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급성 중증 뇌종창 환자의 양측성 감압개두술 후 뇌압 및 뇌혈류 측정
유도성,김달수,허필우,조경석,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suck,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3
Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.
저체온요법 치료 환자에서의 두개강내와 액와부의 온도차이
유도성,김달수,허필우,조경석,김재건,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyung-Suck,Kim, Jae-Gun,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7
Objective : The brain temperature is about $0.4-1^{\circ}C$ higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. Methods : Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia( over $38^{\circ}C$), normothermia($36-38^{\circ}C$) and hypothermia(under $36^{\circ}C$). Total 1671 paired sample data were collected and analyzed. Results : The temperature difference between the cerebral cortex and the axilla was $0.45{\pm}1.04^{\circ}C$ in hyperthermic patients, $0.97{\pm}1.1^{\circ}C$ in normothermic patients and $1.04{\pm}0.81^{\circ}C$ in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). Conclusion : From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.
유도성,조경근,박춘근,지철,이길송,나형균,이상원,최창락 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.3
Ossification of ligamentum flavum is a very rare disease and one of the new disease entities in myelopathy. We report three cases of ossification of ligamentum flavum in thohcic spine causing thoracic myelopathy. Main symptoms of this disease are numbness of both legs and feet. gait distlirbance and spastic motor weakness. Simple spine X-ray. metrizamide myelogram CT and MRI are most useful diagnostic tools. Sufficient decompressive laminectomy and facetectomy are treatment of choice.
Endovascular Treatment of the Distal Internal Carotid Artery Large Aneurysm
배홍주,유도성,허필우,이태규,조경석,이상복 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.3
Objective : According to the development of endovascular technique anddevices, larger aneurysms on the distal internal carotid artery (ICA) canbe treated using a less invasive method. The authors report on clinicaland angiographic outcomes of these aneurysms treated using an endovasculartechnique. Materials and Methods : Data on 21 patients with large aneurysms atdistal ICA treated by endovascular method between January 2005 andDecember 2012 were included in this retrospective analysis. Results : Clinical outcome of patients showed strong correlation with theinitial neurologic status (p < 0.05). Aneurysm morphology showed saccular,fusiform, and wide-neck in 12, six and three patients. Six patients underwentstent assisted coiling and the other 15 patients underwent simplecoiling. Aneurysm occlusion was performed immediately after embolizationwith near-complete (Raymond class 1-2) in 20 patients (95.2%) andincomplete (Raymond class 3) in one patient (4.8%). Delayed thromboticocclusion occurred in two patients and their clinical result was fatal. Anotherfive patients died in the hospital, from massive brain edema and/or increasedintracranial pressure due to initial subarachnoid hemorrhage. Overallmortality was 30% (seven out of 21). Fatal complication related to theendovascular procedure occurred in two patients with thrombosis at middlecerebral artery (one with stent, the other without it). Conclusion : Recent developed endovascular device and technique is safeenough and a less invasive method for distal large or giant aneurysms. Based on our analysis of the study, we suspect that coil embolization oflarge distal ICA aneurysms (with or without stenting) is effective and safe.
김달수,유도성,허필우,김재건,조경석,강준기,Kim, Dal Soo,Yoo, Do Sung,Huh, Pil Woo,Kim, Jae Keon,Cho, Kyoung Suok,Kang, Joon Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6
MMD의 외과적 치료에서 소아에서는 직접 및 간접적인 혈관문합술을 병합하거나 아니면 간접적인 혈관문합술들을 병합하여 시행하는 경향이 있고, 성인에서는 혈관의 직경이나 MMD의 진행속도로 보아 STA-MCA 문합술과 같은 직접적인 수술이 많이 활용되고 있으나, 소아나 성인에서나 모두 공통적으로 보다 넓은 뇌표면에 여러 가지 수술방법을 병합하는 것이 좀더 광범위한 범위에 뇌혈류 공급을 증가 시키는데 도움이 된다고 보는 경향이다. 수술의 적응증은 혈관조영상에서의 나타난 질병의 정도보다는 acetazolamide를 이용한 PET 나 SPECT 검사로서 뇌혈류 예비량에 기준을 두고 있는 현상이 혈류 역학적으로도 합리적인 것으로 보인다. 수술후 합병증을 줄이려면 수술중에 정상탄산, 정상체온, 정상혈압을 유지 시킴과 동시에, 수술직후 통증관리도 철저히 하는 것이 매우 중요하다. The authors reviewed the recent trend of surgical treatment for pediatric as well as adult onset moyamoya disease(MMD). Combined direct and indirect arterial anastomosis or multiple indirect arterial bypasss has been increasing for pediatric MMD and direct arterial bypass is recommended for adult MMD, especially in patients with hemorrhagic MMD. Besides perioperative complications related to the management of MMD and 1999 annual report by the Research Committee on Spontaneous Occlusion of the Circle of Willis(Moyamoya Disease) of the Ministry of Health and Welfare, Japan will be summarizd.
김병섭,유도성,허필우,조경석,이상복 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3
Bilateral multiple intracranial hemorrhagic infarction after cranioplasty is an extremely rare complication. We present a case of a bilateral multiple intracranial hemorrhagic infarction following cranioplasty with an autologous bone graft. A 63-year-old woman had a previous decompressive craniectomy after a right middle cerebral artery infarction. The possible pathogenesis of the complication is discussed. (Kor J Cerebrovascular Surgery 12(3):136-140, 2010)