난치성 전두엽 간질의 외과적 치료

김정목,김형일,김근수,김철진,이정청,이민철 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

Recent advances of neuroimaging and electrophysiological monitoring technique have contributed in improving the surgical outcome of frontal lobe epilepsy. The authors have analysed 36 consecutive cases of intractable frontal lobe epilepsy that were treated at our institute between September. 1992 and December, 1995 to determine the clinical, electrophysiological, and neuroimaging characteristics as well as to delineate the efficacy of surgical treatment in improving the seizure outcome. The patients consisted of 19 males and 17 females. The mean age of the seizure onset and the mean duration of epilepsy were 14.9 and 11.6 years, respectively. Magnetic resonance imaging(MRI) showed no lesion in 9 patients and pathological lesions in 27 patients. The types of the lesions observed included primary brain tumor, mostly low-grade glioma in 10 patients, cortical dysplasia in 4, posttraumatic scar in 4, neocortical gliosis in 3, cyst in 3, and postencephalitic atrophy in 3. Intracranial recordings were performed in 23 cases to determine the epileptogenic zone. The surgical outcome was graded according to Engle’s Classification as Class A in 20 patients. Class B in 2, Class C in 9, and Class D in 5. The surgical outcome was promising regardless of the presence or the absence of the lesion on MRI, invasive recording, age of seizure onset, and duration of epilepsy.

선택적 후근절제술의 수술중 근전도 감시방법과 치료효과

김형일,김연희,김완호,김근수,김동찬 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Selective posterior rhizotomy(SPR) has been known to reduce the spasticity as well as to improve the quality of life in patients with intractable spasticity. Twenty patients underwent SPR under intraoperative electrophysiological monitoring(IOM). Fifty-two percent of sacrolumbar rootlet were cut after electrical stimulation. Eighteen patients(90%) with spastic type of cerebral palsy showed marked reduction of spasticity and functional improvement without any complication. The patients who did not respond to SRP had mixed types of spasticity. IOM facilitate the selection of pathological rootlets regardless of anaesthetic level. intensity of electrical stimulation, and individual variability of responses. It is concluded that careful selection of surgical candidates and of pathological rootlets under IOM are important to reduce the spasticity. thereby to obtain a better outcome.

피질이형성증과 동반된 난치성 간질의 외과적 치료

김형일,김연희,이민철,정애자,권지현,최하영,Andre Palmini 啓明大學校 醫科大學 1995 계명의대학술지 Vol.14 No.2

The advent of neuroimaging technique has enabled the accurate diagnosis of structural abnormalities associated with intractable epilepsy. Among these, neuronal migration disorders(NMDs) or cortical dysplasias(CDs) involving cerebral cortex are increasingly recognized as a major cause of intractable epilepsy. CDs are expressed as variety of forms depending upon the time of injury to the developing nervous system. CDs are highly and intrinsically epileptogenic. It is crucial to completely resect the epileptogenic zone in focal CDs for better seizure outcome. Hemispherectomy or multilobar resection is preferred for hemimegalencephaly. Callosotomy can be chosen in the diffuse CDs who have intractable drop attacks. However, resective surgery can benefit the selected patients with diffuse CDs if localizing information persists.

Rolandic Cortical Dysplasia : 증례보고 Case Report

김형일,정채경,최하영,Palmini, Andre,이민철,이정청 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.6

The advent of MRI enables us to make an in-vivo diagnosis of cortical dysplastic lesions which are highly epiletogenic and show the variety of seizure patterns. Authors report a case of rolandic cortical dysplasia who had highly intractable focal motor clonic seizures. Invasive recording with subdural grid was very helpful in delinating the epileptogenic area as well as in functional mapping of eloquent areas. Total removal of dysplastic lesion could treat this highly intractable epilepsy successfully.

국소성 피질이형성증의 외과적 치료

조관국,김형일,이민철,김근수,김연희,정창오,Neto, Pedro R. 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

Corticai Dysplasia(CD) is increasingly recognized as a cause of intractable epilepsy since it can be easily diagnosed with high resolution magnetic resonance imaging(MRI). We analyzed 24 consecutive cases with cortical dysplasia who underwent resective surgery at our institute between September. 1992 and December. 1995. MRI was demonstrated to be a decisive tool to identify CD in 16 cases(66.7%). However, the remaining 8 cases(93.9%) were confirmed to have CD based on histological examination. Location of the lesion included temporal(n=9), central(n=5), multilobar(n=5), and frontal(n=5). Intracranial EEG recording was performed to delineate the epileptogenic zons in 16 cases : subdural grid(10 cases) and depth electrode(6 cases). Resection was performed in temporal(n=9), frontal(n=7), central(n=5). parietal(n=1), and muitilobar(n=1). Complete resection was possible in 15(62.5%) and partial resection in 9(37.5%). Histological examination revealed dyslamination of cortical layers only(n=9), additional dysplastic neurons(n=7), and additional balloon cells(n=8). Surgical outcome was graded as seizure free(n=14 : 58.3%), rare seizures(n=3 : 12.5%). <50% reduction of seizure frequency(n=2 : 8%), and no change(n=5 : 20.8%) after mean follow-up of 12.7 months. The most influencing factor on the surgical outcome was the degree of completeness of resection(p<0.05). However. detectability of CD on MRI, severity of histological findings, age of seizure onset, and duration of seizure were not significantly related with the surgical outcome High suspicion is required to detect the CD among the patients with intractable epilepsy and surgical strategies should be well-planned to improve the surgical outcome in the patients with CD.

불안정성 흉요추체 방출형 골절 환자에서 기구를 이용한 고정술의 결과

안병조,이정청,김재은,김형일,김철진,최하영 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.9

Fifty six patients with unstable thoracolumbar bursting fractures were treated using variable internal fixation devices such as the Kaneda Anterior Fixation System(Kaneda device), the Z-Plate-ATL^(TM) Anterior Fixation System(Z-Plate ATL^(TM)device), the Harrington device. Cotrel-Dudousset(CD) or Compact Cotrel Dubousset(CCD) device of Steffee Transpedicular System with or without decompression. Suchy internal fixation devices were grouped into anterior and posterior internal fixation devices and compared with each other in the aspect of the degree of neurological improvement, the changes of the vertebral height and the kyphotic angle, the duration of admission, and postoperative complications. In conclusion, the anterior internal fixation device appears to be of more benefit in the management of patients with unstable thoracolumbar bursting fracture

하지방사통을 동반한 성인 협부결손성 요추전방전위증의 후방요추간유합술 및 추경나사고정술후 추적결과

최철,김근수,최하영,김철진,김형일,이정청 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.4

달맞이꽃 종자가 혈중 Cholesterol치 및 면역반응에 미치는 영향

신동규,최하영,김형일,이정청 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.3

달맞이꽃 종자가 생체 생리활성에 미치는 영향을 규명하기 위한 지금까지의 수 많은 연구에도 불구하고 이의 투여가 혈청 cholesterol(CHO)치에 미치는 영향에 관해서는 논란이 많으며, 만약 달맞이꽃 종자를 투여함으로 혈청CHO치가 변화된다면 이로 인하여 생체 면역 반응이 변조될 가능성을 유추할 수 있음에도 불구하고 면역 반응에 있어서 달맞이꽃 종자가 CHO치와의 상호 작용을 규명키 위한 연구 보고는 전무하다. 이에 저자는 달맞이꽃 종자가 정상 동물의 혈중 CHO치에 미치는 영향을 평가하기 위하여 토끼에 달맞이꽃 종자(EPS)를 섭식시키거나 또는 그 추출물(EPE)을 투여한 후 경시적으로 혈청CHO치의 변동을 측정하였으며, 아울러 달맞이꽃 종자 투여에 의한 CHO치의 변화가 생체 내 세포성 및 체액성 면역반응에 미치는 영향을 평가하기 위하여 마우스에 EPE와 CHO를 단독 또는 병합 투여한 후 면양적혈구로 면역하여 족척종창 반응으로 측정한 Arthus반응과 지연성 과민반응(DTH) 그리고 적혈구 응집 항체가로 측정한 체액성 면역 반응에 미치는 달맞이꽃 종자의 영향을 측정하였던 바 다음과 같은 성적을 얻었다. 1) 혈중 CHO치는 EPS 및 EPE 모두 투여 4일까지는 유의한 영향을 보이지 않았으나, 이들을 계속 투여하면 대조에 비하여 현저히 저하되었으며, 그 저하의 정도는 EPE투여군에 비하여 EPS군에서 더욱 현저하였다. 2) Arthus반응은 EPE와 CHO를 단독 또는 혼합투여시 모두 유의한 영향을 받지 않았다. 3) DTH반응은 CHO단독 투여군에서는 유의한 영향을 받지 않았으나 EPE 단독 투여군에서는 현저히 저하되었으며, CHO는 EPE 투여에 의한 DTH반응의 감소를 유의하게 회복시켰다. 4) 항체 반응은 EPE 투여군에서는 현저히 그리고 CHO 투여군에서는 다소 저하되었으며 EPE와 CHO를 혼합 투여시는 CHO 단독 투여군에서의 그것과 유의한 차이를 보이지 않았다. 이상의 성적은 달맞이꽃 종자가 혈청 CHO치, DTH 및 항체 반응 모두를 저하시키며, 특히 EPE의 투여에 의한 면역 반응의 감소는 EPE의 혈청 CHO감소 작용에 부분적으로 의존함을 제시한다. Evening primrose oil(EPO), which contains 72% cis-linoleic acid and 9% cisgamma linolenic acid, has been clinically used for treatment of number of diseases in human and animals. And it is also known to lower cholesterol(CHO) level of hypercholesterolaemic individuals. But the role of EPO as CHO-suppressant is controversal, and the relationship of EPO to CHO level in immune regulating activities is unclear at present. To evaluate the effect of evening primrose on the normal plasma CHO-levels. rabbits were fed with evening primrose seed(EPS) or injected with evening primrose seed-extract(EPE), and measured the plasma CHO-levels by duration of treatment. Both of EPS and EPE did not influence the plasma CHO-levels until 4 day treatment and thereafter the levels were significantly reduced. For the investigation of the EPE-effect on immune response to sheep erythrocytes(SRBC), mice were injected with EPE for 4 days before SRBC-sensitization or with CHO just before SRBC. Sensitization or with CHO in regulating effect of immune response was evaluated by the measuring the footpad swelling reaction and antibody response to SRBC. EPE itself did not influence Arthus reaction but it remarkable reduced delayed type hypersensitivity (DTH) and antibody production in comparison with control. CHO slightly increased Arthus reaction and DTH, but it somewhat decreased antibody responses. However, CHO significantly recovered the EPE-induced decrement of DTH and humoral immunity. These results led to that conclusion the evening primrose triggers the decrease of plasma CHO-levels and immune responses, and suggested that the mechanisms responsible for the nonspecific immune inhibitory effect of evening primrose might be partially due to the decrement of the CHO-levels.

Simplified adaptor for stereotactic surgery in non-human primates

Kim, Hyung-Sun,Byun, Donghak,Kim, Ra Gyung,Kang, Goo-Hwa,Park, Ji-Young,Yang, Young-Su,Han, Su-Cheol,Kim, Hyoung-Ihl Elsevier 2018 Journal of neuroscience methods Vol.295 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>It is challenging for researchers performing stereotactic procedures to transition from small animals to non-human primate (NHP) experiments. The NHP stereotactic atlas is based on ear-bar zero (EBZ), which is an anatomical reference frame that is not visible during surgery. Most current NHP stereotactic systems require high-cost MRI or CT imaging and complex computer processing to determine the stereotactic coordinates, limiting the procedure to those with significant expertise.</P> <P><B>New method</B></P> <P>We have designed a simplified adaptor consisting of a circular arc for coronal tilt, a carrier for electrodes or cannulas, and an anchor to attach the adaptor to a conventional stereotactic frame. Our adaptor allows easy identification of the EBZ with the help of an anchor notch, and provides digital distance sensors without the need for imaging data or computer processing. Our system enables the use of trajectories that avoid injury to important structures and vessels.</P> <P><B>Results</B></P> <P>We tested the accuracy of our system using simulated targeting with phantoms, and demonstrated sub-millimeter accuracy. Infusion of methylene blue also showed satisfactory staining in target structures deep in the brain.</P> <P><B>Comparison with existing methods</B></P> <P>This system does not require high-cost imaging and extra training to determine EBZ. Once EBZ is set automatically by the system itself, targeting is similar to that in small animal stereotactic procedure.</P> <P><B>Conclusion</B></P> <P>Our simple adaptor will aid researchers who plan to conduct experiments involving stereotactic surgery in NHPs.</P> <P><B>Highlights</B></P> <P> <UL> <LI> A simple adaptor is proposed for stereotactic surgery in non-human primates. </LI> <LI> This adaptor can be attached to a conventional animal stereotactic frame. </LI> <LI> It allows identification of ear bar zero without imaging and computer processing. </LI> <LI> Simulation study shows the submillimeter precision in targeting. </LI> <LI> The proposed system will be useful for unexperienced translational researcher. </LI> </UL> </P>

Sensory-parietal cortical stimulation improves motor recovery in severe capsular infarct

Kim, Ra Gyung,Cho, Jongwook,Ree, Jinkyue,Kim, Hyung-Sun,Rosa-Neto, Pedro,Kim, Jin-Myung,Lee, Min-Cheol,Kim, Hyoung-Ihl SAGE Publications 2016 Journal of cerebral blood flow and metabolism Vol.36 No.12

<P> The prevalence of subcortical white matter strokes in elderly patients is on the rise, but these patients show mixed responses to conventional rehabilitative interventions. To examine whether cortical electrical stimulation can promote motor recovery after white matter stroke, we delivered stimulation to a small or wide region of sensory-parietal cortex for two weeks in a rodent model of circumscribed subcortical capsular infarct. The sham-operated group (SOG) showed persistent and severe motor impairments together with decreased activation in bilateral sensorimotor cortices and striatum. In contrast, sensory-parietal cortex stimulation significantly improved motor recovery: final recovery levels were 72.9% of prelesion levels in the wide stimulation group (WSG) and 37% of prelesion levels in the small stimulation group (SSG). The microPET imaging showed reversal of cortical diaschisis in both groups: in both hemispheres for the WSG, and in the hemisphere ipsilateral to stimulation in the SSG. In addition, we observed activation of the corpus callosum and subcortical corticostriatal structures after stimulation. The results from the c-Fos mapping study were grossly consistent with the microPET imaging. Sensory-parietal cortex stimulation may therefore be a useful strategy for overcoming the limits of rehabilitative training in patients with severe forms of subcortical capsular infarct. </P>