뇌정위적 정신수술의 장기 추적 결과

손병철,김문찬,이철,강준기,Son, Byung-Chul,Kim, Moon-Chan,Lee, Chul,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : Stereotactic psychosurgery is known as one of effective means of treating in some medically intractable psychiatric illness. However, it is unfamiliar and it's long-term clinical result has not reported in our country. The authors evaluated its long-term results of pscychosurgery and discussed its neuroanatomical basis. Methods : Since 1993, eight patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses. All were referred from psychiatrist of these disorders, one was aggressive behavior, five were obsessive-compulsive disorders(OCD), and two were depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were done for aggressive behavior, and limbic leukotomy was done for OCD and depression with anxiety. The results of OCD were evaluated with with YBOCS(Yale-Brown obsessive compulsive scale) and VAS (visual analogue scale), CGI(clinical global impairment) in OCD, and OAS(overt aggression scale), MMS, WAIS were checked for the evaluation of aggressive behavior. Hamilton depression scale(HAMD) was used for evaluation of depression. Ventriculography was used in the first five patients and MR-guided stereotaxy was used in recent three cases for localization of target. The lesions were made with radiofrequency lesion generator. Results : With long-term follow up(mean 45 months) in five OCDs, mean YBOCS declined from 34 to 3(n=5). All returned to previous social life. In OAS scores of aggressive behavior during six-year follow up, scores declined from 8 to 2 with clinical improvement. In two patients with depression with anxiety, HAMD declined from 28.5 to 16.5(n=2). There was no operative mortality and no significant morbidity except one case of mild transient urinary incontinence. Conclusion : With these long-term results, authors assumed that stereotactic psychosurgery could be one of safe and effective mtherapeutic methods in several medically intractable psychiatric illness.

중뇌종양에 의한 적핵진전에 대한 Vim 시상핵절제술 - 증례보고 -

손병철,김문찬,류경식,강준기,Son, Byung-Chul,Kim, Moon-Chan,Ryu, Kyung-Sik,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

This 26-year-old man gradually developed a disabling midbrain tremor involving both distal and proximal part of left upper arm. On neurologic examination, oculomotor palsy, and ataxia of the left arm were noted. Radiologic examination revealed a mass lesion on midbrain tegmentum. He was tentatively diagnosed as brain tumor (presumably germinoma) without stereotactic biopsy. Conventional radiation therapy was given for this lesion. Although there was improvement in the radiologic imaging, his midbrain tremor worsened and became untolerable. The authors performed MR-guided stereotactic Vim-thalamotomy. With macroelectrode stimulation and radiofequency lesioning, his resting, postural and action tremors were almost completely abolished in both distal and proximal part of left upper extremity. Authors consider that Vim thalamotomy is still an effective means of controlling midbrain tremor involving proximal upper limb.

C형 간염의 진단을 위한 역전사중합효소연쇄반응과 효소면역측정법의 타당성 평가

손병철,전진호,박영홍,신해림,조규일,김종한,정귀옥,이종태,이채언,백낙환,Son, Byung-Chul,Chun, Jin-Ho,Park, Yeong-Hong,Shin, Hai-Rim,Cho, Kyu-Il,Kim, Jong-Han,Jung, Kui-Oak,Lee, Jong-Tae,Lee, Chae-Un,Paik, Nak-Whan 대한예방의학회 1995 예방의학회지 Vol.28 No.2

This study was conducted to estimate the validity of reverse transcriptase-polymerase chain reaction(RT-PCR) compared to enzyme immunoassay(EIA) for the detection of hepatitis C virus (HCV) infection. EIA for antibody to HCV(anti-HCV) and RT-PCR for HCV was executed on the subjects from Pusan and Kyungnam area with questionnaire survey to collect some relating factors of HCV infection. As the result from 617 cases, the prevalence of HCV infection was 1.5% by EIA and 3.7% by RT-PCR(p<0.05), and the age standardized rate was 1.7% and 3.4% by EIA and RT-PCR, respectively. The prevalence of hepatitis B surface antigen(HBsAg) was 6.8% by enzyme linked immunosorbent assay(ELISA) and the age standardized rate was 7.7%. It was the higher in male group comparing to female group(p<0.01). Both of the prevalence of HCV and HBsAg were higher in elevated asparate aminotransferase(AST) and alanine aminotransferase (ALT) group than in normal AST and ALT group(p<0.01). There was no specific risk factor of HCV infection. Though the degree of agreement of EIA and RT-PCR by gamma statistics was 97.2%, it showed a significant difference between the two methods(p<0.01). For the detection of HCV infection, positive predictive value of EIA was 66.7% and negative predictive value of EIA was 97.2%. This study suggests that negative result to anti-HCV by EIA didn't mean the free state of HCV infection, therefore it would be helpful that further monitoring for HCV infection by RT-PCR in the case of elevated AST and ALT and/or clinically suspected.

뇌실로 파열되어 있는 뇌농양에 대한 뇌정위적 내시경하 제거술 - 증례보고 -

손병철,김문찬,강준기,Son, Byung-Chul,Kim, Moon-Chan,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

The major indication of endoscope in neurosurgical field is intraventricular procedures. Recently, it can be used selectively in the intraaxial mass lesion associated cavity. For example, cystic mass, with liquefied necrosis, and blood clot can be approached with this technique. The authors present its usage in brain abscess ruptured into lateral ventricle. The neuroendoscope was introduced into abscess cavity through stereotactic guidance, the pus was then removed through continuous irrigation and suction under direct video visualization. The intraventricular pus was also cleaned through gentle, direct endoscopic irrigation and suction. The postoperative clinical course was uneventful. Brief overview is given for this intraaxial neuroendoscopic procedure.

Crouzon 증후군 환아에서 시신경 감압

손병철(Byung Chul Son),양승호(Seung-Ho Yang),전신수(Sin Soo Jeun),이상원(Sang Won Lee) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.1

Six-year old boy with Crouzon’s syndrome underwent reconstruction and frontoorbital advancement for brachycephaly 3 years ago. The vision of the left eye had been gradually decreased for 3 months recently. Finger count apart from 30cm was failed. Visual acuity of the right eye was 0.4. The optic disc of the left eye was pale. Visual evoked potentials (VEP) of the left side showed the delayed latency compared with that of the right side. There was no symptom of increased intracranial pressure. Extradural anterior clinoidectomy and optic canal decompression was performed via small temporal craniotomy. The vision of the left eye was improved to 0.05. We report a case of Crouzon’s syndrome underwent optic canal decompression for the treatment of visual deterioration. Optic canal decompression could be effective for vision recovery in patients with Crouzon’s syndrome initially underwent craniofacial surgery.

선형가속기를 이용한 뇌수막종의 뇌정위적 방사선수술

류경식,손병철,김문찬,서태석,계철승,윤세철,강준기,Ryu, Kyung-Sik,Son, Byung-Chul,Kim, Moon-Chan,Suh, Tae-Suk,Kay, Chul-Seung,Yoon, Sei-Chul,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Objective : To evaluate the role of stereotactic LINAC radiosurgery in treatment of meningiomas, the authors retrospectively analyzed the result of radiosurgery in our institute. Method: During last ten years, twenty patients underwent stereotactic LINAC radiosurgery(LINAC SRS) for meningiomas. The mean age of the patients was 51 years(22-78 years). The most common tumor location for radiosurgery was parasagittal, sphenoid wing and tentorial area. With regards to indications of radiosurgery for meningiomas, LINAC radiosurgery was done for primary treatment in six patients, for postoperative residual tumors in eleven patients, for postoperative regrowth in three patients. Mean tumor volume was $5.14cm^3$($0.28-15.1cm^3$), mean field diameter was 2.01cm(1.2-3cm). The mean marginal dose was 20.55Gy(13-30Gy). The follow-up evaluation was done annually with radiologic findings and clinical status. The mean follow-up period was 46.8(24-120) months. Result : In the radiologic response, the tumor volume was reduced in five(25%) of twenty patients, fourteen showed arrested growth(70%), but one patient showed increased growth(5%). In the clinical response, nine patients improved clinically(45%), ten patients was stable(50%) and one patient worsened during follow-up period. With regards to correlation with radiologic and clinical response, in nineteen patients who showed radiologic response to radiosurgery(decreased and arrested growth after radiosurgery), nine patients(47.4%) improved and ten patients (52.6%) showed no change, one patient(5%) had symptomatic radiation necrosis at four years after SRS, which needed craniotomy. Conclusion : The overall control rate of meningiomas with LINAC radiosurgery was 95% in radiologic follow up and 95% clinically. The radiation complication rate was 5%. These results indicate that LINAC radiosurgery can be considered as safe and effective method for meningiomas.

이차성 삼차신경통에서 경피적 고주파 삼차신경절제술에 의한 동통조절 효과

강승범,손병철,김문찬,강준기,Kang, Seong-Buhm,Son, Byung-Chul,Kim, Moon-Chan,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.1

Objective : There are many treatment modalitis in management of idiopathic trigeminal neuralgia. In the secondary trigeminal neuralgia, there has been only sporadic reports of the etiology. Authors report the treatment result of secondary trigeminal neuralgia with percutaneous radiofrequency rhizotomy. Methods : During last ten years, 129 trigeminal neuralgias were treated by percutaneous radiofrequency(RF) rhizotomy by authors. Among them, nine patients were secondary trigeminal neuralgias. These patients refused treatment for the primary cause and only wanted pain control. The offending lesions were three arachnoid cysts, six tumors. The mean age was 47.8 years and the mean duration of follow-up was 6.2 years. The right V2,3 distribution was most prevalent area of pain. Authors used the conventional Hartel's anterior approach and straight electrode for RF lesion generation. Result : The early result was satisfactory. Eight of nine patients became free of pain and one patient needed minimal dose of carbamazepine. The overall pain control was 100%. There was no mortality or morbidity for initial RF rhizotomy. During follow-up, four patients showed recurrence of pain(44%). Among these, two underwent repeated RF rhizotomy and became free of pain. The other two were controlled with medical management. Conclusion : These results indicate that the percutaneous RF rhizotomy is effective means of pain control. Overall recurrence was somewhat higher than that of idiopathic trigeminal neuralgia. Even with recurrence, however, repeated RF rhizotomy seems to be effective method of control of pain in these cases.

크롬 취급 사업장의 작업환경 및 근로자 폭로 실태에 관한 연구

유병철,손병철,전진호,손혜숙,한용수,이채언,정운,Yu, Byung-Chul,Son, Byung-Chul,Jun, Jin-Ho,Han, Yong-Soo,Son, Hye-Sook,Lee, Chae-Eun,Jeong, Woon 대한예방의학회 1994 예방의학회지 Vol.27 No.3

For the purpose of providing the basic data for health management of workers who are exposed to chromium and for improving the quality of working environment, the authors evaluated blood and urinary level of chromium, the occupational history. AST, ALT, Hb, Hct, nasal specular examinaton on 287 workers who have been dealed chromium compounds in 56 manufacturing Industries of five types, that is, 38 metal plating services(plating),4 manufacture of other fabricated metal products (fabricated metal product), 5 manufacturing of dyestuff(dyestuff), 6 dressing and dyeing of leather(leather), 3 others(manufacture of pottery and ceramic househod wares, motor vehicles, electronic valves and tubes and other electronic components) and also measured the level of chromium in air from February to October 1993. The results were as follows ; 1. The utilized type of chromium compounds was the hexavalent state in plating fabricated metal product dyestuff, leather and the trivalent state in .other, and atmosperic chromium concentration as geometric mean was $0.0138mg/m^3(0.001{\sim}0.068mg/m^3)$ in plating, $0.0115mg/m^3(0.006{\sim}0.015mg/m^3)$ in fabricated matal product, $0.068mg/m^3(0.002{\sim}0.019mg/m^3)$ in dyestuff, $0.0083mg/m^3(0.002{\sim}0.028mg/m^3)$ in leather $0.0039mg/m^3(0.003{\sim}0.005mg/m^3)$ in other by the type of industry and it exceeded TLV-TWA ($0.05mg/m^3$) in five (13.6%) of plating services. 2. The geometric mean of chromium in blood was $1.54{\mu}g/dl(0.10{\sim}3.62{\mu}g/dl)$ in Plantng, $0.94{\mu}g/dl(0.27{\sim}2.82{\mu}g/dl)$ in fabricated metal product, $0.51{\mu}g/dl(0.10{\sim}3.25{\mu}g/dl)$ in dyestuff, $0.87{\mu}g/dl(0.15{\sim}8.00{\mu}g/dl)$ in leather, $0.55{\mu}g/dl(0.20{\sim}2.28{\mu}g/dl)$ in other by the type of industry(p<0.001). 3. The geometric mean of chromium in urine was $14.47{\mu}g/l(6.90{\sim}28.00{\mu}g/l)$ in planting, $4.63{\mu}g/l(0.24{\sim}43.00{\mu}g/l)$ in fabricated metal product, $5.93{\mu}g/l(1.00{\sim}33.00{\mu}g/l)$ in dyestuff, $11.09{\mu}g/l(0.80{\sim}48.00{\mu}g/l)$ in leather, $12.41{\mu}g/l(10.10{\sim}41.00{\mu}g/l)$ in other by the type of industry(p<0.001). 4. As the result of nasal specular examination, twenty four cases (8.4%) of nasal septal perforation among 287 total subjects was observed, and there were 17 (9.7%) cases in plating, 4 csaes (14.3%) in dressing and dyeing of leather. In the comparison of chromium concentration in blood and urine between the perforated group and non-perforated group, the perforated group showed a significantly higher value as $1.883{\pm}3.055{\mu}g/dl\;and\;0.793{\pm}0.815{\mu}g/dl$(P<0.001), $21.31{\pm}34.610{\mu}g/L\;and\;9.304{\pm}11.079{\mu}g/L$ (P<0.001). 5. The mean concentration of chromium in blood, urine and the mean level of AST, ALT, Hb and Hct in exposure group were higher than those of control group(p<0.001).

경도 두부외상 환자에서 뇌좌상주위 부종영역에서의 자기공명분광법을 이용한 대사변화

홍상수,손병철,최병길,김의녕,김범수,박춘근,최보영,김문찬,강준기,Hong, Sang-Su,Son, Byung-Chul,Cho, Byung Gil,Kim, Euy-Nyeng,Kim, Bum-Soo,Park, Chun-Kum,Choe, Bo-Young,Kim, Moon-Chan,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objectives : In order to evaluate the metabolic changes associated with pericontusional edematous area in mild head injury, proton magnetic resonance spectroscopy(1H-MRS) was performed in mild head injury patients (initial GCS score 13-15) with focal brain contusion. Methods : Seven head injury patients with initial GCS 13-15(3 males and 4 females : age range 15-65 years, mean age 33 years) have underwent 1H-MRS evaluations. The patients were examined within 7 days after injury(n=7) and 2 months after injury(n=5). The region of interest(ROI) was selected in the edematous area adjacent to traumatic brain contusion upon T2-weighted MR images and a corresponding region of the contralateral hemisphere (ROC, region of contralateral corresponding hemisphere) was examined as well. The metabolic ratios of NAA/Cr and lactate/Cr were compared between ROIs, ROCs and control values. Results : In initial NAA/Cr ratios, the values of ROIs were significantly lower than those of the controls(p=0.009), but there was no difference either between ROIs and ROCs(p=0.410) or between ROCs of patients and the control (p=0.199). In lactate/Cr ratios, the ROIs in all seven patients and the ROCs in two showed increased lactate signals. The lactate/Cr ratios of the ROIs were significantly elevated as compared to those of the ROCs(p=0.02) and the control(p=0.015). In two months follow-up, lactate signals were absent or significantly reduced(p=0.015). In no patients, clinical or radiological deterioration has been observed. Conclusion : Our 1H-MRS results demonstrate that there are significant ischemic changes in pericontusional edematous areas as indicated by elevated lactate signals in the patients with mild head injury. But there were no consistent neural loss or dysfunction in these area. There findings suggest that pericontusional edematous areas can be vulnerable to secondary brain insults even in the patients with mild head injury.

뇌수막종에서 선형가속기를 이용한 방사선수술 효과

계철승(Chul Seung Kay),윤세철(Sei Chul Yoon),정수미(Su Mi Chung),유미령(Mi Ryung Ryu),김연실(Yeon Sil Kim),서태석(Tae Suk Suh),최규호(Kyuho Choi),손병철(Byung Chul Son),김문찬(Moon Chan Kim) 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.2

목 적 :뇌수막종 환자들을 대상으로 선형가속기를 이용한 방사선수술을 시행한 결과에 대하여 환자의 임상적 증상과 방사선학적 추적검사를 통해 그 효과를 알아보고자 하였다. 대상 및 방법 : 1988년 7월부터 1998년 8월까지 20명의 뇌수막종 환자들을 대상으로 6 MV 선형가속기를 이용하여 방사선수술을 시행하였다. 20명의 환자들 중 4명(20%)은 남성, 16명(80%)은 여성이었으며, 평균연령은 51세(22∼78세)였다. 종양의 뇌내 위치는 측시상동 부위(parasagittal area)와 접형골 부위(sphenoid wing)가 8례(40%)로 가장 많았다. 방사선 수술 전에 시행한 신경외과적 수술의 횟수를 보면 1회 시행한 경우가 11례, 2회가 2례, 3회 시행한 경우가 1례였으며, 수술을 시행하지 않고 방사선수술만을 시행한 경우는 6례였다. 종양의 평균 부피는 5.72 cm3 (0.78∼15.1 cm3)였으며, 2차 시준기(secondary collimator)의 지름의 중간 값은 2 cm (1∼3 cm)이었다. 종양변연부의 평균조사량은 19.6 Gy (9∼30 Gy)였다. 추적관찰기간은 2.5∼109개월로 중앙값은 53개월이었다. 결 과 :방사선학적 검사와 신경학적 검사상 모두 반응률은 95%였다. 방사선추적검사상 종양의 부피가 줄어든 경우는 5례(25%), 종양의 부피에 변화가 없는 경우는 14례(70%), 그리고 종양의 부피가 증가된 경우가 1례(5%)였다. 종양의 부피가 증가된 1례를 제외한 19명의 환자중, 4명의 환자에서 추적 영상 검사상 중심부괴사의 소견이 보였다. 임상적 증상의 호전여부에 따른 신경학적인 검사상 증상의 호전이 있었던 경우는 9명(45%), 증상의 변화가 없었던 경우는 10명(50%)였다. 증상이 악화되었던 1명(5%)의 환자는 수술을 시행하여, 방사선 괴사의 소견을 보였다. 결 론 :뇌수막종 환자들에서 선형가속기를 이용한 방사선수술은 부작용 없이 시행할 수 있는 효과적인 치료법으로 생각된다. Purpose : To evaluate the role of linac based radiosurgery (RS) in the treatment of meningiomas , we retrospectively analyzed the results of clinical and follow up CT/MRI studies . Methods and Materials : From the 1988 July to 1998 April, twenty patients of meningioma had been treated with 6 MV linear accelerator based radiosurgery. Of the 20 patients , four (20%) were ma le and 16 (80%) were female. Mean age was 51 years old (22∼78 years old). Majority of intracranial location of tumor for RS were parasagittal and sphenoid wing a rea. RS was done for primary treatment in 6 (30%), postoperative res idual les ions in 11 (55%) a nd regrowth after surgery in 3 (15%). Mean tumor volume was 5.72 cm3 (0.78∼15.1 cm3) and secondary collimator s ize was 2.04 cm (1∼3 cm). The periphery of tumor margin was prescribed with the mean dose of 19.6 Gy (9∼30 Gy) which was 40∼90% of the tumor center dose. The follow up duration ranged from 2.5 to 109 months (median 53 months). Annual CT/MRI scan was checked. Results : By the follow up imaging studies , the tumor volume was reduced in 5 cases (25%), arrested growth in 14 cases (70%), and increased s ize in 1 case (15%). Among these respons ive and stable 19 patients by imaging studies , there showed loss of contrast enhancement after CT/MRI in four patients . In clinical response, nine (45%) patients were cons idered improved condition, 10 (50%) patients were stable and one (5%) was worsened to be operated. This partly resulted in necros is after surgery. Conclusion : The overall control rate of meningiomas with linac based RS was 95% by both imaging follow- up and clinical evaluation. With this results , linac based RS is cons idered safe a nd effective treatment method for meningioma.