배양조건에 의한 일과성 저산소상태 후 신경세포회복의 차이

문수현,오재인,박윤관,정흥섭,이훈갑,이기찬,Moon, Soo-Hyeon,Oh, Jae-Inn,Park, Youn-Kwan,Chung, Heung-Sub,Lee, Hoon-Kap,Lee, Ki-Chan 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objective : The transverse hippocampal slice is one of the most commonly studied in vitro models of mammalian brain physiology. However, despite its broad usage, there has been no standardization of slice preparation techniques or recording condition. It is well known that variations in recording conditions can result in profound different effects to neuronal responses. Evoked field potentials, recorded extracellularly, were used to investigate the effects of variations in hippocampal slice preparation protocol on hypoxia responses of CA1 neurones. Material & Methods : Before hypoxic injury, hippocampal slices were incubated for 4 hours. During incubation period, the slices were placed in a incubation chamber($21^{\circ}C$) for recovery from preparation injury and then transferred to recording chamber($34^{\circ}C$) for more recovery and baseline electric recording with current stimulation(0.1Hz). Various time periods in incubation chamber and recording chamber were applied to each experimental group(group 1=60min : 180min, group 2=90min : 150min, group 3=180min : 60min, time in incubation chamber : time in recording chamber) before 10 min hypoxia produced by replacing 95% $O_2$+5% $CO_2$ mixed gas to 95% $N_2$+5% $CO_2$ gas. Calcium, Magnesium ions and several drugs effecting on glutamate receptor also were studied. Recoveries from hypoxic injury of hippocampal slices were estimated by percent recovery of population spike(PS). Statistic analysis of study were performed using paired t-test. Results : The percent recovery of PS after 10min hypoxia was considerably enhanced by increasing the period of current stimulation during incubation period before hypoxic injury. Temperature effect on the result of this experiment was also studied(group 4) but the result from this showed no statistic significance. Low magnesium ion concentration of artificial CSF(Mg-free aCSF) during incubation period enhanced the recovery of PS but low calcium (calcium-free) and high magnesium ion concentration(2mM) reduced it after hypoxic injury. L-glutamate($100{\mu}M$) and AP-5($50{\mu}M$) had no effect on the recovery of PS but CNQX($10{\mu}M$) in artificial CSF during incubation period markedly enhanced the recovery of PS. Co-treatment of AP-5($50{\mu}M$), CNQX($10{\mu}M$) and high magnesium concentration(2mM) enhanced recovery of PS in immediate following period of hypoxic injury but the effect of cotreatment after then decayed rapidly and lost statistic significance. Conclusions : Judging from above results, the condition of baseline recording is important in observing the recovery of population spike after hypoxia, and the time and the condition should be controled more strictly to obtain reliable results.

소아에서 뇌수두증의 단락술 이후 발생한 석회화된 만성 경막하 혈종 - 증례보고 -

박준오,권택현,박윤관,정흥섭,이훈갑,서중근,Park, Juno,Kwon, Taek-Hyun,Park, Youn-Kwan,Chung, Hung-Seob,Lee, Hoon-Kap,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Post-shunting subdural hemorrhages are usually small and self-limited, and they can be recognized on the routine post-operative CT examinations. However, delayed subdural bleeding may occur without any clinical symptoms or signs. Thus the hematoma remains undetected, and it can be increased in size and sometimes become calcified with time. We experienced a case of 15-year-old male with a large calcified subdural hematoma who had undergone shunt operation 10 years previously. With pertinent review of the literatures, we discuss the possible mechanism of calcification and the proper way of treatment in calcified chronic subdural hematoma.

불완전하게 결찰된 뇌동맥류의 혈관내치료 - 증 례 보 고 -

임동준,정용구,조태형,이훈갑,김세훈,김근회,권택현,정흥섭,박정율,박윤관,이기찬,서중근,Lim, Dong-Jun,Lee, Hoon-Kap,Cho, Tae-Hyoung,Chung, Yong-Gu,Kim, Se-Hoon,Kim, Keun-Hoe,Kwon, Taek-Hyun,Chung, Heung-Seob,Park, Jung-Yul,Park, Youn-Kwan,L 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Residual aneurysm is a challenging problem after clipping procedure for the aneurysms. The anthors describe one patient in whom endovascular treatment was sucessfully done to treat residual aneurysm after surgical clipping. We discussed the role of endovascular coil occlusion in case of incomplete surgical obliteration of aneurysms.

뇌간에 발생한 단발성 뇌낭미충증 - 증례보고 -

박준오,정용구,임동준,조태형,이훈갑,이기찬,서중근,Park, Juno,Chung, Young-Gu,Lim, Dong-Jun,Cho, Tae-Hyong,Lee, Hoon-Kap,Lee, Ki-Chan,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Isolated brainstem invlovement of neurocysticercosis is rare. We present the clinical and radiological features of a patient with a solitary cysticercus granuloma in the brainstem confirmed by MRI and CSF ELISA test. Good response was obtained from conservative treatment, using praziquantel. We believe that patients from regions where cysticercosis is endemic, who have no systemic disease, who present with nonprogressive symptoms and signs of brainstem involvement, and display a solitary ring-enhancing mass in the brainstem measuring less than 20mm on neuroimaging may be managed conservatively.

단일 국소방사선 조사 후 백서 대뇌 피질의 초급성기 변화에 대한 연구

강신혁,정용구,김한겸,김철용,이훈갑,Kang, Shin-Hyuk,Chung, Yong-Gu,Kim, Han-Kyum,Kim, Chul-Yong,Lee, Hoon-Kap 대한신경외과학회 2005 Journal of Korean neurosurgical society Vol.37 No.5

Objective: We investigated the morphologic changes within 24 hours after a single ${\gamma}$-irradiation in the rat brain. Methods: Forty Sprague-Dawley rats were used. After a burr hole trephination on right parietal area, cerebral hemisphere was irradiated with 2Gy and 5Gy using iridium-192($^{192}Ir$), respectively. The effect was assessed at 4, 8, 12 and 24 hours after irradiation. The histological changes were scored following the detection of edema or disarray severity. TUNEL-positive cells exhibiting apoptotic morphology were counted in irradiated region. Results: Cortical edema and disarray were initially showed at 4 or 8 hour and almost all defined at 24 hour after irradiation. And the injury was wedge shape. TUNEL-positive cells were minimal at 8 hour after irradiation as the number of positive cells were $2.6{\pm}5.27$(n=5) after 2Gy, and $0.8{\pm}0.84$(n=5) after 5Gy. But, the number of apoptotic cells were increased markedly to $60{\pm}6.24$ at 12 hour after 2Gy and to $104{\pm}19.7$ at 24 hour after 5Gy. Conclusion: There were prominent morphologic changes immediately after ${\gamma}$-irradiation. And, apoptosis was increased according to the time period. These findings implicate that brain irradiation induces rapid apoptotic change, which may play an important role in the pathogenesis of radiation-induced pathologic conditions.

Craniopharyngioma : Comparison of Tumor Characteristics Relevant with Initial Symptomatology between Children and Adults

박동혁,박정율,김주한,정용구,이훈갑,이기찬,서중근,Park, Dong Hyuk,Park, Jung Yul,Kim, Joo Han,Jung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.8

목 적 : 두개인두종은 적어도 일부분이 상부 터어키안에 존재하는 양성종양이다. 그러나 이 종양으로 인한 증상과 징후는 종양의 위치뿐만 아니라 그 크기와 환자의 나이등에 영 향을 받는다고 알려져 있다. 이번 연구에서 본 저자들은 성인과 소아에서 증상과 연관된 두개인두종의 임상적 특징을 후향적으로 분석하였다. 방법 및 대상 : 1990년부터 1999년까지 두개인두종으로 치료를 받은 23명(성인 : 16명, 소아 : 7명)을 대상으로 종양의 크기, 성장양상과 주변조직으로의 침윤정도와 증상과의 연관성을 연구하였다. 분석을 위해 16명의 성인(남자 : 8명, 여자 : 8명, 평균연령 : 43.7세)과 7명의 소아(남자 : 5명, 여자 : 2명, 평균연령 : 10.1세)에게 MRI 및 CT를 시행하였으며 3차원적으로 종양의 부피를 측정하였다. 결 과 : 두개인두종에서 3대 주증상은 두개강 내압상승과 연관된 증상, 내분비 기능 이상, 시력이상이다. 종양의 크기는 소아군에서 성인군보다 컸으며 시력이상, 두개강 내압 상승과 연관된 증상, 뇌수두증도 소아군에서 더 많았다. 그러나 내분비 기능 이상과 시상하부와 시상, 뇌하수체, 전두엽과 다른 피질부위와 연결의 이상으로 인한 신경정신적과적인 증상은 성인군에서 더 많았다. 결 론 : 이번 연구에서 두개인두종은 종양의 크기와 침윤성은 두개강 내압 항진과 연관된 증상 및 시력 증상과 연관이 많으며 소아군에서 더 흔하게 나타났다. 하지만 종양의 성장 양상은 소아군과 성인군에서 주된 차이를 발견하지 못했다. Objectives : The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. Material and Methods: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M : F=8 : 8, mean age : 43.7 years) and 7 children(M : F=5 : 2, mean age : 10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. Results : The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.

Unilateral Hydrocephalus in Congenital Atresia of the Foramen of Monro

김종현,정용구,이남준,김세훈,이훈갑,이기찬,서중근,Kim, Jong Hyun,Chung, Yong Gu,Lee, Nam Joon,Kim, Se Hoon,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.3

일측성 수두증은 여러가지 원인에 의해 발생될 수 있으나 주로 종양이나 감염등에 의한 후천적인 몬로공 폐쇄의 경우가 대부분이고 선천성 몬로공 폐쇄에 의한 일측성 수두증은 그 예가 많지 않다. 산전초음파 검사로 태아의 선천성 일측성 수두증을 진단했고 출산 후 수술적 방법을 통해 치료한 예는 국내에 아직 보고된 바가 없어 이를 문헌고찰과 함께 보고한다. Unilateral hydrocephalus is an uncommon disease which may result from obstruction of the foramen of Monro. Congenital or acquired lesions obstructing this foramen have been reported. We present a case of prenatally diagnosed fetal unilateral hydrocephalus. Ventriculoperitoneal shunt operation was performed and following the procedure, ventricular size was decreased and patients neurological status was improved.

전 교통 동맥 동맥류 치료의 예후인자

박준오,권택현,박윤관,정흥섭,이훈갑,서중근,Park, Juno,Kwon, Taek-Hyun,Park, Youn-Kwan,Chung, Hung-Seob,Lee, Hoon-Kap,Suh, Jung-Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : The anterior communicating artery(ACoA) is known to be the most frequent location of intracranial aneurysms, but the complex arterial anatomy of the ACoA region makes this aneurysm among the most difficult one to treat. In the treatment of ACoA aneurysms, the direction of aneurysmal fundus is known to be very important in the surgical tactics. All ACoA aneurysms in our series were classified according to its direction, and analyzed the clinical features in order to investigate the prognostic factors influencing upon the surgical outcome. Methods : The authors reviewed 236 cases of ruptured ACoA aneurysms that were operated from 1990 to 1997, were classified according to Pia's classification. Results : The incidence rate of the ACoA aneurysm was 35.1%(236/672). Ventral group was more common than dorsal group, especially in ventro-caudal projection subgroup(36.0%). Poor preoperative clinical grade(Hunt-Hess grade IV and V) patients were more common in dorsal group(13.1%) than ventral group(2.6%). Rebleeding and intracerebral hematoma were more commonly seen in ventral group. However, vasospasm, hydrocephalus, hyponatremia, and intraventricular hemorrhage were observed more frequently in dorsal group. Worse outcome was more common in dorsal group than ventral group, especially in dorso-caudal projection subgroup. Also, poor outcome was identified in patients with intracerebral hematoma, intraventricular hemorrhage, hyponatremia, and hypertension, although statistically insignificant. In cases with the A1 dominancy, there was no difference in surgical outcome between the right and left side approach. The higher the aneurysmal neck from the planum sphenoidale, the worse outcome via pterional approach. Conclusion : It seems that the preoperative clinical grade, aneurysmal direction, and the height of aneurysmal neck, especially in the pterional approach, would be the major prognostic factors, and that intracerebral hematoma, intraventricular hemorrhage, hyponatremia, hydrocephalus and the intraoperative aneurysmal rupture would be the minor prognostic factors.

당뇨 환자에서 경막외 농양과의 감별을 요한 원발성 척추 경막외 임파종 - 증례보고 -

김세훈,임동준,조태형,정용구,이훈갑,이기찬,서중근,Kim, Se Hoon,Lim, Dong Jun,Cho, Tai Hyoung,Chung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.3

척추 경막외 임파종은 전체 임파종의 7%정도를 차지하며, 가장 흔한 증상으로 척수 압박 증세를 유발하는 것으로 알려져 있다. 그 중에서도 원발성 척추 경막외 임파종, 즉 다른 장기의 침범 소견 없이 척추에만 국한되어 나타난 임파종은, 당뇨병 환자에서 급성 척수 압박 증상으로 나타났을 때, 척추 경막외 농양과의 감별을 요한다. 저자들은 48세의 여자 당뇨 환자에서 흉추부의 통증으로 내원 1개월 전까지 여러 차례 침술치료를 받고 난 후 통증이 악화되고 급성 하반신 부전마비와 배뇨 장애 및 감염 징후가 있어 본원에 내원하여, 병력과 제반 검사상 수술전에 척추 경막외 농양으로 진단되었던 원발성 척추 경막외 임파종 1례를 수술 치험하고 보고하는 바이다. Primary spinal epidural lymphoma(SEL), i.e. occurring in the absence of any detectable extraspinal lymphoproliferative disorder, is an unusual cause of spinal cord compression. The authors report a 48-year-old, diabetic woman presented with back pain followed by acute paraparesis and voiding difficulty. She had been treated with acupunctures on her back before admission, and complete blood count showed leukocytosis with neutrophilia and increased erythrocyte sedimentation rate(ESR). Thoracic spine magnetic resonance imaging(MRI) revealed an epidural mass extending from T5 to T8 with compression of the spinal cord. Emergency decompressive laminectomy was performed with a tentative diagnosis of spinal epidural abscess, but a B-cell lymphoma was final pathologic diagnosis. Further staging showed no other sites of lymphoma, and the spinal lesion was treated by chemotherapy and radiotherapy. The authors stress that primary SEL can mimic spinal epidural abscess(SEA) in the diabetic patient and should be a diagnostic consideration in patients with a syndrome of acute spinal cord compression manifested by a prodrome of back pain and neuroimaging consistent with an epidural compressive lesion, especially in a diabetic.

포장술을 시행한 뇌동맥류의 치료 성적

권택현,정흥섭,박윤관,조태형,임동준,박정율,정용구,이훈갑,이기찬,서중근,Kwon, Taek Hyun,Chung, Hung Seob,Park, Youn Kwan,Cho, Tai Hyoung,Lim, Dong Jun,Park, Jung Yul,Chung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objective : Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. Method : Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. Result : Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. Conclusion : It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.