뇌동맥류 파열 환자에서 경두개도플러 검사의 임상적 의의

강성돈,문성근 圓光大學校 醫科學硏究所 1998 圓光醫科學 Vol.14 No.2

The velocity of blood flow through the middle cerebral artery was measured by transcranial doppler(TCD) in 51 patients with ruptured cerebral aneurysm. A correlation between measured maximal mean blood flow velocities and clinical factors including age, Hunt-Hess grade, Fisher grade, outcome was made. Furthermore, the author analyzed the relationship of TCD velocities with delayed ischemic neurologic deficit(DIND) to determine its reliability in given patients. An age-dependent reduction of the measured maximal mean velocities was found (r = -0.3683, p < 0.01). There was no significant difference between the flow velocities and evaluated clinical factors. When the flow velocities of 11 patients who developed DIND were compared with those of patients without deficits, no significant difference was seen. A significant increase in flow velocities in the day before the onset of DIND was found only in 3 of 11 cases. However, the rate of rise of flow velocities when studied daily, with a rate of > 50 ㎝/sec/day showed significant association with DIND(p<0.005, Fisher's exact test). These results suggest that high TCD flow velocities do not necessarily mean poor neurological status or dense subarachnoid hemorrhage, and a early steep rise of velocities during a day can predict the development of DIND.

뇌동맥류 수술 시 시력소실의 원인으로서 두피절편 견인의 역할

강성돈,김재덕 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.7

뇌동맥류성 지주막하 출혈에 있어서 Symptomatic Vasospasm에 기여하는 위험 인자

강성돈,김한규,박경우,조경기 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.3

The prediction of possibility which patient will develop vasospasm constitutes a further advance in the management of this complication. So the possible clinical risk factors predicting ischemic complication of subarachnoid hemorrhage were retrospectively investigated in patients with ruptured intracranial anuerysm. A comparative analysis of risk factors contributing to symptomatic vasospasm was carried out between 40 patients with symptomatic vasospasm as DID(Delayed Ischemic Neurologic Deficit) group and 52 patients without symptomatic vasospasm as Non-DID group, those who were selected among 349 cases of ruptured intracranial aneurysm admitted to department of neurosurgery at Presbyterian Medical Center, Jeon Ju for 6 years from August, 1982 to July, 1988. Peripheral WBC count, clinical grade, hematocrit, blood glucose level, EKG findings, age, sex and aneurysm location of admission failed to show a prognostic value as a factor developing delayed ischemic neurologic deficit in the patients. However a statistically significant rise in peripheral WBC count was observed at the beginning of clinical deterioration and also systolic blood pressure at admission were significantly higher in DID than Non-DID group. The results suggest that the increase of peripheral WBC count observed at the time of neuroglocial deterioration of delayed onset and high systolic blood pressure at admission might be a risk factor for developing vasospasm.

뇌졸중의 역학적 동향에 대한 연구

강성돈,정진원,문병순,김종문 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.4

척수 부신경 섬유종 : 증례보고

강성돈,김한규,신문수,조기홍,조경기 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.1

Only 6 cases arising on the eleventh cranial nerve have been reported in the world literature. The case of an 51-year-ald woman with spinal accessory neurilemmoma is presented. A cystic mass at the valecular region, which is associated with hydrocephalus, was demonstrated on computed tomogragh scan. The tumor was totally removed. The spinal accesory nerve root was confirmed through suboccipital craniectomy. It is benign and mortality appears quite low.

중증 뇌동맥류 환자에서 출혈 위치의 임상적 의의

강성돈 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.4

Many factors contributing to outcome of aneurysmal rupture patients have been studied but clinical significance of hemorrhage location based on CT in poor grade aneurysm(Hunt-Hess grade IV or V) patients is still unclear. The study was undertaken in order to try to outline the relative influence of hemorrhage location upon eventual outcome in poor grade patients with aneurysmal subarachnoid hemorrhage(SAH). Sixty-six SAH patients with early aneurysm surgery during the recent 3.5-year period. who were grouped into patients with intraventricular hemorrhage(IVH). intracerebral hematoma(ICH). ICH combined with IVH(ICH+IVH). and SAH according to hemorrhage locations were comparatively analized. Most of the poor grads patients(84.8%) were associated with ICH or IVH and the high frequency(67.9%) of IVH patients had an associated with ICH in contrast with the small number(32.1%) ofpure IVH Outcoms was good in 26(394%) and poor in 40(60.6%) The presence of ICH on initial CT revealed better outcome compared to patients without ICH(60.7% vs 23.7%). However. ICH+IVH revealed poor outcome compared to patients without ICH+IVH(100% vs 44.7%). Ruptured anterior cerebral aneurysm caused an ICH+IVH more frsquently and consequently more poor outcome than aneurysms in other anterior circulation. Additionally we relatively compared surgical outcome between aneurysmal sylvian or temporoparietal hematoma(ICH-sylvian or t-p) and hypertensive putaminal hematoma(H-lCH-putamen) sampled randomly under the similar conditions as much as possible There was no significant difference in mortality between the two(26.1% vs 30.0%) but morbidity(especiaily motor weakness) was significantly lower in patients with aneurysmal ICH-sylvian or t-p(8.7% vs 50.0%). Overall results suggest that in Hunt-Hess IV-V aneurysm patients IVH itseif doss not independently correlate with prognosis. but when associated with an iCH it is related to a grave prognostic significance, and aggressive surgery for ICH lead to a better outcome with less morbidity

양호한 임상등급의 뇌동맥류 환자에서 최근 6년간 수술 치험 : 수술 결과와 그 영향인자 Surgery Outcome and its Contributing Factors

강성돈 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

It became possible for a beginner of aneurysm surgery to shorten the stabilization period of surgical technique recently with several advances in the management of subarachnoid hemorrhage, such as early surgery, aggressive critical care, anesthetic technique, calcium channel blockers, and hypervolemia. The present study was conducted to determine whether surgical outcome actually changed over the years and what factors contributed to these changes. 219 good grads(Hunt-Hess grade Ⅰ to Ⅲ ) patients with ruptured intracranial aneurysms operated by the same operator within 3 days after the attack from 1990 to 1995 were selected to reduce selection bias. All possible clinical and radiological factors for surgical outcome were analyzed to find significant factors, and then distributions of each significant factors were examined between 2 treatment periods(1990 to 1993 vs 1994 to 1995). Surgical outcome began to improve significantly since 1994(1990 93 vs 1994 95. p<0005) : 75.0%(12/16) in 1990. 80.8%(21/26) in 1991. 77.4%(24/31) in 1993. 78.4%(40/51) in 1993. 87.8%(36/41) in 1994. 96.3%(52/54) in 1995 experienced good outcome. The decrease of postoperative surgical complications was the only factor influencing an increase of good outcome between 2 treatment periods. The distribution and characteristics of other possible biological significant factors for outcome were not different statistically. Improvement of surgery outcome by a vascular neurosurgeon depends on the number of experienced cases, and case qualities such as distributions of aneurysm size, location, and clinical grade etc. These results suggest that surgical technique importantly affects the change of surgical outcome, and consequently, considering usual level of surgical technique, more careful approach with assistance of an experienced vascular neurosurgeon than surgery by oneself will be necessary for first 4 to 5 years of aneurysm surgery.

진성 후교통 동맥류 : 증례보고 Case Report

강성돈 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.7

칼페인 길항제의 전신투여에 의한 지주막하출혈성 혈관연축의 완화

강성돈 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.2

뇌동맥류 파열에 의한 불량등급 환자에서 Acetazolamide 경두개도플러검사를 이용한 뇌혈관운동반응성의 평가

강성돈,김종문 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.5

Objective : A greater reduction in cerebral blood flow has been shown in poor-grade patients with aneurysmal subarachnoid hemorrhage. The present study is designed to evaluate cerebral vasomotor reactivity(VMR) using a transcranial doppler(TCD) with acetazolamide(AZ) challenge in those patients and to investigate its predicting value for outcome. Methods : Firstly, we compared the effect of AZ and most extensively using CO2 stimuli(breath-holding method) on middle cerebral artery flow velocity(FV) in the same control adults(n=12) to examine the reproducibility of AZ test. Secondly, the changes of FV of lesional and contralateral hemispheres after injection of AZ, which was measured one week after early surgery of poor-grade patients with aneurysmal subarachnoid hemorrhage, were compared between patients who showed good outcome(Group 1, n=22) and poor outcome(Group 2, n=22). Results : There was a close correlation between both stimulation methods, indicating a strong similarity of the vasodilatory effects of CO2 and AZ. The FV at rest(lesional : 71.5±38.6cm/s, contralateral : 49.4±22.6cm/s) increased significantly after administration of AZ(lesional : 90.5±40.1cm/s, contralateral : 66.5±25.4cm/s, P<0.01, Student's t test) in Group 1. However, all had an insignificant increase of FV after AZ challenge compared with the baseline values in Group 2. The difference between the values at rest and after AZ had an increasing tendency but it was not significant, between Group 1 and 2(repeated measures ANOVA, P=0.06). Conclusion : These results demonstrate that the assessment of VMR by the change of FV using TCD together with AZ test in poor-grade patients with aneurysmal subarachnoid hemorrhage seems clinically helpful for predicting surgical outcome.