Medulloblastoma &PNET

최중언 가톨릭중앙의료원 가톨릭암센터 1999 암심포지움 Vol.- No.2

실험적 수두증 고양이에서의 뇌혈류변화

최중언,이규창,허승곤,박형천,임승철,오성훈 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

To evaluate the cerebral blood flow in feline hydrocephalic brain, this study was designed to measure the regional cerebral blood flow(rCBF ; frontal and periventricular area) by the hydrogen clearance method in different stages of the kaolin-induced hydrocephalus and the postshunt status. The results were as follows : 1) A reduction of rCBF was detected in the left periventricular area at two weeks after kaolin injection. A significant reduction of rCBF was revealed in the left periventricular area at two and four weeks after kaolin injection. However, the rCBF of the left frontal cortex was significantly decreased at four weeks after kaoline injection. 2) At one week after shunt operation, the significant restroration of rCBF was found in the left frontal cortex and the left periventricular area.

천막상부 대뇌반구 양성 원섬유형 성상세포종의 치료결과 및 예후인자 분석

최중언,김은영,정상섭,이규창 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.7

The natural history of supratentorial hemispheric low-grade fibrillary astrocytomas is extremely variable. Although many patients survive for an extended period of time, other patients show a rapidly progressive course and early death. In an effort to clarify the natural history and prognostic factors, we conducted a retrospective study. Of 49 patients treated at Yonsei University Hosital between January 1980 and December 1991 for histologically confirmed low-grade fibrillary astrocytomas of cerebral hemisphere. 46 patients were followed for more than 30 months. Pilocytic and gemistocytic astrocytomas were excluded, as were tumors originating in the basal ganglia, thalamus, hypothalamus, optic pathways, and posterior fossa. Mixed gliomas were also excluded. Survival rates were estimated by the method of Kaplan-Meir. The prognostic factors were analyzed by log-rank test and Cox stepweise multiple regression test for multivariates. The 46 patients consisted of 31 males and 14 females who ranged in age from 6 to 64 years(median 32.9 years). The median symptom duration before diagnosis was 10 months(1-120 months). Frontal lobe was the most common site of involvement and 70% of patients presented with seizure. Ten(21.7%) cases were surface(gyral) type and 36 were located mainly in the deep white matter. Gross total removal was performed in 11 patients(24%), and 29 patients(63%) received postoperative irradiation. Overall actuarial survival rates at 5, 10 years were 59%, 54%, respectively. Five-year progression-free survival was 52.7%, Of 16 patients with recurrence or progression of tumor with a median time to recurrence of 29 months, 6 underwent additional resection of tumor. A dedifferentiation toward astrocytoma Grade 3 or 4 occurred in 2 of 6 patients(33.3%). The median time from recurrence to death was 8 months. Younger age(<30 years), long symptom duration(>8 months), normal preoperative mental status, a history of preoperative seizure, the presence of cyst, well-defined tumor margin, and no extension into the corpus callusum or contralateal hemisphere were associated with a better prognosis on univariate analysis. Among 7 good prognostic factors, the significance of preoperative mental status and sharpness of the tumor border were confirmed by multivariate stepweise regression test.

소아 난치성 간질에서 뇌량절단술

최중언,윤수한,이병인 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

Four children with medically refractory multiform seizures were submitted for section of the corpus callosum for last 3 years. These patients had medically intractable generalized seizures diagnosed preoperatively as the Lennox-Gastaut syndrome characterized by a combination of seizure patterns, most frequently drop attack with generalized tonic-clonic, generalized tonic and atonic seizure. Guided by pre- and intra-operative electroencephalographic monitoring the section was carried out in the anterior 2/3 or 4/5 part of callosum. Five to 28 month's postoperative follow-up suggests good results : three patient showed no more drop attack except intermittent focal myoclonic seizures in 1 case and one patient had generalized seizures less in frequency than preoperative state. Corpus callosotomy seems to be an effective surgical approach for the intractable epilepsy with drop attack of multifocal origin, but longer follow-up is needed.

뇌성마비환자의 강직성 하지마비에서 선택적 척수신경후근 절단술

최중언,윤수한,김은영,김선호,박창일 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.6

Selective posterior rhizotomies were camed out in 30 patiendmean age, 7 years) with cerebral palsy. The procedure involves lumbmacral laminectomy with stimulation of the rootlets from the second lumbar to the second sacral posterior roots on the involved side. Those rootlets showing abnormal EMG response with abnormal muscle contraction were cut under the surgical microscope. The mean follow-up period was 10 months. The outcome was evaluated with the preoperative and postoperative Peacocks grading system. AU patients became improved in spasticity and 17(57'2) patients improved in functional Peacock grading. The young and intelligent patients became more improved but that was not sigdcant stastically. The functional grade was stastically sigmfkant prognostic factor The low functional group become more improved. Longer follow-up is expected to show more improvement in functional grade.

Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus

최중언 수술실간호분야회 1996 수술간호 Vol.4 No.1

두개골 조기유합증의 수술적 치료

최중언,김영수,정상섭,이규창 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.4

Authors made a clinical analysis on 22 patients of craniosynostosis who had been treated surgically at Severance Hospital from Jan. 1975 to Jun. 1983 and the results were summarized as follows. 1) In analysis of type of craniosynostosis, all of patient showed synostosis of coronal suture : 7 cases had simple involvement of coronal suture, 14 cases had multiple suture involvement and 1 Crouzen's disease. 2) In sex distribution, male were 13 and female were 9 cases. Patient who had been on early operation within 6 months after birth were 6 cases (27%). 3) The most common clinical symptoms on admission were mental and developmental retardation and most patient showed palpable ridge along the suture of synostosis. 4) In brain CT scan finding, ventricular dilatation, cortical atrophy, low density areas and subdural effusion were commonly found in cases who diagnosis and operation were delayed. These findings were thought to be the secondary effect of increased intracranial pressure in early stage of craniosynostosis. 5) Among several operative methods, lateral canthal advancement of supraorbital margin showed good surgical results to provide adequate expansion of frontal bone. Early operation also revealed good results. 6) To make an early detection of craniosynostosis it will be necessary to give pediatricians and general practitioners more information about this disease.

대뇌질환에 있어서 안구운동반응

최중언 최신의학사 1974 最新醫學 Vol.17 No.1

Nystagmus is an involuntary, rhythmic, to and fro oscillation of the eyes. Such ocular movements may be easily elicited in the normal individuals by a series of moving target before the eyes. This physiologic reflex is known as optokinetic nystagmus. This phenomenon was first observed by Purkinje in 1825 while watching a crowd at a cavalry parade in Vienna. It is generally known that the optokinetic responses are disturbed in parietal lobe lesions. Also such a lesion manifests a visual field defect. However authors have found that the prediction of a disturbance in these responses in some cases of parietal lobe lesion has not always been borne out. As a control group, one hundred healthy adults were examined and all of them showed normal symmetric optokinetic responses. In this study, 17 cases of cerebral paragonimiasis which predilects to localize in the lower part of the posterior parietal lobe, 28 cases of brain tumor, 11 cases of head injury, 3 cases of A-V malformation, 1 case of cerebral thrombosis, 3 cases of brain abscess, 1 case of cysticercosis, and 1 case of abnormal calcification were observed for optokinetic nystagmus with correlation to the location of lesion and the visual field defect. It is this author's suggestions that the optokinetic response is most likely to be disturbed in lesions involving the lower part of the posterior parietal or parietoccipital lobe where the optic radiation and efferent optomotor pathway is also easily damaged. Abnormalities in the optokinetic response are not dependent on involvement of the visual pathway and also the response does not necessarily depend on the continuity of the association pathways between the occipital and frontal cortices. It seems that unless a cortical lesion involving the optomotor area is large enough in size, the optokinetic response can not be disturbed.

Cerebral Rete Mirabile 10 예에 대한 임상관찰

최중언,김광명,지상휘,김순철 대한신경외과학회 1978 Journal of Korean neurosurgical society Vol.7 No.1

Cerebral rete mirabile is an entity of particular disease which showed the specific angiographic findings. Many authors have been reported this disease with various discussion in opinion. It's exact pathogenesis and etiology were however unable to establish. Authors had experienced a total of 10 cases with cerebral rete mirabile from a period of 1973 to 1977, which were confirmed by cerebral angiography. We attempted to analyse it clinically and discussed with the review of literature. The result were summarized as following; 1) In age and sex distribution, 8 patients were over 20 years old age and 2 cases were below 20. 7 cases were female and 3 male. 2) Majority of cases (8 of 10 cases) were accompanied with subarachnoid hemorrhage and only 2 cases were non-hemorrhagic which all were over 20 years. 3) In 8 cases with subarachnoid hemorrhage initial symptoms were mainly impairment of consciousness and signs of meningeal irritation such as headache and vomiting etc. Other common initial symptoms in both non-hemorrhagic and hemorrhagic cases were hemiparesis, speech disturbance and seizure. 4) All cases disclosed the characteristic angiographic findings of cerebral rete mirabile. A patient showed nonfilling of left carotid system and anomaly of left vertebral artery. Aneurysm of anterior communicating artery was combined in other case. It is our consideration that vertebral angiography must be helpful in this disease to demonstrate the collateral circulation and an abnormal findings of vertebrabasilar system.

Ⅲ. 션트수술의 합병증

최중언 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.2

There had been a lot of changes and advances in treatment of hydrocephalus. Many efforts also had been made to prevent complication of shunting, but there are a lot of inevitable problems in shunting operation. This paper attempts to review and summarize these shunt complications.