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종례 : 례다발성 신경외 전이를 동반한 혈관주위 세포종 -증례보고-
서진호 ( Jin Ho Seo ),정철구 ( Chul Ku Jung ),김현우 ( Hyun Woo Kim ),하호균 ( Ho Gyun Ha ) 대한뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2
The authors describe a case of the intracranial hemangioperictyoma with multiple extradural, extraneural metastases to cervical vertebra, thoracic spinal cord, lung, chest wall, and intra-abdominal organs. A 41-year-old man presented with right-sided peripheral type facial palsy, decreased visual acuity, deafness, intermittent headache. Initial neuroimaging studies suggested malignant meningioma or hemangiopericytoma with involvement of the internal auditory canal. A surgical intervention was performed and the tumor was gross-totally removed. The histopathological diagnosis was confirmed as hemangiopericytoma. After 4 years later, he had a C5 metastasis, which had been treated with C5 corpectomy with cervical fusion. Further evaluations revealed multiple metastases in liver, lung, pancreas, periaorta area, thoracic and lumbar vertebra. At liver biopsy, hemangiopericytoma was confirmed, which had a similar character to an intracranial lesion. The patient was treated with radiotherapy, chemotherapy and cyberkife-sterotactic radiosurgery (CK-SRS), but dead due to medical problem 7 years after initial diagnosis. Although the hemangiopericytomas have a strong tendency to both local recurrence and extracranial metastasis, in our case, there was no local recurrence in brain parenchyme and no severe neurologic deficits for living after aggressive treatment. We carefully suggest that aggressive treatment with combined modality for hemangiopericytoma may influence on tumor control and to maintain stable neurological state without severe deficits.
김기수(Ki Soo Kim),정철구(Chul Ku Jung),김윤미(Yoon-Mee Kim),고경옥(Kyong-Og Ko),이영혁(Young Hyuk Lee) 대한소아신경학회 2004 대한소아신경학회지 Vol.12 No.2
중추신경계의 비전형 기형/횡문 종양은 주로 영유아기에 많이 발생하는 매우 희귀한 종양으로 구토, 기면, 보챔 등의 비특이적 증상이나 두통, 뇌신경마비등의 증상이 나타날 수 있다. 진단은 대뇌전산화 다층촬영과 핵자기 공명 영상을 통하여 할 수 있고 조직검사를 통해 확진할 수 있다. 이 종양은 원시 신경 외피 종양-수모세포종과 매우 유사하여 흔히 잘못 지단되는 경우가 많으나 비전형 기영/횡문 종양이 좀더 어린 연령에서 발생하고 소뇌에 발생한느 경우가 더 적으며 치료에 대한 반응이 매우 나쁘다. 치료는 수술, 항암 화학요법, 방사선치료 등으로 구성되어 있고 치료에 대한 예후는 매우 나쁘다. 저자들은 중추형 안면 신경마비를 주소로 내원한 2세 된 여아에서 비전형 기형/횡문 종양 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Primary central nervous system atypical teratoid/rhabdoid tumors are rare and extremely aggressive malignancies of early childhood. These tumors are most common in infants less than 2 years of age. Diagnosis is based on distinctive light microscopic and immunohistochemical findings, coupled with a molecular genetic analysis. A histologic features of these tumors are epithelial and/or mesenchymal components in addition to rhabdoid, with or without neuroepithelial fields. The expression of the epithelial membrane antigen, vimentin, and the smooth muscle actin are characteristic of these tumors. Treatment includes surgery, chemotherapy, and radiotherapy. Prognosis is poor despite of an aggressive therapy. We report one case of an atypical teratoid/rhabdoid tumor in a young child. She is an 18 month-old-girl who presented with central type facial palsy. After extensive surgery she improved transiently but relapsed immediately. Her condition was not permitted to receive radiotherapy or chemotherapy. Thereafter, with phrenic nerve palsy, she suffered from recurrent episodes of pneumonia and respiratory difficulties. Finaly, she was expired three months after the diagnosis and treatment.
임상 : 측뇌실 삼각부 병변에 대한 두정-후두 반구간 쐐기앞부분 접근법
신대섭 ( Tae Sob Shin ),정철구 ( Chul Ku Jung ),김현우 ( Hyun Woo Kim ),박경석 ( Keung Suk Park ),김재명 ( Jae Myung Kim ) 대한뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.2
Objective:Surgical approaches to trigonal region known to date may cause neurological deficits such as visual field defect, hemiparesis, speech disturbance, acalculia and disconnection syndrome. A parieto-occipital interhemispheric precuneus approach, however, may not bring about these neurological deficits and can reduce morbidity. Materials and Methods:A parieto-occipital interhemispheric precuneus approach was conducted on 10 patients with lesions in the trigone and the paratrigonal area(4 cases of trigonal meningioma, 3 cases of high grade thalamic astrocytoma, 2 cases of thalamic glioblastoma and 1 case of paratrigonal ganglioglioma). Results:No mortality occurred. Surgery-related morbidity such as speech disturbance, hemiparesis, acalculia, visual field defect and disconnection syndrome were not found postoperatively. Visual disturbance was gradually improved in all of 10 cases. Conclusion:It is deemed that the parieto-occipital interhemispheric precuneus approach is a desirable approach to trigonal lesions as it enables to keep out of critical structures such as optic radiation, splenium and cortex with essential function.
두개인두종 수술시 뇌하수체경이 절단된 환자에서 요붕증의 자연해소 -증례보고-
김지훈 ( Ji Hun Kim ),고정호 ( Jung Ho Go ),김현우 ( Hyun Woo Kim ),하호균 ( Ho Gyun Ha ),정철구 ( Chul Ku Jung ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2
A 27-year-old man visited to our institute suffered from diabetes insipidus(DI) symptoms and progressively decreasing visual acuity. The brain magnetic resonance imaging(MRI) showed 4.4×4.3×3.8 cm sized brain tumor situated on the suprasella area and his symptoms and laboratory findings were compatible with panhypopituitarism. Surgery was scheduled and craniotomy via right pterional, trans-lamina terminalis approach was performed and total removal was achieved. However, in the last stageght procedure, proximal pemoval was ach, which was the origin site lasttr, was the origin site for that tumor, was transected. The pathology was confirmed for craniopharyngioma and postoperatively, headache was improved 3 days after the surgery. Panhypopituitarism needed continuous hormonal replacement therapy but interestingly, DI symptoms were improved spontaneously, 5 days after surgery through administration of 6 times of vasopressin for 4 days. With review of the literatures, the authors reports the case of craniopharyngioma that the DI symptoms were resolved spontaneously, despite of transectioning of the pituitary stalk during surgery.
터-키안배 및 터-키안배 주위 병소 수술중 시력 보존을 위한 시각유발전위 반응
이일우,정철구,조태훈,박춘근,윤석훈,백민우,김달수,강준기,송진언 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.3
Damage to the visual system is an unfortunate complication of surgery in the area of the optic nerve and chiasm. It is now possible to monitor the functional status of the visual system intraoperatively at regular intervals. We studied the patients during parasellar surgery to determine if this technique could be used to indicate potential danger to the visual system. Our objective was to determine if the visual evoked respone was sensitive and dynamic enough to detect premorbid changes in the function of the visual system. This is accomplished by recording the Visual Evoked Potential Response to flash of light from light - emitting diodes goggle. 1) We studied two patients during sellar and parasellar surgery to determine if this technique could be used to indicate potential danger to the visual system. 2) It was benefit to determine if the intraoperative VEP was sensitive and dynamic enough to detect premorbid changes in the function of the visual system. 3) The VEP showed conduction was blocked when the optic nerve was manipulated and restored when the optic nerve was decomressed. 4) After the optic nerves were decompressed, VEP of nearly normal latency, amplitude and form was recorded. 5) Changes in the VEP pararell improvement of function after surgical removal of sellar and parasellar tumors. 6) Determination of improved nerve conduction permitted the prediction of visual recovery during surgery.
박춘근,정철구,김달수,김문찬,강준기 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.4
Although evolution and time course of ischemic brain should be a matter of interest to investigation in the research of brain ischemia as well as traumatic brain injury, few papers have ever been reported. Authors observed quantitatively sequential changes of infarct size and regional cerebral blood flow(rCBF) to assess the evolution of focal ischemic brain infarct in the rat following left MCAO. Fifteen rats, weighing 250g to 370g, were used in this experiment. The experiment animals were divided into three groups : 6, 24 and 48 hours groups(HG) after MCAO. The rCBF of bilateral caudate nuclei was measured by hydrogen clearance methods. Areas of brain infarction were delineated by triphenyl-tetrazolium chloride(TTC) at the preselected 8 coronal levels of forebrain. The areas of brain damage were drawn on scale diagrams(×4 actual size) of forebrain and measured by a plannimeter. In the experimental groups, just after MCAO, rCBF of the ipsilateral caudate nucleus was reduced to 20.4±6.5 to 24.6±7.9㎖/100g/min from the basal value of around 117 to 121㎖/100g/min and showed a tendency of getting more reduced to 19.4±7.6㎖/100g/min by 48 hours. The rCBF of the contralateral caudate nucleus was maintained in the basal value throughout the experiment. Comparing the total amounts of ischemic damage of 48HG to those of 6 and 24 HG, the infarction size was significantly increased in cerebral hemisphere as well as cerebral cortex and caudate nucleus(p<0.05). But there was not any significant difference between 6 and 24 HG. This experiment provides evidence for the evolution of focal ischemic brain infarct without any further change of decreased rCBF. The data suggest that it is disirable to observe the change of pathologic findings by not less than 48 hours following the arterial occlusion in the study of ischemic brain infarction in the rat, paticularly as long as ischemic damage is delineated by TTC.
김달수,정철구,강준기,송진언,최창락 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9
The case of a 55-year-old male developed high flow carotid-cavernous fistula(ccF) after head trauma was successfully treated by a direct microsurgical approach to the cavernous sinus. The cavernous sinus was approached through Dolenc's anteromedial and paramedial triangle by a combined extradural and subdural route. A single tear in the wall of horizontal segment of the cavernous carotid artery was obliterated using Sugita clip while temporary clips were placed on the supraclinoid and the petrous portion of the internal carotid artery.