difficult and complex compared with that of adults. However, studies outlining the clinical effect of pediatric IAs remain sparse. METHODS We retrospectively reviewed the data from patients aged ≤18 years admitted to our hospital from 2000 to 2017 with a diagnosis of IAs. RESULTS From the sample of 8207 patients with an IA diagnosis, 26 patients with 33 IAs were involved. Our cohort included 17 males and 9 females, with a mean age of 12.5 years. The mean follow-up duration was 4 years and 3 months. Seven patients (26.92%) were assumed to have a traumatic origin for their IAs. Ruptured aneurysms were more common than unruptured ones (61.53% vs. 38.46%). Complex features were observed in 14 aneurysms (42.42%). Initially, microsurgical and endovascular treatment were both performed in 10 patients (38.46%). A good recovery was obtained in 16 patients (61.54%) as determined by the Glasgow outcome scale scores at the 6-month follow-up visits. The complete obliteration of aneurysms was observed in 17 patients (65.38%). Endovascular treatment was the initial treatment in 3 patients with incomplete obliteration. CONCLUSIONS The treatment of pediatric IAs is challenging and technically demanding owing to their discrete nature compared with adult IAs and the need for greater surgical skills. We found a male predominance, with internal carotid artery bifurcation as the most frequent location of the aneurysms. Despite the greater incidence of ruptured and complex aneurysm cases, many patients had experienced a good recovery at the 6-month follow-up examinations.
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Affiliation(s)
- Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heui Seung Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do Hoon Kwon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Sheen JJ, Park W, Kwun BD, Park JC, Ahn JS. Microsurgical treatment strategy for large and giant aneurysms of the internal carotid artery. Clin Neurol Neurosurg 2019; 177:54-62. [DOI: 10.1016/j.clineuro.2018.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/15/2018] [Accepted: 12/16/2018] [Indexed: 11/27/2022]
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Jia ZY, Jiang YY, Woo JM, Hwang SM, Lim OK, Kim TI, Park JC, Lee HS, Kim ES, Lee DH. In Vitro Evaluation of Fusiform-Shaped Stents for Wide-Neck Intracranial Aneurysm Treatment. Neurointervention 2018; 13:117-123. [PMID: 30196682 PMCID: PMC6132037 DOI: 10.5469/neuroint.2018.00976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Wide-neck aneurysms (WNAs) associated with a dilated parent artery (PA) are not uncommon morphological abnormalities and usually cause inappropriate wall apposition and incomplete neck coverage of a tubular stent in stent-assisted coiling of aneurysms. We aimed to introduce a fusiform-shaped stent (FSS) and test its effectiveness in treating intracranial WNAs associated with a dilated PA using a three-dimensional (3D) model. MATERIALS AND METHODS Two FSS types were designed with the middle one-third segment dilated by 10% (FSS10) and 20% (FSS20) and were compared with the tubular-shaped stent (TSS). A patient-specific 3D WNA model was prototyped and produced, and in vitro stent placement was performed. Angiographic images of the three stent types were analyzed and compared using predetermined parameters. RESULTS The stent lumens were significantly larger in FSS10 and FSS20 than in TSS in the middle segments (P=0.046), particularly FSS20 (P=0.018). The non-covered area at the ostium tended to be smaller in FSS10 and FSS20 than in TSS, but the difference was not significant (P>0.05). The stent length was significantly longer in FSS10 and FSS20 than in TSS. The stent cell size was significantly larger in FSS than in TSS. CONCLUSION Better vessel wall apposition and aneurysmal neck coverage was observed for FSS than for TSS. No significant difference was observed between FSS10 and FSS20.
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Affiliation(s)
- Zhen Yu Jia
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan Yuan Jiang
- Department of Medical Biotechnology, Dongguk University, Goyang, Korea
| | - Jung Min Woo
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon Moon Hwang
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ok Kyun Lim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Deok Hee Lee
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Park W, Park ES, Lee S, Park JC, Chung J, Lee JM, Ahn JS. Intracranial Hemorrhage After Superficial Temporal Artery-Middle Cerebral Artery Direct Anastomosis for Adults with Moyamoya Disease. World Neurosurg 2018; 119:e774-e782. [PMID: 30096496 DOI: 10.1016/j.wneu.2018.07.266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intracranial hemorrhage, such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and intraventricular hemorrhage (IVH), is an extremely rare complication after surgical revascularization for moyamoya disease (MMD). However, the incidence, timing, prognosis, possible mechanism, and prevention are not well known. METHODS Adult patients with MMD who underwent direct bypass or combined bypass and experienced ICH, SAH, or IVH within 7 days postoperatively were enrolled in this study. The medical records and radiologic findings of these patients, together with their intraoperative video recordings, were reviewed retrospectively. RESULTS Direct superficial temporal artery (STA)-middle cerebral artery (MCA) bypass or combined bypass was performed for 222 hemispheres in 193 adult patients with MMD between January 2001 and December 2016. Intracranial hemorrhage occurred perioperatively in 8 hemispheres (3.6%) in 8 patients. The hemorrhages developed immediately after STA-MCA direct anastomosis during surgery in 3 patients. Hemorrhage on computed tomography and neurologic deterioration were also observed immediately postoperatively in 2 patients and during the postoperative period in 3 patients. Although 4 patients received medical management, neurosurgical treatment was needed in the other 4 patients. One patient died, and 6 patients were left with moderate or severe disabilities. CONCLUSIONS Intracranial hemorrhage (ICH, IVH, or SAH) after direct bypass for adult patients with MMD is an extremely rare but fatal complication. Although these hemorrhages can be associated with hyperperfusion syndrome, no effective prevention has been established.
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Affiliation(s)
- Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaewoo Chung
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Min Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kim MC, Ahn YK, Cho JY, Lee KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Hong YJ, Park HW, Kim JH, Jeong MH, Cho JG, Park JC. 469Optimal timing of extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated by profound cardiogenic shock after resuscitated cardiac arrest. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M C Kim
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - Y K Ahn
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - J Y Cho
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - K H Lee
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - D S Sim
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - H J Yoon
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - N S Yoon
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - K H Kim
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - Y J Hong
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - H W Park
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - J H Kim
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - M H Jeong
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - J G Cho
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - J C Park
- Chonnam National University Hospital, Gwangju, Korea Republic of
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49
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Park H, Kim M, Jeong HK, Kim KH, Kim HY, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC. P3506The impacts of cancer staging on cardiac function in multiple myeloma. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - M Kim
- Chonnam National University Hospital, Nephrology, Gwangju, Korea Republic of
| | - H K Jeong
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - K H Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - H Y Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - J Y Cho
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - H J Yoon
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - Y Ahn
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - M H Jeong
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - J G Cho
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - J C Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
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50
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Park H, Kim M, Jeong HK, Kim KH, Kim HY, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC. 6135Left atrial global longitudinal strain as a new predictor of cardiotoxicity in breast cancer patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - M Kim
- Chonnam National University Hospital, Nephrology, Gwangju, Korea Republic of
| | - H K Jeong
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - K H Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - H Y Kim
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - J Y Cho
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - H J Yoon
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - Y Ahn
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - M H Jeong
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - J G Cho
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
| | - J C Park
- Chonnam National University Hospital, Cardiology, Gwangju, Korea Republic of
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