중증뇌질환에서 뇌압감시장치상 뇌압변동인자와 예후판정에 대한 연구

고삼규,임좌혁,지용철,문충배,최병연,조수호 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.2

두개강내 뇌실질, 혈액, 뇌척수액으로 구성되어 있고 이 두개강내의 부피와 압력은 Monro-Kellle doctrien에 의해 일정하게 유지되고 있다. 뇌압은 두개강내의 여러 생리병리학적 상황에 의해 영향을 받고 특히 뇌내 병변의 발생으로 변동된다. 저자들은 1985년 4월부터 1986년 9월까지 영남대학교 의과대학 부속병원에 입원한 뇌실질내 출혈환자 33례와 두부손상환자 10례등 총 43례에서 지속적인 뇌압측정을 실시하여 뇌압측정, 논압변동인자추적, 예후와의 관계등을 관찰하여 다음과 같은 결과를 얻었다. GCS이 높을수록, 혈종량이 적을수록, 뇌압의 amplitude가 낮을수록, A-wave의 빈도가 낮을 수록, 탄성치가 낮을수록 뇌압이 낮았고, 좋은 예후를 보였다. 환자의 예후와의 관계를 보면 GCS이 12이상인 경우 ADL Ⅰ 및 ADL Ⅱ에 속한 경우가90%, 7이하인 경우는 19%이었으며, 내측피막이 손상된 경우에 서 ADL Ⅰ에 속한 경우는 없었고, 내측피막이 손상되지 않은 경우에서는 48%가 ADL Ⅰ에 속하였다. 또한 혈종의 량이 10㎖이하인 경우는 50%가 ADL Ⅰ에 속하였고 20㎖이상인 경우는 ADL Ⅰ에 속한 경우가 없었다. PCO₂가 25∼29㎜Hg인 경우는 ADL Ⅰ 및 ADL Ⅱ에 속한 경우가 없었다. 뇌압의 amplitude, A-wave의 출현빈도, 뇌탄성치, 뇌압의 변동추이를 알게되어 환자의 예후 를 짐작할 수 있었다. 즉 뇌압의 amplitude가 높을수록, A-wave의 출현횟수가 빈발할수록, 뇌탄성치가 높을수록 환자의 ADL이 불량했다. 또한 뇌압이 점차 상승되었던 군에서 ADL이 불량했다. 이상의 결과로 보아 내원당시의 GCS, 내측피막의 손상여부, 혈종량, PCO₂등이 환자의 예후에 영향을 미쳤고 또한 지속적인 뇌압 측정으로 뇌압의 amplitude, A-wave의 출현빈도, 뇌탄성치, 뇌압의 변동추이를 측정함으로써 환자의 예후를 짐작할 수 있었다. The cranium can be thought of a as shallow, rigid sphere of constant volume. There are three main components within the intracranial space: brain, cerebrospinal fluid and blood. Intracranial volume and pressure are maintained constantly by Monroe-Kellie doctrine. Also intracranial pressure is influenced by a number of physiologic factors and it will be changed with intracranial lesion. Now we were look for the possible factors that influence the intracranial pressure with continuous intracranial pressure monitoring. At the same time we studied the possibility of the relationship, between factors that influence ICP and ADL (Ability of Daily Life) in 43 severe brain lesions (33 cases; intracerebral hematoma, 10 cases ; head injury). In cases of higher GCS, smaller hematoma, lower amplitude of ICP, lesser frequency of A-wave and lower elastance, the ICP were lowed. Ninety percent of cases that GCS is over 12 was belong to ADL Ⅰ and Ⅱ. but only nineteen percent of cases that GCS is under 7 was belong to ADL Ⅰ and Ⅱ. No case of internal capsule involved group was belong to ADL I but forty-eight percent of cases whose hematoma volum is under 10ml was belong to ADL Ⅰ. Fifty percent of cases whose hematoma volume is under 10 ml was belong to ADL Ⅰ and no case that hematoma volume is over 20㎖ was belong to ADL Ⅰ. Cases that PC02 is in the range of 25㎜Hg-29㎜Hg were not belong to ADL Ⅰ. In cases of higher amplitude of ICP, higher frequency of A-wave and higher elastance, the patient's ADL was grave. And in cases of ICP was progressively increased, the prognosis was also grave. Consequently we are able to guess that patient's prognosis will be influenced by initial GCS, internal capsule involvement, hematoma volume, PCO2, amplitude of ICP, frequency of A-wave, brain elastance and curve of ICP.

자발성 뇌간출혈의 정위적 흡입술

고삼규,지용철,문충배,최병연,조수호 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.2

Usually cases of brain stem hemorrhage reveal high mortality and poor prognosis in spite of meticulous medical or surgical treatment. Recently we experienced stereotaxic evacuation of brain stemhemorrhage with Brown-Robert-Wells(B.R.W.) system in four cases. If there were residual hemorrhage after initial aspiraion, those were evacuated with Urokinase irrigation via stereotaxically placed catheter in the hematoma. The entry point of our operation get on the crossing point of midpupillary line and 1㎝ behind coronal suture. Preliminary results: 1) Volume of removed hematoma :5㎖(average) 2) Dates of urokinase irrigation: 2 to 4 days after operation 3) No hydrocephalus, no surgical mortality 4) Average Glasgow coma scale was improved from 6 in preoperative state to 12 in postoperative state. 5) Operation was performed within 24 hours. 6) Advantages of our procedure: (1) Accurate, simple and safe. (2) Under local anesthesia. (3) Less traumatic procedure. (4) Could remove hematoma completely with Urokinase.

경추 부위에 발생한 극외측 추간판 탈출증 - 증례 보고 -

지용철,고삼규,이시우 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.1

Galen정맥의 진성 뇌동맥류 기형 : Case Report

배장호,고삼규,김오룡,김선용,지용철,최병연,조수호 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.6

A 27-year-old male was suffered from seizure due to Galenic aneurysmal malformation which was mainly fed by thalamoperforating circumferential(P2) and posterior cerebral artery(P4) and drained through basal vein of Rosenthal because of agenesis of straight sinus. The aneurysmal dilatation was successfully extirpated by excision of feeding arteries and draining veins including inferior sagittal sinus and straight sinus. We report a case of true aneurysmal malformation of vein of Galen.

불안정 경척추 골절 및 아탈구의 내고정술

정을수,고삼규,김오룡,지용철,최병연,조수호 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1

불안정 하경추손상의 치료로서 기구고정술이 Halo vest에 의한 고식적 치료법보다 효과적인 방법이라 할 수 있으며, 여러 가지의 내고정기구는 각기 특성을 가지고 있으므로 어느 한가지만으로 모든 유형의 손상에 다 적용할 수는 없다. 따라서 골절(손상) 양상이나 신경압박 부위 및 술자의 기호에 따라 알맞는 내고정기구를 택하여 보다 더 세밀한 시술을 함으로써 Halo Vest등의 고식적요법에 비해 좋은 결과를 얻을 수 있다. Recently various kinds of anterior or posterior cervical instruments have been used for stabilization of unstable cervical spinal injury. Every device has different characteristics, so none can cover all of the various types of unstable injuries. Forty six patients of unstable cervical spine fracture and subluxation underwent stabilizing operation using the anterior Caspar plate (6 cases) and the Roy-Camille posterior plate system (40 cases) during recent 3-years. Each approach employed depends on the site of compression and mechanism of injury. Six patients who had complete neurological injury expired after the surgery. The follow-up period for the 40 patients was from 5 to 32 months (average-17.5 months). During follow-up period, 16 out 22 patients (72.7%) who had a neurological deficit showed minimal to moderate improvement and only 4 patients (10%) complained of significant arm or neck pain. The only complication of instrumentation was 5 cases of screw breakout, but 3 of them did not have any problem. Radiologically 37 patients(92.5%) had firm fixation after surgery.

뇌 수막종의 임상 및 병리학적 고찰

최상준,고삼규,김동석,김오룡,지용철,최병연,조수호 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.6

The authors analyzed the clinical and pathological characteristics of 66 meningioma patients operated and pathologically confirmed at the Department of Neurosurgery & Pathology, Yeungnam University Hospital from 1984 to 1992. The results are as follows: 1) Meningioma was the most common in the 6th decade(39.4s) and the overall ratio of male to female was 1 : 25. 2) The most common pathologic types were meningothelid type(30.346) and transitional type(30.3 % 1. 3) The predilection sites were convexity, parasagittal and falx in order of frequency. 4) The most common clinical features were LICP signs(57.6%). 5 ) The marginal contour of the tumor on brain cT were more ~rregular, mushrooming and fnnging pattern in the case of angioblastic and atypical type. The brain edema was more severe in the case of these types. However, these findings had no correlation with prognosis. 6 ) There were 9 atypical cases(13.6%). 7) The total removal was done in 53 cases(80.396) and the postoperative mortality rate was 7.5%. 8) The recurrence rate was 9.0% and the mean duration of recurrence was 36.5 months. The recurrence depended on grade of the surgical removal rather than the pathological type.

요추 전방 전위증의 척추경 나사못 고정술후 추적관리

남동수,고삼규,김오룡,지용철,최병연,조수호 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.4

65명의 요추 전방 전위증 환자를 척추경 나사못 고정술후 평균 15개월간 추적관리해 보았다. 술후 요통이 가장 문제시되는 증상이였으며, 이의 완화를 위해 정확한 수기로 꼭 필요한 부위에 기구고정 및 골융합술을 시행하여야 하겠으며, 술후 적절한 요추부 재활운동이 필요하다고 하겠다. 수술의 결과를 평가하는데 있어서는 보다 객관성이 있는 점수제가 바람직하며, 수술의 성공을 위해서는 엄정한 환자선택이 가장 중요하다고 하겠다. Sixty five patients of lumbar spondylolisthesis were treated with pedicle screw fixation during last 3-years. Roy-Camille plate system has been used in 17 patients, steffee system in 41 and Puno/Winter/Byrd(PWB) system in 7. We analysed the changes of symptoms and radiological findings during follow-up observation(average 15 months). After surgery the average time for low back pain reduction was 7 months, Twenty patients(33%) complained a graft donor site pain initially, but almost except one were alleviated after 7.3 months later on an average. Radiologically the reduction degree of the displacement was from 24% on preoperative state to 12% on last follow-up and pseudoarthrosis rate was 8%. Surgical result was evaluated by our score rating system, according to that system 64.5% of the patients had satisfactory result.

자발성 뇌실질내 혈종 크기와 뇌압, 혈압 및 예후와의 관계

남동수,고삼규,김오룡,지용철,최병연,조수호 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1

1990년 4월부터 1991년 2월까지 영남대학교 의과대학 부속병원 신경외과에 입원한 환자중에서 자발성 뇌 실질내 혈종 환자로 뇌정위적 제거술 및 CT 이용수술법을 한 30례의 환자를 extraventricular drainage catheter를 통해 뇌압을 연속 측정하면서 urokinase 세척을 실시하였고, 수술직후, 수술후 2일, 수술후 5일까지의 혈종양의 변화에 따른 뇌압의 상관 관계, 혈압변화와의 관계, 예후와의 상관관계, glasgow coma scale과의 관계 및 재출혈을 포함한 합병증과의 관계를 비교 분석하였다. 첫째, 혈종 크기와 뇌압의 상관 관계에서는 혈종양이 많을수록 뇌압은 높은 분포를 보였으며, 혈압변화와의 관계에 있어서는 혈종양이 많을수록 수축기 혈압은 높았다. 둘째, 예후와의 관계에서는 혈종의 크기가 클수록 ADL은 낮은 분포를 보였으며, Glasgow coma scale과의 관계에 있어서도 혈종의 크기가 클수록 점수가 낮은 분포를 보였다. 셋째, 혈종의 크기와 재출혈을 포함한 합병증에 있어서는 t-test 상에 유의성이 나타나지 않았다. The development of CT scan and sterotaxic surgery with urokinase irrigation made possible early diagnosis and improved survival in the patients of spontaneous intraparenchymal hemorrhage. We had clinically reviewed and analyzed 30 patients of stereotactically treated spontaneous intraparenchymal hemorrhage, according to the hematoma volume, ICP, vital signs, GCS and prognosis. The results were summarzed as follows : 1) As the hematoma volume increasing, ICP was also increased(p<0.05). 2) The systolic arterial pressure was increased as the hematoma volume increasing(p<0.05). 3) Mean ADL was 55±26% and ADL level were decreased in cases of large hematoma(p<0.05). 4) As the hematoma volume increasing, the level of verbal GCS and total GCS was low(p<0.1). 5) No significant correlation was noted between the hematoma volume and complications(T test).

거내소뇌교각 종양의 복합 접근법

남동수,고삼규,김오룡,서장수,지용철,최병연,조수호 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1

With large CPA tumors, the goal of surgery is safe total removal of the tumors and preservation of nearby neural structures. Although the suboccipital approach can be made for large CPA tumors, combined approach is more preferable method for the wide exposure of the CPA including brain stem and the lower cranial nerves. We have recently experienced favorable results by combined approach. Total removal of large tumors were obtained by these approaches. The authors present surgical points of view and a brief review of literature.

Ommaya Reservior를 이용한 거대 낭성 두개인두종 완전 제거 치험 1례

배준호,고삼규,김오룡,지용철,최병연,조수호 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.8

Craniopharyngioma is one of the most challenging, frustrating, and humbling benign intracranial tumors of childhood. Its behavior is a clinical malignancy even though it is benign tumor in microscopically. There is no single treatment of craniopharyngioma and there must be a plan customized for each patient. This decision may, be made from diagnostic studies alone, but in most cases exploration of the tumor and the testing of its adherence to its surroundings will be the only thorough and fair way to determine whether it can be totally excised or not. So the choice of treatment is 'individualize". We experienced one case of giant cystic craniopharyngioma and performed combined operation which were percutaneous intermittent drainage of cystic fluid through Ommaya reservoir and following microsurgical radical excision. There was no complication and marked intellectual and psychological improvement until todays for 20 months.