소아에서 Takayasu 동맥염을 동반한 뇌동맥류 : 증례 보고 Case Report

전호규,하영수,박종운,김영,채권병,이상돈,김재중 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.3

The authors present a case of intracranial aneurysm with Takayasu's arteritis. A 10-year-old boy was admitted with complaints of sudden bursting headache and vomiting. Computed tomographic(CT) scan showed subarachnoid hemorrhage and measured blood p m sum between in each side did differ significantly. Aortoangiogram showed narrowing of the abdominal aorta and stenosis at their origins of the renal arteries. An angiogram of the right carotid artery revealed a saccular aneutysm located at the proximal portion of the middle cerebral artery. Intracranial aneurysm with Takayasu's arteritis is a rare entity, evenmore in children.

원시성 신경외배엽 종양의 임상적 경험

전호규,하영수,박종운,김영,채권병,이상돈,김재중,진태경 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.8

Primitive neuroectodermal tumors(PNETs) are composed of undifferentiated cells resembling germinal matrix cells of the embryonic neural tube. The concept of the primitive neuroectodermal tumors is controversial due to indistinct clinicopathologic entities. While some neuropathologists believe that the PNET concept should be applied to all these tumors with the addition of qualifying terms, the opponents of this approach believe this concept to be too simplistic and that well-established diagnostic entities should not be grouped together as a single entity. Four patients with PNET were reviewed. Although the PNETs bear some differences to posterior fossa medulloblastomas, we should be grouped together as a single pathologic entity because of their primitive nature. The purpose of this study is to review the similarities and differences between two tumors from their histologic and embryologic features.

뇌 측두골 추체부 골절의 임상적 경험

김영,김재중,전호규,이상돈,채권병,박종운,하영수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.3

A retrospective analysis of 36 cases of petrous pyramid fractures was studied clinically and radiographically during last 5 years. Of 503 patients with skull fractures admitted to the Inha University hospital, of which 7.1% involved the petrous pyramid. The most common mode of injury was a motor vehicle accident and the most common age group was the first decade. The anatomic location of fractures in the petrous pyramid were evaluated by high resolution computed tomography and it disclosed 20 longitudinal and 16 transverse fractures. The principal symptoms and signs, occurring alone or in combination, were a otologic problem, facial paralysis and CSF liquorrhea. The otologic problems were noted in almost every case. The facial palsy and CSF liquorrhea were present in 16 cases(36%) and 9 cases(25%), respectively. The anatomic type of fractures well corresponded to the principal symptoms and signs and the prognosis, the development rate of principal symptoms and signs transverse fracture was more higher and the prognosis of that was worse than the longitudinal fracture.

경련발작을 주소로한 측두엽병변의 임상적 연구

김영,김재중,전호규,이상돈,채권병,박종운,하영수 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

We evaluated the temporal lobe lesions in 24 patients who had various types of seizure as initial neurologic symptoms between 1987 and 1992. All patients were studied with radiologic and pathologic procedures. The types of seizure were classified with the International League Against Eilepsy classification. The results were as follows : The age of distribution of patients were 3 to 72 years old. The most common seizure type was generalized tonic-clonic and then complex partial, unclassified type, generalized absence and simple partial motor in order. The usual associated diseases were arachnoid cyst, abscess, glioblastoma multiforme, meningioma and temporal sclerosis. The most common location of the lesions was the inferomedial area in the temporal lobe. The maximal diameters of lesions were ranged from 7 to 78㎜(mean 36㎜)

미만성 축삭 손상 환자의 임상적 분석

이상돈,김재중,전호규,채권병,김영,박종운,하영수 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.8

Thirty four patients with diffuse axonal injury, defined as post-traumatic coma for over 24 hours with Glasgow Coma Scale(GCS) score of 8 or less following nonsurgical resuscitation, admitted to Inha Hospital from January to December 1991, were studied in order to identify clinical analysis. The aim of this study was to find out the effects of barbiturates or other intensive therapy or head elevation on the intracranial pressure(ICP), arteriovenous oxygen difference(AVDO₂) and outcome. The results were as follows : 1) The ratio of male to female was about 6 to 1. 2) In clinical signs at the emergency room, abnormal pupil size was shown 17 cases (61%) under 8-5 on the GCS, but all cases under 5 on the GCS showed abnormal pupil size. 3) Ventricular compression was shown in 19 cases (85%), 17 cases (50%) was showed the ventricular compression & cisternal obliteration. 4) Post-traumatic cerebral infarction was developed 59% of DAI and occured in 88% of ventricular compression and cisternal obliteration. 5) On admission, above 5㎖/100㎖ in AVDO₂ was developed in 32 cases (94%) under 8 on the GCS, but in all cases under 5 on the GCS. Recording of ICP showed above 20㎜Hg in 15 cases (44%). On coagulopathy, our cases showed that decrease of platelet was involved in 5 cases (15%), prothrombin time (PT) prolongation in 11 cases(32%), activated partial thromboplastin time (APTT) in 4 cases, fibrinogen in 5 cases. 6) The mean ICP was slightly lower when the patient's head was elevated at 30 degree than at 0 degree. The mean ICP was moderately lower when the patients were taken barbiturates therapy. ICP tends to increase from the 1st to 3rd day after injury. 7) The mean AVDO₂ was significantly lower when the patients were taken barbiturates therapy, especially at the 1st day. 8) On the relation between Glasgow Outcome Scale(GOS) and Neurological grading (NG), GOS Ⅳ was developed in 8 cases (NG score 3-6), GOS Ⅲ in 5 cases (NG score 7-9), GOS Ⅱ in 2 cases (NG score 10). Total mortality rate was 56%.

소아 두뇌외상에 대한 임상적 관찰

박종운,채권병,이상돈,전호규,김영,하영수 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.2

A clinical analysis was carried out with 400 cases of head injuries under 15 years of age admitted at the Department of Neurosurgery. Inha University Hospital during 4 years from 1987 to 1990. The material was classified into three groups according to main lesions, i.e. 1) simple cerebral contusion without skull fractures. 2) various types of skull fractures. 3) intracranial hemorrhagic lesions, representing such lesions as follows ; a) epidural hematoma, b) subdural hematoma, c) intracerebral hematoma, intraventricular and subarachnoid hemorrhage. The results were as follows; 1) The age incidence was greatest in 7 years of age, and 188 cases(47%) were included in the age group between seven and ten. The accident occurred mostly from March to May, especially in April. 2) The head injuries were caused by traffic accident(203 cases: 51%), fall down(152 cases : 38%), etc. In clinical pictures, neck sprain(52.8%), nausea and vomiting(47.5%), and early epilepsy (9%) were developed. 3) The linear skull fracture was higher than other type fractures(74.6%) and the locations of skull fractures were parietal, occipital, temporal and frontal bone in order of frequency. 4) Among the intracranial hemorrhagic lesions, EDH was most common lesion, 73 cases (79%) of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures but of the patients with skull fracture, 51.4% were accompanied by hemorrhagic lesion. Lucid interval was observed in 15 of the cases with intracranial hemorrhagic lesions and contre-coup injury was developed in 19(12%). 5) In the GOS, the high scored cases on the GCS were better than the low scored cases. 4 cases of 23 people scored under 8 on the GCS died, 14 cases of them were included in the age between 6 and 10(61%). 6) Associated injuries were found in about 16% of the total patient, the most common injury was clavicle fracture and most frequent sequala was post traumatic syndrome. The late epilepsy was occurred in about 13% of the early epilepsy cases except the cases had pre-traumatic epilepsy history.

뇌교부 출혈의 예후에 대한 임상분석

채권병,하영수,박종운,김영,이상돈,전호규,김재중 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.8

Pontine hematoma would be diagnosed and made its follow-up readily as the extent of hematoma could be clearly defined since the CT scan was available, especially with MRI in recent. Authors attemped to analyse 20 cases of pontine hematoma clinically, considering factors to influence their prognosis, admitted in Inha hopital from March 1989 to February 1992. Classification of pontine hematoma was made out according to the findings of brain CT scan taken on admission : 2 cases of Type T1 to the hematoma localized in the tegmentum unilaterally, 1 case of Type T2 to those in the tegmentum bilaterally with some extent into the 4th ventricle, 12 in Type T3 to those in the tegmentum, midbrain and mostly the 4th ventricle, and 5 in Type B to those in the basis pontis mainly with tegmentum and midbrain. Of 219 spontaneous intracerebral hematoma, pontine hematoma was 9.1%. 17 hypertension and 11 previous CVA episodes including 7 cerebral infarction and 4 ICH were encountered. Age distribution was 50% in 6th decade and male to female ratio was 3:2. On admission 14 cases were under 6 in Glassgow coma scale, 16 small reactive pupils and 1 ocular bobbing. Particularly, nuclear facial paralysis was 14 in initial bilateral type, of which 7 dead within 10 days, 5 fixed in left facial paralysis and 1 case into right paralysis later. Four surgical interventions were 1 simple EVD, 1 Urokinase irrigation through EVD, 1 steretactic aspiration and 1 direct hematoma removal. Prognosis was related to various factors : GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS. Type T1 and T2, and unilateral facial paralysis in which the ratio of left to right was 2:1, while it was very poor in patients who were GCS below 6. Type B and bilateral facial paralysis. On the contrary, 7 of 20 cases were dead within 10 days, 13 patients alive for more 3 months after the hemorrage were observed with fixed facial paralysis in nuclear type, 1 bilateral, 4 right, and 8 left side. It is suggested and requested for further careful follow-up that the hemorrage may occur from the border zone between paramedian, short and long circumferential arteries supplying transection area of the pons unilaterally, near on around the facial nucleus, more frequent in left side.