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불완전하게 결찰된 뇌동맥류의 혈관내치료 - 증 례 보 고 -
임동준,정용구,조태형,이훈갑,김세훈,김근회,권택현,정흥섭,박정율,박윤관,이기찬,서중근,Lim, Dong-Jun,Lee, Hoon-Kap,Cho, Tae-Hyoung,Chung, Yong-Gu,Kim, Se-Hoon,Kim, Keun-Hoe,Kwon, Taek-Hyun,Chung, Heung-Seob,Park, Jung-Yul,Park, Youn-Kwan,L 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4
Residual aneurysm is a challenging problem after clipping procedure for the aneurysms. The anthors describe one patient in whom endovascular treatment was sucessfully done to treat residual aneurysm after surgical clipping. We discussed the role of endovascular coil occlusion in case of incomplete surgical obliteration of aneurysms.
파종성 악성 핍지신경교종 환자에서 시행한 뇌실내 Methotrexate의 효과 - 증례보고 -
김상돈,정용구,김세훈,임동준,조태형,이훈갑,서중근,이기찬,Kim, Sang-Don,Chung, Yong-Gu,Kim, Se-Hoon,Lim, Dong-Jun,Cho, Tae-Hyung,Lee, Hoon-Gap,Suh, Jung-Keun,Lee, Ki-Chan 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7
Oligodendrogiomas account for about 4 per cent of intracranial gliomas and surgery is known to be an essential first step to establish an accurate diagnosis and when oligodendrogliomas recur with or without anaplastic features after initial resection, radiation and chemotherapy consisting of the administration of procarbazine, lomustine, and vincristine are usually indicated. We report our experience of an excellent result with intraventricular methotrexate chemotherapy for a patient with disseminated anaplastic oligodendroglioma. A 29-year-old male patient presented with diplopia and headache for two months. MRI showed a irregular, faintly enhanced mass in the posterior fossa. The hisotological diagnosis was an anaplaplastic oligodendroglioma and he was treated with chemotherapy of PCV regimen and radiotherapy followed by surgery. CSF dissemination was revealed by a follow-up MRI during the period. Intraventricular methotrexate(0.175mg/kg) was given twice a week for 4 weeks through ommaya reservoir and the size of the multiple tumors was decreased significantly on follow-up MRI. This case report suggests that an aggressive treatment involving intravent-ricular chemotherapy may be helpful even when anaplastic oligodendrogliomas disseminates to leptomeninges.
단일 국소방사선 조사 후 백서 대뇌 피질의 초급성기 변화에 대한 연구
강신혁,정용구,김한겸,김철용,이훈갑,Kang, Shin-Hyuk,Chung, Yong-Gu,Kim, Han-Kyum,Kim, Chul-Yong,Lee, Hoon-Kap 대한신경외과학회 2005 Journal of Korean neurosurgical society Vol.37 No.5
Objective: We investigated the morphologic changes within 24 hours after a single ${\gamma}$-irradiation in the rat brain. Methods: Forty Sprague-Dawley rats were used. After a burr hole trephination on right parietal area, cerebral hemisphere was irradiated with 2Gy and 5Gy using iridium-192($^{192}Ir$), respectively. The effect was assessed at 4, 8, 12 and 24 hours after irradiation. The histological changes were scored following the detection of edema or disarray severity. TUNEL-positive cells exhibiting apoptotic morphology were counted in irradiated region. Results: Cortical edema and disarray were initially showed at 4 or 8 hour and almost all defined at 24 hour after irradiation. And the injury was wedge shape. TUNEL-positive cells were minimal at 8 hour after irradiation as the number of positive cells were $2.6{\pm}5.27$(n=5) after 2Gy, and $0.8{\pm}0.84$(n=5) after 5Gy. But, the number of apoptotic cells were increased markedly to $60{\pm}6.24$ at 12 hour after 2Gy and to $104{\pm}19.7$ at 24 hour after 5Gy. Conclusion: There were prominent morphologic changes immediately after ${\gamma}$-irradiation. And, apoptosis was increased according to the time period. These findings implicate that brain irradiation induces rapid apoptotic change, which may play an important role in the pathogenesis of radiation-induced pathologic conditions.
Unilateral Hydrocephalus in Congenital Atresia of the Foramen of Monro
김종현,정용구,이남준,김세훈,이훈갑,이기찬,서중근,Kim, Jong Hyun,Chung, Yong Gu,Lee, Nam Joon,Kim, Se Hoon,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.3
일측성 수두증은 여러가지 원인에 의해 발생될 수 있으나 주로 종양이나 감염등에 의한 후천적인 몬로공 폐쇄의 경우가 대부분이고 선천성 몬로공 폐쇄에 의한 일측성 수두증은 그 예가 많지 않다. 산전초음파 검사로 태아의 선천성 일측성 수두증을 진단했고 출산 후 수술적 방법을 통해 치료한 예는 국내에 아직 보고된 바가 없어 이를 문헌고찰과 함께 보고한다. Unilateral hydrocephalus is an uncommon disease which may result from obstruction of the foramen of Monro. Congenital or acquired lesions obstructing this foramen have been reported. We present a case of prenatally diagnosed fetal unilateral hydrocephalus. Ventriculoperitoneal shunt operation was performed and following the procedure, ventricular size was decreased and patients neurological status was improved.
허혈성 뇌혈관질환에서 자기공명혈관조영술의 가치에 대한 임상연구
임동준,조태형,정용구,김백현,김근회,김세훈,권택현,정흥섭,박정율,박윤관,이훈갑,이기찬,서중근,Lim, Dong-Jun,Cho, Tae-Hyoung,Chung, Yong-Gu,Kim, Baek-Hyun,Kim, Keun-Hoe,Kim, Se-Hoon,Kwon, Taek-Hyun,Chung, Heung-Seob,Park, Jung-Yul,Park, Youn-K 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8
Objectives : To determine the contribution of cranial magnetic resonance angiography(MRA) for the evaluation of patients with ischemic cerebrovascular accident. Methods : Magnetic resonance image(MRI) and MRA studies performed on 34 patients with ischemic stroke were retrospectively reviewed with the clinical records. Results : There were 9 transient ischemic attacks and 25 completed strokes in our series. Twenty-three of 34 MRA examinations(68%) were positive for stenosis or occlusion. The distribution of stenotic or occlusive vascular lesions were correlated with the location of infarction in 22 of the 23 positive cases(96%). MRA provided additional information not obtained from the MRI in 19 cases(56%). Conclusions : Vascular lesions demonstrated on intracranial MRA show a high correlation with infarct distribution. MRA provided information adjunctive to conventional MRI in a majority of cases. We conclude that MRA is an important noninvasive component of the complete evaluation of ischemic stroke.
신경교종에서 뇌동맥내 Carboplatin주입후 발생한 안구 합병증 - 3례보고 -
김주한,이장보,정용구,박정율,이훈갑,서중근,Kim, Joo-Han,Lee, Jang-Bo,Chung, Yong-Gu,Park, Jung-Yul,Lee, Hun-Kap,Suh, Jung-Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5
Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma : 3, Grade III Astrocytoma : 1, Grade IV Astrocytoma : 5, Gliofibroma : 1, Oligodendroglioma : 1) underwent IAC regimen with carboplatin($300mg/m^2$) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.
당뇨 환자에서 경막외 농양과의 감별을 요한 원발성 척추 경막외 임파종 - 증례보고 -
김세훈,임동준,조태형,정용구,이훈갑,이기찬,서중근,Kim, Se Hoon,Lim, Dong Jun,Cho, Tai Hyoung,Chung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.3
척추 경막외 임파종은 전체 임파종의 7%정도를 차지하며, 가장 흔한 증상으로 척수 압박 증세를 유발하는 것으로 알려져 있다. 그 중에서도 원발성 척추 경막외 임파종, 즉 다른 장기의 침범 소견 없이 척추에만 국한되어 나타난 임파종은, 당뇨병 환자에서 급성 척수 압박 증상으로 나타났을 때, 척추 경막외 농양과의 감별을 요한다. 저자들은 48세의 여자 당뇨 환자에서 흉추부의 통증으로 내원 1개월 전까지 여러 차례 침술치료를 받고 난 후 통증이 악화되고 급성 하반신 부전마비와 배뇨 장애 및 감염 징후가 있어 본원에 내원하여, 병력과 제반 검사상 수술전에 척추 경막외 농양으로 진단되었던 원발성 척추 경막외 임파종 1례를 수술 치험하고 보고하는 바이다. Primary spinal epidural lymphoma(SEL), i.e. occurring in the absence of any detectable extraspinal lymphoproliferative disorder, is an unusual cause of spinal cord compression. The authors report a 48-year-old, diabetic woman presented with back pain followed by acute paraparesis and voiding difficulty. She had been treated with acupunctures on her back before admission, and complete blood count showed leukocytosis with neutrophilia and increased erythrocyte sedimentation rate(ESR). Thoracic spine magnetic resonance imaging(MRI) revealed an epidural mass extending from T5 to T8 with compression of the spinal cord. Emergency decompressive laminectomy was performed with a tentative diagnosis of spinal epidural abscess, but a B-cell lymphoma was final pathologic diagnosis. Further staging showed no other sites of lymphoma, and the spinal lesion was treated by chemotherapy and radiotherapy. The authors stress that primary SEL can mimic spinal epidural abscess(SEA) in the diabetic patient and should be a diagnostic consideration in patients with a syndrome of acute spinal cord compression manifested by a prodrome of back pain and neuroimaging consistent with an epidural compressive lesion, especially in a diabetic.
강신혁 ( Shin Hyuk Kang ),정용구 ( Yong Gu Chung ) 대한뇌종양학회 2004 대한뇌종양학회지 Vol.3 No.2
Multiple pathways are involved in maintaining the genetic integrity of a cell after its exposure to ionizing radiation. However, failure of these pathways results in cell death by inducing irreversible changes. Cellular injury of the radiation primarily leads to double-strand DNA breaks and DNA damage initiates signals that can ultimately activate either temporary checkpoints that permit time for genetic repair or irreversible growth arrest that results in cell death. One of the key proteins in the checkpoint pathways is the tumor suppressor gene p53, which coordinates DNA repair with cell cycle progression and apoptosis. Radiation also acts directly on the plasma membrane of several cell types, activating acid sphingomyelinase, which generates ceramide by enzymatic hydrolysis of sphingomyelin. Ceramide then acts as a secondary messenger in initiating an apoptotic response via the mitochondrial system. The numerous data are presented to show that in irradiated cells the balance between proapoptotic and antiapoptotic signaling may determine the apoptotic outcome in vitro and in vivo. An improved understanding of these signaling system may offer new opportunities for the modulation of radiation effects in the treatment of the human tumors.
유증상성 터어키안 내 지주막 낭종의 수술적 치험 -증례보고-
박동혁 ( Dong Hyuk Park ),정용구 ( Yong Gu Chung ),임동준 ( Dong Jun Lim ),조태형 ( Tai Hyeung Cho ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2
We report the presentation and surgical management of one case with symptomatic intrasellar arachnoid cyst. A 37-year-old female presented with a 2-month history of headache. On neurological examination and preoperative hormonal evaluation, she had no abnormalities. The preoperative magnetic resonance images revealed a intrasellar mass which was hyperintense on T1-weighted image without enhancement after Gd-DTPA administration, and hypointense on T2-weighted image. She underwent transsphenoidal surgery. The cystic lesion was incised, and the colorless cystic fluid like CSF was drained without any solid portion. Postoperative course was uneventful. With regards to intraoperative findings, this lesion was diagnosed as arachnoid cyst.