육아종성 염증을 동반한 송과체 배아종 - 증례보고 -

문경섭,정신,강삼석,김인영,김현우,이정길,김태선,김재휴,김수한,이제혁,Moon, Kyung Sub,Jung, Shin,Kang, Sam Suk,Kim, In Young,Kim, Hyun Woo,Lee, Jung Kil,Kim, Tae Sun,Kim, Jae Hyoo,Kim, Soo Han,Lee, Je Hyuk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Germinoma associated with chronic granulomatous inflammation of pineal gland has been rarely reported in the literature. The mechanism of chronic granulomatous inflammation is not understood well. We report a case of chronic granulomatous inflammation in pineal germinoma. In a 17 year-old male who suffered from headache and diplopia for six months, the mass of pineal gland was detected by brain MRI and removed through occipital transtentorial approach. The pathological specimen revealed the mass was predominantly composed of chronic granulomatous inflammation associated with small portion of germ cell tumor nests In the pathological interpretation of chronic granulomatous inflammation of pineal mass, it would be obliged to search for the presence of germ cell component.

운동중추 주변에 위치한 전이성 뇌종양의 수술 후 운동 기능에 대한 평가

김상효,정신,강삼석,이정길,김태선,김재휴,김수한,이제혁,Kim, Sang Hyo,Jung, Shin,Kang, Sam Suk,Lee, Jung Kil,Kim, Tae Sun,Kim, Jae Hyoo,Kim, Soo Han,Lee, Je Hyuk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : Intracranial metastasis is responsible for nearly 50% of mortalities of systemic cancers. Although its frequency is increasing and there is little doubt that improving the quality and expectancy of life is the final goal, the mode of treatment is still disputed. The authors report the postoperative motor function after surgery in patients with metastatic tumors around the motor cortex. Materials and Methods : We studied 24 patients with metastatic tumors around the central sulcus during the last 22 months. Motor function was assessed pre- and post-operatively as well as its response to corticosteroids. MRI, neuronavigation system and intraoperative ultrasonography were used for tumor localization and functional MRI and cortical stimulator were used to define the motor cortex. Results : Single metastasis was found in 13 cases(54%) and 11 cases(44%) had multiple foci. Thirteen cases were located in precentral, 7 in postcentral, and 4 in superior or middle-frontal lobe. The most common primary focus was the lung(16 cases). There was no difference in postoperative motor function improvement between the steroid responsive group and non-responsive group(92% versus 90%). Ninty-two percent of the patients showed significant improvement of motor function and lived independently but there was worsening in the upper extremity in one and in another no improvement. Whole brain radiation of 3000cGy was given in all cases and 4 patients died of recurrence in primary or intracranial focus during mean follow-up periods of 14 monthes. Conclusion : Surgery may provide substantial improvement of the motor function and quality of life of the patients with metastatic tumors around the motor cortex.

천막상부 및 하부에 다발성으로 발생한 혈관모세포종 - 증례보고 -

김철수,정신,강삼석,이정길,김태선,김재휴,김수한,이제혁,Kim, Cheol-Soo,Jung, Shin,Kang, Sam-Suk,Lee, Jung-Kil,Kim, Tae-Sun,Kim, Jae-Hyoo,Kim, Soo-Han,Lee, Je-Hyuk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

A rare case of multiple supratentorial and infratentorial hemangioblastomas in a 50-year old man is presented. There were neither manifestations of visceral tumors nor familial history. The two tumors were totally removed in two sessions and the diagnosis in both tumors were hemangioblastomas.

Studies on the Interactions of $M_1-,M_2-receptors$ with Nicotinic Receptors in Rabbit Sympathetic Ganglia

김종근,류춘식,강삼석,Kim, Jong-Keun,Rhu, Choon-Sik,Kang, Sam-Suk The Korean Society of Pharmacology 1992 대한약리학잡지 Vol.28 No.2

교감신경절 전달에 무스카린성 수용체 아형과 니코틴성 수용체가 기능적으로 어떻게 작용하는지를 알아 보기 위하여 척수가토에서 척수를 통한 교감신경절전섬유의 자극에 의한 승압반응과 신경절 $M_1$수용체 및 니코틴성 수용체 흥분제인 McN-A-343과 DMPP의 승압반응에 대한 $M_1$수용체 길항제인 pirenzepine, $M_2$수용체 길항제인 AF-DX116 및 니코틴성 수용체 길항제인 mecamylamine의 영향을 조사하였다. 먼저 $M_1$ 및 $M_2$수용체의 작용을 선택적으로 차단하는 pirenzepine과 AF-DX116의 용량을 구하기 위해 chlorisondamine-처리가토에서의 $M_1$수용체를 통한 작용인 McN-A-343의 혈압상승작용과 $M_2$수용체를 통한 작용인 bethanechol (BCh)에 의한 심박수감소작용을 50% 억제하는 양$(LD_{50})$을 각각 구한 결과 pirenzepine의 혈압상승작용에 대한 $ID_{50}$가 $30\;{\mu}g/kg$였으며 AF-DX116의 심박수감소작용에 대한 $ID_{50}$가 $27\;{\mu}g/kg$였다. 제 8흉추부위에 삽입한 전극을 통한 교감신경절전섬유 전기자극에 의해 혈압상승작용 $(24{\pm}1.8\;mmHg)$을 나타냈으며 이 혈압상승작용은 pirenzepine 3, 10, 30 및 $100\;{\mu}g/kg$에 의해 $20{\sim}25%$정도 용량에 관계없이 비슷한 정도로 억제되었으나 AF-DX116 $100\;{\mu}g/kg$에 의해서는 영향받지 않았다. Mecamylamine은 용량의존적으로 이 승압작용을 억제하였으며 mecamylamine의 이 억제작용은 pirenzepine $30\;{\mu}g/kg$에 의해서는 유의하게 강화되었으나 AF-DX116 $100\;{\mu}g/kg$에 의해서는 영향받지 않았다. 척수이단가토에서 McN-A-343 $(100\;{\mu}g/kg)$ 및 DMPP $(100\;{\mu}g/kg)$는 혈압상승작용을 나타냈으며 pirenzepine과 AF-DX116은 McN-A-343의 승압작용은 용량의존적으로 억제하였으나 DMPP의 승압작용에는 영향을 미치지 못하였고 mecamylamine은 양약물의 승압작용을 모두 용량 의존적으로 억제하였다. 이상의 실험성적은 척수가토에서 절전교감신경절 자극에 의한 혈압상승에는 $M_1$수용체의 흥분이 일부 관여하나 $M_2$수용체의 흥분은 관여하지 않으며 교감신경절전달에서 $M_1$수용체의 흥분이 니코틴성 전달을 부분적으로 용이하게 하나 $M_2$수용체는 작용하지 않음을 시사하고 있다. Effects of a $M_1$ receptor antagonist, pirenzepine, a $M_2$ receptor antagonist, AF-DX116, and a nicotinic receptor antagonist, mecamylamine on the pressor responses to preganglionic sympathetic nerve stimulation (PNS) and McN-A-343 and DMPP in spinal (pithed) rabbits were investigated, in order to elucidate a functional role of $M_1$, $M_2$ and nicotinic receptors in ganglionic transmission. Pirenzepine and AF-DX116 selectively inhibited the McN-A-343-induced pressor response in chlorisondamine-treated rabbit and the BCh-induced bradycardia, respectively. Electrical stimulations of preganglionic sympathetic outflow at T8 level produced increases in blood pressure. Pirenzepine $(3\;{\mu}g/kg)$ significantly inhibited the PNS-induced pressor response and the degree of inhibition was not changed by increasing the doses to $100\;{\mu}g/kg$. AF-DX116 $(100\;{\mu}g/kg)$ had no effect on the PNS-induced pressor response. Mecamylamine inhibited the PNS-induced pressor response in a dose-dependent manner. The inhibitory action of mecamylamine was significantly augmented by combined-treatment with pirenzepine $(30\;{\mu}g/kg)$ but AF-DX116 $(100\;{\mu}g/kg)$ did not affect the inhibitory action of mecamylamine. McN-A-343 and DMPP elicited pressor response in the spinal rabbit. Pirenzepine and AF-DX116 dose-dependently inhibited the McN-A-343-induced pressor response but they did not affect DMPP-induced pressor response. Mecamylamine inhibited both pressor responses induced by McN-A-343 and DMPP. These results suggest that not only nicotinic receptors but also $M_1$ receptors play a facilitatory role in ganglionic transmission but $M_2$ receptors do not contribute the transmission in spinal (pithed) rabbits.

배양된 대뇌피질세포에서 산화성 손상에 대한 6R-Tetrahydrobiopterin의 억제작용

문경섭,이제혁,강삼석,김수한,김재휴,정신,김태선,이정길,Moon, Kyung Sub,Lee, Je Hyuk,Kang, Sam Suk,Kim, Soo Han,Kim, Jae Hyoo,Jung, Shin,Kim, Tae Sun,Lee, Jung Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9

Objective : 6R-Tetrahydrobiopterin(BH4) is a cofactor for the aromatic amino acid hydroxylases which is essential for the biosynthesis of catecholamines and serotonin. It also acts as a cofactor for nitric oxide synthase, and stimulates the release of some neurotransmitters such as dopamine, serotonin, acetylcholine and glutamate. Recently, it has been reported that BH4 could induce cellular proliferation and enhance neuronal survival. This study was performed to investigate the antioxidative effect of BH4 on the various oxidative insults in mouse cerebral cortical cell cultures. Methods : Iron ion(FeCl2), zinc ion(ZnCl2), sodium nitroprusside(SNP) and buthionine sulfoximine(BSO, a glutathione depletor) were used as oxidants. Cell death was assessed by measurement of lactate dehydrogenase efflux to bathing media at the end of exposure. Result : All 4 oxidants induced neuronal cell death associated with cell body swelling, which was markedly inhibited by trolox($100{\mu}M$), a vitamin E analog. BH4($10-100{\mu}M$) markedly inhibited the neuronal cell death induced by all 4 oxidants($20{\mu}M\;Cu^{2+}$, $20{\mu}M\;Zn^{2+}$, $1{\mu}M$ SNP or 1mM BSO). However, BH4 failed to inhibit the neuronal cell death induced by 24hr exposure to $20{\mu}M$ NMDA. Conculsion : These results suggest that BH4 has antioxidative action independently of any actions of enzyme cofactor.

소뇌교각부 수막종의 후향적 분석

김상효,김석철,정신,강삼석,김태선,이정길,김재휴,김수한,이제혁,Kim, Sang Hyo,Kim, Suk Chul,Jung, Shin,Kang, Sam Suk,Kim, Tae Sun,Lee, Jung Kil,Kim, Jae Hyoo,Kim, Soo Han,Lee, Je Hyuk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

1) 소뇌교각부 수막종의 빈도는 1.6%, 소뇌교각부 종양의 16%를 차지했고, 14례(82%)가 여성 이었다. 2) 증상은 청신경 장애(12례), 두통(10례), 소뇌장애(9례) 순이었다. 3) 종양은 주로 천막으로 확장 되었고(11례), 병리소견은 16례(94%)에서 양성 이었다. 4) 11례에서 내이도의 후방에, 3례에서 전방에 종양이 위치했고 3례에서는 en-plaque형 수막종 이었다. 5) 수술은 모두 S상 정맥동 후방접근법을 시행하여 14례에서 전적출을 시행하였다. 이중 1례에서 방사선 치료를 시행하였으며, 아전적출을 시행한 3례중 2례에서 방사선 치료를 시행하였다. 6) 제 7 및 8 뇌신경 복합체는 9례에서 종양의 전방에, 4례에서 종양의 후방에 위치했다. 7) 수술후 장기 추적관찰 결과는 16례에서 양호하였으며, 1례에서 사망하였다. 추적검사상 1례에서 재발하였다. Objective : To investigate the postoperative result and prognostic factors in cerebellopontine meningioma. Materials & Methods : During the years 1990 through 1999, a retrospective study of 17 cerebellopontine angle meningiomas was performed. The retromastoid approach was used in all cases : 14 tumors were excised totally and 3 tumors subtotally. Results : Fourteen patents were females with a median age of 58.7 years. The most common presenting complaints were 8th cranial nerve dysfunction and headache. Most of the tumors were large(>4cm) and extended into the tentorial regions. Histological examination revealed benign meningiomas in 16 patients and atypical in one patient. Tumors were located posterior to the internal auditory meatus in 11 cases and anterior in three cases with three cases of en-plaque type. Two of three patients whose tumors were subtotally excised received radiation therapy. Tumor has recurred in one patient. Postoperative result was good in 16 cases with one mortality case. Conclusion : This results suggest that site of 7th-8th cranial nerves complex, en-plaque type meningioma, and petroclival meningioma extended into the clivus were significant prognostic factors. Postoperative radiation therapy is recommended for cases of subtotal resection.

후두 경천막 접근법

정신 ( Shin Jung ),문경섭 ( Kyung Sub Moon ),강삼석 ( Sam Suk Kang ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1

Until the introduction of microsurgery, the surgical result of pineal region tumors was very poor with high mortality and morbidity. However, there have been remarkable improvements with advanced imaging, surgical approaches, and microsurgery. Now the main surgical approaches to pineal region tumors are the occipital transtentorial approach and the infratentorial supracerebellar approach. Surgical techniques of the occipital transtentorial approach are described here. The occipital transtentorial approach is showed to be effective not only for pineal body tumors, but also for superomedial cerebellar tumors. Current operative techniques allow safe, effective removal of pineal region tumors. To date, published results of this operative approach have been excellent with little risk of specific complications including hemianopsia, parenchymal venous infarction, and air embolus. Our surgical results are presented.

자발성 척추 경막외 농양의 수술적 치료

이정길,김수한,김은성,김태선,정신,김재휴,강삼석,이제혁,Lee, Jung-Kil,Kim, Soo-Han,Kim, Eun-Seong,Kim, Tae-Sun,Jung, Shin,Kim, Jae-Hyoo,Kang, Sam-Suk,Lee, Je-Hyuk 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objective : The goal of this study was to recognize the clinical feature and associated risk factors in spinal epidural abscess(SEA), and to improve the outcome accordingly. Methods : A retrospective study was performed in 14 patients with SEA who underwent surgical intervention at our hospital between 1990 and 1999. Results : After a mean follow-up period of 10.2 months(range, 1-57 months), 8 patients had no or minimal deficits, 4 patients had severe paresis or plegia and/or bowel/bladder dysfunction, and 2 patients died due to medical complications. Staphylococcus aureus was the predominant pathogen, isolated in 9 patients(64.3%). Cervical and thoracic spinal epidural abscesses showed a tendency to develop rapidly and were associated with severe neurological deficits. Conclusion : Thoracic spinal epidural abscesses were associated with a poorer prognosis than those in other regions. Therefore, it should be treated more aggressively. Good neurological recovery can be obtained despite severe neurologic deficit when treated by early diagnosis and prompt surgical intervention.

두개골 또는 뇌로 전이된 갑상선암 - 7례 분석 -

김석철,정신,김재성,이정길,김태선,김재휴,김수한,강삼석,이제혁,박재우,이민철,Kim, Seok-Chul,Jung, Shin,Kim, Jae-Sung,Lee, Jung-Kil,Kim, Tae-Sun,Kim, Jae-Hyoo,Kim, Soo-Han,Kang, Sam-Suk,Lee, Je-Hyun,Park, Jae-Woo,Lee, Min-Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Skull or brain metastasis from thyroid carcinoma is rare. Between Jan. 1993. and Jan. 2000. the authors experienced 7 cases of skull(4 cases) or brain(3 cases) metastasis from thyroid carcinoma. Clinical characteristics, radiologic findings and pathologic features were analyzed retrospectively. Among 4 cases of skull metastasis, 3 cases were follicular carcinoma and one was papillary carcinoma with follicular variant. All cases of brain metastasis were papillary carcinoma. We treated the patients by combination with surgical resection, radioactive iodine therapy and radiation therapy. Characteristics of skull or brain metastasis from thyroid carcinoma is reviewed with a pertinent literature.

정위적 뇌생검의 임상분석

김영욱,김재휴,서승권,이정길,김태선,정신,김수한,강삼석,이제혁,Kim, Young Wook,Kim, Jae Hyoo,Seo, Seung Kweon,Lee, Jung Kil,Kim, Tae Sun,Jung, Shin,Kim, Soo Han,Kang, Sam Suk,Lee, Je Hyuk 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.1

Objective : This study was undertaken to evaluate the benefits and risks of the stereotactic biopsy in brain lesions. We assessed the diagnostic accuracy and morbidity rate associated with the stereotactic biopsy. Methods : The authors present a review of 47 patients, who underwent stereotactic biopsy using Cosman-Roberts-Wells(CRW) stereotactic apparatus during last six years. Results : Target locations were supratentorial in 36 cases, infratentorial in 9 and multiple in 2. According to pathological diagnosis, the largest group was neoplasm(29) followed by infection(9), infarction(2), cyst(2), and non-specific(5). Definitive diagnosis could be made in 42 of 47 cases(89.4%). When the mass lesion had been suspected as neoplastic condition, the diagnostic rate was 96.7%(29/30). It was being much higher than that of non-neoplastic lesion, 76.5%(13/17). The treatment modality was changed in 15 cases(32%) because the result of stereotactic biopsy was different from clinical diagnosis. Subsequent craniotomy after stereotactic biopsy was then performed in 6 cases, and the pathological diagnoses were precisely coincident in all of these cases. There were two complications(4.3%) : One intratumoral hemorrhage in glioblastoma and a transient hemiparesis in benign astrocytoma. There was no mortality in this series. Conclusion : The precise histological verification is crucial to determine the adequate treatment modality in intracranial lesions. Stereotactic biopsy is a safe and accurate diagnostic procedure for intracranial lesions with a low complication rate.