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중대뇌동맥 동맥류 파열 환자의 출혈 양상에 대한 임상적 분석
김훈,심영보,황형식,최재준,김성민,박용기,최선길,Kim, Hun,Shim, Young Bo,Hwang, Hyung-Sik,Choi, Jae Jun,Kim, Sung Min,Park, Yong Kee,Choi, Sun Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6
Objectives : The rupture of middle cerebral artery(MCA) aneurysm usually cause or is associated with higher incidence of intracerebral hemorrhages(ICH) than any other aneurysmal ruptures. Also, the outcome of patients who had ICH is known to be worse than patients who had subarachnoid hemorrhage(SAH) only. The authors report the bleeding pattern and outcome of ruptured MCA aneurysm patients. Patients and Methods : A total 106 ruptured MCA aneurysm patients who were surgically treated were included and they were divided into 2 groups by the initial brain CT findings according to the presence or absence of ICH over 10cc in amount. The clinical data were analysed retrospectively. Results : The overall mortality was 18.9%. Among 81 patients(76.4%) who had subarachnoid hemorrhage(SAH) only, 68 patients(84%) showed favorable outcome. Twenty five patients(23.6%) had ICH over 10cc in amount with or without SAH, and among them, 11 patients(44%) showed favorable outcome. The ICH was located in temporal lobe(15 patients, 60%), frontal lobe(3, 12%), sylvian fissure(6, 24%) and frontal-temporal lobe(1, 4%). Among 15 patients who had ICH in temporal lobe, only 4 patients(26.6%) showed favorable outcome and all 3 patients who had ICH in frontal lobe showed favorable outcome. Conclusion : ICH was presented in 23.6% of ruptured MCA aneurysm patients and the prognosis of patients with ICH was worse than patients with SAH only. The ICH was located mainly in the temporal lobe and sylvian fissure.
김상우,김성민,심영보,최선길,Kim, Sang Woo,Kim, Sung Min,Shim, Yong Bo,Choi, Sun Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2
Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. The authors presented a case of 41 years old male with intramedullary and intradural extramedullary tuberculoma of the thoracic spinal cord without systemic involvement. The preoperative diagnosis was a metastatic cancer. Subtotal removal of intradural extramedullary and intramedullary mass was performed and pathological diagnosis was tuberculosis granuloma. We suggest that Intramedullary spinal tuberculoma must be considered in the differential diagnosis of the spinal cord compressive lesions in our country.
다분절 퇴행성 경추질환에서의 전방 금속판 사용 유무에 따른 환자의 예후분석
김상우,김성민,신동익,조용준,심영보,최선길,Kim, Sang Woo,Kim, Sung Min,Shin, Dong Ik,Cho, Yong Jun,Shim, Young Bo,Choi, Sun Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12
Objectives : The rates of pseudarthrosis for two- and three level fusion have been reported to be 17-63 and 50% without anterior cervical plating. The purpose of this study is to assess the effects of anterior cervical plating in the treatment of multilevel degenerative cervical disease such mostly the additional risks associated with hardware implants and its benefits, fusion rate and radiographic results, and clinical outcomes. Methods : Forty-seven patients who underwent operations between 1993 and 1997 were retrospectively reviewed. The technique for operation was same for both groups(Smith Robinson with autologous iliac bone graft). Group I consisted of 35 consecutive patients treated with anterior cervical decompression and fusion with anterior cervical plate fixation. Group II consisted of 12 consecutive patients treated without plate fixation. We compared clinical outcomes by Prolo score, radiographic results in the rate of fusion, cervical lordosis by Gore angle, disc height by Farfan method, and surgical complications between two groups. Results : The favorable clinical outcomes(excellent and good) by Prolo score were observed with the use of anterior cervical plate fixation(89% vs 75%). The successful fusion rate of multilevel cervical fusion was as seen with anterior cervical plate fixation(97% vs 75%). The overall graft complication rate in multilevel fusions was decreased, with anterior cervical plate fixation, and the hardware related complications were relatively minimal without serious consequences. Conclusion : Anterior cervical plate fixation in the treatment of multilevel cervical disorders is an effective stabilizing method which provides increased bony fusion rate, decreased graft complications, maintained cervical lordosis, early mobilization of the these patients without serious hardware related complications.
외상성 척수공동증의 치료를 위한 지주막하강 재건술 - 증례보고 -
정대진,김성민,김훈,심영보,박용기,최선길,Chung, Dai Jin,Kim, Sung Min,Kim, Hun,Shim, Young Bo,Park, Yong Kee,Choi, Sun Kil 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2
The authors report a posttraumatic syringomyelia in a 30-year-old man who has complained pain, weakness of upper arm and dissociation sensory loss since 2 months before. He was underwent by decompressive laminectomy from T12 to L1, reduction of encroached bony fragments, transpedicular screw fixation from T12 to L2 and posterolateral bony fusion due to burst fracture of L1 at other hospital 3 years ago. Preoperative spinal MRI was highly suggestive of wide-spread, multiseptated syringomyelia from C3 to thoracolumbar junction. We performed wide decompressive laminectomy from T10 to L2 and subarachnoid space reconstrucion composed of microdissection of meningeal fibrosis widely, iatrogenic meningocele formation with lefting the dura mater opened for treatment of spinal-spinal pressure dissociation. Clinical manifestations and radiological findings of the patient were improved after the operation. This technique was thought to be superior to shunting procedures in cases of wide-spread, multiseptated post-traumatic syringomyelia.
미만성 척수 경막외 농양을 동반한 화농성 척추염 - 증 례 보 고 -
김훈,김성민,정대진,심영보,박용기,최선길,Kim, Hun,Kim, Sung Min,Chung, Dai Jin,Shim, Young Bo,Park, Yong Kee,Choi, Sun Kil 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8
We report a case of pyogenic spondylitis on L2 and L3 with diffuse epidural abscess up to T4 to L3 and large psoas abscess. A forty-nine-year old male was presented with progressive back pain, left flank pain and ab-dominal distention, weakness of the both legs and voiding and defecation difficulty during last 2 months. Initially multiple coronal hemilaminectomies from T4 to T12 were done for the treatment of diffuse thoracic epidural ab-scess. Then second operation via left retroperitoneal approach was performed for lumbar spondylitis and psoas abscess on third day after initial operation. After removal and curettage of pyogenic psoas and epidural abscess and spondylitis (L2-L3), iliac bone grafting with Keneda instrumentation from L1 to L4 was done simultaneously. Postoperative course has been unevenful without recurrent infection. The literature on diffuse epidural and large psoas abscess with pyogenic spondylitis are reviewed and instrumentation for stabilization of pyogenic spondylitis is also discussed.
축추이하 경추부에서 골절 또는 탈구없이 발생한 급성 경수 손상환자의 치료
김성민,심영보,김훈,조용준,박용기,최선길 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.1
Background: Cervical cord injury without fracture or dislocation can occur after a minor trauma. The benefits of surgical treatment in these patients with pre-existing cervical stenosis is controversial. This study was designed to evaluate outcomes and radiographic findings and to determine optimal treatment for these patients. Method: Radiographic findings on the cervical spinal sagittal diameter (spinal canal /vertebral body (SC/VB) ratio), MRI results, and outcomes based on Frankel and Prolo's grade were investigated retrospectively in 29 patients with acute cervical cord injury without fracture or dislocation in the subaxial cervical spine. Sixteen (16) patients were treated operatively, and 13 were treated nonoperatively. Result: Clinical diagnosis were 17 cervical stenosis (12 spondylotic stenosis, 3 ossified posterior longitudinal ligaments, and 2 developmental stenosis), 9 disc herniations, and 3 cord contusions only. The average midbody and stenotic SC/VB ratios (mean ±S.D.) were 0.75±0.12 and 0.64±0.14, respectively. In patients with spondylotic stenosis, the stenotic SC/VB ratio was 0.58±0.15. Surgical treatment were performed in 9 cases of spondylotic stenosis, 5 of disc herniation, and 2 of developmental stenosis. Patients who showed mild to moderate thecal sac compression /normal or edema only in the cord signal on MRI had a better prognosis. In patients with spondylotic stenosis, the stenotic SC/VB ratio in the diseased level was smaller (mean total: 0.58; operated cases: 0.56; and conservative cases: 0.68), and the outcomes of operated cases were relatively better without any intramedullary hemorrhage being found on MRI. Conclusion: The outcomes for patients with acute spinal cord nijury without fracture or dislocation in the subaxial cervical spine are relatively good. The sagittal spinal canal diameter of patients is stenotic, and the sagittal spinal canal diameter and MRI findings are important factors in selecting treatment options (operative or conservative). Surgical decompression in patients with spondylotic stenosis may beneficially affect the neurological and functional out-comes, but the numbers of patients are relatively small.