전두엽으로 확장된 Suprasellar Germinoma의 1예

고학종,신동휘,한대희 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.2

A 19-year-old boy was admitted with complaints of headache and generalized seizure for 5 months. On physical examination, he had a moon-face, a fatty breast, no sexual hair, and childish voice. Neurological examination showed no abnormality except slightly decreased visual acuity in the left eye. Lumbar CSF had total 194 leucocytes in a high power field, and among these 95% was lymphocyte. Marked sellar ballooning was seen in simple skull X-rays. Both carotid angiogram revealed bilateral Ai elevation as tent-like fashion, and subfrontal mass was suspected in lateral view. Transfrontal Conray ventriculography was done, and accidentally tumor cyst was punctured and dark pinkish blood was evacuated Transcoronal ventriculography was again performed and we knew the cystic subfrontal midline mass. Tumor mass was nearly removed, and pathological report was germinoma. He was discharged and. radiation theraphy was given. He is well for 7 months post-operatively.

Dumb-bell 모양의 요추 Ganglioneuroblastoma 일예 보고

고학종,차희중,최길수,심보성 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.2

The ganglioneuroblastoma is a rare tumor originating form the sympathetic chain. Both cytologically and biologically it is intermediate between the highly malignant neuroblastoma and the benign gauglioneurinoma. The predilection site of neoroblastoma is adrenal medulla, but ganglioneuroblastoma and ganglioneurinoma are frequently located in the retropreitoneum and mediastinum. We have recently experienced the dumb-bell shaped ganglioneuroblastoma at L-2 and 3 level. A 2 year-old-girl was admitted to Seoul National University hospital on May-1975 with complaints of lumbar back pain and kyphosis for 6 months. She had normal motor and spincter function. Neurological examination showed normal. Simple lumbar spine x-ray showed the widening of interpedicular distance and erosion of the pedicle at L-2 and L-3. On lateral view scalloping of posterior herder of L-2 was found. Lumbar puncture and myelography were failed. Total laminectomy at L-2, L-3 was done. Dumb-bell shaped mass was seen half in the extradural intraspinal space and half in the extraspinal space with pedicle in the widened intervertebral foramen. The mass was adult thumb-tip sized, dark greyish tan color, modular surfaced, and well encapsulated. The tissue diagnosis was ganglioneuroblastoma. Post-operatively urinary secretion of vanyl-mandelic acid level was normal limit.

Pituitary Apoplexy의 1예 보고

고학종,조맹기,채진,최길수,심보성 대한신경외과학회 1973 Journal of Korean neurosurgical society Vol.2 No.2

A 46 years old woman was admitted to the department of Neurosurgery, Seoul National University, complaining of a sudden severe headaches and vomiting 7 days before admission. Three days later her vision became poor in the left eye and totally blind on the day of admission. She had amenorrhea for 15 years. On neurological examination, she was somewhat lethargic but fully conscious. Both optic discs were normal. Left pupil was dilated, fixed and totally ophthalmoplegic. Because of poor cooperation the visual field examination was not performed. Tongue protrusion was deviated to the right side. Cerebrospinal fluid was bloody. Skull X-rays showed a large pituitary fossa with erosion of the left anterior, clinoid process and dorsum sellae. Left carotid angiogram showed a finding of suprasellar extension of the intrasellar mass. Retrograde brachial angiogram showed remarkable posterior displacement of the distal portion of the basilar artery. Left subfrontal approach was done and found a huge suprasellar mass compressing the left optic nerve. The tumor was aspirated and blood clot was obtained. The capsule was incised and content with hematoma was evacuated. Histologic examination showed complete blood clot with no recognizable neoplasm. Post-operatively, her left eyeball began to move and she was able to sec some objects in close distance few hours after surgery.

"터어키" 鞍주위 점액성 연골육종의 1예 보고

고학종,김현집,조병규,김국기,채진,최길수,심보성 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.1

Cartilaginous tumors of the skull base are rare. The authors recently encountered a case of parasellar myxochondrosarcoma. The clinical and more important differential diagnosis of the tumors of skull base are presented. A 49 years old Korean housewife was admitted to the dept. of Neurosurgery, Seoul National University Hospital because of the progressive visual disturbance of 3 years' duration. She had had mild headaches for 7 years. On physical examination, left homonymous hemianopia was noted. She could only see the moving hand in front of her right eye. Left visual acuity was quite normal. Other cranial nerves were not involved. Plain skull x-rays showed multiple stippled irregular calcifications around the right parasellar area. There was no evidence of bony destruction on the axial view. Right carotid angiogram showed the opening of carotid siphon, elevation of the bifurcation point of ICA, nonvisualization of the right ACA, and the forward-upward displacement with the thinning of the right internal carotid artery by the compression of the parasellar mass. There was no tumor blush or abnormal vessels. At surgery, a huge white avascular mass in the parasellar region, compressing and enveloping the right optic nerve and internal carotid artery was subtotally removed. The tumor mass extended far posterior to the dorsum sellae. The exact site of the origin was difficult to identify. The histologic diagnosis was myxochondrosarcoma. She was recommended the radiation therapy and discharged without improvement of her visual field in 3 weeks postoperatively.

뇌종양 환자에서의 유두부종의 형광안저촬영 소견에 대한 고찰

고학종,조병규,손효정,채진,최길수,심보성 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

Fluorescein retinal angiography has been used in order to make differential diagnosis between true papilledema and pseudopapilledema, and to make early confirmation of the incipient papilledema. After injection of 5cc of 10% fluorescein sodium into antecubital vein, the fluorescein retinal angiographic findings of 6 normal adults and 17 papilledematous patients of the brain tumor were obtained by Zeiss fundus camera (exciter filter: Kodak Wratten 47 A, barrier filter: Schott GG 14). 1. The characteristic findings of papilledema in the disc are: a. Leakage of fluorescein from capillaries and persistence of the fluorescence till late stage. b. Capillary dilatation. c. Microaneurysm. 2. The massive leakage of the fluorescein is seen in the patients of the 3rd ventricular or posterior fossa tumor. 3. The decreased visual acuity is prominent in the patients showing marked capillary dilatation and microaneurysm.

요추추간핵 마미강내 탈출 1예 : case report

김국기,고학종,조병규,채진,최길수,심보성 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.1

Rupture of the lumbar intervertebral disc into the dural sac is very rare. Total of 11 cases have been reported in the literatures. In Korea, one case of the intradural herniated disc of L_(4,5) interspace was reported at Seoul National University Hospital in 1972. Patients of the intradural herniated disc have usually a long history of recurrent low back pain and sudden exacerbation of symptoms with radiating pain on both lower extremities precipitated by minor trauma. A 47 years old female was admitted to Seoul National University Hospital complaining of severe low back pain and radiating gluteal pain on both sides. She had intermittent lumbago of 25 years' duration. Eight months prior to admission, radiating gluteal pain on both sides developed in addition to the aggravation of the lumbago due to minor back trauma. Physical and neurological examination showed local protrusion and the tenderness of the L3, L4 spinous process area, the hyperalgesia on the right L3, L4, and L5 dermatomes, no saddle anesthesia, normal dorsiflexion of both ankles and great toes, slight decrease of the right knee jerk and bilateral absence of the ankle jerk, and no sphincter dysfunction. Myelogram showed complete block at the L3-4 interspace level. Total laminectomy of the L3 and L4 was done. When the dura was opened, a solid round mass of a thumb-tip size was seen occupying the whole dural sac, compressing the nerve roots. The mass was a herniated disc from L3-4 interspace that had ruptured through central part of the posterior longitudinal ligament and ventral dural wall. Protruded intradural mass was removed en masse after incision of the overlying arachnoid membrane and the remaining L3-4 interspace disc material was removed in pieces extradurally. The mass was revealed as a degenerated nucleus pulposus on microscopic examination. The patient had an uneventful recovery with improvement of the neurological deficits.

뇌도수관 폐쇄로 인한 수두증 4예

차희중,고학종,김현집,최길수 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.2

Aqueductal obstruction has been an interesting entity among hydrocephalic patients because of its possible permanent cure by interventriculostomy alone, eliminating the need of external shunt problem. Recently we have experienced four such cases as following. Case 1: A 21 years old female was admitted due to headache and deteriorating visual acuity. Positive neurologic findings were bilateral papilledema and rapidly deteriorating visual acuity. Conray ventriculogram revealed bilateral symmetrical hydrocephalus with obstruction at the distal portion of the aqueduct. Suboccipital craniectomy was performed. Cistema magna and fourth ventricle were dried. With 3.5 cm upwards advancement of Nelaton tube from the orbex, resistence was felt. And with further advancement, giving sensation of membrane rupture was felt. We confirmed good passage of C. S. F. and closed without the tube remained. The patient was discharged two weeks later with much improvement clinically. Case 2: A 20 years old male was admitted due to sudden onset of coma. Positive neurologic findings were bilaterally dilated pupil, increased DTRs, and positive toe signs. Conray ventriculogram revealed marked hydrocephalic pattern with cupping like obstruction at the distal portion of the cerebral aquedct. Operative findings were the same as in case 1, but rubber catheter was remained in the cerebral aqueduct. Post-operative course revealed high fever due to pneumonia, but much clinical improvement was achieved until discharge. Case 3: A 6 years old girl was admitted due to unsteady gait and headache. Neurologic findings were bilateral papilledema,'hyperactive DTRs, positive toe signs and generally disturbed cerebellar function. Radiologic and surgical findings were the same as in case 1, but a tube was remained in situ. Post-operative state revealed satisfactory. Case 4: A 14 years old boy was admitted due to headache and unsteady gait. Positive neurologic findings were hyperactive DTRs, positive toe signs and disturbed 1t. cerebellar function. Conray ventriculogram revealed marked hydrocephalus and obstruction at the mid-portion of aqueduct. Proximal aqueduct was markedly dilated. Suboccipital craniectomy was performed, when 3.7 cm adavancement of the tube, resistance was felt, but giving sensation of membrane rapture was not felt. So the tube was remained in situ. Post-operative state revealed drowsy consiousness, right lateral gaze palsy and transient C.S.F. leakage. Surgical mortality was zero, and the. complications of case 4 were supposed due to inadequate placement of the tube. From these, we feel that simple membraneous puncture' without catheter tube placement may be better if surgeon feels the giving sensation of membrane puncture when the tube advancement to make C. S. F. passage. Otherwise, the catheter may be well left in situ.

가족성 양측성 청신경종

김종현,고학종,최운성,채진,최길수,심보성 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.1

The familial occurrence of bilateral acoustic neuroma has rarely been reported in the literatures, and its inheritance is known to be an autosomal dominant trait in association with or without von Recklinghausen's disease. Recently, we experienced an unusual case of bilateral acoustic neuroma, which was familially occurred in mother and her son. A 18-year-old Korean boy was referred to us due to bilateral hearing disturbance and staggering gait of one year duration. There were no stigmata of von Recklinghausen's disease. Neurological examination, simple skull films and vertebral angiograms revealed various evidences of bilateral cerebellopontine angle tumors. At operation, a hen egg-sized firm mass was subtotally removed at the left cerebellopontine angle region and a peanut-sized mass was totally removed at the right cerebellopontine angle region via suboccipital craniectomy. The histological diagnosis was neurofibroma. In family history. 13 years ago his mother was operated on C6-7 neurofibroma at her age of 28 years, and again operated on bilateral acoustic tumors 2 years later. The histological diagnosis was also neurofibroma.

초점성 뇌허혈에서 재관류가 국소뇌혈류 변화에 미치는 영향에 관한 실험적 연구

정희원,고학종,김현집,조병규,김성완,민병구,한대희,심보성,최길수 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.3

Reperfusion into focal ischemia using a transorbital snare ligature was studied in 20 unanesthetized cats following middle cerebral arrtery (MCA) occlusion of 1 to 6 hours duration. Changes of a regional cerebral blood flow (rCBF) were investigated upon with a hydrogen clearance method in the center and periphery of the MCA territory, which were correlated with the size of infarct delineated by a 2% triphenyl tetrazolium chloride solution and with the occurrence of severe brain edema or hemorrhagic infarct. The results were as followings: 1) Post-ischemic hyperperfusion was usually found after 1 hour occlusion of MCA followed by 2 hours recirculation. Final rCBF, however, reached pre-occlusion value and little or no infarct was found. 2) In the 2 hours occlusion-reperfusion group, hypoperfusion after reopening of MCA was regularly found in both the center and the periphery of ischemia, which was well contrasted with hyperperfusion in the I hour occlusion group and was accompanied by evident but mild infarcts. 3) After 4 and 6 hours occlusion, there was usually evident post-ischemic hyperperfusion soon followed by development of severe hypoperfusion and a higher grade of infarct and hemispheric swelling was found. 4) Final hypoperfusion after transient MCA occlusion was observed only after ischemic periods lasting 2 hours or more irrespective of preceding post-ischemic hyperperfusion and was only related to the duration of the occlusion and not to the degree of blood flow disturbance. 5) Spontaneous hyperemia during occlusion was found in 3 of the 5 cats used in each of the 4 and 6 hours occlusion groups, in which there was marked hyperperfusion after reopening of MCA followed by severe hypoperfusion and transtentorial herniation associated with resulting extensive hemorrhagic infarct and marked hemispheric swelling. 6) Hemorrhagic infarcts were found in one cat of the 4 hour-occlusing group and two of the 6 hour-occlusion group, all of whom showed early hyperemia before reperfusion predictable of such a detrimental result. 7) These data indicate that potential hazard for surgical revascularization in the acute stage of ischemic stroke should be considered in case profound ischemia had already progressed for 4 hours or more and especially when hyperemia during the initial stage of severe ischemia is observed at the center and the periphery of the ischemic area expected.

Hutchinson형 신경아세포종 1예

차희중,고학종,최길수 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.1

Metastasis of neuroblastoma into the central nervous system is well known, but, in fact rare clinically. Recently we had experienced one such case, which was characterized by sudden onset of paraplegia and blindness and delayed appearance of radiologic findings. A 7 years old Korean boy was admitted to the pediatric ward of the Seoul National University. Hospital on September 28, 1975 due to sudden onset of paraplegia. All physical, laboratory and simple thoracic spine X-ray findings were normal except for albuminocytologic dissociation in the C.S.F. Guillain Barre syndrome was suspected and steroid therapy was recommended. On November 10, 1975, he was readmitted due to sudden loss of visual acuity bilaterally. At first all radiologic examinations revealed no clue to the lesion. After 4 months from the onset, there appeard typical pedicular destruction of the thoracic spine and confirmed it as neuroblastoma by surgery.