외상성 뇌실질내 혈종에 대한 상측방 키홀을 통한 내시경적 혈종 제거

박성진,하호균,정호,이상걸,박문선,Park, Sung-Jin,Ha, Ho-Gyun,Jung, Ho,Lee, Sang-Keol,Park, Moon-Sun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Objective : As a minimally invasive strategy, endoscopic technique was introduced for removal of the traumatic intracerebral hematoma. Material and Method : A 54-year-old man with three-day history of seizure and progressive mental deterioration after traffic accident was presented. Computerized Tomography(CT) of the brain showed a huge intracerebral hematoma on the right frontal lobe and ventricle. The operation was performed via right frontal superolateral keyhole with 2cm eyebrow skin incision. Using 0-degree and 30-degree angled lens 4mm rigid endoscopes, nearly all of the hematoma was evacuated under the direct endoscopic visualization and a ventricular catheter was exactly placed into the frontal horn of the right lateral ventricle at the end of procedure. Results : The seizure was discontinued and neurological status had been improved during postoperative periods. Postoperative CT demonstrated that most of the hematoma was removed and the ventricular drainge tube was exactly placed in the right foramen of Monro. Conclusion : With endoscopic technique, the authors successfully evacuated traumatic intracerebral hematoma and exactly placed the ventricular drainage catheter under direct visualization. This technique may be considered as an another option for removal of traumatic intracerebral hematoma.

전방 경추 미세 추간공 확대술 : 경추증에 대한 최소침습적 전측방 접근법

박성진,하호균,정호,이상걸,박문선,Park, Sung-Jin,Ha, Ho-Gyun,Jung, Ho,Lee, Sang-Keol,Park, Moon-Sun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.1

Objective : Various surgical approaches have been implemented to fulfill the ideal goals of treatment for cervical spondylotic lesions. Conventional approaches are represented by anterior approach with or without fusion and posterior approach. The authors has applied newly developed anterior cervical microforaminotomy for these lesions on minimally invasive basis. Materials and Method : Twenty-one patients, with cervical HIVD, or stenosis, or both, underwent anterior cervical microforaminotomy between March, 1998 and April, 1999. Fifteen patients underwent unilateral decompression, and 6 bilateral decompression via unilateral foraminotomy. Operation of one level was performed in 16 patients, 2 levels in 4 patients, and 3 in 1 patient. The foraminotomy was accomplished by resecting the uncovertebral joint. Through this hole, compressed nerve root was decompressed by removing the spondylotic spur or disc fragment, and diagonal removing of posterior osteophyte from foraminotomy site to begining of contralateral nerve root made spinal cord decompression. Results : The outcome was excellent in 17 patients(81%) and good in 4 patients(19%) based on Odom's criteria. No complication was encounterd, and average post-operation hospital stay was 3.7 days. Conclusions : These results indicate that anterior cervical microforaminotomy provide adequate neural decompression, minimum postoperative discomfort and fast recovery.

성인 수도관 폐쇄증에 대한 내시경적 제3뇌실 누공술 : 이중개창술 - 증례보고 및 수술수기 -

심용진,하호균,정호,김용석,박문선,Shim, Yong-Jin,Ha, Ho-Gyun,Jung, Ho,Kim, Yong-Seog,Park, Moon-Sun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objective : Endoscopic third ventriculostomy is gaining popularity as a minimally invasive surgical option for certain types of hydrocephalus as an alternative to shunting. The authors have tried to fenestrate down to the subdural space passing through the prepontine cistern to lessen or avoid the chance of redoing due to healing. Materials and Method : A 48-year-old male patient with several years of intractable headache was presented. Magnetic Resonance Image(MRI) of the brain revealed marked ventricular dilatation with stenotic cerebral aqueduct. A 2.3mm flexible steerable endoscope($Neuroview^{(R)}$) was introduced via precoronal route and accessed to the third ventricular floor. Using 3-French Fogarty balloon catheter, thin third ventricular floor and the arachnoid membrane of the prepontine cistern were fenestrated, so called "double fenestration". To confirm the fenestration, subdural compa-rtment of the left abducens nerve was identified during the procedure. Forceful pulsating flow through the orifice convinced the patency of the opening. Results : The patient was discharged on the third postoperative day without any postoperative complications. The postoperative follow-up MRI of the brain, at second and sixth months, clearly demonstrated the flow void through the third ventricular floor. Conclusions : Endoscopic third ventriculostomy was successfully performed on an adult hydrocephalus patient with aqueduct stenosis. The third ventricular floor and arachnoid membrane of the prepontine cistern were fenestrated to achieve double fenestration to minimize the chance for failure. The details of this procedure and results are described.

요추 협착증에 대한 일측성 추궁절개술을 통한 미세 수술적 감압술

심용진,하호균,이종선,김용석,박문선,김주승,Shim, Yong-Jin,Ha, Ho-Gyun,Lee, Jong-Sun,Kim, Yong-Seog,Park, Moon-Sun,Kim, Joo-Seung 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

종례 : 례다발성 신경외 전이를 동반한 혈관주위 세포종 -증례보고-

서진호 ( Jin Ho Seo ),정철구 ( Chul Ku Jung ),김현우 ( Hyun Woo Kim ),하호균 ( Ho Gyun Ha ) 대한뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2

The authors describe a case of the intracranial hemangioperictyoma with multiple extradural, extraneural metastases to cervical vertebra, thoracic spinal cord, lung, chest wall, and intra-abdominal organs. A 41-year-old man presented with right-sided peripheral type facial palsy, decreased visual acuity, deafness, intermittent headache. Initial neuroimaging studies suggested malignant meningioma or hemangiopericytoma with involvement of the internal auditory canal. A surgical intervention was performed and the tumor was gross-totally removed. The histopathological diagnosis was confirmed as hemangiopericytoma. After 4 years later, he had a C5 metastasis, which had been treated with C5 corpectomy with cervical fusion. Further evaluations revealed multiple metastases in liver, lung, pancreas, periaorta area, thoracic and lumbar vertebra. At liver biopsy, hemangiopericytoma was confirmed, which had a similar character to an intracranial lesion. The patient was treated with radiotherapy, chemotherapy and cyberkife-sterotactic radiosurgery (CK-SRS), but dead due to medical problem 7 years after initial diagnosis. Although the hemangiopericytomas have a strong tendency to both local recurrence and extracranial metastasis, in our case, there was no local recurrence in brain parenchyme and no severe neurologic deficits for living after aggressive treatment. We carefully suggest that aggressive treatment with combined modality for hemangiopericytoma may influence on tumor control and to maintain stable neurological state without severe deficits.

척수팽대와 낭종을 동반한 척수-연수 연접부의 혈관아세포종 - 증례보고 -

박성진,정호,이상걸,박문선,하호균,양기화,Park, Sung-Jin,Jung, Ho,Lee, Sang-Keol,Park, Moon-Sun,Ha, Ho-Gyun,Yang, Ki-Hwa 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Hemangioblastoma of the central nervous system rarely occurs in cervicomedullary junction. The unique pathologic features of the tumor involving midline structures are grossly solid in consistency and accompanying extensive spinal cord enlargement. A 63-year-old women presented with progressive right motor weakness and tingling sensation. The MR image showed a well enhancing mass having a cyst and diffuse cord enlargement in the cervicomedullary junction. A total surgical resection was performed and hemangioblastoma was histologicaly verified. Postoperative MR image showed the disappearance of cord enlargement. The right motor weakness was also improved. The authors report a rare case of hemangioblastoma in cervicomedullary junction and the pathophysiology of the spinal cord enlargement are discussed.

후방 추체 경유 신전 절골술 - 증 례 보 고 -

정호,김용석,박문선,하호균,이종선,김주승,Jung, Ho,Kim, Yong-Seog,Park, Moon-Sun,Ha, Ho-Gyun,Lee, Jong-Sun,Kim, Ju-Seung 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objective : Flat back syndrome constitutes a syndrome complex characterized by the loss of normal lumbar lordosis. Various techniques of correction for flat back syndrome have been reported. Posterior extension osteotomy has certain drawbacks. Forceful hyperextension of the spine may result in vascular complications such as rupture of the aorta or the inferior vena cava and stretching of superior mesenteric artery, and pseudoarthrosis. We describe a rationale and technique of transvertebral posterior extension osteotomy to avoid complications of posterior extension osteotomy and to achieve an correction of 30 degrees of flat back syndrome. Method : A 63-year-old woman with degenerative lumbar kyphosis presented with low back pain, thigh pain, knee pain and walking difficulty. Transpedicular fixation from L1 vertebra to S1 vertebra was accomplished for lumbar degenerative kyphosis. After 6 months, the patient presented with flat back syndrome. A second operation was performed with transvertebral posterior extension osteotomy. Result : With short segemental fusion, early bone fusion and correction of 30 degrees were achieved. Conclusion : Transvertebral posterior extension osteotomy provide an 30-60 degrees of correction of flat back syndrome. This technique is considered to be good method for the revision of lumbar degenerative kyphosis.

공동-지주막하 단락술로 실패한 외상후 척수공동증에 대한 공동-흉막강 단락술 - 증례보고 -

이창우,김용석,이종선,박문선,하호균,김주승,Lee, Chang-Woo,Kim, Yong-Seog,Lee, Jong-Sun,Park, Moon-Sun,Ha, Ho-Gyun,Kim, Joo-Seung 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

The authors report a case of syringo-pleural shunt for recurrent distal obstruction of syringosubarachnoid shunt in a 23-year-old woman. She complained of tingling sensation and dysesthesia on the left upper extremity. Neuroradiologic imaging studies revealed syringomyelia in the left lateral side of the cord from medulla to 7th thoracic cord level. We identified intraoperatively high internal pressure of the syrinx cavity due to distal shunt tube obstruction. Syringo-pleural shunt was performed and cavity size was markedly decreased at later follow up MRI. In conclusion, the posttraumatic syrinx, especially in cases with previous syringosubarachnoid shunt or diffuse subarachnoid scarring, can be successfully managed with syringo-pleural shunt.

두개인두종 수술시 뇌하수체경이 절단된 환자에서 요붕증의 자연해소 -증례보고-

김지훈 ( Ji Hun Kim ),고정호 ( Jung Ho Go ),김현우 ( Hyun Woo Kim ),하호균 ( Ho Gyun Ha ),정철구 ( Chul Ku Jung ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

A 27-year-old man visited to our institute suffered from diabetes insipidus(DI) symptoms and progressively decreasing visual acuity. The brain magnetic resonance imaging(MRI) showed 4.4×4.3×3.8 cm sized brain tumor situated on the suprasella area and his symptoms and laboratory findings were compatible with panhypopituitarism. Surgery was scheduled and craniotomy via right pterional, trans-lamina terminalis approach was performed and total removal was achieved. However, in the last stageght procedure, proximal pemoval was ach, which was the origin site lasttr, was the origin site for that tumor, was transected. The pathology was confirmed for craniopharyngioma and postoperatively, headache was improved 3 days after the surgery. Panhypopituitarism needed continuous hormonal replacement therapy but interestingly, DI symptoms were improved spontaneously, 5 days after surgery through administration of 6 times of vasopressin for 4 days. With review of the literatures, the authors reports the case of craniopharyngioma that the DI symptoms were resolved spontaneously, despite of transectioning of the pituitary stalk during surgery.

임상 : 전방 두개저부 병변에 대한 두개 안면 접근법; 합병증

김근식 ( Geun Sik Kim ),김승민 ( Seong Min Kim ),정승영 ( Seung Young Chung ),정성삼 ( Sung Sam Jeong ),박문선 ( Moon Sun Park ),하호균 ( Ho Gyun Ha ),김한규 ( Han Kyu Kim ) 대한뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.2

Objective￡ºThe purpose of this study is to describe the commom complications of craniofacial approaches to lesion on anterior skull base and some technical refinements to prevent the complications. Methods￡ºAuthors reviewed medical records and radiological findings of 21 operations(including 2 reoperations) of 19 patients having anterior skull base tumors treated by craniofacial approaches from 1998 to 2004 . Results￡ºTwenty-one operations showed several complications. Those were cerebrospinal fluid leakage(3), meningitis(1), anosmia(3), epidural hematoma(1), pneumocephalus(1). Cerebrospinal fluid leakage was treated by lumbar drainage. Meningitis was treated by lumbar drainage and appropriate antibiotics. Epidural hematoma and pneumocephalus were resolved spontaneously. The complication of transfrontal and transnasomaxillary approach was none. The complications of transfrontal nasal approach were anosmia(1) and epidural hematoma(1). Cerebrospinal fluid leakage(3), meningitis(1), anosmia(2), and pneumocephalus(1) arose in the transfrontal nasal-orbital approach. Conclusion￡ºMotality and morbidity of craniofacial approach is relative low. Water-tight duroplasty, strong reconstrucion of anterior skull base and lumbar drainage are important for prevention of cerebrospinal leakage. We think that the lesion of anterior skull base is safely performed by appropriate craniofacial approach and reconstruction.