반쪽안면경련환자에서 미세혈관수술의 치료결과에 대한 연구 ( Microvascalur Treatment of Hemifacial Spasm )

이봉암(Bong Arm Rhee),정제태(Jae Tae Chung),임영진(Young Jin Lim),김태성(Tae Sung Kim),김국기(Gook Ki Kim),임언(Won Leem) 경희대학교 경희의료원 1993 慶熙醫學 Vol.9 No.1

가족성 편측안면경련 - 증 례 보 고 -

정승영,이봉암,임영진,김태성,김국기,임언,Chung, Seung Young,Rhee, Bong Arm,Lim, Young Jin,Kim, Tae Sung,Kim, Gook Ki,Leem, Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

The authors report two cases of familial hemifacial spasm according to the clinical and three dimensional shortrange magnetic resonance angiography(3D-SRMRA) findings. In the family of the first case, there were five patient's with acquired hemifacial spasm in successive generations. Three male and two female patients in successive generations of the same family developed acquired hemifacial spasm. Four patients were on the left side and one was on the right side. In the family of the second case, there were three patient's with acquired hemifacial spasm in successive generations. Two brothers developed left-sided hemifacial spasm. 3D-SRMRA finding of the probands demonstrated that both anterior inferior cerebellar artery in first case and anterior inferior cerebellar artery & vertebral artery in second case offend the 7th cranial nerve respectively. The presence of familial clustering of these rare disorders suggest an underlying genetic predisposition. All family pedigrees suggest that a pattern of autosomal-dominant inheritance with partial penetrance.

뇌실복강간 단락술 후 발생한 뇌지주막 낭종 - 증 례 보 고 -

최광영,이봉암,임영진,김태성,김국기,임언,Choi, Kwang Yeong,Rhee, Bong Arm,Lim, Young Jin,Kim, Tae Sung,Kim, Gook Ki,Leem, Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

A 4-month-old female patient admitted because of hydrocephalus. She was premature infant with germinal matrix hemorrhage at gestational period 27 wks. A ventriculoperitoneal shunt with a low-pressure type valve was placed. Follow-up CT scan obtained 3 months after VP shunt placement, revealed a new Lt. middle cranial fossa cyst. The girl was readmitted to hospital at 7 months after VP shunt placement, complaining of lethargy and vomiting. A CT scan was demonstrated a increase in size of a cyst, She subsequently underwent a left-sided pterional craniotomy with partial excision of membrane and cyst fenestration into the basal cisterns. Follow-up CT scan after 18 months revealed reaccumulation of cyst, the girl was reoperated on. After 2 months, the size of cyst was not decreased. Finally, She underwent a cystoperitoneal shunt. Follow-up CT scan after 5 months was demonstrated disappeared cyst and reexpansion of brain parenchyma. We report the development of a symptomatic sylvian fissure arachnoid cyst developed after ventriculoperitoneal shunt.

수술적 치료를 받은 수근관 증후군 환자에서 고식적인 방법과 내시경적 방법의 비교 연구

권영준,김태성,임영진,이봉암,임언,김국기,Kwon, Yung-Jun,Kim, Tae-Sung,Lim, Young-Jin,Rhee, Bong-Arm,Leem, Won,Kim, Gook-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

The carpal tunnel syndrome is one of the most common entrapment neuropathy. Surgical treatments consist of conventional open technique, alternative technique using retinaculatome, and endoscopic surgery. This study compares the outcomes of surgical treatment of carpal tunnel syndrome following conventional versus endoscopic release. The authors reviewed 56 cases of 33 patients with carpal tunnel syndrome treated surgically in our institute from January 1991 to May 1998. The follow-up evaluation was possible in 36 cases of 20 patients who had conventional release and in 11 cases of 7 patients with endoscopic release. The following parameters were evaluated for comparison : improvement of symptom, return to normal work, recovery of strength of grip and pinch, rate of complication, follow-up electrophysiologic finding. Compared with open decompression, the group of endoscopic decompression needed significantly less time to go back to work(p<0.001). Also strength of grip and pinch improved faster in the group of endoscopic decompression as well, compared with open decompression(p<0.05). These results indicate that endoscopic procedure is an excellent, minimally invasive method to treat carpal tunnel syndrome, performed by surgeons who are fully aware of the anatomy.

두부 손상후 발생한 지연성 렌즈선조체 동맥부위 뇌경색

박재현 ( Jae Hyun Park ),이봉암 ( Bong Arm Rhee ),고준석 ( Jun Seok Koh ),임영진 ( Young Jin Lim ),김국기 ( Gook Ki Kim ),김태성 ( Tae Sung Kim ) 경희대학교 경희의료원 2004 慶熙醫學 Vol.20 No.2

특발성 및 이차성 삼차 신경통에 대한 감마나이프 방사선수술의 역할 - 수술적 치료와의 비교 -

김상현,임영진,임언,이봉암,고준석,김태성,김국기,Keem, Sang Hyun,Lim, Young Jin,Leem, Won,Rhee, Bong Arm,Koh, Jun Seok,Kim, Tae Sung,Kim, Gook Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5

Objective : To evaluate the role of Gamma Knife radiosurgery in essential and tumor-related(secondary) trigeminal neuralgia, outcomes of radiosurgery and microsurgery were compared each other. Methods : Five patients with essential trigeminal neuralgia underwent stereotactic radiosurgical treatment with Leksell Gamma Knife and twenty five patients were treated with microsurgery during the same period(1994. 1-1997. 6). A 4-mm collimator was used and REZ or proximal portion of trigeminal nerve was targeted with maximal dose of 60-72Gy. The mean follow-up after radiosurgery was 39.4 months and that after microsurgery was 47.9 months. Results : At the last follow-up, four patients(80%) had excellent(pain free) or good(50-90% pain relief) outcomes, one(20%) had poor control after radiosurgical treatment. Twenty-three patients(92%) had excellent or good outcomes and two(8%) had poor results after microsurgery. Postoperative complications occurred in ten(40%) with microsurgery, but there were no complications in patients with Gamma Knife radiosurgery. Six patients with secondary trigeminal neuralgia received radiosurgical treatment directed at their tumors, and three patients were surgically treated. Three of six(50%) patients treated with Gamma Knife had pain relief while two of three patients with surgical treatment showed immediate pain relief. Post-treatment complications were developed in two of six radiosurgical patients and in one of three surgical patients. Conclusion : Gamma Knife stereotactic radiosurgery may be considered as a useful and alternative option for the treatment of essential and secondary trigeminal neuralgia owing to of its safety and less complications. The preliminary results obtained in our series appear encouraging, although the outcome is not so good as that of surgery.

후순환계 뇌동맥류의 임상양상과 치료예후 - 전순환계 동맥류와의 비교분석을 중심으로 -

정제훈,김국기,고준석,임영진,김태성,임언,이봉암,Jeong, Je Hoon,Kim, Gook Ki,Koh, Jun Seok,Lim, Young Jin,Kim, Tae Sung,Leem, Won,Rhee, Bong Arm 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9

Object : With the recent variable treatment modalities and the development of microsurgical techniques, outcomes of surgical and medical management of aneurysm have shown much progress in the last 10 years. However, the management of posterior circulation aneurysm is still a debatable due to its difficulty in limited surgical approach, complicated anatomical structure and many small perforators to vital structure. The purpose of this study is to compare the results of clinical manifestation and outcome of surgery with respect to anterior and posterior circulation aneurysms. Material and Methods : We evaluated the 33 patients with PCAs(posterior circulation aneurysm) and 359 patients with ACAs(anterior circulation aneurysm) treated between 1994 and 1999, retrospectively. Results : Posterior circulation aneurysms showed higher tendency(5 cases, 14.7%) to have unusual shapes, such as dissecting or fusiform compared with anterior circulation aneurysm(15 cases, 4.2%). There were more multiple aneurysms in posterior circulation aneurysm(8 cases, 26.5%) than anterior circulation aneurysm(59 cases, 16.2%). The number of patients with Hunt-Hess grade III or IV on admission were 91(25.3%) in anterior circulation aneurysms, and 14(42.4%) in posterior circulation aneurysms. There were higher incidences of vasospasm and acute hydrocephalus in patients with posterior circulation aneurysm. In cases of anterior circulation aneurysm, neck clipping was possible in 97%. But, in posterior circulation aneurysm, neck clipping was possible only in 67.7% of each. Two hundred forty four cases(85.0%) of all anterior circulation aneurysms and 22 cases(78.6%) of all posterior circulation aneurysms showed good recovery(GR) or moderate disability(MD). The postoperative mortality rates of anterior and posterior circulation aneurysms were 4.9% and 10.7%, respectively. Conclusion : These results indicate that there exist substantial differences with respect to that there were few difference in the aspect of surgery and management outcome between posterior circulation aneurysms and anterior circulation aneurysms.

유즙 호르몬 과분비 선종에 대한 감마 나이프 수술의 역할

허진우,임영진,임언,양재영,고준석,김태성,이봉암,김국기,Hur, Jin Woo,Lim, Young Jin,Leem, Won,Yang, Jae Young,Koh, Jun Seok,Kim, Tae Sung,Rhee, Bong Arm,Kim, Gook Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Objective : The treatment for prolactin secreting pituitary adenoma(prolactinoma) include pharmacology, surgery, radiation therapy or radiosurgery. The recent development of radiological imaging and microsurgery has made transsphenoidal microsurgery the treatment of choice for most prolactin secreting pituitary adenoma. Despite its low morbidity and mortality, relatively high recurrence and failure rate have been reported. Recent advances in neuroimaging provide a precise targeting in radiosurgery for treatment of prolactin secreting pituitary adenoma. In this regard, Gamma knife radiosurgery has been proposed as an alternative primary treatment modality or adjuvant therapy. Patients and Methods : Twenty three patients with prolactin secreting pituitary adenoma have been treated with Gamma knife radiosurgery in our institute from March 1992 to September 1998. We analyzed clinical, radiological and endocrinological changes in 21 patients who were followed up for an average of 35.7 months. Results : The mean age was 34.9 years and 16 patients were treated with Gamma knife radiosurgery as primary treatment and 5 patients underwent Gamma knife radiosurgery for residual tumors after microsurgery. The margin of the tumor was incorporated within the 40 to 80% and the mean marginal dose was 24.5 Gy. Clinical improvement in the last follow-up were present in 17 cases(81.0%) and 3 of 5 infertility patients became pregnant after Gamma knife radiosurgery. Tumor control rate after Gamma knife radiosurgery was 100%. Endocrinological normalization in the last follow-up were obtained in 12 cases(57.1%). In three cases, hormonal normalizations were present in early period(3-32 months) but serum hormone levels were elevated subsequently. Conclusion : We conclude that the Gamma knife radiosurgery for prolactin secreting pituitary adenoma seems to be safe and effective as adjuvant therapy after microsurgery and primary treatment modality in selective patients.

GradeⅠ요추부 척추 전방 전위증의 치료 : 감압성 후궁절제술과 고정기구 삽입술의 비교

정승영,김국기,임영진,김태성,임언,이봉암,Chung, Seung Young,Kim, Gook Ki,Lim, Young Jin,Kim, Tae Sung,Leem, Won,Rhee, Bong Arm 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : Controversy exists which surgical treatment better in lumbar grade I spondylolisthesis, decompressive laminectomy with or without lumbar instrumentation. Methods : Out of Sixty-four patients with lumbar spondylolisthesis underwent surgery, 18 patients operated with decompressive laminectomy alone and 44 patients with decompession and lumbar instrument, during recent 5-years between January, 1994 and December, 1998. The author studied a long term follow-up in the above two groups to analyzing the overall clinical outcomes in each group and to determining the incidence of pos-toperative radiologic instability. Results : 1) Overall postoperative symptoms improvement were not so different in both groups. 2) Postoperative progressive subluxation is more common after decompressive laminectomy without instrumentation than with instrumentation group. 3) Overall clinical outcomes were slightly better in decompressive laminectomy without instrumentation than with instrumentation group but there was no significant difference. 4) Postoperative radiologic changes did not seem to influence the patient-reported clinical outcomes. 5) Postoperative complications is more common in decompressive laminectomy with instrumentation group than without instrumentation group. Conclusion : In the surgical management of grade I spondylolisthesis, the efficiency and superiority of surgical treatments requires the cost effectiveness and risk/benefit analysis of decompressive laminectomy with or without instrumentation. Therefore, Further detailed studies of long term follow up in a large number of patients in each group are needed for choice of best treatment.

양성 신경교종의 감마나이프 방사선수술 - 장기 추적 결과 -

천세명,임영진,임언,김태성,김국기,이봉암,Chun, Sae Myoung,Lim, Young Jin,Leem, Won,Kim, Tae Sung,Kim, Gook Ki,Rhee, Bong Arm 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objectives : The purpose of this study is to assess the long-term outcome and delayed complications of Gamma Knife radiosurgery for low grade glioma(LGG). Methods : Among 31 patients of LGG who had been treated by using Leksell Gamma Knife between March 1992 and December 1996, we could follow up more than 5 years(range 5-9 years) in 17 patients and evaluated their clinical feature, changes of tumor volume and post-radiosurgical complications. Results : During the mean follow-up period of 7.6 years, the tumor was decreased in 5 patients(29.4%), unchanged in 4(23.5%), increased in 4(23.5%) and recurred in 4(23.5%). The tumor control rate was 52.9%(9/17). We have experienced eighteen postradiosurgical complications in 10 patients(58.8%). Early complication was none and delayed complications included radiation necrosis with cyst in ten cases, bleeding in five, radiation-induced edema in one and malignant transformation in one. Two patients ultimately died as a result of tumor progression during the follow-up period. The mortality rate was 11.7%. Conclusion : Gamma Knife radiosurgery may be useful as an adjunctive therapy for small volume, deep-seated LGG. Although radiosurgery can effectively prevent growth of solid tumor, several delayed complications such as radiation necrosis, cyst formation, bleeding or malignant transformation can develop during the long-term followup period. Because of the possible slow growth rate of LGG and development of the delayed complications, the long-term efficacy of radiosurgery requires further analysis.