뇌혈류 및 대사 (Ⅱ)

許春雄 최신의학사 1980 最新醫學 Vol.23 No.4

뇌척수액 순환 및 장애

허춘웅 한국의학사 1981 診斷과治療 Vol.1 No.2

뇌동맥류 출혈후에 발생하는 뇌수종

허춘웅,김문찬,최창락,송진언,김춘열 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.2

Authors analysed 74 cases of hydrocephalus which developed as a sequela, of the ruptured intracranial aneurysm for the incidence correlated to the site of aneurysm and the detection time of hydrocephalus. We also studied the outcome of hydrocephalus following the aneurysm surgery. Correlations between the frequency of hydrocephalus and the intracerebral hematoma, the vasospasm, and the number of bleeding were attempted. Followings are the results: 1) Of the 207 cases of ruptured aneurysms, the incidence of hydrocephalus was 35.8%. Most common site of aneurysm associated with hydrocephalus was vertebrobasilar, internal carotid, middle cerebral, and anterior communicating artery in turn. 2) Of the 74 cases of hydrocephalus after the ruptured aneurysm, the incidence of hydrocephalus-which was persistent in spite of aneurysm surgery was 11.1% of cases. 3) It has shown that 89% of hydrocephalic cases were recovered after the aneurysm surgery. 4) Hydrocephalus was detected after aneurysm surgery in 8% of cases who had no evidence of ventricular dilatation preopereatively. 5) The hydrocephalus was frequently detected from 2 to 4 weeks after hemorrhage from the intracranial aneurysm although it was not uncommon to find hydrocephalus in a week. 6) The hydrocephalus developed after aneurysm surgery was frequently found 3 to 4 weeks post-operatively. 7) Repeated hemorrhage and incidence of hydrocephalus, a sequela of the ruptured intra cranial aneurysm was not closely related.

급성 허혈성 뇌병소에 대한 혈압강하의 영향에 관한 실험적 연구

허춘웅,박춘근,김문찬,김달수,하영수,강준기,송진언 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

Controlled hypotension and temporary clip of feeding artery are used to reduce bleeding and to facilitate the neurosurgical operations, especially in intracranial aneurysm surgery, but the microvasculature of acute ischemic brain from impaired blood flow is quite susceptible to decrease in blood pressure and blood volume. The reversibility of brain damage following an ischemic brain lesion depends on the amount of regional cerebral blood flow as well as the severity of ischemia. The present study was designed to elucidate the effect of controlled hypotension on cerebral blood flow, cerebrovascular resistance, and pathological changes in acute ischemic brain lesion. Cerebral ischemia was induced in cats by middle cerebral artery occlusion for 6 hours through the transorbital appraoch. Forty-nine cats were divided into 3 groups, namely control group with mean blood pressure maintained at normal after right middle cerebral artery occlusion, hemorrhagic hypotension group with mean blood pressure decreased to 80, 60, and 40 ㎜Hg by with drawing of blood after right middle cerebral artery occlusion and drug-induced hypotension group with mean blood pressure decreased to 80, 60, and 40 ㎜Hg with arfonad infusion after right middle cerebral artery occlusion Regional cerebral blood flow was measured by the hydrogen clearance method following middle cerebral artery clipping and gradual decreasing mean blood pressure. Cerebrovascular resistance was calculated after regional cerebral blood flow was measured and size of infarct were examined in each groups after the experiment was completed. Results were as follows: 1) In control group, regional cerebral blood flow and cerebrovascular resistance of the right parietal area with mean blood pressure maintained at normal after right middle cerebral artery occlusion were 19.4±2.1㎖/2.1㎖/100g/min and 5.5±0.4㎜Hg/㎖/100g/min. The size of cerebral infarct was minimal in 71% of the control group. 2) In hemorrhagic hypotension group, regional cerebral blood flow of the right parietal area with mean blood pressure decreased to 80, 60, and 40 ㎜Hg was 17.6 ±1.5, 15.4±3.8, and 7.8±2.9㎖/100g/min respectively, thus 6, 25, and 57% lower than the control group. Cerebrovascular resistance of the right parietal area with mean blood pressure at 80 and 60㎜Hg was 4.7±0.1 and 4.5±0.3㎜Hg/㎖/100g/min respectively, thus showing a gradual decrease in relation to the decreasing mean blood pressure. With mean blood pressure reduced to 40 ㎜Hg, the cerebrovascular resistance drastically increased to 5.1±0.5㎜Hg/㎖/100g/min. When mean blood pressure was reduced to 60 and 40 ㎜Hg, the size of infarct was marked in 57 and 85% of the hemorrhagic hypotension group. 3) In drug-induced hypotension group, regional cerebral blood flow of the right parietal area with mean blood pressure reduced to 80, 60, and 40 ㎜Hg was 19.1±2.3, 17.8±3.1, and 7.4±2.7㎖/100g/min respectively, thus 2, 10, and 38% lower than the control group. The regional cerebral blood flow of the right parietal area in the drug-induced hypotension group was slightly higher than the hemorrhagic hypotension group when mean blood pressure was reduced to 80 or 60㎜Hg, while there was no significant difference of regional cerebral blood flow in the both groups when mean blood pressure was reduced to 40㎜Hg. Cerebrovascular resistance of the right parietal area with mean blood pressure at 80 and 60 ㎜Hg was 4.1±0.3 and 3.1±0.2㎜Hg/㎖/100g/min respectively, thus showing a gradual decrease in relation to decreasing mean blood pressure. With mean blood pressure reduced to 40㎜Hg, the cerebrovascular resistance was 5.6±0.9㎜Hg/㎖/100g/min, thus higher than the hemorrhagic hypotension group. When mean blood pressure was decreased to 60 and 40 ㎜Hg, the size of infarct was marked in 42 and 85% of the drug-induced hypotension group. The extent of cerebral infarct was more extensive in the hemorrhagic hypotension group than in the drug-induced hypotension. 4) In the contralateral hemisphere of the infarct, there was no change in regional cerebral blood flow when the mean blood pressure was decreased to 80 and 60㎜Hg but when the mean blood pressure decreased to 40㎜Hg, the regional cerebral blood flow was markedly reduced in all groups. When the mean blood pressure decreased to 60 ㎜Hg there was no change in cerebrovascular resistance, however when the mean blood pressure was at 40 ㎜Hg, there was a drastic increase in cerebrovascular resistance in all groups. Due to loss of autoregulation in the ischemic brain lesion, the regional cerebral blood flow depends on the brain perfusion pressure and accordingly when there is ischemic brain lesion., the hemorrhagic hypotension produces serious brain infarction and edema than drug-induced hypotension.

정상척추골동맥 조영상에서의 척추기저동맥계 분포상의 측정치

허춘웅,이춘장,하영수,이정길,한대희,강준기,송진언 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.2

Angiographic diagnosis of lesions of the posterior fossa requires detailed knowledge of the normal anatomy of both arteries and veins of the brainstem and cerebellum. For this perfose we measured normal distribution of the vertebrobasilar vessels from three base lines namely clival line, Twining line and foramen magnum line. In the measurement are also included some of the methods which were published in the past. This paper is based on the results of the measurements on 18 cases of normal vertebral angiogram among 77 cases of serial vertebral angiography performed at Catholic Medical center from October 1972 to August 1975. The result obtained were as follows: 1) Distance from the most posterior portion of the pericallosal artery to the clival line is 6.55±0.68㎝. 2) Distance from the most posterior potion of the arcuate portion of the lateral posterior choroidal artery to the clival line is 5.16±0.61㎝. 3) Distance from the posterior portion of the quadrigeminal portion of the medial posterior choroidal artery to the clival line is 4.87±0.67㎝. 4) Distance from the most posterior portion of the distal segment of the medial posterior choroidal artery to the clival line is 4.47±0.49㎝. 5) Distance from the bifurcation portion of the basilar artery to the clival line is 1.22±0.26㎝. 6) Distance from the forward convexity of the basilar artery to the clival line is 0.15±0.11㎝. 7) Distance from the choroidal point to the clival line is 2.99±0.51㎝. 8) Distance from the posterior medullary portion of the PICA to the clival line is 2.58±0.45㎝ 9) Distance from the tuberculum sellae to the Torcular Herophilli (Twining line) is 10.96±0.52㎝. 10) Distance between the tuberculum sellae to the point on the Twining line crossed by a perpendicular line drawn from the choroidal point is 6.61±0.40㎝. 11) Distance from the superior portion of the anterior culminate segment of the superior cerebellar artery to the Twining line is 3.28±0.48㎝. 12) Distance from the supratonsilar portion of PICA to e Twining line is 0.97±0.42㎝. 13) Distance from the colliculocentral point to the clival line is 3.74±0.37±㎝. 14) Distance from the crural portion of the anterior pontomesencephalic vein to the clival line is 1.65±0.33㎝. 15) Distance from the crural portion of the anterior pontomesencephalic vein to the colliculocentral point is 2.51±0.35㎝. 16) Distance from the copular point to the clival line is 3.99±0.51㎝. 17) Distance from the copular point to the line drawn from the anterior margin of the foramen magnum is 1.63±0.38㎝. 18) Distance from the highest point of the lateral posterior choroidal artery to the Twining line is 4.74±0.37㎝. 19) Distance from the highest point of the medial posterior choroidal artery to the Twining line is 4.35±±0.34㎝. 20) Distance between two bisected points of the anterior culminate segment of the superior cerebellar artery by a line drawn parallel to the Twining line at 1㎝ from the top of the anterior culminate segment is 2.86±0.29㎝.

뇌량부에 발생한 동정맥기형의 완전 적출 1예 : Case Report

허춘웅,윤석훈,송진언 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.1

The arteriovenous malformations (AVMs) of the corpus callosum are distinct anatomical and surgical entities. The AVMs of the corpus callosum are supplied by the pericallosal arteries if the malformations are located in the anterior and middle portion of the callosum and the AVMs of the splenium are usually fed by the pericallosal and posterior cerebral arteries. Radical excision of the callosal AVMs became successful with microsurgical techniques since a few years ago. The authors report a case of the callosal AVM, who had subarachnoid hemorrhage twice prior to this admission, and the studies with angiography and computed tomography revealed an AVM involing the middle portions of the corpus callosum. Radical excision of the AVM was accomplished by microsurgical techniques without neurologic sequela.

두개강내-외 혈관 문합술

허춘웅 한국의학사 1982 診斷과治療 Vol.2 No.1

고혈압성 뇌실질내 출혈환자의 치료

허춘웅,강준기 한국의학사 1981 診斷과治療 Vol.1 No.1

腦梗塞과 抗血栓劑

許春雄 藥業新聞社 1986 (月刊) 醫藥情報 Vol.1986 No.1

접형동연골종의 1예 : Case report

허춘웅,김문찬,최창락,송진언 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.1

Although intracranial cartilaginous tumor are distinctly uncommon, they have several distinct features. They are slow growing tumors with predirection for the base of skull and plain skull roentgenogram often demonstrates destruction and calcification at the site of the tumors. The authors report a case of cartilaginous tumor arisen from the sphenoid sinus with characteristic features. Biopsy yielded the pathologic diagnosis of chondroma.