뇌동맥류 수술에서 미세혈관 도플러 검사의 임상적 의의

주진양,허승곤,이규창 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

The authors measured flow velocity of intracranial arteries to verify the patency of the parent arteries and branches after clip placement during aneurysm surgery. Before the clinical study, experimental sonographic recording was done with a feline aorta. The patency was evaluated by recording the flow velocity and pulse waveform using intraoperative microvascular Doppler sonography. The results of the clinical study were summarized as follows : (1) The patency of the parent artery can be proved. (2) The complete clipping of aneurysmal sac can be confirmed. (3) Vasospasm or narrowing of the arterial caliber can be detected. (4) Severe arteriosclerosis may mimic decreased flow velocity. It is suggested that the use of intraoperative microvascular Doppler sonography is an atraumatic and reliable method of testing the optimal clipping of the aneurysm and patency of the parent artery.

부뇌량팽대 동정맥 기형의 수술에서 시야의 보존 - 증례보고 -

주진양,안정용,Joo, Jin Yang,Ahn, Jung Yong 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Parasplenial arteriovenous malformations(AVMs) are rare vascular malformations which have distinct clinical and anatomical features. They are situated at the confluence of the hippocampus, isthmus of the cingulate gyrus and the gyrus occipitotemporalis medialis. These lesions are anterior to the calcarine sulcus and their apex extends towards the medial surface of the trigonum. Posterolaterally, these lesions are in close proximity to the visual cortex and optic radiation. The objectives in the surgery of parasplenial AVMs are complete resection of the lesions and preservation of vision. These objectives must be achieved with comprehensive understanding of the following anatomical features :1) the deep central location of the lesions within eloquent brain tissue ; 2) the lack of cortical representation of the AVMs that requires retraction of visual cortex ; 3) deep arterial supply ; 4) deep venous drainage ; 5) juxtaposition to the choroid plexus with which arterial supply and venous drainage are shared. A 16-year-old female student presented with intraventricular hemorrhage from a right parasplenial-subtrigonal AVM. The lesion, fed by posterior cerebral artery and drained into the vein of Galen, was successfully treated by the inter-hemispheric parietooccipital approach. To avoid visual field defect a small incision was made on precuneus anterior to the calcarine sulcus. In this report, the authors describe a surgical approach with special consideration on preservation of visual field.

뇌동맥류 파열 환자에서 경두개 도플러 검사의 임상적 의의

주진양,허승곤,이규창 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.2

The authors performed prospectively the transcranial Doppler monitoring of middle cerebral arteries in 37 patients with ruptured cerebral aneurysm. The entry criteria for the study were confined to the patients who had clinical Grades of 1, 2, or 3, and were operated within 4 days after bleeding. There were several sonographic risk factors of developing delayed ischemic deficits; 1) An early steep increase of flow velocity exceeding 120㎝/sec. 2) An increase of maximum flow velocity more than 140㎝/sec. 3) The flow velocity increasing simultaneously with the onset of delayed ischemic deficit in which case preventive treatment was impossible. 4) Prolonged elevation of flow velocity for more than 7 days despite of aggressive treatment. It seemed to be mandatory to start preventive and aggressive treatment for the asymptomatic patients who showed higher flow velocity than 140㎝/sec. Transcranial Doppler sonography has another potential on deciding the timing of surgery.

출혈성 뇌동정맥기형의 혈관조영촬영소견에 대한 분석

주진양,김동익,진병호,허승곤,이규성,이규창 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.4

The authors studied angiographic features in relation to risk of hemorrhage in 102 cerebral arteriovenous malformations(AVM's). Statistical analysis demonstrated that AVM's with following characteristics had high risk of hemorrhage : 1) small nidus ; 2) deep, posterior fossa, cortico-callosal, cortico-ventricular location ; 3) one or two draining veins ; 4) deep venous drainage ; 5) high grade stenosis of major venous drainage. The authors suggest that as the venous drainage system is significantly associated with the risk of hemorrhage in AVM's, careful preoperative angiographic evaluation of the venous drainage system is mandatory for decision making in the management of patients with AVM's.

척수종양에 관한 임상적 고찰

주진양,김영수,이규창 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.2

To provide a guideline of accurate diagnosis and proper methods of treatment of spinal cord tumor, the author analyzed 83 cases of spinal cord tumor who had been operated at the Department of Neurosurgery of Yonsei University College of Medicine during last 10 odd years. The results were summerized as follows; 1) The ratio of male to female was 1.6 : 1 and 41 % of the 83 patients were in the 4th and 5th decade. 2) The most common histopathologic type was neurinoma(48.2%) ,and the rests were metastatic tumor (15.7%), astrocytoma (9.6%), and ependymoma(4.8%). The distribution of the tumors was thoracic (50.6%), cervical (26.5%), and lumbosacral (20.5 %). The location of the tumors was intradural extramedullary (48.2 %), extradural (25.3%), and intramedullary (19.3%). 3) The common clinical features were pain, motor disturbance, sensory disturbance, and sphincter disturbance. In radiologic diagnostic tests, there were abnormal findings in 49.3% of plain X-rays. The entire 77 cases of myelography showed subarachnoid blockade. The computerized tomographic metrizamide myelography (CTMM), regarded as the most accurate diagnostic method, showed the exact location of the tumor and the relationship of the tumor with the spinal cord and the dura in entire 8 cases. 4) Thirty six neurinomas (90 %) and all 8 meningiomas (100%) could be excised totally. In 30 neurinomas (75%) and 5 meningiomas (62.5%), the patients regained their motor function postopratively. In 37 neurinomas (92.5%) and 8 meningiomas (100%), the patients' sphincter function was recovered. The results of operation were particulary excellent in the cases with neurinoma and meningioma. 5) Among the 10 astrocytomas, total excision was performed in 2 cases, and decompressive laminectomy with biopsy was performed in 4 cases. Postoperative radiotherapy was performed in 2 cases. 6) Among the 3 intramedullary ependymomas, total excision was possible in 2 cases. Subtotal excision was performed in a case with caudal ependymoma. 7) In 9 metastatic tumors, primary tumors of which were unknown preoperatively, and in 3 metastatic tumors in which the stability of the spine was deranged, surgical treatment was performed. In 3 cases, radiation therapy was followed postoperatively.

급성 척수 손상 고양이에서 21-Aminosteroid U74389F 투여가 척수 혈류와 체성감각 유발전위에 미치는 영향

주진양,김영수 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

A growing body of biochemical, physiological, and pharmacological evidence has suggested that oxygen free radical-induced lipid peroxidation plays a key role in progressive posttraumatic spinal cord ischemia. Recently, it has been reported that the newly developed compound. U74006F, a non-glucocorticoid 21-aminosteroid, is extremely potent as an inhibitor of lipid peroxidation and effective preventor from the posttraumatic ischemia. In this investigation, the effects of 21-aminosteroid U74389F, analog of U74006F on posttraumatic spinal cord blood flow and somatosensory evoked potential have been studied in cats. The results of this study are summarized as follows : (1) U74389F, given 3㎎/㎏, blood flow decreased significantly and somatosensory response returned to none of five cats. (2) U74389F, given 10㎎/㎏ or 20㎎/㎏, the blood flow did not decreased and maintained near the preinjury level. The recovery rate of somatosensory evoked potential ranged from 40 to 60%. 3) There was no statistical difference of blood flow change between the cats treated with 10㎎/㎏ and those treated with 20㎎/㎏ U74389F. It is thought that the adequate dosage of U74389F to prevent posttraumatic spinal cord ischemia is more than 10㎎/㎏ and timing of administration did not affect the blood flow. 4) The less decrease of blood flow with 10㎎/㎏ or 20㎎/㎏ of U74389F, was statistically significant compared to much more decrease in naloxone-treated cats. The reason is thought to be much longer half life of U74389F in serum. From the above results, it is speculated that U74389F has beneficial effect on posttraumatic spinal cord ischemia and functional recovery. The effects last longer than those of naloxone.

두개골 해면혈관종 수술치험 1예

주진양,박용구,최중언,정상섭,이규창 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.4

A case of calvarial cavernous hemangioma is presented. The tumor was located in the postero-parietal bone, which was expanded extra and intracranially. The tumor and the attached dura were excised en bloc after ligation of superior sagittal sinus which had been completely obstructed on angiography. The preoperative X-ray and operative findings are presented. The authors reviewed the previously reported cases.

성인에서 뇌실복강간 도관술후 복부도관의 항문을 통한 체외배출 : Case Report

주진양,최중언,이규창 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.6

We report a case in which the peritoneal shunt catheter caused performation of the bowel and was eliminated through the anus. Perforation of the bowel by a shunt catheter is very rare particularly in adult. The mechanism of bowel perforation is discussed It is emphasized that prevention or treatment of ventriculitk and peritonitis is important in this case.

Clinical Risk Factors Affecting Procedure-Related Major Neurological Complications in Unruptured Intracranial Aneurysms

장이욱,주진양,김용배,정준호,서상현,홍창기 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.4

Purpose: The operative risk and natural history rupture risk for the treatment of unrupturedintracranial aneurysms (UIAs) should be evaluated. The purpose of this study was to report our experience with treating UIAs and to outline clinical risk factors associated with procedure-related major neurological complications. Materialsand Methods: We treated 1158 UIAs in 998 patients over the last 14 years. All patients underwent operation performed by a single microvascular surgeon and two interventionists at a single institution. Patient factors, aneurysm factors, and clinical outcomes were analyzed in relation to procedure-related complications. Results:The total complication rate was 22 (2.2%) out of 998 patients. Among them, complications developed in 14 (2.3%) out of 612 patients who underwent microsurgeryand in 8 (2.1%) out of 386 patients who underwent endovascular procedures. One patient died due to intraoperative rupture during an endovascular procedure. The procedure-related complication was highly correlated with age (p=0.004), hypertension(p=0.002), and history of ischemic stroke (p<0.001) in univariate analysis. The multivariate analysis revealed previous history of ischemic stroke (p=0.001) to be strongly correlated with procedure-related complications. Conclusion: A historyof ischemic stroke was strongly correlated with procedure-related major neurologicalcomplications when treating UIAs. Accordingly, patients with UIAs who have a previous history of ischemic stroke might be at risk of procedure-related majorneurological complications.

고양이에서 국소 뇌혈류의 지속적 및 반복 차단시 Nimodipine과 21-aminosteroid (U74389G)가 뇌혈류와 뇌경색에 미치는 영향

박현선,주진양,김선호,이규창 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.3