투명세포성 수막종

서의교,이규성 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.31 No.3

해면정맥동의 수술적 접근법

서의교 이화여자대학교 의과학연구소 2006 EMJ (Ewha medical journal) Vol.29 No.2

단일 모동맥에서의 다발성 뇌동맥류

서의교,안정용,주진양,Seo, Eui Kyo,Ahn, Jung Yong,Joo, Jin Yang 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12

Objective : Multiple cerebral aneurysms reportedly account for 14-33% of all cerebral aneurysms. However, multiple separate aneurysms on single parent artery are uncommon. The majority of these are found on middle cerebral artery(MCA). Multiple aneurysms arising from anterior communicating artery(ACoA) are rare. We report 5 cases of multiple aneurysms developed separately on single artery and describe angiographic and operative findings of these lesions. Materials and Methods : Among 127 patients of cerebral aneurysms operated in our hospital, only 5 had multiple aneurysms on single parent artery. Results : Among 5 cases, 4 were diagnosed preoperatively and the only one was found intraoperatively. Two were found on MCA bifurcation, one on M2 and two on ACoA. All separate aneurysms developed on single parent artery were treated successfully with multiple clipping. Conclusion : Multiple cerebral aneurysms, developed separately on single parent artery, are uncommon. Furthermore, those arising from ACoA are very rare. Despite the advanced technology in radiological examinations, multiple cerebral aneurysms may not be detected on preoperative study only. Close proximity or smaller size of the lesion may be responsible for the preoperative false negative angiographic findings.

뇌량주위동맥에 발생한 외상성 뇌동맥류 - 증례보고 -

서의교,주진양,Seo, Eui Kyo,Joo, Jin Yang 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Traumatic intracranial aneurysms are rare, compromising less than 1% of intracranial aneurysms. The case of 20-year-old man suffered from delayed frontal intracerebral hematoma, subarachnoid hemorrhage and intraventricular hemorrhage from traumatic pericallosal aneurysm 12 days after head injury is presented. Traumatic pericallosal artery aneurysm is always near the falcine edge, is unrelated to arterial branching point. Sudden movement of brain and artery causes vessel wall injury against the stationary edge of the falx. Because of high mortality rate of ruptured traumatic aneurysm, clinical suspicion must be focused on the prompt diagnostic work-up and early treatment.

후두엽 뇌동정맥기형과 시야결손

서의교,박현선,주진양,이규창 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.4

The authors analyzed 38 consecutive cases with an occipital arteriovenous malformation(AVM) in regard to visual field defect. The incidence of occipital AVM was 10.4% among 367 patients with a cerebral AVM treated between 1975 and 1994 in our institute Bleeding rate of occipital AVM in this series was 86.8%(33 casss) and it was significantly higher than that of AVM in other locations. Of 38 cases, 15 patients(39.5%) had a visual field defect on admission and all of them were accompanied by intracerebral hematomas caused by the rupture of AVMs. The presence o# visual field defect did not correlate with angioarchitecture in reference to pattern of nidus. feeding artery and draining vein. Of 15 patients with visual field defect, 10 patients showed homonymous hemianopsia and five patients. homonymous quadrantanopsia. The size and location of intracerebral hematoma correlated well with the type of visual field defect Among 38 patients. 2l patients underwent microsurgical resection(occipital interhemispheric approach: 11 parietooccipitai approach : 10) with six preoperative embolization and 1 postoperative gamma knife surgery Fifteen patients underwent gamma knife surgery with five preoperative embolization. One patient underwent embolization only. The results of treatment were as follows; There were no mortality and morbidity except for visual field defect We confirmed complete resection or obliteration o# malformed vessels in 25 patients and reduction of the nidus size in eight patients. Fivs patients were not followed After gamma knife surgery. two patients showed rebleeding during the follow up period Among f9 patients who had no visual field defect before treatment. three patients showed visual field defect after treatment(one after microsurgical resection using occipital interhemispheric approach. two after preoperative embolization. In 15 patients with visual field defect before treatment. four patients showed improvement in their visual field defect after treatment(three after microsurgical resection using occipital interhemispheric approach. one after gamma knife surgery). The paristooccipital approach did not change the status of visual field in any of the ten patients In occipital AVM. visual field defect was the most serious morbidity. Ruptured occipital AVM had a higher incidence of hemorrhage causing a visual field defect and had a higher indication of direct surgical approach than AVM of other location lu planning surgery of occipital AVM, one has to count microsurgical anatomy based on the visual pathway as well as clinical findings such as the angioarchitecture. location of intracerebral hematoma. and preoperative visual field

모야모야병의 진단과 치료

서의교 이화여자대학교 의과학연구소 2013 EMJ (Ewha medical journal) Vol.36 No.1

Moyamoya disease is a cerebrovascular disease of unknown etiology, which is characterized by bilateral stenosis or occlusion at terminal portion of internal carotid artery and at proximal portion of anterior cerebral artery and /or middle cerebral artery and abnormal vascular network in the vicinity of the arterial occlusions. It occurs frequently in Asian countries, particularly in Korea and Japan, but is rare in Western countries. To establish the etiology of moyamoya disease, much about the pathology from autopsies, factors involved in its pathogenesis, and its genetics have been studied. It may occur at any age from childhood to adulthood and in general, initial manifestation is cerebral ischemic symptoms in children and intracranial hemorrhage symptoms in adults. Because it progress and cause recurrent stroke, early diagnosis and proper management has been recognized. Cerebral angiography is essential for definitive diagnosis and treatment plan. Magnetic resonance imaging/magnetic resonance angiography is useful for diagnosis and follow-up tools after revascularization. Evaluation of the cerebral hemodynamics by single photon emission computed tomography and positron emission tomography is useful for diagnosis and assessment of the severity of cerebral ischemia in moyamoya patients. Surgical revascularization is effective for moyamoya disease manifesting as ischemic symptoms, to prevent further ischemia and infarction. In hemorrhagic type moyamoya disease, revascularization can be considered. Direct bypass, indirect synangiosis and combined methods are used. Outcomes of revascularization are excellent in preventing transient ischemic attacks in most patients.

경추-흉추 연접부에 생긴 단일 형질세포종 : 증례보고 Case Report

서의교,윤영설,조용은,김영수 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

A case of solitary plasmacytoma on the cervicothoracic junction is reported. Solitary palsmacytoma of the spine is uncommon and it may cause cord compression. The authors present the case of a 61-year old female patient with the symptoms of paraparesis and posterior neck pain. Spine MRI revealed cord compression from a bony mass at the level of C7-T2. After corpectomy and total mass removal, anterior interbody fusion with Ham's titanium mesh filled with allograft bone was performed, followed by radiotherapy. The patient has improved after operation and walks alone without assist. The solitary plasmacytoma of the spine is a lesion with the potential for long term remission or even cure in some cases. The above case was reported by the authors together with literature review.

본태성 다한증 환자의 수술 후 발생하는 보상성 다한증

서의교,조용은,윤도흠,김영수,Seo, Eui Kyo,Cho, Yong Eun,Yoon, Do Heum,Kim, Young Soo 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objective : Essential hyperhidrosis is a pathological condition of excessive sweating beyond that required to cool the body, though poorly understood, originating from a dysfunction of the sympathetic nervous system. Thoracoscopic sympathectomy is the most popular treatment for upper limb hyperhidrosis, because it is a safe, effective, minimally invasive, and time-saving method. However, the common complication is the compensatory hyperhidrosis in other areas of the body, notably on the back, chest, abdomen, and buttocks. Compensatory hyperhidrosis is severe enough for some people, especially those living in a warm climate or engaging in heavy physical activities, to regret ever having had operation. The pathophysiological mechanisms underlying compensatory hyperhidrosis are incompletely understood, even though it is thought to be a truly compensatory feature related to thermoregulation of the body. Materials and Methods : we studied the clinical features of total 233 patients who were diagnosed as essential hyperhidrosis and treated with thoracoscopic sympathectomy or sympathicotomy from March 1992 to July 2000. Results : The success rate of thoracoscopic sympathetic surgery(sympathectomy or sympathicotomy) was 98.7%. The global rate of compensatory hyperhidrosis was 77% ; 84% in group T2, 3 sympathectomy, 76% in group T2 sympathectomy, 43% in group T2, 3 sympathicotomy and 59% in group T2 sympathicotomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathectomy and in T2, 3 sympathectomy than in T2 sympathicotomy and T2, 3 sympathicotomy with significancy in statistic analysis(p<0.01). The precipitating factors of compensatory hiperhidrosis, including heat(warm weather), anxiety, stress, and exertion were noted. The compensatory hyperhidrosis was the main cause of patient dissatisfaction after thoracoscopic sympathectomy. Conclusion : The degree of compensatory hyperhidrosis is closely related to the extent of thoracic sympathectomy.

신경계중환자실에서 적극적 감시배양과 탈집락을 통한 MRSA감염 관리활동

정선영,서의교,이미애,손희정,최희정,현석경 한국의료QA학회 2009 가을학술대회 Vol.2009 No.3

경후두과 접근법 및 경후두과와 접근법을 이용한 추골동맥 및 후하소뇌동맥 동맥류의 수술적 치료

양나래,서의교 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.3

Objective : Since posterior circulation vascular lesions are adjacent to important structures such as the brain stem and lower cranial nerves, the acquisition of anatomical information and the careful selection of approaches are essential for the surgical treatment of these lesions. We examined the characteristics and the indications of the far lateral suboccipital approach which exposes lesions without retraction of the brain stem for the treatment of either a vertebral artery (VA) or posterior inferior cerebellar artery (PICA)aneurysm. We present the best diagnostic tool to determine the approaches. Methods : We have reviewed 11 patients who received surgical treatments between 2005 and 2011 for VA or PICA aneurysms. All of the patients had 3-dimensional computed tomography (3DCT) angiography performed to investigate the relation of the location between the aneurysm and hypoglossal canal. Results : Eight of the 11 patients were treated with the transcondylar fossa approach (TCFA) as their lesions were located proximal to the hypoglossal canal, while three were treated with the transcondylar approach (TCA) as their lesions were located distal to the hypoglossal canal. Of the three patients treated with the TCA, one had temporary palsy of the 11th cranial nerve and the others recovered without any neurological defects. 3DCT angiography showed the relation of the location between the aneurysm and hypoglossal canal. Conclusion : The TCFA and TCA are good approaches to expose lesions without retraction of the brain stem. To determine the approaches for the surgery of VA or PICA aneurysms, using 3DCT before surgery is advantageous in understanding the positional relations between the hypoglossal canal and the lesions. During the actual surgery, the posterior condylar canal through which the posterior condylar emissary vein passes can be used as an anatomical landmark for TCFA. With this approach,craniocervical instability can be avoided.