뇌동맥류의 수술중 파열 : 빈도, 원인, 처치의 고려사항에 대하여 Incidence,Cause, and Considerations in the Management

이훈갑,송준혁 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.5

Intraoperative aneurysmal rupture is an undesired event that not only interrupt surgical procedures hut also has negative effects on surgical outcome. To define the incidence. cause. and management of the intraoperative aneurysmal rupture, a retrospective analysis was performed on patients with cerebral aneurysms operated from January 1990 to December 1994. A total of 292 aneurysmal patients were included in this study. There were 15 intraoperative aneurysmal ruptures(5.4%). Rupture occured during predissection in 1 case. during the dissection in 8 cases, and during the clip application in 6 cases. Admission grade. size. location of aneurysm. operation timiming. and mean arterial pressure during the dissection did not have significant influence on the incidence of intraoperative rupture. The outcomes were worse in the patients with intraoperative rupture than in non ruptured patients(p<0.05). The skills and experience of the surgeon, rather than the location of aneurysm, stage of rupture and treatment methods, may be the more crucial factor that determine the surgical outcomes.

뇌동맥류를 병발한 Moyamoya병 1예

이훈갑,조순구,이기찬,주정화 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.2

Moyamoya disease is a particular disease of the circle of Willis which is characterized by its progressive obstruction and associated with different cerebral vascular malformations and infrequently associated with aneurysms. A 23 year old Korean woman was admitted to the Department of Neurosurgery, Korea University Hospital, because of stuporous mentality and Rt. sided hemiplegia. She fell down and almost immediately lost consciousness on the day morning of admission. Neurological findings included neck stiffness, moderatelly bilateral dilated pupils, Rt. sided hemiplegia, positive bilateral Babinski's sign and positive Kernig's sign. Lumbar puncture revealed grossly bloody cerebrospinal fluid. Carotid angiogram revealed marked stenosis of supraclinoid portion of intracranial internal carotid arteries with extensive collateral small arterial net work at the base of the brain. Small aneurysmal sac was visualized at the distal end of the small arterial network probably distal portion of posterior choroidal artery. Brain computed tomograph showed hematoma at the posterior portion of left side thalamic area and in the left lateral ventricle. The patient had operation for removal of hematorna and died on the 2nd day of postoperation. Based on this case, mechanisms of formation cf aneurysms in moyamoya disease are discussed.

체성자극에 의한 원심성 미주신경 단일섬유 활동성의 변화

이훈갑,주정화 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.1

A study has been made of efferent single fibers in the cat whose axon is projected to the cardiac branches of the right vagus. The main objective of this experiment was to replicate some of the mechanisms involving vagal efferent discharges and to observe the effect of somatic stimulation, pain and coldness, on the discharges. Electrical activities of a single of a single fiber were recorded on the central segments of small cut strands separated from the right cervical vagus under the pentobarbital sodium anesthesia. The fiber was considered to be cardio-inhibitory in function because of the activity in inverse effect on the heart rate in almost all conditions. Pain and cold stimulation of skin reflexly excited these fibers, as did stimulation of baroreceptor in the carotid sinus. Response to the somatic stimulation applied on the skin, by the increase of impulse frequency. amplitude, discharge duration and puke rate of electrical discharges were observed. The auther observed that efferent fibers in the cutaneous nerve excited the cardiac efferent vagal fibers in response to reflex stimulation.

거대세포 교아종 1례

이훈갑,노순성,이기찬,주정화 대한신경외과학회 1979 Journal of Korean neurosurgical society Vol.8 No.2

A rare case of a giant-celled glioblastoma arised from the intracranial portion of the right frontal base is presented. Clinical presentation was that of increased intracranial pressure with bilateral optic papilledema. Skull X-rays showed an erosion of the right orbital roof. Right carotid angiogram confirmed the presence of a tumor in the frontal base.

뇌낭미충증에 대한 실험적 연구

이훈갑,김성학,이기찬,주정화 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.1

Cerebral cysticercosis may produce many complications and various types of tissue reactions to the parenchyma of the brain. The purpose of the present investigation was to study the nature of the reactions of the brain tissue responding to a direct contract with the fluid contents of cysticercus cyst. The experiments were performed in 15 albino rats in which the brain lesions were made on the frontal region by injecting the fluid contents which was obtained from subcutaneous nodules of human patient with cysticercosis. The fluid contents, 0.5ml for each animal, was injected with 26 gauge hypodermal needle into the left cerebral hemisphere beneath the cortex for experimental group, and same amount of normal saline into the right hemisphere identical to the region of the left for the control group. Histopathological studies were carried out on the train lesions at interval of 3 days, 7 days and 15 days following injection of the contents and normal saline. Findings of generalized and regional edema of the brain were observed in varying degrees, which were evident and severe in 3-day and 7-day experimental groups and decreasing in severity thereafter. In the group of normal saline injection, the microscopic findings of the lesions were mainly of a mild inflammatory reactions with scattered fibroblast or condensation of the nervous tissue. In 3-day experimental group, there were pleomorphic infiltration of neutrophils and histiocytes. In 7-day experimental group, there were prominent cellular reaction, gliosis and vascular proliferation more than those observed in 3-day group. In 15-day experimental group, inflammatory cells and gliosis were reduced in number and. degree, but definitive granuloma with proliferation of vascular fibroblast in its outer layer was developed.

체성자극에 의한 원심성 미주신경 단일섬유 활동성의 변화

이훈갑 고려대학교 의과대학 1981 고려대 의대 잡지 Vol.18 No.1

A study has been made of efferent single fibers in the cat whose axon is projected to the cardiac branches of the right vagus. The main objective of this experiment was to replicate some of the mechanisms involving vagal efferent discharges and to observe the effect of somatic stimulation, pain and coldness, in the discharges. Electrical activities of a single fiber were recorded on the central segments of small cut strands separated from the right cervical vagus under the pentobarbital sodium anesthesia. The fiber was considered to be cardio-inhibitory in function because of the activity in inverse effect on the heart rate in almost all conditions. Pain and cold stimulation of skin reflexly excited these fibers, as did stimulation of baroreceptor in the carotid sinus. Response to the somatic stimulation applied on the skin, by the increase of impulse frequency, amplitude, discharge duration and pulse rate of electrical discharges were observed. The author observed that efferent fibers in the cutaneous nerve excited the cardiac efferent vagal fibers in response to reflex stimulation.

뇌동맥조영상에서 조영제의 혈관외루출에 대하여

이훈갑,이종두,노경정,신규만,이기찬,주정화 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

There have been many reports of angiographic extravasation since the first description by Jamieson in 1952. Preoperative differential diagnosis between epidural and subdural post-traumatic blood collections is not always possible on the basis of cerebral angiographic signs alone, but many authors considered. that extravasation of the contrast medium from a ruptured meningeal vessel is commonly considered as a definitive angiographic sign of epidural hematoma. Some authors feel that an extravasation of contrast medium from rupture of the middle meningeal artery does not necessarily indicate an epidural hematoma since it may also be formed rarely in cases of subdural or intracerebral blood collections. The authors report 6 cases of angiographic extravasation in head injury patient, 3 epidural hematoma, 2 subdural hematoma and one intracerebral hematoma.

실험적 뇌혈관연축에 대하여 칼슘길항제가 뇌혈류 및 뇌대사에 미치는 효과

이훈갑,박정율,주정화 최신의학사 1994 最新醫學 Vol.37 No.9

두부손상 환장의 응급처치

이훈갑 한국의학사 1987 診斷과治療 Vol.7 No.2

Cryptococcus性 腦髓膜炎 1例

李勳甲,田春瑞,辛圭萬,盧敬正,김춘원,李基燦,朱正和 대한신경외과학회 1973 Journal of Korean neurosurgical society Vol.2 No.2

A case of cryptococcal meningitis is reported, which occured in a 25-year old female whose chief compaints ware severe headache, vomiting and double vision lasting one month. Neurological examination on admission (September 7, 1973) showed no significant abnormalities except for the bilateral papilledema and subjective horizontal diplopia. Simple skull and chest films including results of specific diagnostic procedures were grossly intact. Cerebrospinal fluid examination disclosed pleocytosis, increased protein, and decreased sugar and chloride, levels which was the finding compatible with those of tuberculous meningitis etc. The subject was treated under the diagnosis of tuberculous meningitis. Two weeks after the admisson, direct smear of the spinal fluid showed numerous yeast like cells, and cryptococcus neoformans was confirmed by India ink preparation and culture in Sabouraud's glucose agar. Amphotericin B was administered by slow intravenous drip over a span of several hours starting with 0.25㎎/㎏ of body weight and increasing gradually up to 1.25㎎/㎏ of body weight daily. Clinical improvements of the patient's condition along with disappearance of cryptococcus neoformans in CSF examination were obtained by the treatment with Amphoteric in B injection, although a fall in hemoglobin, hypopotassemia, moderate degree of fever and occasional vomiting were observed as side effects during the course of treatment. Cryptococcus is highly fatal infection caused by cryptococcus neoformans which is a special predilections for the central nervous system. Crytococcosis may also involve the lungs, bones and skin, and occurs with increased frequency in patients with leukemia or lymphomas. This infection is most common in male adult, and the protal entry is the respiratory tract.