경추 전방 유합 환자의 장기 수술 결과에 영향을 주는 방사선학적 요인 분석

최일승,서대희,박성춘,채의병,최선욱,송관영,강동수,Choe, Il Seung,Seo, Dae Hee,Park, Sung Choon,Chae, Euy Byung,Choi, Sun Wook,Song, Kwan Young,Kang, Dong Soo 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Object : Anterior cervical discectomy and fusion is accepted as appropriate surgical intervention for disease processes of the ventral cervical spine. In some cases, however, improvement of symptom following operation develop myelopathy or rhizopathy at longterm follow-up. We studied to clarify the correlation between clinical results and plain radiologic findings at long term follow-up. Methods : A total of 86 patients who underwent anterior cervical discectomy and fusion were grouped into deteriorated and good recovery group. These two groups were compared in lateral functional roentgenograms on the cervical kyphosis and disc height at fused level, sagittal plane rotation and dynamic sagittal canal diameter at adjacent level. Results : The presence of cervical kyphosis and disc height at fused level do not correlate with long term followup results. Sagittal plane rotation of more than 20 degrees were identified in 36% of the cases in deteriorated group, whereas the same findings were identified in 15% of the cases in good group. Sagittal diameter of less than 12mm were identified in 48% of the cases in deteriorated group, whereas the same finding were identified in 8% of the cases in good group. Preoperatively, sagittal plane rotation of more than 20 degrees at adjacent level were identified in 28% of the cases in deteriorated group, whereas the same findings were identified in 13% of the cases in good group. Preoperatively sagittal diameter of less than 12mm at adjacent level were identified in 40% of the cases in deteriorated group, whereas the same finding were identified in 7% of the cases in good group. Conclusion : Large sagittal plane rotation and small dynamic sagittal diameter at adjacent level were factors that might be associated with later clinical deterioration after cervical anterior fusion.

척추제 병변 환자에 대하여 경경부 접근법을 통한 전방감압 및 후방고정술의 효과

최일승,박성춘 關東大學校 醫科大學 醫科學硏究所 2002 關東醫大學術誌 Vol.6 No.1

It is well known that anterior decompression and posterior and posterior fixation is effective surgical treatment for lesion involving vertebra body. However, this combined approach is very invasive method and may cause serous complication. As for spine metastasis, this approach is inappropriate because of poor medical condition. A 40-year-old man who had known lung cancer developed a sudden paraplegia. Emergency CT myelogram showed large epidural mass involving vertebra body and pedicle at T10 level. Corpectomy, anterior fusion, and posterior fixation were performed simultaneously via only transpediculr approach. Removal of tumor was done, and neurologic function improved in postoperative period. The author report efficacy of transpedicular approach by which simultaneously decompression as well as posterior fixation could be done.

뇌동맥류에 대한 3차원 전산화단층촬영 혈관조영술의 진단적 가치

최일승,김영수,고용,오성훈,오석전,김남규,김광명,이승로 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.9

The authors have evaluated the efficacy of three dimensional computed tomographic angiography(3-DCTA) in diagnosing intracranial aneurysm. This literature studied thirty five patients harboring forty intracranial aneurysms using dynamic CT scan with intravenous contrast enhancement. After injection of 2㎎/㎏ of nonionic contrast material(Rayvist^(R)) intravenously, rapid dynamic CT scanning with thin section was performed. Three dimensional reconstruction was performed using the GE 9800 HR suface-rendering method with a threshold of about 100 Hounsfield units(HU). The authors comparatively analysed this 3-DCTA with conventional to surrounding vessels. While 3-DCTA clearly detected 38 aneurysms, conventional angiography did 37 ones. There was no significant difference between 3-DCTA and conventional angiography in demonstrating aneurysmal direction, but 3-DCTA was superior to conventional angiography in demonstrating aneurysmal shape, its neck and surrounding vascular structures. 3-DCTA showed deliberate anatomy of aneurysm and adjacent vessels through 3 dimensional image, and its operative view is helpful in surgical planning 3-DCTA might be expected to substitute for conventional angiography in the near future.

골반에서 발생한 혈관외피종의 뇌 전이 : 증례 보고

최일승,김영수,고용,오성훈,오석전,김남규,김광명 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.9

It is well known that intracranial hemangiopericytoma commonly metastasizes elsewhere in the body, espacially bone and lung. However, brain metastasis of extracranial hemangiopencytoma is very rare. The authors report a case of intracranial metastatic hemangiopericytoma from pelvis in a 41 year old woman. Neurologic symptoms developed 14 months after discovering the pelvic mass. After surgjcal excision, the clinical course was improved.

Early Posterior Decompression and Reduction for T3 Burst Fracture with Complete Paraplegia

최일승 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.5

We report a case of T3 burst fracture with complete paraplegia that recovered after emergent posterior decompression and reduction. A 17-year-old boy presented with complete paraplegia which had progressed rapidly after motor cycle accident. Emergency posterior decompression and reduction was performed. After operation, lower extremity motor improved and could walk after 6 month. Even with the complete paraplegia resulted from upper thoracic burst fracture on arriving at hospital, we may expect favorable result from emergency posterior decompression and reduction if the patient is young and the motor is not absolutely paralysed at the time of early trauma period.

척추 수술시 의인성 경막 파열로 인한 뇌척수액 누수 환자의 치료 결과

최일승 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.6

Objective : This study is designed to analyse the result of cerebrospinal fluid(CSF) leakage due to unintended incidental durotomy in spine surgery and to determine the timing of repair operation for CSF leakage. Methods : Iatrogenic dura tearing occurred in 114 cases among the 1626 spine operation patients. This study included 29 consecutive patients with postoperative CSF leakage at the operative wound who did not underwent intraoperative dural closure. Results : Of the 29 patients in this study, 24% had clinical symptom after CSF leakage. Four patients reported headache, three reported aggravation of lumbago. Reoperation for dura or wound repair were performed in 12 cases. Incidence of reoperation was higher in patients who underwent total laminectomy including resection of spinous process than in those who underwent partial hemilaminectomy. The CSF obtained at the reoperation was cultured. Staphylococcus aureus were cultured in 5 patients and not in 7 patients. The mean period between reoperation and the first CSF wound leakage was longer in culture positive group(14.8days) than in culture negative group(6.6days). The period between reoperation and the first CSF leakage in all of the culture positive patients was longer than 10 days. Conclusion : In case that CSF wound leakage in total laminectomy patients persist longer than 10days in spite of conservative management, we recommend to perform dura/wound repair without delay.

수두증을 동반한 후두와 종양의 치료결과

최일승,서대희,이우택,박성춘,채의병,오석전 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.6

뇌 동정맥기형과 합병된 모야모야병

서대희,최일승 關東大學校 醫科大學 醫科學硏究所 2002 關東醫大學術誌 Vol.6 No.1

This report describes an unusual moyamoya case which was associated with arteriovenous malformation (AVM). A 37-year-old woman was presented with altered mentality. On initial evaluation computerized tomography showed a temporo-parietal intracerebral hemorrhage and due to her rapid neurological deterioration, she underwent craniotomy and hematoma evacuation. During the operation, vascular entangled mass with associated vessel was observed and resected. The biopsy finding confirmed arteriovenous malformation and postoperative angiography showed Suzuki stage Ⅲ moyamoya disease. Postoperatively, the patient fared well and remains without neurological symptoms during 13 months follow-up period. We report a rare moyamoya case associated with AVM.

경접형동 접근법의 수술적 범위 : 미세수술 해부학

김재민,최일승,백광흠,김충현,김남규 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.2

두통환자에 대한 방사선학적 검사의 진단적 가치

반성수,최일승,안치성,정명훈,최선욱,송관영,강동수,Ban, Sung Soo,Choe, Il Seung,Ahn, Chi Sung,Jung, Myung Hun,Choi, Sun Wook,Song, Kwan Young,Kang, Dong Soo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Objective : The goal of this study is to identify the significant radiologic abnormalities in patients complaining headache and to determine predictive factors for clinically significant radiological abnormalities. Method : The study population was 410 patients having underwent CT or MRI study among 1000 patients complaining headache in outpatient basis between 1996-1999. All of these patients answered self-administered questionaire about their headaches. We reviewed the patient's charts and the questionaires and examined the radiologic study results. Result : Of the 410 patients referred for CT or MRI study, male : female ratio was 1 : 1.97. Twenty-five patients(6.1%) revealed clinically significant organic lesions. Mean age was 46.1 in radiologic abnormal group and 48.4 in normal group. Short symptom duration(p<0.01), motor weakness(p<0.05), vomiting(p<0.05), cranial nerve palsy(p<0.05), and trauma history(p<0.05) were factors indicated higher incidence of radiologic abnormality. But, patients age, and severity of headache were not associated with clinically significant radiologic lesion. The ratio of radiologic abnormality was 0.8% in patients not having any risk factor. Conclusion : The results indicate that radiologic study should be done in headache patients having the risk factors such as short symptom duration, motor weakness, vomiting, cranial nerve palsy, trauma history. For patients without any such a risk factor, the radiologic study doesn't seem mandatory.