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상시상정맥동결찰을 통한 원위부 전대뇌동맥류의 수술적 치료
심찬식,임영진,김태성,김국기,이봉암,임언 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.9
Interhemispheric approach has been accepted as a standard method approaching distal anterior cerebral artery(DACA) aneurysm. In this approach, most authors use the surgical method retracting the superior sagittal sinus(SSS) after dural reflection. However, it results in limited surgical space and makes the surgical procedure difficult technically. To overcome the limitation, we tried to ligate and cut SSS in 13 patients out of 23 patients of DACA aneurysm from Mar. 1983 to Feb. 1993. Out of total 583 intracranial aneurysms operated on in that period, the proportion of DACA aneurysm was 3.95%. Mean age was 52.7 years ranging from 32 to 66 years. The sex ratio was 7 : 16, showing female predominancy. As presenting symptoms, twenty two patients had subarachnoid hemorrhage and one patient had a third nerve palsy due to an unruptured posterior communicating artery aneurysm. On admission, 4 patients(17.4%) were in grade Ⅰ, 10(43.5%) in grade Ⅱ, 6(26.1%) in grade Ⅲ, 3(13%) in grade Ⅳ according to the Hunt and Hess grading system. In 18 patients(78.3%), aneurysms were located at bifurcation of pericallosal and callosomarginal artery and in 5(21.7%) at bifurcation of frontopolar and pericallosal artery. Associated vascular anomalies were A1 hypoplasia(2 cases), multiple aneurysms(5 cases), fenestration of anterior cerebral artery(1 case) and arteriovenous malformation(1 case). Thirteen cases were operated on with ligation of the SSS and 10 without ligation. Overall surgical outcomes scored by Glasgow outcome scale were : 11 patient(47.8%) in Grade Ⅰ, 6(26.1%) in Grade Ⅱ, 2(8.7%) in Grade Ⅲ, 4(17.4%) in Grade Ⅴ. The outcomes in ligation group were : 8 patients(61.5%) in Grade Ⅰ, 4(30.8%) in Grade Ⅱ, 1(7.7%) in Grade Ⅲ, and no death. The outcomes in non-ligation group were : 4 patients(40%) in Grade Ⅰ, 1(10%) in Grade Ⅱ, 1(10%) in Grade Ⅲ, and 4(40%) in Grade Ⅴ. These results showed that the patients operated on with ligation of SSS had more favorable outcomes than the patients without ligation. It seems that the ligation of SSS in the interhemispheric approach might provide several advantages and better operative outcome over the conventional method.
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Carpal Tunnel Syndrome의 임상적 고찰
심찬식,김국기,임영진,김태성,이봉암,임언 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.3
Authors reviewed 37 cases of 25 patients with carpal tunnel syndrome treated surgically at Department of Neurosurgery of Kyung Hee University Hospital from January 1981 to February 1992 The sex ratio was 1 : 24 showing female predominancy. Distribution of age ranged from 26 years to 65 years. Duration of symptoms ranged from 15 days to 20 years. Tinel's sign was positive in 24 patients and 10 patients had muscle atrophy. Twelve patients were operated on both hands, 7 patients on the right and 6 patients on the left Operations were performed under the general anesthesia in 4 patients, under the axillary block in 3 patients and under the local lidocaine infiltration in 18 patients. In postoperative periods 5 patients experienced transient aggravation of numbness of fingers 1 patient had wound problem. 1 patient hypalgesia and 1 patient transient motor weakness which was thought to be due to residual effect of axillary block Surgical outcomes were good in 35 cases(94.6%), fair in 1 case(27%) and poor in 1 case(2.7%).
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인공 추간반 수핵 치환술이 추간반 높이와 운동 범위에 미치는 영향:예비보고
이상호,김동윤,심찬식,최원철,최건,이호연 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.5
Objective : The purpose of the current study is to investigate the effect of the prosthetic disc nucleus replacement on the mobility and height of the intervertebral disc and adjacent segments. Methods : Thirteen patients who underwent L4-L5 prosthetic disc nucleus replacement were included in this study. A retrospective review of clinical and radiological data was conducted. The L4-L5 disc height and sagittal rotation angle of L3-L4, L4-L5, L5-S1 were measured in the static and dynamic lateral radiographs pre- and postoperatively. Results : There were seven men and six women whose mean age was 37 years (range, 24-49 years). The mean follow-up period was nine months (range, 6-14 months). In all cases the L4-L5 motion segment demonstrated angular motion between flexion and extension with a mean of 4°(±2.3°) of sagittal rotation angle. The disc height increased from preoperative levels by 117%. There was no difference in angular motion of adjacent segments between pre- and postoperative data. Conclusion : The prosthetic disc nucleus replacement after discectomy is shown to restore the disc height and maintain segmental mobility.
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경피적 내시경 요추 수핵제거술 환자를 위한 Remifentanil을 이용한 진통중심의 진정
황경일,이호연,심규대,심동윤,심찬식,이상호 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.1
Background: The aim of this study was to examine the safety and efficacy of sedation and analgesia using remifentanil during percutaneous endoscopic lumbar discectomy (PELD). Methods: Eighty ASA patients with physical status 1 or 2 who underwent a PELD were enrolled in this study. They were randomized to receive one of two treatments: a fentanyl bolus of 0.7μg/kg 5 min before the procedure and of 0.7μg/kg during the procedure (n = 40, group F), or a remifentanil titration at an infusion rate of 0.1-0.3μg/kg/min available throughout the procedure according to the appeal of pain, level of sedation and side-effects (n = 40, group R). The observer's assessment of alertness/sedation (OAA/S) scale, blood pressure, heart rate, respiratory rate, SpO2, and end tidal CO2 were assessed and measured during and/or after the procedures. The visual analogue scale of pain (VAS), and the patient and endoscopist satisfaction scale were assessed after the procedures. Results: There were no significant differences between the two groups in terms of the recovery characteristics, incidence of complications and satisfaction score of patients. In 92.5% of the cases among the remifentanil group, the spine surgeon made uniform judgements that remifentanil worked better than the usually used fentanyl procedure, whereas in 7.5% of the cases the effects were indifferent. The VAS score of the R group was significantly lower than that of the F group. Conclusions: We concluded that sedation and analgesia with remifentanil is very useful for painful local procedures such as PELDs. (Korean J Anesthesiol 2006; 50: 36~41)
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