추체사대 수막종의 수술과 관련하여 뇌 정맥조영상의 의미

황승균,곽호신,백선하,오창완,이상형,김동규,김현집,정희원,Hwang, Sung-Kyun,Gwak, Ho-Shin,Paek, Sun Ha,Oh, Chang-Wan,Lee, Sang Hyung,Kim, Dong Gyu,Kim, Hyun Jib,Jung, Hee-Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.10

Objective : A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of $Labb{\acute{e}}$ in surgical removal of petroclival meningiomas. Patients and Methods : The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent & equal on both sides), Type B(confluent & non-dominant on tumor side), Type C(confluent & dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of $Labb{\acute{e}}$ was analyzed with respect to its draining point and its collaterals to other superficial veins. Results : Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of $Labb{\acute{e}}$, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. Conclusion : For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of $Labb{\acute{e}}$.

제2형 신경섬유종의 증거를 포함하지 않는 청신경초종과 소뇌교각 수막종의 병발 증례 -증례보고-

황승균 ( Sung Kyun Hwang ),김성학 ( Sung Hak Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.1

We present a rare case of coexisting cerebellopontine(CPA) meningioma and vestibular schwannoma(VS) without evidence of neurofibromatosis type-2(NF-2). And, possible mechanism of genesis of these tumors without evidence of NF-2 is discussed.

김치로부터 분리된 Leuconostoc sp. strain YSK 균주에 의한 덱스트란 생산 조건의 최적화

황승균(Seung Kyun Hwang),홍준택(Jun Taek Hong),정경환(Kyung Hwan Jung),장병철(Byung Chul Chang),황경숙(Kyung Suk Hwang),신정희(Jung Hee Shin),임성팔(Sung Paal Yim),유선균(Sun Kyun Yoo) 한국생명과학회 2008 생명과학회지 Vol.18 No.10

본 연구는 발효 김치 액으로부터 덱스트란 생산 균주를 분리하고 생산 최적 생산 조건을 설정하기 위하여 반응표면분석법을 이용하였다. 발효 조건의 독립변수들은 배양 온도, pH, 효모 추출물의 농도, 온도, 기질의 농도로 정하고 Box-Benken 디자인를 이용하여 실험을 설계하였다. 최종 분리된 균주는 Leuconost℃ sp. strain SKY로 잠정적으로 명하였다. 연구 결과 덱스트란 생산은 3.90 - 22.40 g/l이고, 균체량 생산은 0.69-2.85 g/l, 수율은 0.10-0.64, 생산 속도 0.16-0.85 g/l-hr의 범위에서 분석이 되었다. 표면반응분석 결과 덱스트란 생산에 가장 영향을 미치는 것은 배양 pH이고 다음에 효모 추출물의 농도 그리고 온도의 순으로 나타났다. 균체량 생산에 가장 영향을 미치는 것은 배양 pH이고 다음에 효모 추출물의 농도 그리고 온도의 순으로 나타났다. 생산 수율에 가장 영향을 미치는 것은 배양 pH 이고 다음에 효모 추출물의 농도 그리고 온도의 순으로 나타났다. 덱스트란 생산 속도에 가장 영향을 미치는 것은 배양 pH이고 다음에 효모 추출물의 농도 그리고 온도의 순으로 나타났다. 결론적으로 최적 생산 조건은 온도는 27-28℃이고, pH는 7.0이며, 효묘 추출물은 6-7%의 범위에서 결정이 되었다. 이러한 조건에서 생산된 덱스트란양은 22g/l이고, 생산 수율은 약 60%정도이며, 생산 속도는 0.8g/l/hr이었다. A bacterium producing non- or partially digestible dextran was isolated from kimchi broth by enrichment culture technique. The bacterium was identified tentatively as Leuconostoc sp. strain SKY. We established the response surface methodology (Box-Behnken design) to optimize the principle parameters such as culture pH, temperature, and yeast extract concentration for maximizing production of dextran. The ranges of parameters were determined based on prior screening works done at our laboratory and accordingly chosen as 5.5, 6.5, and 7.5 for pH, 25, 30, and 35℃ for temperature, and 1, 5, and 9 g/l yeast extract. Initial concentration of sucrose was 100 g/l. The mineral medium consisted of 3.0 g KH₂PO₄, 0.01 g FeSO₄ㆍH₂O, 0.01 g MnSO₄ㆍ4H₂O, 0.2 g MgSO₄ㆍ7H₂O, 0.01 g NaCl, and 0.05 g CaCO₃ per 1 liter deionized water. The optimum values of pH and temperature, and yeast extract concentration were obtained at pH (around 7.0), temperature (27 to 28℃), and yeast extract (6 to 7 g/l). The best dextran yield was 60% (dextran/g sucrose). The best dextran productivity was 0.8 g/h-l.

성인 쿠싱병의 치료성적과 예후인자

박철기,황승균,곽호신,유헌,정영섭,백선하,김동규,정희원,김성연,홍승관,Park, Chul-Kee,Hwang, Sung Kyun,Gwak, Ho-Shin,Yoo, Heon,Chung, Young Seob,Paek, Sun Ha,Kim, Dong Gyu,Jung, Hee-Won,Kim, Seong Yeon,Hong, Seung Kuan 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Objectives : The authors analyzed the surgical series of Cushing's disease to evaluate the proper treatment policy and to verify the possible prognostic factors. Material and Methods : Of 50 patients diagnosed as Cushing's disease and operated at Department of Neurosurgery of our institute between 1988 and 1999, 48 patients with available medical records were analyzed retrospectively. Mean follow-up period was 48 months(3 to 109 months). Preoperative diagnosis was made after evaluating the patients with multiple-stage endocrinological studies and 31 selective patients were evaluated with inferior petrosal sinus sampling(IPSS). Magnetic resonance imaging(MRI) and/or high resolution computerized tomography(CT) was done in all patients. A total of 51 transsphenoidal adenomectomy(TSA) were performed including 3 revision for initial surgical failure cases. Remission was decided on the basis of both endocrinological criteria and clinical status. Radiation and/or ketoconazole therapy were applied to failed cases. For the verification of prognostic factors, the authors evaluated the statistical significance of multiple variables over remission rate by chi-square test. Result : Sensitivity of IPSS for central localization was 93.5% which was better than that of MRI(87.5%). But for lateralization, it was 72.4% for IPSS versus MRI 90.5%. Success rate of TSA was 82%(42/51) and recurrence rate was 9%(4/48). When including adjuvant treatments for surgically failed cases, overall success rate was 89.6% and all of 3 reoperated cases(TSA) due to recurrence were successful. Significant complication occurred in 7.8%(4/51) after TSA including hypopituitarism, diabetes insipidus, and visual loss. Non-existence of tumor in MRI and prolonged symptom duration(>3 years) were significant prognostic factors. Conclusion : TSA can be considered as initial treatment for Cushing's disease. In surgically failed cases, multiple treatment modality may improve the overall outcome and repeated TSA for recurrent cases seem to provide similar success.

수막 혈관주위세포종의 임상상, 치료 및 장기 추적 결과

이준호,황승균,곽호신,백선하,김동규,김현집,정희원,Lee, June-Ho,Hwang, Sung-Kyun,Gwak, Ho-Shin,Paek, Sun Ha,Kim, Dong Gyu,Kim, Hyun Jib,Jung, Hee-Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objectives : Meningeal hemangiopericytoma is a rare tumor. Clinical and radiological features are similar to those of an ordinary meningioma. But its biological behavior is quite different from those of a meningioma as it brings profuse bleeding in the operation field, frequent recurrence and metastasis to other systemic organs even in the case of gross total resection. In order to find out the prognostic factors and to compare longterm outcome after various treatment modalities, the authors reviewed consecutive 20 operated cases of meningeal hemangiopericytoma to characterize their clinical features, surgical outcomes and effectiveness of the radiation therapy. Methods : Twenty patients with a hemangiopericytoma were treated between 1982 and 1999 in our department. They are composed of 13 patients of hemangiopericytoma and 7 patients who were initially diagnosed as angioblastic type meningioma and then confirmed as a hemangiopericytoma after review of their previous histopathology slides. The mean follow-up period was 99 months(1-256 months). The long-term outcomes after various treatment modalities were evaluated according to recurrence-free survival and image follow-up. Recurrence-free survival curves are compared between the patient groups according to the extent of removal and radiation therapy. Results : There were 10 cases of recurrence and 4 cases of distant metastases ; lung, liver and femur(2 cases) respectively. The 5-year recurrence rate was 37%, while the 10-year recurrence rose to 77%. There was also statistically significant difference of median recurrence-free survival between the completely-resected group(Simpson grade 1 or 2) and partially-resected group(Simpson grade 3 or 4 or 5) ; 137 months compared to 47 months, respectively(p=0.009). The median recurrence-free period after subtotal resection of tumor and postoperative radiotherapy was 47 months compared to 117 months of the patients who underwent gross total resection of tumor and did not receive radiotherapy. But radiation therapy alone did not show significant difference in recurrence-free survival. Marked tumor volume reduction and easy removal of tumors without bleeding were found in 2 recurred cases. Conclusion : The extent of tumor resection and presence of metastasis are the most important factors related to long-term outcome of the patients with hemangiopericytoma. Radiation therapy after the first operation did not have a role in extending the recurrence-free survival, but it affected favorably to decrease the size of residual mass and intraoperative bleeding during the second operation.

비정형성 및 악성 뇌수막종의 임상분석 : 52례 연구

박홍준,곽호신,황승균,김정은,이상형,정희원,김동규,조병규,Park, Hong-Jun,Gwak, Ho-Shin,Hwang, Sung-Kyun,Kim, Jeong Eun,Lee, Sang Hyung,Jung, Hee-Won,Kim, Dong Gyu,Cho, Byung-Kyu 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9

Objective : Atypical and malignant meningiomas(AM, MM) are known to be rare and show aggressive behavior. Limited data are available concerning the clinical features, effectiveness of surgical removal and role of radiation therapy with AM, MM. The authors report our experience of AM, MM, with respect to clinical features. Methods : Twenty-four cases of AM and 28 cases of MM, who were operated between 1988 and 1999 were retro-spectively studied review of medical records and radiological findings. These were compared with control group of 24 cases of menigiomas manifestating usual clinical course, which are selected arbitrarily among operative cases between Apr. 1999 and Dec. 1999. Mean follow-up periods were 26(1-91) months for AM and 23(1-62) for MM. Authors analyzed the prognostic factors for survival, and statistical analysis were accomplished by Kaplan-Meier method and log-rank test. Results : Differences of clinical features between control groups and these atypical and malignant meningioma group were not significant. However, the location of MM was frequent in non-basal area(p<0.01). In AM, there were 4 patients of recurrence, and 3 patients of mortality. Among mortality cases, only one patient died of tumor progression, the other patients died of other causes. The survival at 2 year and 5 year in this group were 88% and 74% respectively, and in MM, 11 patients died due to tumor progression and 2 had spinal metastasis. The survival at 2 year and 5 year were 72% and 20%, respectively. For extent of resection, total removal(Simpson grade 1 or 2) was less often achieved in MM compared with AM(50% vs. 83%). Extent of resection of tumor and postoperative radiation therapy did not affect survival in both AM, MM. Conclusions : Clinical behavior of AM showed more benign than that of MM. Prognostic factor for survival is not related extent of resection of tumor and postoperative radiation therapy. However, further investigation with long-term follow-up and additional cases is mandatory.

Recurrence and Extraneural Metastasis in 31 Meningeal Hemangiopericytomas

김정훈,김준수,김창진,황승균,정희원,권병덕,Kim, Jeong Hoon,Kim, Joon Soo,Kim, Chang Jin,Hwang, Sung Kyun,Jung, Hee Won,Kwun, Byung Duk The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.3

목 적 : 높은 재발율과 전이 가능성의 특징을 갖고 있는 수막 혈관외세포종은 perivascular pericytes에서 기원하는 드문 종양으로, 저자들이 경험한 수막 혈관외세포종에 있어서 종양의 재발 및 신경계외 전이에 대하여 알아 보고자 한다. 연구 대상 및 방법 : 1982년부터 1999년까지 수술을 시행하여 수막 혈관외세포종으로 진단받은 31명의 환자를 대상으로 후향적 연구를 시행하였다. 진단 후 재발까지의 기간, 재발에 영향을 미칠 수 있는 여러 가지 인자들, 그리고 신경계외 전이의 기간 및 부위 등을 분석하였다. 결 과 : 총 31명의 환자들 중 12명의 환자들에서 원발성 부위에 종양이 재발하였다(38.7%). 전체의 환자들에서 재발이 발생하지 않았던 평균 기간(recurrence-free period : RFP)은 104개월이었으며 처음 수술 후 5년, 그리고 10년의 재발이 발생하지 않았던 율(recurrence free period : RFP)은 각각 59.2%, 33.6% 이었다. 원발성 부위에 종양의 재발을 보였던 12명의 환자들 중 4명의 환자들에서 첫 수술 후 5년 이후에 재발을 관찰 할 수 있었다. 처음 수술시의 절제 정도가 재발에 가장 큰 영향을 미쳤다. 처음 수술시에 완전 절제한 군의 RFP는 111 개월이었으며, 추적 관찰 5년째 RFR는 완전 절제한 경우 72.7%, 불완전 절제한 경우 20.8%로 그 차이는 통계 적으로 유의하였다(p=0.0060). 통계적으로 유의성은 없었지만 완전 절제 후 부가적인 방사선 치료를 시행하였을 경우가 완전 절제만을 시행한 경우보다 RFR가 높아 추적 관찰 5년째의 RFR는 각각 100%, 그리고 70.3% 이었다(p=0.3359). 4명의 환자들(12.9%)에서 수막 혈관외세포종의 신경계외 전이가 발생하였으며, 이 경우 신경계 외 전이의 평균 기간은 107개월, 그리고 추적 관찰 5년, 10년째의 신경계외 전이율은 각각 4.4%, 24.9% 이었다. 결 론 : 수막 혈관외세포종은 수술적 제거 후 원발성 부위에 또는 원발성 부위에서 멀리 떨어진 부위에 재발의 가능성이 무척 높은 종양이다. 이러한 재발의 가능성을 줄이는 가장 중요한 인자는 수술적 제거 정도로 처음 수술시에 가능한 완전 절제를 시도하여야 한다. 그리고 처음 수술시에 완전 절제가 가능하였다고 하여도 완전 절제 후 부가적인 방사선 치료를 시행하는 것이 재발의 위험성을 낮출 수 있을 것으로 생각한다. 원발성 부위의 재발 또는 신경계외 전이는 오랜 시간이 지난 후에도 가능할 수 있으므로 장기간의 추적 관찰이 필요하다고 생각한다. Purpose : Meningeal hemangiopericytoma(M-HPC), characterized by a high local recurrency and metastatic potential, is a rare neoplasm arising from perivascular pericytes. A retrospective study was performed to identify the recurrence and extraneural metastasis in M-HPC. Materials and Methods : We reviewed the records of 31 M-HPC patients treated from 1982 through 1999 at our institution. The time to recurrence and the various parameters affecting recurrence were determined. Extreneural metastasis was also analyzed. Results : The rate of local recurrency was 38.7%(12/31). The overall average recurrence-free period(RFP) before the first recurrence was 104 months, with overall recurrence-free rates(RFRs) at 5 and 10 years after first surgery of 59.2% and 33.6%, respectively. Of the 12 patients who experienced local recurrence, 4 had recurrences 5 years later after the first surgery. Complete excision at the first operation significantly extended the average time before first recurrence from 43 to 111 months. The 5-year RFRs for the groups of complete excision and incomplete excision were 72.7% and 20.8%, respectively(p=0.0060). Although there was no statistical significance, complete excision followed by adjuvant radiotherapy of more than 50Gy extended the RFP. The 5-year RFRs for the groups of complete excision and complete excision with adjuvant radiotherapy were 70.3% and 100%, respectively(p=0.3359). Four patients(12.9%) presented one or more extraneural metastases that were developed at an average of 107 months after the first operation with the 5- and 10-year metastasis rates of 4.4% and 24.9%, respectively. Conclusions : M-HPC has a propensity to recur either locally or at distant sites after surgical resection. Complete excision is the most important factor to reduce recurrence. However, even with complete excision, adjuvant radiotherapy of more than 50Gy significantly reduces the risk of recurrence. Local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up.

상의하 파종을 보인 재발성 상의하세포종의 증례 보고

설호준 ( Ho Jun Seol ),황승균 ( Sung Kyun Hwang ),최윤라 ( Yoon La Choi ),지제근 ( Je G Chi ),정희원 ( Hee Won Jung ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Subependymoma is a rare, slow growing, rarely recurrent tumor. We report a case of recurrent subependymoma with subependymal seeding. An intraventricular tumor in the left temporal horn was detected in a 48-year-old female who presented with a 4-year history of dizziness and memory disturbance. Following near total surgical resection, a tumor diagnosis of subependymoma was confirmed by scattered clusters of isomorphic nuclei embedded in a dense fibrillary matrix of glial cell processes. Twenty six months after surgery, follow-up(F/U) magnetic resonance(MR) imaging revealed tumor recurrence in the previous site which necessitated linear accelerator radiosurgery(LINAC). A further 21 months later, F/U MR imaging showed recurrent, multiple, enhanced, nodular lesions in the enlarged left lateral ventricle for which the patient underwent reoperation. Radiological and operative findings revealed local relapse with subependymal seeding. The pathological finding was similar to that of the previous tumor and compatible with subependymoma. Immunohistochemical studies revealed that glial fibrillary acidic protein(GFAP) was positive and CD-99 was negative. The patient underwent radiation therapy for the residual tumor. This case history suggests that symptomatic residual tumors require close observation even though the clinical course of subependymoma is usually benign.

광범위한 심부 정맥계의 경색:후두개와 수술 후 발생한 드문 합병증

이대규 ( Dae Kyu Lee ),황승균 ( Sung Kyun Hwang ),김동규 ( Dong Gyu Kim ),정희원 ( Hee Won Jung ),한문희 ( Moon Hee Han ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1

Objective and Importance:Infarction of the deep cerebral venous system is a rare clinical entity and is different from the infarction of the superficial system in its presenting symptoms, severity of the disease and prognosis. The authors present a case of extensive infarction of the deep venous system associated with a postoperative epidural abscess in the posterior fossa following the surgery of a vestibular schwannoma. Pathogenesis is also discussed with diagnosis and treatment. Clinical Presentation:A 43-year-old woman underwent total removal of a vestibular schwannoma through retromastoid suboccipital craniectomy. The immediate postoperative course was uneventful. A high fever occurred on the eighth postoperative day and she subsequently became stuporous. Computed tomography(CT) revealed a crescent-shape lesion at the epidural space around the craniectomy site. Diffuse low-density lesions in the bilateral basal ganglia, thalamus and frontal paraventricular white matter were also seen. Intervention:Revision of the previous wound was performed and the epidural abscess was removed. Postoperative magnetic resonance(MR) imaging showed extensive infarction in the same areas that were seen in the previous CT scan. Occlusions in the straight and lateral sinus were demonstrated by MR venography. Anticoagulation therapy was started and the neurological status of the patient gradually improved. Conclusion:Although an infarction of the deep cerebral venous system is rare, it may occur in patients with postoperative intracranial infection in the vicinity of the dural sinus. A suspicion and rapid diagnosis are important, so that the morbidity of the disease may be reduced and the prognosis for the patient may be improved if an adequate treatment regimen would be taken early.

댄디-워커 기형이 동반된 다수의 선천성 멜라닌 세포 모반

류소민 ( So Min Lyu ),이상우 ( Sang Woo Lee ),정승현 ( Seung Hyun Cheong ),명기범 ( Ki Bum Myung ),최유원 ( You Won Choi ),황승균 ( Sung Kyun Hwang ),최혜영 ( Hae Young Choi ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.1

Congenital melanocytic nevi (CMN) are benign pigmented lesions found in about 1% of all newborns or shortly after birth. Giant melanocytic nevi, with multifocal involvement, show significantly greater risk of developing malignant melanomas and neurocutaneous melanosis (NCM), particularly in a posterior axial location. NCM is a rare congenital disease characterized by multiple (≥3) small nevi, or at least one large congenital melanocytic nevus in combination with cerebral and/or leptomeningeal melanin deposits or melanoma. Dandy-Walker malformation (DWM) consists of a cystic dilatation of the fourth ventricle, hypoplasia or aplasia of the cerebellar vermis, and enlarged posterior fossa with or without hydrocephalus. The association of DWM and NCM has rarely been reported in the literature. A 3 month-old girl presented with increased head circumference and multiple various sized black plaques on her whole body. She underwent a ventriculoperitoneal shunt operation when she was 2 months-old. A skin biopsy was taken from the largest and darkest plaque of the trunk and showed hyperpigmentation of the basal layer of the epidermis. The dermis contained nevus cells in nests and sheets throughout the dermis, but no cellular atypia was noted. Magnetic resonance image (MRI) of the brain revealed severe hydrocephalus with hypoplasia of cerebellar vermis and agenesis of cerebellar tonsil which are consistent with Dandy-Walker malformation. We recommended a spinal MRI for check up the presence of leptomeningeal melanosis, but could not evaluate the result because of her being adapted. Herein, we present a rare case of multiple congenital melanocytic nevi in association with DWM in a neonate. (Korean J Dermatol 2012;50(1):60∼66)