손상 척주와 수술 척주에 따르는 하부 경추 손상의 외과적 치료방법의 선택

장태안,김종문 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.5

개두술과 Interstitial Brachytherapy 후 두피에 전이된 다형성 교아종

장태안,허승곤,박경우,정남,신문수 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.10-11

Extracranial metastasis of glioblastoma multiforme is still rare with or without relation of previous surgery. The patient who had a history of the craniotomy & stereotactic interstitial brachytherapy for the management of glioblastoma multiforme was presented with low back pain initially and multiple scalp nodule was noticed on 10th hospital day. Follow up brain CT had no evidence of tumor reccurrence and biopsy of these nodules revealed a histopathologic picture similar to that of primary glioblastoma multiforme and positive for GFAP stain. Authors reviewed the literature & reported this unusal case.

하부 요추 방출 골절의 수술방법 결정시 고려 요인들

장태안,김종문,Jahng, Tae-Ahn,Kim, Jong-Moon 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.

성인요추 척추전방전위증의 외과적 치료 : 치료방법간의 비교 Comparision of Various Method

장태안,김종문 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.4

In retrospective study of 35 cases(male=17. female=18) of lumbar spondylolisthesis(isthmic 24 degenerative 6 iatrogenic 5) treated with different surgical management. we elucidate the result of follow-up radiologic changes and surgical outcome Percent-slip was reduced and percent-disc height was increased in all three groups at 1 month after the operation But S months follow-up after the operation revealed that percent-slip was increased to around the value of preoperation in PPLF group(Pedicle screw flxation with posterolateral fusion. 13cases) and PLIF group(Posterior lumbar interbody fusion only. 11cases) and that percent-disc height was decreased compared to postoperative 1 month in PPLF group. Although PPlF group(Pedicle screw fixation with posterior lumbar interbody fusion, 11cases) showed better correction and maintenance But there was no significant differences in overall outcome among the three surgical groups(PPLF 76.9% PLIF : 81.8% PPIF 81 8%, % of satisfaction) and the outcome of surgery was not related with bone union rate(PPLF=76.9% PLIF=72.7%, PPIF=81.8%) or accompanied NIC and HNP. There were S patients with complications(17.1%), such as two wound infection. two screw fractures and two others. Further longterm follow-up and evaluation is needed for clarifying the efficiency and superiority in surgical options associated with type. degree of slip, complications. bone fusion and patient satisfaction.

후방경유 직접 정복과 고정 및 골유합을 통한 불안정 교수형 골절의 치료

장태안 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.4

자발성 뇌실질내 혈종 치료에 대한 Pelorus System을 이용한 뇌정위적 흡인술과 개두술 간의 비교 분석

장태안,박경우,정남,조경기 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.4

To date no definite conclusion has been reached regarding the suitability of treatment for spontaneous intracerebral hematoma. With remarkable development of CT gurded stereotatic technique, stereotatic evacuation is in preference to conventional craniotomy due to local anesthetics and minimal invasion. Authors present the result of comparative study on conventional craniotomy vs stereotatic evacuation using Pelorus system with urokinase irrigation and drainage from Jan. 1985 to July 1989 (102 conventional craniotomy and 35 CT guided stereotatic evacuation). Stereotatic evacuation revealed better result compared to conventional craniotomy in activity of daily living(ADL) and improvement of motor weakness, and it had not influenced by hematoma location and volume. Urokinase irrigation using catherter with distal multiple side hole could remove the remained hematoma rapidly and easily. These results may provide that stereotatic evacuation with urokinase irrigtion can be one of the definite treatment of spontaneous intracerebral hematoma.

뇌동맥류 조기수술후 발생한 뇌혈관연축에 영향을 미치는 임상적 인자

최양문,장태안,강성돈,김종문 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.12

Much controversies still exist with respect to the risk factors influencing symptomatic cerebral vasospasm. In our study, the patient group had some unique characteristics, ie. : 42.5%(65) of the 153 patients were aged 60 years or older(mean : 55.6 years) and consequently the proportion of Hunt-Hess grade 3-5 was higher than grade 1-2(57.5% vs. 42.5%). The authors analyzed the relationship between vasospasm and Hunt & Hess grade, Fisher grade, hydrocehalus, age & hypertension among these 153 early operative cases after a 3 year follow up study. The incidence of vasospasm was significantly higher in the Hunt-Hess grade, Ⅲ, Ⅳ, Ⅴ and the Fisher grade Ⅲ, Ⅳ, compared to grade Ⅰ& Ⅱ, and also in preoperative hydrocehalus but it was insignificant in old and hypertensive patients. These results suggest initial severe direct insults and complicating preoperative hydrocephalus increase the chance of postoperative symptomatic vasospasm in this older aged, poorer grade study group.

최소침습기법을 이용한 요추감압술, 추체간 유합술 및 나사못 고정술-예비보고

문경윤,장태안 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.3

Objective : With improvement in endoscopic visualization and surgical tools, several minimally invasive procedures such as transpedicular fixation, interbody fusion, or decompression have advocated their respective advantages. But all these procedures are developed separately and are not related to other techniques. The authors utilize these procedures as organized procedure like comprehensive conventional procedure. This study is designed to study early results of minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation. Methods : We utilized minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation on 12 consecutive patients(9 female, 3 male, mean age 54.8 years). For decompression, unilateral laminectomy and controlateral laminar undercutting was performed through tubular retractor, and interbody fusion(PLIF or TLIF) was done with one cage and bone packing. Pedicle screw fixation was done using expandable tubular retractor under endoscopic visualization and fluoroscopic guidance. Contralateral screw fixation was done with the same manner. Results : There were five spinal stenosis and seven degenerative spondylolisthesis. All patients received one level (L4-5) decompression, interbody fusion, and fixation. Mean operating time was 245.8 minutes. There was dural tear in one patient. All patients were excellent or good with average follow up of 7.2 months. Bone fusion was not evident due to short-term follow-up, but there were no instability or screw loosening. Conclusion : Although it is small series and has short-term follow-up, this study demonstrates that minimally invasive decompression, interbody fusion, and pedicle screw fixation are feasible and effective.

척수종양 수술에 있어 추궁성형술의 유용성

송영기,장태안 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.3

Objective : Laminoplasty is one of the potential surgical options for compressive spinal pathologies. The use of laminoplasty in spinal cord tumor surgery is not popularized by this time. To demonstrate the usefulness of laminoplasty in spinal cord tumor surgery, the authors analyze the results of patients who underwent laminoplasty for removal of cervical spinal cord tumor. Methods : Between 1992 and 2000, 47 patients had received operation for the removal of the cervical spinal cord tumor. Of them, 29 patients were enrolled for this study. 17 patients received laminoplasty and 12 patients received laminectomy. The medical records and radiologic studies were analyzed retrospectively. The mean followup duration was 61.6 months. Results : Modified Kurokawa method for laminoplasty was utilized in all cases. Neurilemmoma was the most common pathology. Average operated segments ware 2.8 segments in laminectomy group and ware 3.8 segments in laminoplasty group. Taking time for the operation with laminoplasty(avg. 291min) was longer than that for laminectomy(avg. 275min). Kyphotic deformity was developed in 1 patient in laminoplasty group and in 2 patients in laminectomy group. All laminoplasty patients revealed stability in radiologic follow-up. One patient who underwent laminoplasty presented recurrent neurilemmoma, which could be removed easily by virtue of less adhesion and undistorted anatomy. Conclusion : This study demonstrates that patients who underwent laminoplasty have less kyphotic deformity and keep space with protection from adhesion. We conclude that the laminoplasty is one of the useful procedures, especially in younger patients with large multiple intradural tumors and mass over several segments.

자발성 종양내 출혈로 뇌졸중을 초래한 수막종 1례

정진환,장태안,김종문 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.11

Spontaneous intracranial hemorrhage occurs in approximately 4% of cases of intracranial or metastatic carcinoma and occasionally in pituitary adenomas. By contrast hemorrhage into meningiomas in exceedingly rare. Because of their unusual clinical presentation, these cases were not diagnosed correctly prior to radiological studies. The histological features of the hemorrhagic meningiomas are described and the importance of adequate radiological investigations and early radical surgery is stressed. In this report the authors present a case of spontaneous intracranial hematoma associated with meningioma and a review of other reports.