중증 뇌동맥류 환자의 조기수술과 지연수술

함인석,박연묵,김승래 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.6

73명의 중증 뇌동맥류 환자들중 조기수술군 38명과 지연수술군 35명을 대상으로하여 신경학적 장애의 변화를 관찰하였으며 치료의 결과 및 합병증을 비교분석하였다. 지연수술군에서 수술을 기다리는 동안 54.3%가 신경학적 장애의 호전을 나타내었으나 34.3%는 수술전 합병된 재출혈과 뇌경색으로 사망하였다. 동맥류 접근시 ventriculostomy가 필요했던 경우는 조기수술군에서는 50%, 지연수술군에서는 26.1%였다. 출혈에 의한 두개강내 합병증의 발생 빈도는 지연수술군에서는 재출혈(p<0.05)과 수두증의 발생 빈도가 현저히 높았다. 그러나 혈관연축에 의한 뇌경색증은 양군에서 의의 있는 차이는 없었다. 치료의 결과는 good 상태로 회복된 것은 조기군에서 47.4%, 지연군에서 28.6%이었고, 사망율은 조기군에서는 23.6%, 지연군에서는 45.7%였으며(p<0.05), 입원 동안 주된 사망원인은 조기수술군에서는 뇌경색증에 의한 것으로서 15.8%였고, 지연수술군에서는 뇌경색증과 재출혈에 의한 것으로서 각각 22.8% 및 17.4%였다. The decision of proper time for operation on ruptured aneurysm is a very important tactic of treatment, because of the following major complications after subarchnoid hemorrhage. Recently it is widely accepted opinion that the ruptured aneurysm should receive an early operation for lower mortality and morbidity by preventing possible complications after subarachnoid hemorrhage such as rebleeding, symptomatic vasospasm and even hydrocephalus. Since 1985, we applied early to emergency surgery to the clinically deteriorating or nonimproving patients after aneurysm rupture and delayed surgery to the ameriolating patients who were placed under close observation. The early to emergency surgery on poor risk patient was performed within 48 hours after recent subarachnoid hemorrhage and delayed surgery was done after 2 weeks. Of the selective 95 poor-condition patients admitted to Kyungpook National University Hospital over the past 4 years from 1984, 60 got early surgeries and 35 delayed surgeryes. Among the 60 patients in the early group, 22 patients with considerable intracranial hemorrhage were exempted from this comparative study. A few cases of vertebrobasilar aneurysms were not included in this paper for a little value in significance. In this prospective study, we evaluated the results of early and delayed surgeries of poor risk patients through clinical analysis and comparison, and we could gain better results from early surgeries.

뇌수두증 환자를 위한 Ventriculotransverse Sinus Shunt

함인석,김병훈,이충형,황성규,박연묵,김승래 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

뇌수두증을 위한 측뇌실 횡경 정맥동간 문합술(ventriculotransverse sinus shunt)법의 수술방법을 처음으로 소개하였다. 6명의 수두증 환자에서 Pudenz low pressure valve를 이용하여 ventriculotransverse sinus shunt를 적용하여 치료를 시도하였으며 이들중 4명에서 술후 신경학적 장애의 호전을 나타내었다. 특히 고압 수두증 환자에서 신속한 호전을 보였다. 2명의 정상압 수두증 환자들은 술후 저압 발브(low pressure valve) 기능은 정상이었으나 신경학적으로 호전이 없어 측뇌실 복강간 문합술(Ventriculoperitoneal shunt)로 전환하였다. Ventriculotransverse sinus shunt는 복강이나 상시상 정맥동(superior sagittal sinus)을 이용한 문합술법보다 해부생리학적 면에서 유리할 것으로 사료되며, 고압 수두증 환자나 전신상태가 나빠 국소마취가 필요한 경우에 일차적으로, 혹은 일차적으로 시도했던 다른 문합술이 실패한 경우 같은 수술법으로의 재교정 대신에 시도해 볼만한 장래성 있는 방법으로 생각된다. 향후 더 많은 예를 실시하고 장기간 추적검사가 요할 것으로 사료된다. The new operative technique of ventriculotransverse sinus shunt for hydrocephalus is introduced in this paper. This method has been applied to 6 hydrocephalic patients with PudenzHeyer low pressure valve in our department of Kyungpook National University Hospital from June 1990 to May 1992. 4 cases including 2 high pressure hydrocephalus of all the patients improved in neurologic deficit within 2 weeks postoperatively. 2 cases of normal pressure hydrocephalus installed the same shunt showed no improvement without any shunt valve dysfunction. so the shunts were revised to ventriculoperitoneal shunts. The choice of transverse sinus rather than superior sagittal sinus for CSF recipient of shunt seems more reasonable anatomically and physiologically. And this procedure could first apply to the poor risk patients with local anesthesia in such cases with old age, deteriorated, and to the patients requiring revision of the other shunting. To confirm the effect and perspect for contineous using this new technique. more patients applying this method and long term follow-ups of them should be needed

脊椎 損傷 患者에 關한 臨床的 觀察

咸印碩,金乘來 慶北大學校 醫科大學 1982 慶北醫大誌 Vol.23 No.1

1973년 부터 1980년까지 경북대학병원 신경외과에 입원, 관찰된 남, 녀 243명의 척추 및 척수 손상 환자에 관해서 손상의 원인, 부위, 및 양상과 신경학적 장애 및 치료의 결과에 대한 경향을 분석, 관찰한 결과는 다음과 같다. 척추 손상은 남자가 205명(84.4%), 여자가 38명(15.6%)으로서 남, 녀의 비는 5.4대 1이였으며, 20세에서 49세의 연령층에서 67.8%로서 높은 발생 빈도를 나타내었다. 손상의 원인은 추락에 의한 것이 45.3%로서 가장 많았으며 다음이 교통사고에 의한 것으로서 31.7%였다. 손상의 부위는 경추부가 49%로서 가장 높은 발생 빈도를 나타내었고 흉, 요추부에서 25.5%, 흉추부에서 16.0% 그리고 요추부에서 10.3%이었다. 척추 손상은 전위 골절이 47.7%, 단순 골절과 불완전 탈구가 26.7%로서 주로 경추부에서 발생되었으며 압박 골절은 25.5%로서 주로 흉, 요추부에서 발생되었다. 척추 손상으로 척수와 신경근의 손상이 함께 유발된 것이 222명(91.3%)이었고 척수의 완전 손상은 139명(57.2%)이었으며, 부분 손상은 83명(34.1%)이었다. 척추 손상 환자 243명 중 수술을 시도한 88명(36.2%)과 비수술군 155명의 치료 결과는 일반 노동 종사에 가능한 "Excellent"와 "Good"이 전체 척추 손상자 중에서 83명(34.2%), 척수의 부분 손상을 나타낸 83명 중에서 59명(71.1%) 그리고 척수의 기능이 완전 상실된 139명 중에서 3명(2.2%)이었다. 사망율은 243명의 척추 손상자 중 19명으로서 7.8%였다. To evaluate the causes, site, types of spinal injuries, neurological disorders and clinical end results after surgical and, or nonsurgical treatments, a series of 243 cases of acute spinal injuries with and without cord damage, admitted to the department of neurosurgery Kyungpook National University Hospital, Taegu, Korea, from 1973 through 1980, were studied with following results; Among 243 cases 38 females (15.6%) and 205 males (84.4%) were found, resulting in male to female ratio of 5.4 to 1 and 67.8% of the cases were occurred in the age group from 20 to 49 years old. Main cause was fall down (45.3%), and traffic accident(31.7%) was next. The incidence of sites of spinal injuries showed as following in order; Cervical spine 49%; thoracolumbar spine, 25.5%; thoracic spine, 16.0% and lumbar spine, 10.4%. The types of spinal fracture revealed fracture-dislocation (47.7%), simple fracture and subluxation (26.7%), and compression fracture (25.5%). Fracture-dislocation, and simple fracture and subluxation were found commonly at the cervical portion of the spine, and compression fracture, mainly at the thoracolumbar spine. Spinal fractures associated with damage of spinal cord and roots were found in 222 cases (91.3%) among 243 cases, of which 139 cases (57.2%) showed evidences of complete cord damage and 83 cases (34.1%), partial damage. In clinical end results of 88 cases (36.2%) in surgical group and 155 cases (63.8%) in nonsurgical group, the number of cases who could return to work were 88 cases (34.2%) among 243 spinal injuries, 59 cases (71.1%) among 83 cases of partial cord damage, and 3 cases (2.2%) among 139 cases with complete cord damage. Ninteen deaths of 243 spinal injuries occurred only in the patients with complete cord damage, resulting in overall motality rate of 7.8%.

중증 뇌동맥류의 조기(응급)수술

함인석,김승래 慶北大學校 醫科大學 1986 慶北醫大誌 Vol.27 No.4

출혈을 일으킨 뇌 동맥류 환자에서 출혈에 의한 이환율과 사망율을 최대한 줄이기 위해서는 가장 중요한 것이 수술 시기의 결정이다. 동맥류의 재출혈 시기와 출혈에 의한 혈관 압축이 발생 시기를 충분히 고려한다면, 수술시기의 선택으로써 조기 수술의 시도는 동맥류 환자에서 적용할 가치가 있을 것으로 생각된다. 본 저자는 신경학적 장애가 점차 악화중인, 혈종에 의한 점유 효과가 없는 4명의 Grade 4. 환자에서와 Grade 5. 환자에서도 가능한 응급으로 시도한 조기 수술을 적용함으로써 좋은 결과를 얻을 수 있었다. The decision of surgical time is the most important factor in reducing, to the minimum, the mortality rates of reptured intracranial aneurysmal patients. In view of the time of rebleeding and vasospasm due to subarachnoid hemorrhage, early surgery is derirable in deciding the time of operation. The authors performed early surgeries on the poor-risk patients(Grade 4 and 5) with gradually deteriorating neurological conditions. The operated patients were all without intracranial hematoma showing mass effect. The outcome of the operation was satisfactory with bright prospect.

뇌수종을 위한 Ventriculosagittal-sinus Shunt

함인석,박연묵,김승래 慶北大學校 醫科大學 1983 慶北醫大誌 Vol.24 No.1

23명의 뇌수종 환자에서 측뇌실과 상시상 정맥동을 연결하는 Ventriculosagittal-sinus shunt 를 시행하고 그 결과를 분석, 관찰하였다. 성별 및 연령 분포는 남자가 19명(82.6%), 여자가 4명(17.4%)이었고 평균 연령은 33세였다. 원인별로는 두뇌 외상에 의한 것이 9명(39.1%), 화농성 뇌막염의 후유증으로 발생된 것이 6명(26.1%), 뇌동맥류에 의한 뇌지주막하 출혈 및 뇌종양에 의한 것이 각각 4명(17.4%)이었으며 이들 중 고압 뇌수종이 10명(43.5%), 정상압 뇌수종이 13명(56.5%)이었다. 수술 치료의 결과는 10명의 고압 뇌수종 중에서 9명(90.0%), 13명의 정상압 뇌수종 중에서 7명(53.8%)이 호전을 나타내었다. 합병증으로 도관의 폐색이 1명(4.3%)이었으며 사망자는 패혈증에 의한 1명(4.3%)이었다. Authors evaluated the surgical results of 23 hydrocephalic in-patients by means of ventriculosagittal-sinus shunt at the department of neurosurgery, Kyungpook national university hospital from Feb. 1980 through Jan 1983. Age and sex distribution was 19 male patients (82.6%) and 4 female patients (17.4%) with average age of 33 years. Of these 23 cases, 10 patients (43.5%) had high pressure of over 200mmH20 and 13(56.5%) had normal pressure on spinal tapping. Surgical results showed remarkeble improvement in 9(90.9%) out of 10 high-pressure hydrocephalic patients. Seven (53.8%) of 13 normal-pressure hydrocephalic patients also showed significant improvement. Occlusion of venous catheter was found in one case (4.3%)and one death (4.3%) occurred due to infection.

총장칼럼 - 스티브 잡스에게 길을 묻다

함인석,Ham, In-Seok 한국대학교육협의회 2012 大學敎育 Vol.175 No.-

총장칼럼 - 세계로! 미래로!

함인석,Ham, In-Seok 한국대학교육협의회 2012 大學敎育 Vol.176 No.-

중증 뇌동맥류 조기(응급)수술

함인석,김승래 慶北大學校 醫科大學 1986 慶北醫大雜誌 Vol.27 No.4

지연성 외상성 뇌졸증의 치험

오봉환,함인석,김승래 慶北大學校 醫科大學 1986 慶北醫大雜誌 Vol.27 No.4

전이성 뇌실질내 종양환자의 예후에 영향을 미치는 인자들

조규협,함인석,김승래 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.3

This study was conducted on 60 metastatic brain parenchymal tumor patients admitted at this hospital between January of 1987 and July of 1993. he mean age of the patients was 54, the youngest 26 and the oldest, 78. The ratio of male v.s. female was 1 : 2.3, 50 were single metastatic and 10 were multiple. The following are the results of the analyses of the factors affecting the prognoses of metastatic brain parenchymal tumor patients : The group operated on showed a significantly prolonged life-span as compared with the group without operation, which was also phenomenal among the single metastatic patients. Among the primary tumors, breast cancer had the longest median survival period, 20 months, and the shortest survival period was one month with the gasrointestinal tumor. As for clinical grade and survival span, those above the Karnofsky scale of 80 survived a median of six months, and those below 50 survived for 2 months. The group with favorable clinical conditions before operation resulted in a significantly long life span. Especially in the group with 80 or above of the Karnofsky scale, the operated group showed a far more excellent prognoses as compared to the non operated group. The median survival time was 20 months in the group with more than 12 months as an interval between diagnoses of primary tumor and metastasis, whereas it was 3 months for the group with an interval of less than 6 months. Thus, the longer the interval, the better the prognosis. This fact was statistically significant. Among the patients with an interval of 12 months or more, the operated group also showed better prognosis than the nonoperated group. The mean six months survival rate was 33.3%, the one-year rate was 23.3%, the two-year rate was 10.0% in all cases. The longest survival time was 36 months. The whole body metastasis was the most common cause of death, accounting for 64.2%.