자발성 두개강내압 저하증

공두식,김종수,박관,남도현,어환,홍승철,신형진,김종현,Kong, Doo Sik,Kim, Jong Soo,Park, Kwan,Nam, Do Hyun,Eoh, Whan,Shin, Hyung-Jin,Hong, Seung-Chyul,Kim, Jong Hyun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Objective : Spontaneous intracranial hypotension is a rarely reported syndrome of spontaneous postural headache associated with low CSF pressure and has rarely been demonstrated radiographically or surgically. But recently, it is being recognized with increasing frequency. The purpose of this study was to characterize clinical and imaging features, etiologic factors, and outcome in the spontaneous intracranial hypotension. Patients and Methods : We reviewed our experience with documented cases of spontaneous intracranial hypotension in 5 consecutive patients with orthostatic headaches from April 1998 to April 1999. Results : The mean age was 41 years(from 35 to 49 years). All patients had postural headaches, which were completely alleviated by recumbency position. Nausea, neck pain, horizontal diplopia, photophobia, and blurred vision were noted in some of the patients. Brain MRI showed diffuse pachymeningeal gadolinium enhancement, subdural collections of fluid, and descent of the brain. The opening pressure from lumbar puncture was $4cmH_2O$ or less in three of five patients whereas the opening pressure was within normal range in two patients. All patients underwent radioisotope cisternography and computerized tomographic myelography. On radioisotope cisternography, CSF leakage was suspected at the level of cervical area(1 patient), upper thoracic area(2 patients), mid-thoracic area(1 patient). Computed tomography myelography revealed extraarachnoid accumulation of contrast media(compatible finding with CSF leakage) at the level of cervical or thoracic area. In all patients, the symptoms resolved in response to supportive measures or epidural blood patch(1 patient). Conclusion : Spontaneous spinal CSF leakage is increasingly recognized as a cause of spinal postural headache. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine and can be demonstrated by variable diagnostic method. The condition is usually self-limiting and its prognosis is typically good.

반측성 안면 경련증에 대한 미세 혈관 감압술 후 발생한 지연성 안면 신경 마비의 임상적 특징

공두식(Doo-Sik Kong),이덕주(Deok-Joo Lee),박재성(Jae-Sung Park),이정아(Jeong-A Lee),박관(Kwan Park) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2

Background : Microvascular decompression for hemifacial spasm provides a long- term cure rate. Delayed facial palsy has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course. Methods : From January, 1998 to April, 2005, 500 consecutive patients underwent microvascular decompression for hemifacial spasm in our institute. The male: female ratio was about 1:3 (131:369) and their mean age was 44.7 years (range: 19-75 years). We investigated the following clinical characteristics for all the patients: age, gender, side of spasm, the offending structures (the compressing vessels), and infection with herpes simplex virus. Their medical recording and radiological data were reviewed. Results : During this period, 49 patients (9.8%) developed delayed facial palsy after microvascular decompression. There were 38 women and 11 men in this study. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.5 days). The palsy was at least Grade II or worse on the House-Brackmann scale. The mean time to recovery was 5.2 weeks (range: 25 days-17 weeks); delayed facial palsy in 48 patients were improved to the complete recovery, but only one patient had remained weakness at the follow-up examination. Conclusion : The incidence of delayed facial palsy (9.8%) was not so low as has been reported the literatures. Although the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment.

증강현실 기반 수술 항법 연구

장태수(taesoojang),공두식(Doo-Sik Kong),우운택(Woontack Woo) 한국HCI학회 2020 한국HCI학회 학술대회 Vol.2020 No.2

본 연구는 증강현실 기술을 활용하여 뇌수술의 한 종류인 비공을 통한 비강내 경접형동접근법을 이용한 뇌하수체 종양 수술(TSA: Endonasal Transsphenodinal Approach through Nostril)의 수술 조건에서 각각 분리된 내시경 화면에 기존 분리되어 있던 의료정보 화면을 내시경 비디오에 증강하여 제공하는 방법에 대한 연구이다. 내시경 접근법 수술은 기존의 다른 수술과 달리 외비에 절개를 할 필요가 없는 비침습 수술이다. 기존의 수술 환경에서 집도를 진행하는 의사의 시야가 환자, 내시경 영상화면, 의료정보 영상화면, 뇌수술 내비게이션 화면으로 분리되어 직관적이지 않은 문제점이 있다. 본 연구에서는 이렇게 직관적으로 통합되지 않은 수술 정보들을 증강현실 기술을 사용하여 직관적으로 사용자인 외과의사에 제공하기 위한 연구를 진행하였다. 이를 위하여 컴퓨터 비젼 기술을 활용하여 내시경 화면에 증강현실 데이터를 출력하기 위한 시스템의 설계 및 구현을 제안하고 논의한다. 이를 통하여 경접형동접근법을 이용한 뇌하수체 종양 수술에서 의료 증강현실 환경을 제공할 것으로 기대된다.

지연성 뇌척수액 전이를 동반한 중등도 송과체종

최재균 ( Jae Gyun Choe ),공두식 ( Doo Sik Kong ),김종현 ( Jong Hyun Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Pineal parenchymal tumor of intermediate differentiation(PPTID) in adult is rare disease, but is capable of cerebrospinal fluid dissemination, similar to pineoblastoma. We present a case of a female patient aged 35 presented with 3-month history of paraparesis and urinary incontinence. Magnetic resonance imaging(MRI) demonstrated multiple vertebral and cerebral metastases originating from pineocytoma on which surgery and postoperative radiotherapy had been performed 7 years earlier, respectively. The patients received radiotherapy on the whole spine and whole brain, and adjuvant chemotherapy. In patients with PPTID, long term attention to leptomeningeal dissemination is required even if the tumor has been removed totally.

례무월경과 유즙 분비가 동반된 과립세포종 -증례보고-

이민호 ( Min Ho Lee ),공두식 ( Doo Sik Kong ),김종현 ( Jong Hyun Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2

Objectives:Pituicytoma is an extremely rare glial neoplasm of the neurohypophysis. The tumor arises from pituicytes, specialized glial cells of the posterior lobe of the pituitary and its stalk. We report a patient with pituicytoma who present-ed with amenorrhea and galactorrhea. Clinical Presentation:A 36-year-old female patient presented with a one year history of amenorrhea and galactorrhea. Brain magnetic resonance imaging (MRI) revealed a 6 mm cystic mass. Intervention:Transsphenoidal resection was performed with gross total resection. A follow-up MRI scan with gadolini-um 1 month after surgery showed no residual mass. Conclusion:Pituicytoma typically presents with either visual symptoms or headaches due to mass effect, or with endo-crinological hypopituitarism. Pituicytoma is a slowly growing localized neoplasm that can be treated by surgical resec-tion. Although the prognosis is good, a long follow-up period and further case investigations are necessary to clarify the biological characteristics of the neoplasm.

가상 환자를 사용한 증강현실 수술 항법 연구

장태수(Tae-Soo Jang),공두식(Doo-Sik Kong),우운택(Woontack Woo) 대한전자공학회 2020 대한전자공학회 학술대회 Vol.2020 No.8

TSA (Endonasal Trans-sphenoidal Approach through Nostril) can be used to remove a pituitary tumor without an incision in the face using an endoscope. Currently performing TSA pituitary tumor surgery is surgery using endoscopic video. In the surgical environment, a zone-type video monitor is using. The video monitor and the monitor of the patient"s medical information navigation system are separated, and thus, there is inconvenient user experience checking different monitors during surgery. This study focuses on improving the discomfort of the user experience by augmented information of the navigation system on the existing endoscopic video. We propose an augmented reality information system using virtual surgical images based on virtual patients using a phantom. Through this, the possibility of navigation technology using augmented medical reality in TSA surgery was confirmed.

뇌하수체줄기에서 발생한 뇌하수체선종

이정훈 ( Jeong Hoon Lee ),공두식 ( Doo Sik Kong ),박관 ( Kwan Park ),김종현 ( Jong Hyun Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

We report two rare cases of pituitary adenomas arising from the pituitary stalk. The major complaints of both patients were headaches and visual disturbances. On magnetic resonance imaging, both tumors were suprasellar in location. Gross tumor excision was performed via the pterional approach. The pathologic diagnoses were pituitary adenomas in both patients. The tumors were shown to be non-functioning by immunochemistry analyses. No remnant tumors existed postoperatively on follow-up magnetic resonance imaging. The pituitary stalk was preserved in both cases and pituitary hormonal activity remained intact postoperatively. One patient had normal visual function pre- and post-operatively;the other patient had improvement in the visual field defect and temporal hemianopsia involving the left eye. While there are many case reports involving ectopic pituitary adenomas, pituitary adenomas originating from the pituitary stalk are extremely rare.

미세혈관감압술 환자 관리를 위한 표준임상지침 개발 및 장기 적용효과 분석

이정아(Jeong A Lee),김정숙(Jung Sook Kim),박관(Kwan Park),공두식(Doo Sik Kong) 한국간호행정학회 2014 간호행정학회지 Vol.20 No.1

본 연구는 미세혈관감압술을 받는 환자를 대상으로 의료의 질 향상과 의료기관 효율적인 운영을 위하여 표준임상지침 개발 및 장기간 적용을 목적으로 하였다. 방법론적 연구로 표준임상지침 개발을 위해 대조군 56명, 실험군(step I) 75명에게 적용평가 후, 7년 동안(Step II) 1,216명에게 지속적으로 적용하였다. 결과는 합병중증 청력소실은 1.8%에서 0% (step I), 0.5% (step II)로, 하부뇌신경마비는 1.8%에서 각각 1.3% (step I), 0.7% (step II)로 감소되었다. 재원일수는 step I 에서 2.56일(25.2%)과 step II 에서 3.05일(30.0%) 감소되었으며, 중환자실 재실기간은 7.9% (step I), 1.8% (step II)가 단축되었다. 환자 1인당 총 진료비는 14.8% (step I) 감소되었고, 일당 진료비는 13.7% (step I), 52.4% (step II) 가 증가되었다. CP 적용에 대한 대상자 만족도는 중환자실에 대한 정보제공 분분이 증가되었다(p =.002). 결론적으로 미세혈관감압술을 위한 표준임상지침은 의료의 질과 환자관리의 효율성을 위해 유용한 것으로 나타났다. 표준임상지침 개발 및 장기활용을 위해서는 잘 조직화된 효율적인 시스템과 다 학제적 간 팀워크라고 할 수 있다. In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed. Methods: This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group. Results: The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.6 days(step I) and 3.0 days(step II). Days of intensive care unit (ICU) stay were reduced by 7.8% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide(p=.002). Conclusion: The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. The key component of the successful application of CP is a well-organized, efficient system and good multidisciplinary teamwork.

소뇌에 발생한 다형성 황색별아교세포종의 악성세포전환

양경훈 ( Kyung Hoon Yang ),남도현 ( Do Hyun Nam ),공두식 ( Doo Sik Kong ),김종현 ( Jong Hyun Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

Pleomorphic xanthoastrocytoma(PXA) is a superficially located, rare glial tumor first described in 1979. It affects young patients, who often present with seizures. The tumor has a relatively favorable prognosis, but 15-20% progress to malignancy. We describe a case of PXA which was benign features at presentation, but underwent anaplastic transformation. Surgery remains the mainstay of treatment. Factors influencing clinical outcome include extent of resection, and histological features such as mitotic index, necrosis and lymphocytic infiltration. The roles of radiotherapy and chemotherapy remain undefined. We advocate lifelong follow-up and establishment of a central registry in order to further understanding of this infrequently encountered tumor.

경미로 접근법을 통한 전정신경초종 수술에서 술 후 안면신경 기능의 분석 : 난외표제 : 전정초종에 대한 경미로 접근법의 안면신경 기능결과

서민영(Min Young Seo),조양선(Yang-Sun Cho),박가영(Ga Young Park),홍성화(Sung Hwa Hong),정원호(Won-Ho Chung),박관(Kwan Park),공두식(Doo-Sik Kong),설호준(Ho Jun Seol) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.1

Introduction : One of the therapeutic goals for vestibular schwannoma (VS) is to preserve the function of cranial nerves, especially the facial nerve (FN). The purpose of this study was to determine the relationship between tumor origin, size and outcomes of FN function in VS surgery via translabyrinthine approach. Methods : To determine the characteristics of tumor and FN outcomes, medical records and MRI were reviewed retrospectively in a series of 39 patients who underwent gross total removal of VS via translabyrinthine approach. FN function was graded according to the House-Brackmann (H-B) grading immediately after surgery and at 1 year postoperatively. Results : The tumor originated from inferior vestibular nerve (IVN) was 38.5 % (n=15) and that of superior vestibular nerve (SVN) was 30.8% (n=12). Twelve out of 15 (80%) patients with IVN tumors and 10 (83.3%) out of 12 patients with SVN tumors achieved HB grade I-II facial nerve function at immediate and 1-year after the surgery. (p=0.825, p=0.396) In comparison between tumor size and FN function, immediate postoperative satisfactory FN outcome of HB I-III were achieved in 4 (80%), 8 (80%), 12 (70.6%) and 3 (42.9%) patients with intracanalicular tumor, tumor less than 1cm, 1.1-2.5cm and 2.6-4cm, respectively. One-year postoperatively, HB grade I-II could be observed in 4 (80%), 9 (90%), 13 (76.5%) and 4 (57.1%) patients. In overall, FN function of HB grade I-III was achieved in 71.8% immediately and 76.9% 1-year after surgery. Conclusions : The result of the facial nerve preservation did not differ significantly according to tumor location. The preservation of facial nerve function seems to be correlated with size of the tumor. More than 3/4 of VS patients could maintain their FN function of HB grade I-II after translabyrinthine approach at 1 year follow-up.