소아기 외상성 경막외혈종 환자에서의 보존적 치료

송시헌 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

With the advent of computerized tomography(CT) , an increasing number of patients with only minimal symptoms and signs are found to harbor considerable amount of acute epidural hematomas. Although most of these patients were still subjected to craniotomy because of the neurosurgeon's ingrained fear of delayed deterioration, the initial stable status of these patients warrants some rethinking about conservative treatment. The purpose of this study was to present a 34 pediatric epidural hematoma patients who were treated conservatively at Chungnam National University Hospital over a recent 6 year period and to define the clinical parameters that may aide in the conservative management of patients with epidural hematomas who were in state of clinically stable minimal symptoms and signs. Analysis of the patients revealed that age, sex, Glasgow Coma Scale score of more than 12, an initial size of the hematoma of less than 40cc, the presence of skull fracture and the hematoma locations are not risk factors for delayed deterioration. This study propose that those children with epidural hematoma who initially have a stable neurological status can be successfully selected for close observation and conservative treatment.

신경외과 영역에서 BANAN^(�)(Cefpodoxime proxetil)의 감염치료효과에 대한 임상적 연구

송시헌,김한겸 최신의학사 1994 最新醫學 Vol.37 No.7

급성 뇌경막외혈종의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

The outcome of acute epidural hematoma has been generally unsatisfactory. This study has analyzed the factors influencing the outcome of 99 patients who underwent acute epidural hematoma evacuation. Seventeen patients(17.2%) died and seventy-eight patients(78.8%) had a favorable outcome. A significant correlation was found beteen the outcome and the motor score at preoperation, pupillary response, bleeding point at operation, the degree of midline shifting, hematoma thickness and hematoma density on computerized tomography. However, the patient's age, the mode of injury, the hematoma location and the shape of the hematoma did not correlated with the outcome.

뇌동맥류성 지주막하 출혈에 대한 뇌전산화 단층촬영의 가치

송시헌 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

Computerized tomographic (CT) scanning is of value in the assessment of cases of subarachn oid hemorrhage (SAH). To determine the localizing, features, rates of detection of SAH due to ruptured aneurysms and to evaluate the correlationship between CT findings, clinical grade, angiographic vasospasm, CT scans, angiograms and clinical records were reviewed in 50 consecutive patients with SAH due to a ruptured aneurysm. In 84 % of all cases, the CT scans showed the presence of SAH. The most common location for an aneurysm was anterior communicating artery. There was somewhat a relationship between the CT grade and the angiographic grade. However, a strict correlation. not only between the CT grade and clinical grade but also between the angiographic grade and clinical grade was not observed.

소아의 흉수내에 발생한 다형성 교아세포종 1예

송시헌,윤희중,금동인,김윤 대한신경외과학회 1982 Journal of Korean neurosurgical society Vol.11 No.3

Primary spinal glioblastoma multiforme is very rare, especially in childhood. 13-year-old boy was admitted to our neurosurgical department because of paraparesis, sensory loss below T10 and sphincter disturbance. Thoracic myelogram showed complete obstruction at T10 level and total laminectomy with partial removal of the intrameduallary cord tumor mass was performed under the impression of spinal cord tumor. Postoperatively, his symptoms and signs unchanged. Pathological diagnosis was intramedullary glioblastoma multiforme involving thoracic cord.

원시성 교세포종 1예

송시헌,민경훈,금동인,김윤,지제근 대한신경외과학회 1982 Journal of Korean neurosurgical society Vol.11 No.3

Among the intracranial glioma, primitive glioma is very rare. We report a case of primitive glioma involving left parietofrontotemporal lobe of 8-year-old boy and who had about 12 months' duration of right sided hemiparesis, headache, vomiting and papilledema. CT scan showed a large, well defined round area of low density with peripheral rim of high density and high density small mass suggesting mural nodule in left frontoparietotemporal region. A left frontoparietotemporal osteoplastic craniotomy was carried out. A small nodule and cystic membrane containing pale yellowish colored proteinous cystic fluid were almost totally removed without difficulty. Postoperatively, the right hemiparesis and headache gradually cleared. Pathological diagnosis was primitive glioma.

소아에 발생한 낭성 핍지신경교종 1 예

송시헌 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

Oligodendroglioma is a relatively rare brain tumor making up to about 5% of all primary intracranial tumors. It's incidence is predominantly in adult, and it is quiet rare in childhood and adolescence. This 9-year-old boy patient presented with 3 months duration of headache, vomiting and I month duration of visual disturbance. Computerized tomography showed large low density and round shaped cystic mass with capsule over frontal lobe that was confirmed by operation. A brief review of oligodendroglioma is presented.

소아 두개저 골절의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

The purpose of this study is to analyze clinical features of 51 patients, who have admitted Chungnam National University Hospital, from January 1, 1992, to, June 30, 1997, with basal skull fracture in children. The results were as follows: 1. The peak age was 3-12 year-old and occured predominantly in male(1.7:1 ratio). 2. The most common cause of trauma was traffic accident(80.4%). 3. The frequent clinical features, in decreasing order of frequency, were pneumocephalus(72.5%), CSF otorrnea(33.3%), raccoon eye(23.5%), CSF rhinorrhea(21.6%), and facial palsy(15.7%). 4. The basal skull fracture line was detected in only 49% of cases by skull X-ray film. 5. The degree of development of paranasal sinus were poor in 68.2%. 6. CSF leak was noted in 66.75 of cases and among them 79.5% of cases were stopped spontaneously.

급성 경막하혈종의 임상적 고찰

송시헌,김태동 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.1

The outcome of acute subdural hematoma(SDH1 had been generally .unsatisfactory. The authors have analyzed the factors influencing the outcome of 70 patients who underwent acute SDH evacuation. Thirty five patients(50%) died and twenty two(31.4%) had a favorable outcome. A significant correlation was found between the outcome and the motor score at operation, the time interval to operation, pupillary response, type of operation and the Glasgow Coma Scale(GCS) at operation. But the patient's age, the mode of injury, the skull fracture, the degree of midline shift, the hematoma location, the type of brain swelling, the hematoma thickness and the systolic blood pressure did not correlate with the outcome scale.

강직성 뇌성마비 환아를 위한 선택적 척수 후신경근 절단술

송시헌 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

Cerebral palsy is a multifaceted disorder of which spasticity is only one aspect. Selective posterior rhizotomy(SPR) is a well-established treatment for spasticity associated with cerebral palsy and favorable results have been reported from a number of different centers. However, the techniques used in performing SPR to treat spastic cerebral palsy remains controversial. A review of the personal experience of the SPR performed at Chungnam National University Hospital(CNUH) for reduction of spasticity in children with cerebral palsy is presented. The SPR procedure performing in CNUH involves an L1 and L2 laminectomy, followed by the about 60.9% selective section of certain lumbosacral posterior spinal nerve rootlets(Ll-S1 or S2), based on the electromyographic responses to their electrical stimulation. All patients showed markedly relieved or disappeared spasticity on post-rhizotomy neurologic examination. Postoperative physical and occupational therapy are felt to be essential for regaining strength and improving motor function following the SPR.