쥐에서 일과성 국소 뇌허혈 후 생긴 재관류 손상시 알부민치료의 효과

허필우,조경석,유도성,김재건,김달수,강준기,Huh, Pil Woo,Cho, Kyoung Suck,Yoo, Do Sung,Kim, Jae Keon,Kim, Dal Soo,Kang, Joon Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : Albumin is a very useful drug for the improving of cerebral blood volume and the oncotic effect in cerebral ischemia or cerebral vasospasm. The purpose of this study was to examine the morphological and neurological effect of albumin therapy on reperfusion injury following transient focal cerebral ischemia. Materials and Methods : 18 Male Sprague-Dawley rats weighing 270-320g were used. The ischemia model was produced by 2-hour period of transient middle cerebral artery occlusion with a poly-L-lysin coated intraluminal suture. The agent(20% human serum albumin[HSA]) or control solution(NaCl 0.9%) was administered intravenously at a dosage of 1% of body weight immediate after reperfusion following a 2-hour period occlusion. Neurological function was evaluated by the postural reflex and the forlimb placing test during occlusion(at 60 min) and daily for 3 days thereafter. The brain was perfusion-fixed, and infarct volumes and brain edema were measured. Results : The HSA significantly improved the neurological score in treated group. The rats of albumin treatment group showed significantly reduced total infarct volume(by 34%) and brain edema(by 81%) compared with salinetreated rats. Conclusion : HSA showed a substantial effect on the transient focal cerebral ischemia and reperfusion injury model. These results may indicate its usefulness in treating reperfusion injury patients after thrombolysis treatment for the thrombo-embolic major cerebral artery occlusions.

우측 측두골에 재발한 연골아세포종의 증례보고

서운경,허필우,이원,김성훈,고택수,허현아,김인수,Seo, Woon-Kyung,Huh, Pil-Woo,Lee, Won,Kim, Seong-Hun,Go, Taek-Su,Heo, Hyun-A,Kim, In-Soo 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

Chondroblastoma was introduced as a rare benign cartilaginous neoplasm by Codman in 1931. It described by Jaffe and Lichtenstein in 1942 as a benign cartilaginous neoplasm that represents less than 1% of all primary bone tumor. It commonly arises in the epiphysis of long bone but, it occurs very rare in temporal area. Sometimes, microscopic identification of chondroblastoma and giant cell granuloma is difficult. An immunohistochemical studies was performed for S-100 protein which is useful in arriving at the correct diagnosis. Treatment modalities are total curettage, en-bloc excision, irradiation, and radiation combined with surgical excision. But radiation therapy was controversial. We describe a case of chondroblastoma which was arisen in the right temporal area and the recurrence that was treated by surgical excision and radiation therapy with review of literature.

허혈성뇌졸중의 수술치료시 동반되는 합병증과 관리

김달수,유도성,허필우,조경석,강준기,Kim, Dal Soo,Yoo, Do Sung,Huh, Pil Woo,Cho, Kyoung Suok,Kang, Joon Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Recently various operative procedures including microsurgery or endovascular surgery have been increasing for the management of ischemic cerebrovascular diseases. Carotid endarterectomy(CEA), extracranial-intracranial(EC-IC) arterial bypass, embolectomy, decompressive craniectomy, arterial transposition, intravascular thrombolysis, and percutaneous transarterial angioplasty and stenting (PTAS) are available surgical modalities for ischemic stroke. This article focuses the complications and perioperative management of patients treated with CEA and carotid PTAS among various surgical managements for ischemic stroke.

급성 중증 뇌종창 환자의 양측성 감압개두술 후 뇌압 및 뇌혈류 측정

유도성,김달수,허필우,조경석,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suck,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

저체온요법 치료 환자에서의 두개강내와 액와부의 온도차이

유도성,김달수,허필우,조경석,김재건,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyung-Suck,Kim, Jae-Gun,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objective : The brain temperature is about $0.4-1^{\circ}C$ higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. Methods : Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia( over $38^{\circ}C$), normothermia($36-38^{\circ}C$) and hypothermia(under $36^{\circ}C$). Total 1671 paired sample data were collected and analyzed. Results : The temperature difference between the cerebral cortex and the axilla was $0.45{\pm}1.04^{\circ}C$ in hyperthermic patients, $0.97{\pm}1.1^{\circ}C$ in normothermic patients and $1.04{\pm}0.81^{\circ}C$ in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). Conclusion : From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.

모야모야병에 대한 최근의 외과적 치료

김달수,유도성,허필우,김재건,조경석,강준기,Kim, Dal Soo,Yoo, Do Sung,Huh, Pil Woo,Kim, Jae Keon,Cho, Kyoung Suok,Kang, Joon Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

MMD의 외과적 치료에서 소아에서는 직접 및 간접적인 혈관문합술을 병합하거나 아니면 간접적인 혈관문합술들을 병합하여 시행하는 경향이 있고, 성인에서는 혈관의 직경이나 MMD의 진행속도로 보아 STA-MCA 문합술과 같은 직접적인 수술이 많이 활용되고 있으나, 소아나 성인에서나 모두 공통적으로 보다 넓은 뇌표면에 여러 가지 수술방법을 병합하는 것이 좀더 광범위한 범위에 뇌혈류 공급을 증가 시키는데 도움이 된다고 보는 경향이다. 수술의 적응증은 혈관조영상에서의 나타난 질병의 정도보다는 acetazolamide를 이용한 PET 나 SPECT 검사로서 뇌혈류 예비량에 기준을 두고 있는 현상이 혈류 역학적으로도 합리적인 것으로 보인다. 수술후 합병증을 줄이려면 수술중에 정상탄산, 정상체온, 정상혈압을 유지 시킴과 동시에, 수술직후 통증관리도 철저히 하는 것이 매우 중요하다. The authors reviewed the recent trend of surgical treatment for pediatric as well as adult onset moyamoya disease(MMD). Combined direct and indirect arterial anastomosis or multiple indirect arterial bypasss has been increasing for pediatric MMD and direct arterial bypass is recommended for adult MMD, especially in patients with hemorrhagic MMD. Besides perioperative complications related to the management of MMD and 1999 annual report by the Research Committee on Spontaneous Occlusion of the Circle of Willis(Moyamoya Disease) of the Ministry of Health and Welfare, Japan will be summarizd.

이중 도관을 이용한 뇌농양의 지속적 세척술 - 수술 수기 -

박재효,유도성,김달수,허필우,조경석,강준기,Park, Jae-Hyo,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suok,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

We present a modified method for the treatment of brain abscess. The double lumen extraventricular drainage (EVD) catheter which was developed for the intracerebral hematoma management, was applied for the treatment of brain abscess drainage. We placed the double lumen EVD catheter into the abscess cavity by free-hand technique and irrigated the abscess cavity continuously with antibiotics solution for 7 days. Simultaneous intravenous antibiotics was administered for 4 weeks. The continuous irrigation with double lumen catheter was found to be safe and effective treatment modality in the brain abscess.

척수 경막외 혈관지방종 - 증 례 보 고 -

김래오,조경석,유도성,허필우,박춘근,김달수,강준기,Kim, Rae-Oh,Cho, Kyoung-Suok,Yoo, Do-Sung,Huh, Pil-Woo,Park, Chun-Kun,Kim, Dal-Soo,Kang, Jun-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Crowth of an angiolipoma of the central nervous system is rare. Only about 60 cases were searched in the literature. We report one case of spinal angiolipoma recently treated in our institution. A 67-year-old man was admitted because of burning sensation on the both lower extremities and paraparesis. He felt burning sensation on the both great toes and it progressively involved to thighs and inguinal area during the past 1 year which gradually worsened. MR image showed a spinal mass lesion at the level of T4 to T6. The lesion was isodense and hyperdense in periphery on T1-weighted image and hyperintense on T2-weighted image. The tumor was located on the posterior area of the spinal cord and markedly enhanced after intravenous Gd-DTPA. At the operation, a soft, dark-red mass was totally removed. On histological examination, the tumor was shown to be mainly composed of mature fatty cells and numerous blood vessels with enlarged lumens. Postoperative course was uneventful and the symptoms improved gradually.

뇌 심부 정맥 혈전증 : 전신적 유로키나제 혈전용해술 후 헤파린 투여 치료법의 성공 증례 - 증 례 보 고 -

박재효,양지호,유도성,조경석,허필우,권성오,김달수,강준기,Park, Jae Hyo,Yang, Ji Ho,Yoo, Do Sung,Cho, Kyoung Suok,Huh, Pil Woo,Kwon, Seong Hh,Kim, Dal Soo,Kang, Joon Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

We present two cases of deep cerebral venous thrombosis(DCVT) with the totally occluded straight sinus. A 42-year-old female received with altered mentality . She has taken antihistamine for six years to treat the paranasal sinusitis. Another 34-year-old female who used the oral contraceptive for 11 months presented with acute behavior change . Both of these patients were diagnosed by computed tomography(CT), magnetic resonance(MR) imaging, and cerebral angiography. They were fully recovered with systemic urokinase thrombolysis followed by heparin therapy. We report that the intravenous thrombolysis was potentially effective management strategy in our cases of DCVT with the totally occluded straight sinus.

두개골 성형술의 사용 재료와 수술 시기에 따른 감염율

김영우,유도성,김달수,허필우,조경석,김재건,강준기,Kim, Young-Woo,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyung-Suck,Kim, Jae-Gun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : Cranioplasty is required to protect underlying brain, to correct major aesthetic deformities, or both. The ideal material for this purpose is autogenous bone. When this is not available, alloplastic or artificial materials may be used. In this study authors compared the infection rate according to the cranioplasty materials(the frozen autologous bone vs. bone cement), and duration of the skull defect. Materials : Between May 1994 and December 1999, 111 patients with skull defect treated with cranioplasty(82 cases of frozen autologous bone and 29 cases of artificial bone material) were included in this study. There were 77 males and 34 females with a mean age of 41.4 years(range 1-85 years). 57 patients had head trauma and 54 had non-traumatic insults. According to the duration of skull defect, there were 28 cases under 1 month, 33 cases of 1-2 months, 15 cases of 2-3 months, 20 cases of 3-6 months and 15 cases over 6 months of duration. Results : Overall infection rate was 9.9%. In cases with frozen autologous bone and artificial bone material, the infection rate was 8.5% and 13.7%, respectively. The infection rate according to the duration of skull defect was 3.6%(among 28 cases) under 1 month of age, while those were 12%(4 among 33 cases) at 1-2 months, 20%(3 among 15 cases) at 2-3 months, 5%(1 among 20 cases) at 3-6 months and 13%(2 among 15 cases) over 6 months. Accoring to the underlying disease, the infection rate in traumatic cases was 12%(7 among 57 cases) and that in non-traumatic one was 3.7%(2 among 54 cases). Conclusion : From this study, it appears that skull defect should be repaired as soon as possible, because early cranioplasty can lower the infection rate. And surgeons could save the patients' cranial bone as possible as they can because autologous bone is not only cost effective in cosmatic purpose but lower the infection rate.