소아 난치성 측두엽 간질의 수술 예후

김선희(Sun Hui Kim),김준성(Joon Sung Kim),김찬종(Chan Jong Kim),우영종(Young Jong Woo),이민철(Min Cheol Lee),김형일(Hyoung Ihl Kim) 대한소아신경학회 2003 대한소아신경학회지 Vol.11 No.1

목적 : 최근 난치성 측두엽 간질에 대한 수술적 치료가 성인에서 뿐만 아니라 소아에서도 활발히 이용되고 있으나 소아 난치성 측두엽 간질 환자에서 수술 예후를 예측할 수 있는 인자에 대한 보고는 많지 않다. 이에 저자들은 난치성 측두엽 간질로 수술을 시행받은 환아들을 대상으로 임상 양상, 병리 소견, 뇌 자기공명영상, 뇌파 소견과 수술 예후와의 연관성을 알아보고자 본 연구를 시행하였다. 방법 : 1994년 11월부터 2000년 7월까지 측두엽 절제술을 시행받은 소아 난치성 측두엽 간질 환자 환아 중 1년 이상 추적 관찰이 가능하였던 12명을 대상으로 발작간기 뇌파, 지속적 비디오-뇌파 감시를 통한 발작기 뇌파, 침습적 뇌파, 뇌 자기공명영상 및 병리 소견과 수술 후 발작 예후를 비교 검토하였다. 결과 : 수술 후 발작 예후는 Engel의 분류상 class I이 5례(41.7%), class II 1례(8.3%), class III 5례(41.7%), class IV 1례(8.3%)로 예후가 좋았던 군(class I, II)은 6례(50%)였다. 발작간기와 발작기 뇌파가 편측 측두엽에 일치되어 나오거나 비디오-뇌파 검사와 침습적인 뇌파 검사에 의해 간질 병소가 국소화되어 간질 병소를 수술로 제거한 경우에는 예후가 좋았으며 병리 검사상 해마 경화증이나 신경교증을 보였다. 그러나 양측 측두엽에서 간질 발작파를 보이거나 측두엽과 외측두엽에 간질 병소가 있었으나 수술로 제거되지 않은 경우는 좋지 않은 예후를 보였으며 병리 검사상 대부분 피질 이형성증을 보였다. MRI에서 이상 소견을 보였던 경우 수술 후 발작 예후는 Engel의 분류에 따라 class I, II가 50%였으며, MRI 검사에 이상 소견을 보이지 않았던 경우 병리 검사상 해마 경화증 소견을 보였고 75%에서 좋은 예후(class I)를 보였다. 두피 뇌파로는 발작 병소를 국소화하기 힘들었고, 비디오-뇌파 검사로 발작 병소의 편측화가 불가능한 경우에 정확한 간질 병소를 파악하기 위하여 시행한 침습적인 뇌파 검사 결과에 따라 수술 예후가 결정되었다. 결론 : 병리 소견이 해마 경화증이나 신경교증의 경우는 수술후 좋은 발작 예후를 보인 반면에 피질 이형성증은 좋지 않은 예후를 보였다. 소아 난치성 측두엽 간질의 수술적 평가에 침습적인 뇌파 검사가 반드시 고려되어야 한다. Purpose : Epilepsy surgery has become increasingly available in children with medically intractable epilepsy including temporal lobe epilepsy(TLE). TLE in children, however, has many different clinical and electrophysiologic characteristics which make presurgical evaluation difficult. The aim of this study is to evaluate the electroencephalographic(EEG) features which might be one of the predictors of postsurgical seizure outcomes in TLE. Methods : Standard EEG, video-EEG, subdural or depth EEG were investigated in 12 children who underwent anterior temporal lobectomy, and their seizure semiology, MRI, and pathologic findings were also reviewed. Postsurgical seizure outcomes were divided into favorable(class I, II) and unfavorable(class III, IV) groups by using the Engel's classification. Results : Half of the patients showed favorable outcomes, whose pathologic findings revealed hippocampal sclerosis or gliosis. Such pathologic findings were not demonstrated in MRI. Interictal epileptiform discharges were concordant with the location of the ictal onset in only 2 cases of the favorable outcomes. For the other 4 cases in the favorable group, focal ictal onset patterns were clearly evident in video-EEG monitorings or invasive EEG studies. Six cases in the unfavorable group showed unlocalized or multifocal interictal or ictal discharges -extratemporal, bitemporal or generalized epileptic activities- even in the invasive EEG studies. Five of them revealed cortical dysplasia in the pathology. Conclusion : The postsurgical seizure outcomes of hippocampal sclerosis or gliosis were more favorable than those of cortical dysplasia. Invasive EEG recordings should be considered for the localization of epileptic foci in the presurgical evaluation of children with intractable TLE.

공통공간 패턴을 이용한 뇌졸증 동물모델의 양전자 방출 단층 촬영데이터 구분 및 패턴 분석

김동현(Donghyeon Kim),조호현(Hohyun Cho),김형일(Hyoung-Ihl Kim),전성찬(Sung Chan Jun) 한국정보과학회 2014 한국정보과학회 학술발표논문집 Vol.2014 No.12

삼차신경통의 치료를 위한 삼차신경절 풍선압박술의 마취관리 -증례보고

김형태 ( Hyung Tae Kim ),안선경 ( Seon Kyeong An ),장인수 ( In Su Jang ),김형일 ( Hyoung Ihl Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1

Trigeminal neuralgia is sudden, usually unilateral, severe brief stabbing recurrent pain in the distribution of one or more branches of the 5th cranial nerve. Treatments of trigeminal neuralgia include systemic trials of medications and surgical procedures such as microvascular decompression, stereotactic radiosurgery, percutaneous glycerol or alcohol rhizolysis, percutaneous radiofrequency rhizotomy, and percutaneous balloon compression (PBC). PBC of the trigeminal ganglion using a balloon catheter was introduced by Mullan and Lichtor in 1983. Since then, many papers have been published describing results of this technique. Typically, this procedure is performed under general anesthesia. However, little is known about the use of PBC for the treatment of trigeminal neuralgia in Korea. We report here our anesthetic management of percutaneous balloon compression of trigeminal ganglion for the treatment of the trigeminal neuralgia by total intravenous anesthesia. (Korean J Anesthesiol 2009; 57: 132~6)

선택적 후근절제술의 수술중 근전도 감시방법과 치료효과

김형일,김연희,김완호,김근수,김동찬 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Selective posterior rhizotomy(SPR) has been known to reduce the spasticity as well as to improve the quality of life in patients with intractable spasticity. Twenty patients underwent SPR under intraoperative electrophysiological monitoring(IOM). Fifty-two percent of sacrolumbar rootlet were cut after electrical stimulation. Eighteen patients(90%) with spastic type of cerebral palsy showed marked reduction of spasticity and functional improvement without any complication. The patients who did not respond to SRP had mixed types of spasticity. IOM facilitate the selection of pathological rootlets regardless of anaesthetic level. intensity of electrical stimulation, and individual variability of responses. It is concluded that careful selection of surgical candidates and of pathological rootlets under IOM are important to reduce the spasticity. thereby to obtain a better outcome.

완전 혈전 형성을 한 거대동맥류

김형일,최하영 의과학연구소 1990 全北醫大論文集 Vol.14 No.2

It is well known that giant aneurysm has partial thrombus in it. However, complete thrombosis of aneurysmal sac is very rare. Moreover it is very difficult to diagnose the completely thrombosed aneurysm because of lack of visualization by cerebral angiography. The anthers present a case of completely thrombosed giant aneurysm which arised from the medical wall of internal carotid artery around the opthalmic artery and which stimulated the parasellar tumor.

간질의 외과적 치료 : 외측두엽 수술방법 Extratemporal Operative Methods

김형일 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.3

The extratemporal operative approaches for intractable epilepsy are reviewed. Intracranial recordings are often necessary for extratemporal epilepsy to define the lateratization as well as the localization of epileptogenic regions and tailor the resection. The operative procedures include cortical resections, corpus callosotomy, and functional hemispherectomy. The author presents an overview of indications for surgery, operative methods, and risks in the medically intractable epileptic patient with extratemporal focus.

Rolandic Cortical Dysplasia : 증례보고 Case Report

김형일,정채경,최하영,Palmini, Andre,이민철,이정청 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.6

The advent of MRI enables us to make an in-vivo diagnosis of cortical dysplastic lesions which are highly epiletogenic and show the variety of seizure patterns. Authors report a case of rolandic cortical dysplasia who had highly intractable focal motor clonic seizures. Invasive recording with subdural grid was very helpful in delinating the epileptogenic area as well as in functional mapping of eloquent areas. Total removal of dysplastic lesion could treat this highly intractable epilepsy successfully.

피질이형성증과 동반된 난치성 간질의 외과적 치료

김형일,김연희,이민철,정애자,권지현,최하영,Andre Palmini 啓明大學校 醫科大學 1995 계명의대학술지 Vol.14 No.2

The advent of neuroimaging technique has enabled the accurate diagnosis of structural abnormalities associated with intractable epilepsy. Among these, neuronal migration disorders(NMDs) or cortical dysplasias(CDs) involving cerebral cortex are increasingly recognized as a major cause of intractable epilepsy. CDs are expressed as variety of forms depending upon the time of injury to the developing nervous system. CDs are highly and intrinsically epileptogenic. It is crucial to completely resect the epileptogenic zone in focal CDs for better seizure outcome. Hemispherectomy or multilobar resection is preferred for hemimegalencephaly. Callosotomy can be chosen in the diffuse CDs who have intractable drop attacks. However, resective surgery can benefit the selected patients with diffuse CDs if localizing information persists.

척추동정맥기형을 동반한 다발성 낭포성 척추강내 수막종 1례

김형일,이정청 전북대학교 의과학연구소 1983 全北醫大論文集 Vol.7 No.1

The multiple and cystic spinal meningioma is rearely encountered. It is an extreme rarity to have the spinal meningioma conbined with the spinal arterivenous malformation(AVM). An unusual combination of multiple and cystic spinal meningioma and spinal AVM is presented. The patient was a 25 year-old man who had progressive paraparesis, voiding difficulty, neck pain and papilledema. The multiple meningioma located in the intradural extramedullary space of the cervical and lower thoracic spine had no any evidence of neurofibromatosis. The tumor had multiple and marked cystic change. The spinal AVM was noted on the surface of the lower thoracic spinal cord, completely seperated from the tumor.

난치성 전두엽 간질의 외과적 치료

김정목,김형일,김근수,김철진,이정청,이민철 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

Recent advances of neuroimaging and electrophysiological monitoring technique have contributed in improving the surgical outcome of frontal lobe epilepsy. The authors have analysed 36 consecutive cases of intractable frontal lobe epilepsy that were treated at our institute between September. 1992 and December, 1995 to determine the clinical, electrophysiological, and neuroimaging characteristics as well as to delineate the efficacy of surgical treatment in improving the seizure outcome. The patients consisted of 19 males and 17 females. The mean age of the seizure onset and the mean duration of epilepsy were 14.9 and 11.6 years, respectively. Magnetic resonance imaging(MRI) showed no lesion in 9 patients and pathological lesions in 27 patients. The types of the lesions observed included primary brain tumor, mostly low-grade glioma in 10 patients, cortical dysplasia in 4, posttraumatic scar in 4, neocortical gliosis in 3, cyst in 3, and postencephalitic atrophy in 3. Intracranial recordings were performed in 23 cases to determine the epileptogenic zone. The surgical outcome was graded according to Engle’s Classification as Class A in 20 patients. Class B in 2, Class C in 9, and Class D in 5. The surgical outcome was promising regardless of the presence or the absence of the lesion on MRI, invasive recording, age of seizure onset, and duration of epilepsy.