청신경 초종에 대한 감마나이프 치료의 임상경험

권양,이동준,이정교,권병덕,황충진 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.10

Microsurgical tumor removal is the treatment of choice to relieve the mass effect for the treatment of acoustic neurinoma patients. Gamma knife radiosurgery is another treatment option for patients with tumor size of less than approximately 4cm. Between May, 1990 and March, 1994, 55 tumor lesions from 50 patients were treated with gamma knife radiosurgery at Asan Medical Center. Following microsurgery, 20 patients underwent gamma knife radiosurgery for tumors not removed surgically. The remaining 30 patients underwent gamma knife radiosurgery alone. For an average follow-up period of 26 months(ranging from 6 to 45 months), 37 lesions out of 39 lesions responded, giving a tumor growth rontrol rate of 94.9%. Facial neuropathy and trigeminal neuropathy were noted in 8% and 6%, respertively. According to these results, it is suggested that gamma knife radiosurgery is an effective alternative therapeutic modality for the management of small to moderate sized acoustic neurinomas.

체외충격파를 이용한 두부손상 모델에서 ¹H 자기공명 영상의 변화와 ^(31)P 자기공명분광법으로 관찰한 뇌의 고에너지 인 대사에 관한 실험적 연구

권양,황충진,최길수 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

The purpose of this study is to describe the ¹H MR imaging findings of focal brain injury by ESWL(Extracoporal Shock Wave Lithotripsy) and to evaluate the changes of high energy phosphate metabolism of the injury using ^(31)P MR spectroscopy. Spectral changes of high energy phosphate metabolites. including Pi(inorganic phosphate). PCr(phosphocreatine). and Adenosine Triphosphate(ATP) were monitored in both trauma(n=5) and control(n=5) groups over 8 hour period following injury. And 'H MR imagings were obtained to evaluate the focal cerebral lesions(n= 10) and compared with the gross and histologic findings of the specimen. The results were as follows : 1) In proton density-weighted MR images. focal areas of high signal intensity were seen in the cerebral hemispheres in S out of 8 traumatized cats(24KV. 500x shock wave). There were corresponding edematous changes in the white and gray matter and petechial hemorrhage in the cortex on gross and histopathologic studies. In 2 traumatized cats(24KV. 1000x shock wave). there were large hematomas in the cerebrum. 2) The decrease of brain pH was maximum in 30 minutes after ESWL injury in the trauma group(n=5) when compared with the control group, but statistical difference between two groups was insignificant. 3) In the trauma group. initial decrease of PCr/Pi was found in 30 to 60 minutes with return to control levels by 2 hour after injury(p<0.05). followed by a second decline in 4 hour that persisted for the remaining 5 hour observation period(p<0.05). 4) No significant changes in ATP concentration were observed during the experimental period. In conclusion, the changes seen above after focal brain injury using ESWL may be indicative of altered energy production, which may account for the reduced capacity of the cell to recover from traumatic injury.

Radiosurgery with Gamma Knife in Korea

권양 가톨릭중앙의료원 가톨릭암센터 1995 암심포지움 Vol.- No.1

뇌동맥류의 혈관내 수술시 합병증 발생과 치료법

권양,Kwon, Yang 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

정위적 방사선수술로 치료한 AOVM의 임상분석

권양,이정교,권병덕,이동준,황충진 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.4

In recent years, an increasing number of patient with AOVMs have been recognized using MRI. When an AOVM is located in a region associated with an unacceptable surgical risk, stereotactic radiosurgry offers an alternative treatment. We treated 21 patients with AOVM using gamma knife radiosurgery from June, 1990 to December, 1993 at Asan Medical Center. The indications for radiosurgery were as follows : 1) Patients who had episodes of hemorrhage from a lesion that had the characteristic images of AOVM in MRI. 2) Patients who had seizures and the focus of these seizures corresponded to the lesion. 3) Patients were excluded if the lesions were located superfically or were accessible to microsurgery. Nine patients presented with hemorrhages and twelve with seizures. The marginal dose was ranged from 10 to 25 Gy at or above the 50% isodose line. Of eight patients followed 12 months or less after radiosurgery, two patients had improved neurologic deficits and one had decreased the seizure frequency with mediciation. Among seven patients followed 12-24 months, MRI showed a reduction of the lesion in one patient and no change in five patients. One patient had perifocal edema. In two patients with seizures, one patient was seizure free without medication and one patient was controlled with medication. In six patients between 24 and 44 months, two patients had smaller lesions and three patients had perifocal edema. Among four patients who had seizures, one patient was seizure free without medication and three had decreased the seizure frequency with medication. Postoperative complications developed two patients, but one patient showed improvement of neurologic deficits after a short period of steroid medication. Stereotactic radiosurgery offers a treatment to a selective patients with intracranial AOVMs.

TCD를 이용한 뇌사의 판정기준

권양,김창진,임승철,권병덕,황충진 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.4

It is generally known that demonstration of absence of cerebral blood flow is necessry to confirm brain death. Transcranial Doppler(TCD) is an accurate method of monitoring the blood flow velocities of the cerebral vessels. We performed transcranial doppler(TCD) examinations on 15 patients in brain death. Anterior criculation was examined through the temporal window or transorbiral window and basilar arteries were examined through the suboccipital window. All of the patients fulfilled the criteria for determination of brain death by clinical criteria, EEG and/or Brainstem Auditory Evoked Response(BAER) or clinical criteria alone, were mechanically ventilated. A TCD waveform abnormality consisting of reversed diastolic components was found in all brain death patients. The net flow veloicties of <10 ㎝/sec were present in all brain death patients. TCD may be a rapid and convenient alternative to cerebral angiography for confirming brain death when institutional protocols require such comfirmation.

뇌하수체 선종의 치료에서 감마나이프의 역할

권양,황충진 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.9

The treatment of choice for symptomatic pituitary adenomas varies according to the hormone secreting types of the adenoma and can include pharmacology surgery, or radiotherapy. The recent development of radiological imaging and microsurgery has made surgery the treatment of choice for most pituitary tumors. However, the long-term tumor control rate after microsurgery varies from 50% to as high as 80%. During the last 38 months (1990.5-1990.9, 1991.5-1994.2), 34 cases of pituitary adenomas were treated by gamma knife at Asan Medical Center. There were 11 cases of prolactinomas, 9 cases of acromegaly, 8 cases of ACTH-secreting tumors and 6 cases of non-functioning tumors. Seventeen patients underwent gamma knife radiosurgery for recurrent or remaining tumors after resective surgery. Another 17 patients were treated primarily with gamma knife. In microadenomas, the mean tumor volume was 221 cumm and the mean marginal dose was 33.1 Gy. In microadenomas, the mean tumor volume was 2690 cumm and the mean marginal dose was 22.6 Gy. Twenty-seven patients have had an average follow-up period of 26 months with a range from 3 to 48 months. As a result, five out of eight prolactinoma patients had normalization of prolactin hypersecretion and seven patients showed clinical cure. On follow-up imaging studies, five out of seven tumors showed no changes in their size, while two showed marked reduction. Two out of for ACTH-producing tumor patients showed normalization of 24 hour urine cortisol levels. On follow-up imaging studies of the two cases, the tumor of one patient disappeared and the other one showed no change. Three out of six acromegalic patients showed clinical responses. Two out of five non-functioning tumors showed reduction in size and three showed no changes. In conclusion, gamma knife radiosurgery seems to be effective as adjuvant therapy for the treatment of remaining or recurrent pituitary adenomas after surgery and primary treatment modality in selective patients.

순환정지와 저체온 및 Barbiturate를 이용한 후혈행 뇌동맥류 수술 3례 : 3 Cases

권양,김창진,임승철,권병덕,황충진,김삼현,황연미,한성민 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.2

Direct approach of technically difficult or inoperable intracranial aneurysms may become possible using complete circulatory arrest with extracorporeal circulation and profound hypotherima and barbiturate cerebral protecion. To avoid difficulties associated with closed chest method, open chest method was used by direct cannulation of the right artium and aorta through the chest. 3 patiens with posterior cirulation aneurysms operated on with these techniques ; 1 large basilar bifurcation aneurysm and 1 irregular shaped vertebro-basilar junction aneurysm and 1 posterior cerebral artery aneurysm were operated on and all had excellent results. Careful attention was needed to the depth of hypothermia, duration of total circulatory arrest, and hemostasis which important factors in the success of these methods.

자발성 뇌출혈 환자의 치료에서 뇌정위수술과 보존적치료의 비교분석

권양,김창진,임승철,권병덕,황충진 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.7

The treatment of patients with spontaneous intracerebral hematoma is still controversial, but stereotaxic surgery is preferred to conservative treatment recently. We analyzed 78 patients with spontaneous intracerebral hematoma and compared the result of treatment between two groups ; 40 patients with stereotaxic hematoma evacuation, 38 patients with conservative treatment. The results were as followings : In thalamic and basal ganglia hematoma, improvement of consciousness level, motor grade and Glasgow coma scale in stereotaxic surgery group was better than that of conservative treatment group and the mortality rate was lower in the stereotaxic surgery group than in the conservative treatment group. Patients with alert or somnolent state preoperatively had better functional recovery in the surgically treated group, but stuporous or comatose patients had no better outcome after surgery. Stereotaxic hematoma evacuation can minimize the brain damage and be performed under the local anesthesia, so it can lower the mortality and morbidity rate of the spontaneous intracerebral hematoma patients.

Nelson씨 증후군 : 1예 보고 A Case Report

권양,정희원,지제근,최길수 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.4

A case of Nelson's syndrome in 23 year-old female, developing 6 years after bilateral adrenalecomy for Cushing's syndrome, is reported. Presenting symptoms were headache and hyperpigmentation of the skin and mucous membrane. Serum ACTH level was markedly elebated above 1000pg/㎖, but serum cortisol level diminished markedly. Transsphenoidal approach (TSA) with removal of gushing out hematoma and tumor underwent. Postoperatively, headache subsided and hyperpigmentation of the skin markedly improved.