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해면정맥동 부위 거대동맥류에 있어서 외경동맥과 중대뇌동맥간 복재정맥 우회 이식술 : 증례보고
전상룡,장웅규,정천기,한대희 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.5
The authors report a case of giant internal carotid artery aneurysm at the cavernous portion which was treated by trapping of internal carotid artery(1CA) after external carotid artery(ECA) to middle cerebral artery(MCA) bypass by long saphenous vein graft. It was impossible to clip the aneurysm because of its position and size. The patient suffered from progressive extraocular movement disturbance and decreased visual acuity. She was intolerant to balloon occlusion test. The size of the aneurysm was 3.5 X 25X 2cm. ECA to MCA bypass was done with saphenous vein graft successfdly. However, computerized tomography shows hemorrhagic infarction at left temporal lobe postoperatively. Two days later, left temporal lobectomy was done because of uncontrollable increased intracranial pressure. Internal carotid artery was trapped with pmxb mal ligation and distal clipping at the supraclinoid segment.
전상룡,권순찬,노성우,임승철,이정교,강신광,강길현,정천기,김현집 대한척추신경외과학회 2004 Neurospine Vol.1 No.1
Objective: Although hypothermia is known to have a neuroprotective effect on brain injuries as well as to decrease intracranial pressure, the neuroprotective effect in spinal cord injury(SCI) has not been proven. The author performed this experiment to evaluate the effect of systemic hypothermia on neurological improvement and histopathological change in traumatic SCI of rat. Methods: In experiment Ⅰ, spinal cord contusions were implemented in 35 rats that had been divided into 3 groups. Rats in Group 1(N=12) were kept with normothermia, while Group 2(N=10) received hypothermic treatment for 5 hours and Group 3(N= 13) for 20 hours. The experiment was held over two weeks and clinical assessment of locomotor function was made by utilizing the Basso-Beattie-Bresnahan(BBB) locomotor rating scale. Histopathological studies were performed at 2 weeks by hematoxylin & eosin, luxol fast blue and TUNEL staining. To analyze the effect of hypothermia for 20 hours on apoptosis, the author evaluated histopathological findings 3 days after SCI in experiment Ⅱ. Eighteen rats with SCI in experiment Ⅱ, were kept with normothermia in Group 4(N=9) and treated by hypothermia for 20 hours in Group 5(N=9). The spinal cords were excised and stained 3 days after SCI. Results: Fourteen days after SCI, BBB scales in Group 1(N=9), Group 2(N=9), and Group 3(N=13) were 7.9±2.8, 10.0±3.2, 13.9±2.5, respectively, which were statistically significant(ANOVA, p=0.001). The area of spinal cord tissue defect in Group 1, Group 2 and Group 3 after 2 weeks were decreased gradually, which were 4.1±2.0 mm², 2.9±1.9 mm², 2.0±1.9 mm², respectively, but statistically insignificant(ANOVA, p=0.064). In experiment Ⅱ, the sizes of necrotic areas in Group 4 and Group 5 were 5.9±2.2 mm², 3.8±2.3 mm², respectively, which were not statistically significant(p=0.074). However, the ratio of TUNEL staining positive cells decreased significantly in Group 5(p=0.015). The ratios were 0.30±0.10 in group 4 and 0.16±0.12 in group 5. Conclusion: In this study, systemic hypothermia for 20 hours improved neurological recovery and decreased the ratio of apoptosis in traumatic SCI of rat. In addition, hypothermic treatment showed a tendency of reducing necrosis and tissue defect after SCI.
척수내 혈관모세포종에 있어서 척수팽대 1례 : A Case Report
전상룡,이상형,한대희 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.12
The following is a report of a case of intramedullary hemangioblastoma with diffuse cord enlargement. A 34 years-old man was admitted complaining of posterior neck pain developed ten months before. Spinal magnetic resonance image then revealed diffuse cord enlargement from the cervical to upper thoracic level, together with well enhancing intramedullary mass at the C_(7)-T₁ level. C_(6)-T₁ total laminetomy was performed and the enhancing mass was removed. Postoperative magnetic resonance image done on the 15th day, revealed that the cord enlargement had disappeared and the signal intensity of the enlarged portion subsequently changed from high to low. The possible pathophysiology of this observation is discussed.
Outcome of Gamma Knife Radiosurgery for Trigeminal Neuralgia
전상룡,이동준,김정훈,김창진,권양,이정교,권병덕,Jeon, Sang Ryong,Lee, Dong Joon,Kim, Jeong Hoon,Kim, Chang Jin,Kwon, Yang,Lee, Jung Kyo,Kwun, Byung Duk The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.9
목 적 : 본 연구는 삼차신경통에 대한 감마나이프 방사선 수술을 한 경우에 있어서 그 장기추적 결과를 분석하고자 하였다. 방 법 : 총 증례수는 11례였고 신경근 입구부(nerve root entry zone)에 수술의 목표점으로 최대량 67~85Gy를 조사하였다. 4mm collimator를 사용하였고 목표점은 뇌교의 표면으로부터 1~6mm 원위부 신경근에 위치하였다. 초기 3례에 있어서는 신경근과 뇌교가 만나는 접합부를 방사선수술의 목표점으로 삼았다. 이들 증례에서는 뇌교에 56 혹은 60Gy가 조사되었다. 후반 8례에서는 목표점을 다소 신경근의 원위부로 이동하여 뇌교의 가장자리가 최대량의 20% 이하로 조사되도록 계획하였다. 결 과 : 평균추적 기간은 25개월(13~50개월)이었다. 통증감소의 시작시점은 수술후 일주일내에서부터 길게는 5개월째였다. 통증의 치료결과는 삼례에서 완전소실, 3례에서 현격히 감소(80~90%)하였고 4례에서는 의미있게 감소하였다. 단 한례에서 최종추적결과 수술전과 같은 정도의 통증재발이 있었다. 전례에서 감마나이프 방사선수술과 관련된 의미있는 정도의 부작용은 관찰되지않았다. 결 론 : 장기추적 결과 감마나이프 방사선 수술이 삼차신경통의 치료에 효과적임이 관찰되었고 향후 이 질환에 대한 일차적 치료법으로 정하기 위하여 좀더 많은 치료경험이 필요할 것으로 사료된다. Objective : This study was undertaken to analysis gamma knife radiosurgery(GKR) effect for trigeminal neuralgia after long term follow-up. Methods : There were 11 trigeminal neuralgia patients. The authors irradiated 67-85 Gy maximally to the nerve root entry zone(NREZ) using single 4mm collimator, just 1-6mm lateral side from the junction of the trigeminal nerve and pons. For the first 3 cases, we targeted the junction between the nerve and the pons. In theses cases, the pons was irradiated 56 or 60 gray in the surface. In the later 8 cases, the isocenter is positioned more distal side so that the brain stem surface would receive less than the 20% isodose. Results : The average follow-up duration was 25 months(13-50 months). Pain relief was noticed within a week to 5 months. In 3 patients, pain was relieved completely and in other 3 patients, mark improvement was achieved(80-90%). Remaining 4 patients showed significant improvement(30-50%). There was recurrence in only one case and she complained with similar intensity of pain at the last follow-up. There was no significant complication related to GKR. Conclusion : GKR is considered effective for trigeminal neuralgia based on the long term follow-up evaluation, but more clinical experience is needed to evaluate the efficacy of GKR for trigeminal neuralgia as a primary treatment modality.
Current Concept of Stem Cell Therapy for Spinal Cord Injury: A Review
오선규,전상룡 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2
Spinal cord injury (SCI) is a catastrophic condition associated with significant neurological deficit, social, and financial burdens. Over the past decades, various treatments including medication, surgery, and rehabilitation therapy for SCI have been performed, but there were no definite treatment option to improve neurological function of patients with chronic SCI. Therefore, new treatment trials with stem cells have been studied to regenerate injured spinal cord. Among various types of stem cells, bone marrow derived mesenchymal stem cells is highly expected as candidates for the stem cell therapy. The result of the current research showed that direct intramedullary injection to the injured spinal cord site in subacute phase is most effective. Neurological examination, electrophysiologic studies, and magnetic resonance imaging are commonly used to assess the effectiveness of treatment. Diffusion tensor imaging visualizing white matter tract can be also alternative option to identify neuronal regeneration. Despite various challenging issues, stem cell therapy will open new perspectives for SCI treatment.