Urokinase 뇌실주입이 뇌실내혈종에 대한 효과에 관한 실험

최순관,김영준,이인수 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.3

For the reduction of morbidity, such as an acute hydrocephalus, following intraventricular hemorrhage, we attempted to produce a lysis of the experimental intraventricular hemorrhage by a direct intraventriular injection of fibrinolytic agent. Urokinase was used as the fibrinolytic activator. Sixty-four adult rabbits were used in this study. The animals were divided into 5 groups to investigate the effect of urokinase in different time interval of urokinase injection. Intraventricular hemorrhage was made by an injection of 0.3cc of antogenous venous blood. Group Ⅰ was the control group in which intraventricular injection of blood or urokinase was only done. In Group Ⅱ and Ⅲ urokinase was injected into the ventricule 30 minutes and 2 hours after the blood injection. In Group Ⅳ urokinase was injected into the ventricle at the same time of the blood injection. In Group Ⅴ urokinase was injected into the ventricle at the same time of the blood injection and then the urokinase injection was repeated 24 hours later. The animals of each group were sacrificed on the 1st, 2nd, 3rd and 7th day successively after the experimental procedures. The brains were examined to observe the outcome of intraventricular hematoma with urokinase injection and the consequent changes of the ventricular system grossly and microscopically. The results were as follows : The duration of the remaining hematoma in the ventricles and basal cisterns was 7 days in both the control and the urokinase injection groups equally. In the group of repeated urokinase injection the duration of remaining hematoma in the ventricular systems were shortened to 5 days after the blood injection. Upon the ventricular dilatation, the blood injection control group showed moderate dilatation persistently for 1 week ; from minimal to moderate dilatations were found in the urokinase injection groups. In the microscopic examination there were no definite abnormal changes on the ventricular walls and leptomeninges throughout 1 week in the urokinase injection control group. The group of repeated urokinase injection revealed milder flattening and denudation of the ependyma of the ventricular system than the group of single urokinase injection.

CO₂ Laser의 혈관응고효과 및 혈관수복효과에 관한 실험

최순관,이인창,도재원,신원한,변박장,이인수 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.1

Lasers have been used safely to aid in the resection of highly vascular tumors or arteriovenous malformation. As far as blood vessel coagulation, arteries up to 2 MM in diameter and veins up to 3 nig in diameter can be reliably sealed with the Nd-YAG laser, and lesser size of vessels can be coagulated with the CO₂ laser. Another advantage of laser is to be a useful tool for small vessel repair or anastomosis without microsuture technique. The aim of this experiment was to investigate intensity and duration of exposure with the CO₂ laser for vessel coagulation and repair. 36 rats weighing 200 to 250 gm, were used in this study. For vessel coagulation of extracranial arteries and veins, power density between 10 and 50 watts/㎠ (W) was applied with handpiece, and for vessel repair or anasomosis 2 W was applied with micromanipulator. The results obtained were as follows: 1) The artery was perforated immediately over 10 W with 0.5 seconds of exposure of smaller focal beam. 2) The artery was constricted in its diameter in defocused beam with 30-40 W, and perforated with 50 W. 3) The lower limit of venous coagulation was 15 W, 0.5 sec. of exposure and 2㎜ of focal beam diameter. 4) The lower limit of arterial coagulation was 10 W, 5 sec. of exposure, 4㎜ of focal beam diameter, and exposure time was reduced to 3 sec. at 20 W. 5) The repair or anastomosis of artery was accomplished with 2 W, 0.05 sec. of exposure of 0.2 ㎜ of focused beam by 6 times of delivery, and the delivery times could be successfully reduced to half under the overlying thin blood clot film on the anastomosis site of the artery. 6) In the histological examination, the entire layer of coagulated vessel wall on the laser delivered side disclosed marked constriction and destruction. On the anastomosis site, re-endothelialization began from 3 days, and completed by 2 weeks after operation.

흉추부 경막내 척수외의 척수 결핵종 1예

김영준,이인수,최순관 순천향대학교 1983 논문집 Vol.6 No.4

The authors report one case of intradural extramedullary spinal tuberculoma, which is one of rare lesions on the literatures. The 20 years old female patient has complained motor weakness and sensory disturbance on the lower extremities by spontaneous onset before one month. On the 5th hospital day, we found complete paraplegia, sensory disturbance and urinary disturbance. There were revealed some pleural effusion on simple films of the chest, but within normal limit on simple films of the thoracic spine. The C.S.F. was clear, and its analysis was within normal limit. The contrast media was obliterated at the upper border of the 8th thoracic vertebra on the myelogram by puncture of lumber region. We performed total laminectomy and removed an intradural extramedullary mass on the right dorsal side of the spinal cord from the 6th to the 8th thoracic vertebra carefully. The mass was adhesive with dura mater and arachnoid membrane. Grossly, this mass showed grayish brown color, oval shape, 3×1. 5×0.8cm in size, relatively hard and well circumscribed. Microscopically, pathologic evaluation confirmed the diagnosis of tuberculoma due to chronic granulomatous inflammation with caseous necrosis. The previous neurologic deficits improved completely one month after the operation, the patient discharged and antituberculous medication was given to protect tuberculous complications for 18 months later on.

전두부 외상성 경뇌막하수종 : 7례 증례보고 A Report of Seven Cases

최순관,변박장,이인수 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.1

Seven cases of traumatic subdural hygroma are presented, with discussion of their predilection in the frontal region, clinical features and postoperative course. It is shown that hygroma can be the principal or secondary cause of the frontal lobe syndrome following head trauma. None of the cases could be well differentiated from chronic subdural hematoma by angiography and CT scan. Therefore a neurosurgical intervention, such as an osteoplastic craniotomy or a simple trephination has born employed for the diagnosis and the treatment. In the operation of the chronic subdural hygroma, the arachnoid flap of it or the membrane, if it is formed, should be wide1y excised. After the operation continuous drainage through a cranial hole for several days would be ideal.

투명중격에 발생한 다형성교아종 1예 : An Autopsy Case Report

최순관,변박장,이인수,지제근 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.2

A 41-year-old woman presented with generalized symptoms of raised intracranial pressure and memory disturbance for the recent events. Carotid angiography showed concave downward elevation of the septal vein and flattening of the internal cerebral vein. Conray ventriculography revealed fairly symmetrical but irregular contour of the septal shadow and well demarcated round filling defect in the posterior third ventricle. After the ventriculography the patient suddenly fell into catastrophe and expired three days thereafter. Autopsy revealed glioblastoma multiforme of the septum pellucidum and the thalamus. The authors report this relativey rare tumor. And the symptomatology is discussed.

Alcohol, phenol, glycerol과 고주파 파괴에 의한 말초신경의 형태학적 변화에 관한 연구

최순관 순천향대학교 1991 논문집 Vol.14 No.2

불인통(intractable pain)에 대한 치료 방법중에서 중추신경이나 말초신경에 대하여 고주파(radiofrequency)를 이용하여 열응고(heat coagulation)를 가하던지 alcohol이나 phenol 또는 glycerol 같은 신경차단액(neurolytic solution)을 이용한 화학적신경차단술(chemical rhizotomy)로 동통은 완화 또는 소실시키고 있다. 그러나 이들 동통 치료 방법의 동통치유 기전에 관한 이론은 여러가지로 분분하다. 저자는 신경외과에 의한 동통 제거를 위한 여러 방법의 이론적 근거를 얻기 위하여, 고주파를 이용한 열응고시 합병증을 유발시키지 않고 동통만 소실시키면서 치료 효과를 나타낼 수 있는 온도를 조직학적으로 비교 조사함과 동시에 alcohol, phenol, 및 glycerol등 화학용액이 각각 말초신경 조직에 일으키는 조직학적 변화와 파괴 정도를 실험적으로 조사 관찰하였다. 실험 방법으로 흰쥐의 좌골 신경에 고주파로 각각 45℃와 75℃로 15초간 열을 가한 다음 1주에서 7주까지 생존시켜 다리의 운동력을 검사한 후 실험 동물을 희생시킨 뒤 좌골신경을 적출하여 toluididine blue 염색을 하여 광학현미경으로 관찰하였고 또한 전자현미경으로 조직학적 검사를 시행하였다. 그리고 화학신경차단제중 무수 alcohol과 5% phenol 및 순수 glycerol을 선택하여 각각 흰쥐의 좌골신경에 도포한 후 1주에서 5주까지 경과한 다음, 흰쥐를 희생시켜서 같은 방법으로 조직학적 검사를 시행하였으며, 신경의 손상 정도를 알기위하여 신경의 절단 면적 중 파괴된 부위의 백분율(%)에 손상 급수(degree)를 곱하여 손상 지수(damage index)를 구한 결과, 모든 실험 군에서 초기에 무수초신경섬유와 유수초신경섬유가 다같이 파괴되었고, 손상 후 1∼2주에 수초의 모양이 변형되었으며, 축삭의 종창, Schwann 세포의 변성 및 간질부에 부종을 볼 수 있었다. 수초의 재생은 75℃로 열응고한 군을 제외한 모든 군에서는 2주에서 부터 나타났으나 75℃로 고주파 열응고한 군은 5주부터 재생 소견이 나타났고 형태에 있어서도 가장 불완전하였다. 손상 지수는 시간의 경과에 대하여는 유의한 차이가 없었으나(p >0.05), 각 군간에는 유의한 차이가 있었다(p<0.05). 75℃로 고주파 열응고한 군이 가장 손실이 심하였고 glycerol 도포군이 가장 손상 정도가 경미한 것으로 미루어 손상 정도만 보아서는 glycerol이 가장 안전한 재제로 보이지만 실제로 임상에서 불인통에 대하여 선택을 할 때에는 신경의 재생에 따르는 재발여부도 함께 고려해야 할 것으로 생각되었다. Various blocking agents have been the rationale for many attempts to relieve intractable pain. Some of them, namely alcohol, phenol, glycerol as chemical agent, and radiofrequency(RF) as the method of thermocoagulation have been usually quoted. The author attempted to verify morphologic change on the nerve fibers and compare with the destructive effect by alcohol, phenol, glycerol and different temperature of RF lesion to the peripheral nerve. For this purpose, an experimental study utilizing a rat sciatic nerve model was undertaken. Forty-three rats were divided into 5 groups : Group Ⅰ: RF with 45℃, for 15 seconds, Group Ⅱ; RF with 75℃ for 15 seconds, Group Ⅲ ; topical application of absolute alcohol, Group Ⅳ ; topical application of 5% phenol, and Group Ⅴ ; topical application of pure glycerol. The rats were sacrificed at interval up to 7 weeks after all the types of injury and sciatic nerves lesions were studied by light and electron microscopy. For assessing the degree of nerve damage, the damage index was designated with the estimated percentage of the cross sectional area affected, multiplied by the degree of destruction ranging from 0(no destruction) to 3(total destruction). The results obtained were as follows ; 1. Early light microscopic findings of nerve damage in all experimental groups were the destruction of both myelinated and unmyelinated fibers which were replaced by macrophages and Schwann cells containing degenerated myelin. Two and 3 weeks after injury, newly formed thin myelin sheaths were seen in the destructed areas. 2. Electron microscopic findings of all experimental groups, at 1 and 2 weeks, were myelin disintegration, axonal swelling and degeneration of Schwann cells, and interstitial edema. Early remyelination appeared at 2 weeks. 3. The damage index of each group was 1.14 ±0.70 in the 45℃ RF lesion(Group Ⅰ), 2.36 ±0.75 in the 75℃ RF lesion(Group Ⅱ), 1.80 ±0.82 in the alcohol application(Group Ⅲ), 1.14 ±0.79 in the phenol application(Group Ⅳ), and 0.39 ±0.40 in the glycerol application(Group Ⅴ). The damage index was not significant in time sequence. No significant difference was observed between the 45℃ Rf lesion and phenol application group(p >0.05). According to above results, the injury revealed the most in the 75℃ RF lesion, and least in the glycerol application group. 4. The evidence of regeneration appeared from 2 weeks after injury, and the RF lesion with 75℃ disclosed inadequate regeneration with marked endoneurial fibrosis. I summarize the above findings, all the types of injury induced unselective damage to the myelinated and unmyelinated fibers of the peripheral nerve. The severity of injury was the most in 75℃ RF and the least in the glycerol application. And remyelination seemed to start at 2 weeks after injury though incomplete in 75℃ RF Practically for the purpose of selection of best agent for the control of intractable pain, both severity of damage and possibility of regeneration may take into account.

Schizencephaly 1例

최순관,변박장,이화동,이규웅,허곤 대한신경외과학회 1973 Journal of Korean neurosurgical society Vol.2 No.1

Yakovlev demonstrated that the Schizencephalies appear to result from injury to developing cerebral vesivles in the second month of intrauterine life. There is a total loss of neurons in restricted symmetrical zones of each developing hemisphere and on either side of the resulting cleft-shaped defects are evidences of subtotal injury to developing neuroblasts. A case of a 4 years old male with Schizencephaly is reported.

성인에 발생한 두개인두종 치험 1예

최순관,구영두,최덕영,임광세 대한신경외과학회 1977 Journal of Korean neurosurgical society Vol.6 No.2

The craniopharyngima has been known to be congenital origin and primary tumor of childhood. The craniopharyngioma may be found at all ages, though nearly one half in the first twenty years of life and equally in either sex. Important differences exist between younger and older patients. In children, signs of increased intracranial pressure, endocrine abnormality and radiological calcification are common. In adults, mental disturbance becomes of increasing importance as well as remaining visual failure and endocrine disturbance. Because of slow growing rate of tumor in adult, subtotal excision is recommended. A 39-year-old male patient, suffering from agitation memory disturbance and almost total blindness, was diagnosed craniopharyngioma by neuroradiologic examinations. After surgical treatment, mental symptoms and visual acuity improved much more than before operation.

대뇌반구 적출술로 치유된 경련발작을 수반한 소아성 반신불수 1예

최순관,김주명,최덕영,임광세 대한신경외과학회 1977 Journal of Korean neurosurgical society Vol.6 No.2

Infantile hemiplegia is the end state of various pathological conditions affecting the cerebral hemisphere before or during birth, or in first few years of life. In 1950, Krynauw first reported that total hemispherectomy could be carried out with beneficial results for infantile hemiplegia with uncontrollable convulsion, temper tantrum and mental deficiency. Hemispherectomy is not suitable for all cases of infantile hemiplegia. but it seems clear that it should be undertaken in any case of established infantile hemiplegia with fits which cannot be controlled by drugs, or in which there is backwardness or deterioration in the patient's intellectual or emotional state. We have recently experinced a 8-year-old boy who was suffering left hemiplegia with intractable epilepsy. Both carotid angiogram and pneumoencephalogram showed right cerebral hemiatrophy. After right hemispherectomy intractable seizure was controlled and personality disorder disappeared completely. But left hemiplegia wasn't definitely improved.

뇌실내출혈환자의 CT 소견과 임상적 경과

최순관,배학근,이인수 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.3

Ninety-three patients who had evidence of intrventricular hemorrhage(IVH) were reviewed. Primary and secondary IVH could be well distinguished by computerized tomographic(CT) brain scan. 11 patients had primary pure IVH and remaining 82 patients were secondary IVH from mainly hypertensive intracerebral hemorrhage. Four patients died and 7 survived in the pure IVH. Three of the 4 who died were aneurysmal rupture. Remaining one was unknown etiology. In CT scan hemorrhage was most frequently found in the occipital horns according to the spine position of the patient during the examination and lesion found in the temporal horns probably due to narrow crescentic shape. In the secondary IVH the distribution of the blood within the lateral ventricle was mainly ipsilateral to the intracerebral hematoma. The point of penetration of the intracerebral hematoma into the lateral ventricle was the posterior body in the basal ganglia or thalamic hemorrhage, the frontal horn in the aneurysmal rupture and the trigone in the arteriovenous malformation. Although the level of consciousness on admission related to the size and location of primary intracerebral hemorrhage or IVH, the ventricular dilatation itself also seemed to contribute to the consciousness state. The degree of temporal horn dilatation correlated more with the clinical grade than the frontal horn dilatation.