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급성 중증 뇌종창 환자의 양측성 감압개두술 후 뇌압 및 뇌혈류 측정
유도성,김달수,허필우,조경석,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suck,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3
Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.
저체온요법 치료 환자에서의 두개강내와 액와부의 온도차이
유도성,김달수,허필우,조경석,김재건,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyung-Suck,Kim, Jae-Gun,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7
Objective : The brain temperature is about $0.4-1^{\circ}C$ higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. Methods : Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia( over $38^{\circ}C$), normothermia($36-38^{\circ}C$) and hypothermia(under $36^{\circ}C$). Total 1671 paired sample data were collected and analyzed. Results : The temperature difference between the cerebral cortex and the axilla was $0.45{\pm}1.04^{\circ}C$ in hyperthermic patients, $0.97{\pm}1.1^{\circ}C$ in normothermic patients and $1.04{\pm}0.81^{\circ}C$ in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). Conclusion : From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.
유도성,조경근,박춘근,지철,이길송,나형균,이상원,최창락 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.3
Ossification of ligamentum flavum is a very rare disease and one of the new disease entities in myelopathy. We report three cases of ossification of ligamentum flavum in thohcic spine causing thoracic myelopathy. Main symptoms of this disease are numbness of both legs and feet. gait distlirbance and spastic motor weakness. Simple spine X-ray. metrizamide myelogram CT and MRI are most useful diagnostic tools. Sufficient decompressive laminectomy and facetectomy are treatment of choice.
양지호,유도성,조경근,황장희,강준기,최창락 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.2
We experienced a case of falcine mesenchymd chondrosarcoma in a 22-year-old pregnant woman. Cartilage cell tumors within the cranium are very rare, only less than 02% of all intracranial tumors. Because a few examples of mesenchymal chondrosarcoma in this location have been reported, we reviewed previous reports cases, to determine the natural history of intracranial chondrosarcomas The distinguishing features of this rare rumor are compared with previous cases of itracranial tumors derived from cartilage.
김병섭,유도성,허필우,조경석,이상복 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3
Bilateral multiple intracranial hemorrhagic infarction after cranioplasty is an extremely rare complication. We present a case of a bilateral multiple intracranial hemorrhagic infarction following cranioplasty with an autologous bone graft. A 63-year-old woman had a previous decompressive craniectomy after a right middle cerebral artery infarction. The possible pathogenesis of the complication is discussed. (Kor J Cerebrovascular Surgery 12(3):136-140, 2010)