전 교통 동맥 동맥류 치료의 예후인자

박준오,권택현,박윤관,정흥섭,이훈갑,서중근,Park, Juno,Kwon, Taek-Hyun,Park, Youn-Kwan,Chung, Hung-Seob,Lee, Hoon-Kap,Suh, Jung-Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : The anterior communicating artery(ACoA) is known to be the most frequent location of intracranial aneurysms, but the complex arterial anatomy of the ACoA region makes this aneurysm among the most difficult one to treat. In the treatment of ACoA aneurysms, the direction of aneurysmal fundus is known to be very important in the surgical tactics. All ACoA aneurysms in our series were classified according to its direction, and analyzed the clinical features in order to investigate the prognostic factors influencing upon the surgical outcome. Methods : The authors reviewed 236 cases of ruptured ACoA aneurysms that were operated from 1990 to 1997, were classified according to Pia's classification. Results : The incidence rate of the ACoA aneurysm was 35.1%(236/672). Ventral group was more common than dorsal group, especially in ventro-caudal projection subgroup(36.0%). Poor preoperative clinical grade(Hunt-Hess grade IV and V) patients were more common in dorsal group(13.1%) than ventral group(2.6%). Rebleeding and intracerebral hematoma were more commonly seen in ventral group. However, vasospasm, hydrocephalus, hyponatremia, and intraventricular hemorrhage were observed more frequently in dorsal group. Worse outcome was more common in dorsal group than ventral group, especially in dorso-caudal projection subgroup. Also, poor outcome was identified in patients with intracerebral hematoma, intraventricular hemorrhage, hyponatremia, and hypertension, although statistically insignificant. In cases with the A1 dominancy, there was no difference in surgical outcome between the right and left side approach. The higher the aneurysmal neck from the planum sphenoidale, the worse outcome via pterional approach. Conclusion : It seems that the preoperative clinical grade, aneurysmal direction, and the height of aneurysmal neck, especially in the pterional approach, would be the major prognostic factors, and that intracerebral hematoma, intraventricular hemorrhage, hyponatremia, hydrocephalus and the intraoperative aneurysmal rupture would be the minor prognostic factors.

포장술을 시행한 뇌동맥류의 치료 성적

권택현,정흥섭,박윤관,조태형,임동준,박정율,정용구,이훈갑,이기찬,서중근,Kwon, Taek Hyun,Chung, Hung Seob,Park, Youn Kwan,Cho, Tai Hyoung,Lim, Dong Jun,Park, Jung Yul,Chung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objective : Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. Method : Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. Result : Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. Conclusion : It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.

배양조건에 의한 일과성 저산소상태 후 신경세포회복의 차이

문수현,오재인,박윤관,정흥섭,이훈갑,이기찬,Moon, Soo-Hyeon,Oh, Jae-Inn,Park, Youn-Kwan,Chung, Heung-Sub,Lee, Hoon-Kap,Lee, Ki-Chan 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objective : The transverse hippocampal slice is one of the most commonly studied in vitro models of mammalian brain physiology. However, despite its broad usage, there has been no standardization of slice preparation techniques or recording condition. It is well known that variations in recording conditions can result in profound different effects to neuronal responses. Evoked field potentials, recorded extracellularly, were used to investigate the effects of variations in hippocampal slice preparation protocol on hypoxia responses of CA1 neurones. Material & Methods : Before hypoxic injury, hippocampal slices were incubated for 4 hours. During incubation period, the slices were placed in a incubation chamber($21^{\circ}C$) for recovery from preparation injury and then transferred to recording chamber($34^{\circ}C$) for more recovery and baseline electric recording with current stimulation(0.1Hz). Various time periods in incubation chamber and recording chamber were applied to each experimental group(group 1=60min : 180min, group 2=90min : 150min, group 3=180min : 60min, time in incubation chamber : time in recording chamber) before 10 min hypoxia produced by replacing 95% $O_2$+5% $CO_2$ mixed gas to 95% $N_2$+5% $CO_2$ gas. Calcium, Magnesium ions and several drugs effecting on glutamate receptor also were studied. Recoveries from hypoxic injury of hippocampal slices were estimated by percent recovery of population spike(PS). Statistic analysis of study were performed using paired t-test. Results : The percent recovery of PS after 10min hypoxia was considerably enhanced by increasing the period of current stimulation during incubation period before hypoxic injury. Temperature effect on the result of this experiment was also studied(group 4) but the result from this showed no statistic significance. Low magnesium ion concentration of artificial CSF(Mg-free aCSF) during incubation period enhanced the recovery of PS but low calcium (calcium-free) and high magnesium ion concentration(2mM) reduced it after hypoxic injury. L-glutamate($100{\mu}M$) and AP-5($50{\mu}M$) had no effect on the recovery of PS but CNQX($10{\mu}M$) in artificial CSF during incubation period markedly enhanced the recovery of PS. Co-treatment of AP-5($50{\mu}M$), CNQX($10{\mu}M$) and high magnesium concentration(2mM) enhanced recovery of PS in immediate following period of hypoxic injury but the effect of cotreatment after then decayed rapidly and lost statistic significance. Conclusions : Judging from above results, the condition of baseline recording is important in observing the recovery of population spike after hypoxia, and the time and the condition should be controled more strictly to obtain reliable results.

소아에서 뇌수두증의 단락술 이후 발생한 석회화된 만성 경막하 혈종 - 증례보고 -

박준오,권택현,박윤관,정흥섭,이훈갑,서중근,Park, Juno,Kwon, Taek-Hyun,Park, Youn-Kwan,Chung, Hung-Seob,Lee, Hoon-Kap,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Post-shunting subdural hemorrhages are usually small and self-limited, and they can be recognized on the routine post-operative CT examinations. However, delayed subdural bleeding may occur without any clinical symptoms or signs. Thus the hematoma remains undetected, and it can be increased in size and sometimes become calcified with time. We experienced a case of 15-year-old male with a large calcified subdural hematoma who had undergone shunt operation 10 years previously. With pertinent review of the literatures, we discuss the possible mechanism of calcification and the proper way of treatment in calcified chronic subdural hematoma.

해마 조직 절편 배양을 이용한 무산소 손상에 대한 MK-801, CNQX, Cycloheximide 및 BAPTA-AM의 효과

문수현,권택현,박윤관,정흥섭,서중근,Moon, Soo-Hyeon,Kwon, Taek-Hyon,Park, Youn-Kwan,Chung, Heung-Seob,Suh, Jung Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objective : Glutamate induced excitotoxicity is one of the leading causes of cell death under pathologic condition. However, there is controversy whether excitotoxicity may also participate in the neuronal death under low intensity insult such as simple hypoxia or hypoglycemia. To investigate the role of NMDA receptor in low intensity insult, we chose anoxia as the method of injury and used organotypically cultured hippocampal slice as the material of experiment. Materials & Methods : The hippocampal slices cultured for 2-3 weeks were exposed to 60 minutes of complete oxygen deprivation(anoxia). Neuronal death was assessed with Sytox stain. Corrected optical density of fluorescence in gray scale, used as cellular death indicator, was obtained from pictures taken at 24 and 48 hours following the insult. The well-known in vivo phenomenon of regional difference in susceptibility of hippocampal sub-fields to ischemic insult was reproduced in HOSC(hippocampal organotypic slice culture) by complete oxygen deprivation injury. Results : $CA_1$ was the most vulnerable to complete oxygen deprivation in hippocampus while $CA_3$ was resistant. Oxygen deprivation for 10 and 20 minutes with glucose(6.5g/l) present was insufficient to induce neuronal death in the cultured hippocampal slice. However, after 30 minutes exposure under anoxic condition, neuronal death was able to be detected in the center of $CA_1$ area. The intensity and area of fluorescence indicating cell death correlated with the duration of oxygen deprivation. NMDA receptor and non-NMDA receptor blocking with MK-801(30 & $60{\mu}M$) and CNQX($100{\mu}M$) did not provide cellular protection to HOSC against damage induced by oxygen deprivation, but increased intracellular calcium buffering capacity with BAPTA-AM($10{\mu}M$) was effective in preventing neuronal death (p=0.01, Student's t-test). Cycloheximide($1{\mu}g/ml$, $10{\mu}g/ml$) provided no protection to HOSC against insult of complete oxygen deprivation for 60 minutes and combined therapy of MK-801(30 & $60{\mu}M$) and cycloheximide(1 & $10{\mu}g/ml$) was also ineffective in preventing neuronal death. Conclusion : The results of this study show that the another mechanism not associated with glutamate receptor(NMDA & non NMDA) may play major role in cell death mechanisms induced by complete oxygen deprivation and increased intracellular calcium during anoxia may participate in the neuronal death mechanism of oxygen deprivation. Further investigation of the calcium entry channel activated during oxygen deprivation is necessary to understand the neuronal death of anoxia.

설인신경초종

박철웅 ( Chul Woong Park ),권택현 ( Taek Hyun Kwon ),박윤관 ( Youn Kwan Park ),정흥섭 ( Heung Seob Chung ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

The schwannomas from the lower cranial nerves have rarely been described, because the determination of lower cranial nerve`s origin is not always possible. The authors report a case of glossopharyngeal schwannoma, where the selective nerve origin was validated by microsurgical findings. A 35-year-old female presented with gait ataxia and headache. The preoperative MRI revealed a large cystic mass in the left cerebello-pontine angle, compressing the brain stem. Via the suboccipital route operation, it was demonstrated that the mass was adhered to the paper-like thinned glossopharyngeal nerve near the jugular foramen without association to other lower cranial nerves. In the cisternal portion, the glossopharyngeal nerve could be identified by its rostral entrance to the jugular foramen. A subtotal tumor removal was achieved to avoid damage of the paper-like thinned glosspharyngeal nerve. After surgery, the patient was discharged without any neurological symptoms and has received stereotactic radiation surgery for small remnant tumor.

뇌 전이를 동반한 크루켄베르크 종양 - 증 례 보 고 -

권택현,조태형,임동준,박정율,박윤관,정용구,정흥섭,서중근,Kwon, Taek-Hyun,Cho, Tai-Hyoung,Lim, Dong-Jun,Park, Jung-Yul,Park, Youn-Kwan,Chung, Yong-Gu,Chung, Hung-Seob,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Krukenberg tumor has been traditionally defined as gastrointestinal malignancy metastatic to the ovary, and is known to account for 1 to 3% of ovarian neoplasms. The nature and behavior of this particularly virulent tumor still remains unclear. We have experienced a case of Krukenberg tumor with brain metastasis. A clinical description of our case is presented with a review of the literature.

척수원추에 발생한 혈관모세포종 - 증례보고 -

문수현,김세훈,권택현,박윤관,정흥섭,서중근,Moon, Soo-Hyeon,Kim, Se-Hoon,Kwon, Taek-Hyon,Park, Youn-Kwan,Chung, Heung-Seob,Suh, Jung Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Intramedullary spinal hemagioblastomas usually develope in cervical or thoracic region of spinal cord, but rarely in conus medullaris. We report a case of hemangioblastoma developed in conus medullaris. The 19-year-old male patient presented with slowly progressing low back pain and paresthesia of both legs. MRI and spinal angiography revealed a well-vascularized mass lesion in the conus medullaris with syrinx formation. Total excision of hemangioblastoma was achieved via posterior approach. Postoperatively, patient's walking difficulty was worsened transiently, but it was improved at discharge.

급성 경막하 혈종에서 응급 두개골 천공의 위치

문수현,김근회,권택현,박윤관,정흥섭,서중근,Moon, Soo-Hyeon,Kim, Geun-Hoe,Kwon, Taek-Hyun,Park, Youn-Kwan,Chung, Hung-Seob,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5

The motality rate of acute subdural hematoma(ASDH) associated with closed head injury is high in spite of recent advances in neurosurgery. Many variables in regard to outcome of ASDH have been assessed. But among them, intracranial pressure(ICP) control and the time interval between injury and operative evacuation are the only things that can be affected by doctor. We introduced a simple method to the management of ASDH for reducing the time interval between injury and operation. When the immediate decompressive operation of ASDH was impossible by any causes, we made a burr hole at the center of hematoma, usually on 2-3cm above temporal squama and 1-2cm behind coronal suture under local anesthesia before main operation. Partial hematoma evacuation was achieved through the burr hole and it was effective in preventing further worsening of patients neurological status before main operation. Prompt hematoma evacuation through the burr hole seemed to be effective in delaying secondary ischemic brain damage and made easy to closing the dura opening and replacement of the bone flap at the end of main decompressive operation. This easy method may reduce the time interval between injury and operation. We represent surgical technique with two cases of ASDH managed with this simple method.

불완전하게 결찰된 뇌동맥류의 혈관내치료 - 증 례 보 고 -

임동준,정용구,조태형,이훈갑,김세훈,김근회,권택현,정흥섭,박정율,박윤관,이기찬,서중근,Lim, Dong-Jun,Lee, Hoon-Kap,Cho, Tae-Hyoung,Chung, Yong-Gu,Kim, Se-Hoon,Kim, Keun-Hoe,Kwon, Taek-Hyun,Chung, Heung-Seob,Park, Jung-Yul,Park, Youn-Kwan,L 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Residual aneurysm is a challenging problem after clipping procedure for the aneurysms. The anthors describe one patient in whom endovascular treatment was sucessfully done to treat residual aneurysm after surgical clipping. We discussed the role of endovascular coil occlusion in case of incomplete surgical obliteration of aneurysms.