복강내의 가성낭포(Pseudocyst)로 인한 뇌실복강 단락(Ventriculoperitoneal Shunt)의 기능부전에 대한 뇌실요관 단락(Ventriculoureteral Shunt) 수술 : Case Report and Technical Note

허륭,신원한,이규,최순관,변박장,김민의,문철,이인수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.5

We report a case of ventriculoureteral shunt to revise malfunctioning ventriculoperitoned shunt in a Byear-old man. The patient had 4 times recurrent pseudocyst filled with cerebrospinal fluid caused by complications at the distal end of the abdominal cathetex. The presence of an abdominal pseudocyst can be detected by performing an ultrasound examination of the abdomen We shall describe the operative technique of the ventriadoureteral shunt procedure without nephrectomy by reimplantation of the ureter and a psoas hitch.

경증 뇌손상 환자의 뇌전산화단층촬영의 의의

허륭,배학근,도재원,이경석,배원경,윤일규,변박장 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.9

The purpose of this study is to identify a group of mild head injury patients having lesions on computerized tomography(CT) and to investigate the risk factors affecting the abnormal findings on CT scan. The study was limited to patients 16 years of age and older with a initial Glasgow Coma Scale(GCS) scores of at least 13 at the time of admission. Of a total of 243 patients studied 156(64.2%) had abnormal CT findings. 49 patients(20.2%) required neurosurgical intervention(craniotomies for hematoma in 33, hematoma in 1 and subdural hygroma in 3). Four patients(2.4%) died of their cranial injury and three died of extracranial causes. The incidence of CT abnormalities for each GCS score was 86.7% in GCS of 13, 68.6% in GCS of 14, and 58.6% in GCS of 15. The factors affecting GCS scores at the time of admission were the presence of loss of consciousness and posttraumatic amnesia. The factors affecting abnormal CT scans were the presence of posttraumatic amnesia and skull fracture. A new lesion or extension of the initial finding on follow-up CT scans was found in 9.3% of 75 patients who underwent follow-up CT scans Even though routine CT scans for mild head injury patients are not always necessary, these results suggest that all patients admitted to hospital after mild head injury should undergo CT scanning to enable early detection of an intracranial lesion.

Therapeutic Effects of Holmium-166 Chitosan Complex in Rat Brain Tumor Model

허륭,박용숙,이종두,정영선,박용구,정상섭,장진우 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.1

This study examined the effectiveness of Holmium-166 (Ho-166) chitosan complex therapy for a malignant glioma. Cultured C6 glioma cells (100,000 in 5μl) were injected into the caudate/putamen of 200-250 gram Wistar rats. Five days later, a Ho-166 chitosan complex was injected into the same site of the glioma injection. Four injection doses were administered: the control group received PBS 10μl, group 1 received an injection of 100μCi (10μl), group 2 received an injection of 50μCi (5μl), and group 3 received an injection of 10μCi (1μl). The average tumor volume for each group was 1.385 mm3 for the control group, 0.036mm3 for group 1, 0.104mm3 for group 2, and 0.111mm3 for group 3. Compared with the control group, the size of the tumors in groups 1, 2 and 3 was reduced by an average of 97.4%, 92.5% and 91.9%, respectively. The Kaplan-Meier survival curve of group 2 was the longest, followed by groups 3, group 1 and the control. The mean survival was 22.8, 59, 60, and 44.6 days for the control group and groups 3, 2 and 1, respectively. H-E staining revealed that group 2 yielded the best results in the destruction of the malignant glioma. TUNEL staining and immunohistochemical studies indicated apoptotic features. The Ho-166 chitosan complex proved to be effective in destroying the malignant glioma.

진료프로세스 최적화를 통한 신경외과. 정형외과, 적정재원일 관리 6시그마 활동

허륭,한수홍,김지인,김영옥,김종미,박운주,권순용,김은숙,성원호,이주영 한국의료QA학회 2008 가을학술대회 Vol.2008 No.2

成人의 輕度 頭部外傷에 對한 臨床硏究

허륭,최순관 순천향대학교 1993 논문집 Vol.16 No.4

경도 두부외상은 두부외상의 많은 부분을 차지할 뿐만 아니라, 중증 두부외상에 비해 더 작은 노력으로도, 더 많은 치료효과를 얻을수 있다. 저자는 1991년 1월부터 1992년 12월까지 2년동안 두부외상으로 순천향대학병원에 입원했던 성인(15세이상) 경도 (Glasgow coma scale;GCS, GCS 13점 이상)두부외상 472례를 대상으로 하여, 경도 두부외상의 임상적 특성과 방사선학적 소견, 그리고 예후를 조사, 분석하였다. 경도 두부외상은 성인 두부외상의 66%를 차지하였고, 남녀비는 2.8:1로 가장 많았고, 46-60세(24.6%), 31-45세(22.7%), 그리고 60세이상 (21.0%) 순이었다. 추락의 비율이 조금 높은점이 경도 두부외상의 특징 중 하나였다. 입원경로는 경도 두부외상이라도 91.5%가 응급실을 경유하여 입원하였고, 외래를 통한 입원(4.9%)과 전과(3.6%)는 적었다. 외상후 내원까지의 시간은 평균 2.8시간 으로서, 68.0%가 6시간 이내로 중등도나 중증에 비해 조금 늦은 편이었다. 입원 유형별로는 직접 응급실로 내원한 경우가 평균 1.0시간으로 가장 짧았고, 인근 병원을 들렸다 올 경우 평균 6.0시간으로 5시간 정도가 더 소요되었다. 내원 당시의 의식은 15점이 66.7%로 가장 많았고, 14점이 20.8%, 그리고 13점이 12.5%였다. 가장 흔한 증상은 두통(77.5%)이었고, 의식소실력 (54.0%), 기억상실(34.5%), 현훈증(19.5%), 그리고 구토(12.5%)등이 비교적 흔한 증상이었으며, 뇌신경 손상(5.7%), 무기력(4.0%), 그리고 발작(1.7%)등은 비교적 드문 증상이었다. 동반손상은 36.6%에서 관찰되었고, 32.8%가 사지골의 골절이었다. 신경외과에 입원한 기간은 평균 19.3일(표준편차 22.8일), 2주 이하가 51.1%였다. 89.6%는 보존적으로 치료할 수 있었으나, 10.4%는 수술이 필요하였다. 수술은 GCS가 낮을수록, 그리고 두개골 골절이 있을 때 많았다. 나이가 많을수록 수술율이 더 높았지만 통계학적 유의성은 없었다. 두개골 골절은 23.9%에서 관찰되었고, 가장 흔한 골절은 선상골절로 전체두개골 골절의 68.1%를 차지하였다. 내원당시의 의식 수준이 낮을수록 골절의 빈도가 높았다. CT는 골절이 발견된 환자와 GCS가 13점과 14점 환자 모두에서 시행하였고, 골절도 없고 GCS가 15점인 환자는 43.4%에서만 시행하였다. 전체적으로 70.1%에서 CT를 시행하였고, 이중 40.2%에서 이상 소견이 발견되었으며, 수술이 필요한 경우는 10.4%였다. 퇴원할 때의 예후는 완전 회복 90.7%, 중등도 장애 5.9%, 중증 장애 1.7% 식물인간 상태0.2%, 그리고 사망이 1.5%였다. 내원시 환자의 의식이 나쁠때, 두개골 골절이 있을 때, CT 소견상 수술을 필요로 하는 병소가 있을 때, 그리고 수술을 했던 예에서 예후가 좋지 않았고, 이 차이들은 통계학적으로도 유의하였다. 연령이 많을수록 예후가 좋지 않는 경향이 있었으나 통계학적으로는 유의하지 않았다. 결론적으로 경도두부외상이라 할지라도 의식수준이 낮거나, 두개골 골절이 있으면서, 신경학적 증상이 있는 경우에는 곧바로 CT를 촬영하여 두개강내 병변을 확인하여야 하고 신경학적 감시를 소홀히 해서는 안된다고 사료된다. Minor head injury shares majority of head injury and we can obtain better results with less efforts than moderate or severe ones. The author investigated clinical features, radiological characteristics, and outcome of the mild(Glasgow Coma Score over 12) head injury. Total 472 adult (over 15 years of age)patients who admitted with minor head trauma to Soonchunhyang University Hospital after head trauma from January 1991 to December 1992 were analyzed. The results obtained were as follows. 1) Minor head injury occupied 66% of all head injuries. 2) The peak incidence was 16-30% years of age (31.8%) and the second was 46-60(24.6%) years of age. 3) The most common cause of minor had injury was traffic road accident (59.8%) 4) Mean time from injury to arrival at hospital was 27.5 hours, and 68% of patients arrived within 6 hours. 5) The GCS on admission was 15 in 66.7%, 14 in 20.8%, and 13 in 12.5%. 6) The most common symptom was headache (77.5%), and episode of loss of consciousness (54.0%), post-traumatic amnesia (34.5%), dizziness (19.5%), and vomiting(12.5%) in order. 7) Fifty-one percent of patients was hospitalized for less than 2 weeks. 8) Most of the patients were treated conservatively, and only 10.4% of patients who had lower GCS or skull fracture. 9) The brain CT scan was performed for the patients with skull fracture, whose GCS was 13 or 14. 10) The final outcome was good recovery in 90.7%, moderate disability 5.9%, severe disability 1.7%, vegetative state 0.2%, and death 1.5%. These data suggested that we should know that in a significant number of patients, the prognosis is poor even though the head injury was mild, and it is necessary to pay attention for those patients with low GCS, skull fracture, and neurologic deficits.

A case report of deleterious SGCE myoclonus: dystonia successfully treated with pallidal deep brain stimulation

장혁,허륭,장일 대한정위기능신경외과학회 2023 대한정위기능신경외과학회지 Vol.19 No.2

SGCE (epsilon (ε)-sarcoglycan gene) myoclonus-dystonia (SGCE M-D) is a pleiotropic neuropsychiatric disorder with an autosomal dominant mode of inheritance, variable severity, and incomplete penetrance. There have been few reports of patients with SGCE M-D who have been successfully treated with deep brain stimulation (DBS). This case report presents a missense mutation (c.289>T) inherited in a Northeastern Asian family affected by SGCE M-D. The individuals with the condition exhibited clinical manifestations of generalized myoclonus accompanied by sustained cervical dystonia. A 38-year-old female had a history of generalized dystonia myoclonus with paroxysmal jerks for the past 10 years. The symptoms gradually worsened over the years, affecting her entire body and interfering with most of her daily activities. Genetic testing identified a single base deletion in exon 3 of the SGCE gene, which was considered the genotype underlying her phenotypic symptoms. After failed attempts with oral medications as an outpatient, she underwent DBS targeting the globus pallidus internus (GPI). Her symptoms significantly improved after the activation of the stimulator. Our case supports the beneficial effect of GPI-targeted DBS in patients who are unresponsive to oral medications and have a genetically confirmed M-D phenotype.

척추강내에 발생한 선천성 표피양 낭종

김용배,허륭,김동석,윤도흠,최중언 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

원발성 중추신경계 임파종의 임상적 특징과 예후인자에 대한 연구

권흠대,허륭,김동석,박용구,최중언,정상섭,Kwon, Heum Dai,Huh, Ryoong,Kim, Dong Seok,Park, Yong Gou,Choi, Joong Uhn,Chung, Sang Sup 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12

Objective : The incidence of primary CNS lymphoma(PCNSL) has been increasing recently. The purpose of this study is to establish of prognostic factors and treatment options for PCNSL. Methods : Thirty-one PCNSL patients were treated in our institute between 1985 and 1997. All patients were histologically confirmed via stereotactic biopsy or open biopsy. The authors retrospectively analyzed clinical characteristics of PCNSL and prognostic factors, including histological cell types, immunohistological cell types and treatment options of PCNSL. Our data were statistically analyzed using Kaplan Meier survival curve and multivariated ANOVA test. Results : The clinical and radiological characteristics of PCNSL were resembled to those of other reports. The most common histological subtype was diffuse large cell type(55.5%). In immunohistolgical study, the incidence of T-cell lymphoma(35.7%) was very higher than that of others. The radiotherapy could prolonged patients' survival(p=0.021). One-year and 3-year survival rate of PCNSL were 66.9% and 45.9%, respectively. One-year survival rate of B cell and T cell lymphoma were 72.7% and 50.0%, respectively. The patients with B-cell lymphoma showed better prognosis than patients with T-cell lymphoma(p=0.049). Conclusion : On the basis of our data, active radiotherapy could prolong patients' survival. the T-cell lymphoma revealed higher incidence than those of other reports and had poor prognosis than that of B cell lymphoma.

자발성 뇌지주막하 출혈 환자에서 뇌동맥류 검출에 대한 고식적 혈관조영술과 3차원 전산화 단층 혈관조영술의 비교

이경수,강창구,허륭,이상훈,정의화,Lee, Kyoung Soo,Kang, Chang Gu,Huh, Ryoong,Lee, Sang Hoon,Chung, Ui Wha 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objectives : Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography( CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). Methods : We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. Results : Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.

두개강내 "De Novo" 동맥류 : 증례 보고 Case Report

현동근,이강목,허륭,최순관,변박장 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.6

There are numerous theories of pathophysiology in intracranial aneurysm, but currently accepted hypothesis was congenital defect of medial layer of vascular wall and the major developing factor was hemodynamics. Almost physcians were belived that treatment of intracranial aneurysm was completely through clipping of aneurysmal neck But many reports were emphasized newly developed intracranial(De Novo) aneurysm after clipping of initially identitied intracranial aneurysm. The authors have same experienced of 2 cases intracranial 'Do Novo" aneurysm. We are stress there were never completed treatment of aneurysm that cliiping of initially identified intracranial aneurysm and should be attention to 'De Novo" aneurysm.