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변박장,권귀향 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
The author report a case of venous malformation within cerebellar hemisphere presenting of hemorrhage. A 35-year-old male was admitted due to sudden onset of vertigo 1 week before admission. Computed tomography (CT) showed lobar shape intracebellar hemorrhage, subcortical cerebellar hemorrhage. Follow up enhanced CT scan showed a large curbilinear draining vein. conventional angiogram disclosed pathognomomic "caput medusae " or "star cluster" shape venous malformation. After conservative treatment for 2 months, subjective symptoms were near totally recovered.
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卞博章,崔淳官,李仁洙 순천향의과대학 1979 Journal of Soonchunhyang Medical Science Vol.2 No.4
The authors describe a patient with intraventricular hemorrhage from an intra cerebral arteriovenous malformation of the occipital lobe which was fed by parietooccipital branch of right posterior cerebtal artery. The CT brain scan contributed to give further information such as intraventicular hematoma which was not found at cerebral arteriography. Much more frequently the malformations are located in superficial or cortical areas and relatively rare. Intracerebral origin is the general pictures of cerebral AVM are discussed.
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소아의 두뇌 손상후 속발된 공뇌증(Porencephaly) 2례
변박장,문충배,이인수 順川鄕病院 1976 順天鄕醫報 Vol.1 No.2
Case 1 is a boy of 5 7-ears, sustained craniocerebral injury and the emergency operation revealed subdural hematoma of ca 100 cc in the left frontal region with diffuse cerebral contusion, the hematoma was removed, and the craniectomy remained a skull defect of ca 7 cm in diameter on the left frontal region. The patient had been in a coma vigil state for two months there-after. When cranioplasty was made 7 months later, we found a large porencephaly in the left frontoparietal region which communicated broardly with the underlying left lateral ventricle. Case 2 is a boy of 3 months, sustained craniocerebral injury to make a linear fracture on the left parietal region and subdural hematoma of ca 60 co on the right frontoparietal region with diffuse cerebra1 contusion. The emergency operation was done to remove the hematoma, and left a skull defect of ca 4 cm in diameter on the right frontoparietal region. There-after the patient had remained in chronic coma like state and the skull had not grown any more. The head circumference had been in 41 cm till the age of 1 year and 5 months. Craniosrnostosis had occurred. At age of 11 months, in 8 months after the emergency operation we had performed the second operation to correct the craniosynostosis, while we found a large porencephaly in the right frontoparietal region which communicated broardly with the underlying right lateral ventricle. And also we ascertained that the development of the brain was ceased to make the secondary microcephaly with the craniosynos tosis. These two children gave rise to the large porencephaly in the frontoparietal area of one cerebral hemisphere as the later complication of the craniocerebral injury like a congenital porencephalic cyst.
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1. 06㎛ Nd : YAG Laser를 이용한 요추간판탈출증의 경피적 수핵감압술
이흥선,변박장,최순관,신원한,권귀향,이인수,이경석,김범태 순천향대학교 1994 논문집 Vol.17 No.4
The 1.06㎛ Neodymium-YAG Laser(800 micron hemisherical) is revealed a useful tool for percutaneous laser disc decompression(PLDD). Especially PLDD would be applied to the management of lumbar disc herniation with minimal intervention. Total irradiated energy to one level of disc space was bout 1000 to 2000 joules. We performed this method at 10 levels, in 7 cases of patients, consisting of 4 males and 3 females with an average age of 37.7 years. Five cases showed excellent and good results, were observed. In two cases, open surgery was required because of unsatisfactory results. The best results were obtained in the protrusion type of disc herniation. We have summarized some advantages of PLDD: a) safe and simple procedure in an outpatient setting, b) avoiding general anesthesia, late spinal instability, c) possibility of repetitive use.
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박원호,김범태,변박장 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.1
Authors compared the surgical outcome of ruptured intracraniai aneurysms in all of 400 patients with their age, sex, admission day from ictus and history of hypertension. The radiological findings with Fisher grade of subarachnoid hemorrhage, hydrocephalus, aneurysmal multiplicity, location of aneurysm, size of aneurysm and the intervals and incidences of clinical vasospasm and rebleeding were investigated. The relationship between preoperative neurological grade and early versus late surgical outcome, causes of unfavorable outcome in the aggravated group were evaluated together. And they were analyzed statistically with a multiple logistic regression model for the retrospective research of the 10 years period from 1984 to 1993. The results were as follows: 1) Age ranged from 19 to 78 years old and the mean of them was 52 years old. The proportion of male and female was each 154 cases (38.5%) and 246 cases(61.5%) and the ratio of them was 1:1.6. 2) The 105 cases (26.2%) of the early surgery (ES) operated less than 3 days from ictus, and the 295 cases (73.8%) of the late surgery (LS) operated with the lapse of more than 3 days from ictus. 3) The duration of hospitalization distributed from a day to 444 days and the average period of them were 26 days in the case of ES and 42 days in the case of LS respectively. 4) The distribution of the preoperative neurological grade appeared 6.7% in grade 1, 67.8% in grade 2, 12.3% in grade 3, 9.3% in grade 4 and 3.0% in grade 5 by Hunt and Hess classification respectively. 5) The history of hypertension were noted each 49 cases in the ES and 130 cases in the LS, and the percentage of them was 45% of all. 6) The proportion of the Fisher grade from 1 to 4 appeared 7.5%, 47.3%, 24% and 17.2% in order respectively. 7) The hydrocephalus occurred 15 cases in the ES and 47 cases in the LS. 8) The radiological finding of aneurysmal multiplicity revealed to 353 cases (88.2%) in single, 39 cases (9.8%) in two and 8 cases (2.0%) in more than three of aneurysms respectively. The site of ruptured aneurysm noted anterior communicating artery in 141 cases (35.2%), internal cerebral artery in 121 cases (30.2%), middle cerebral artery in 107 cases (26.8%), anterior cerebral artery in 19 cases (4.8%) and vertebro-basilar artery in 12 cases (3.0%) respectively. The size of aneurysm was less than 3mm in 15 cases (3.7%), 3∼10mm in 302 cases (75.5%), 11∼25mm in 78 cases (19.5%) and more than 25mm in 5 cases (1.3%). 9) The intervals of clinical vasospasm were less than 3 days in 9 cases, between 4∼7 days in 18 cases, between 8∼14 days in 19 cases, between 15∼21 days in 7 cases, more than 21 days in 6 cases and their incidence occurred to 14.8%. The intervals of rebleeding were less than 3 days in 9 cases, between 4∼7 days in 8 cases, between 8∼14 days in 4 cases, between 15∼21 days in 4 cases, more than 21 days in 3 cases and their incidence occurred to 7%. 10) The causes of unfavorable outcome were initial massive bleeding in 44 cases, delayed ischemic deficit in 11 cases, surgical procedure in 10 cases, medical problem in 2 cases, hydrocephalus in one case and others in 2 cases. The follow-up periods following discharge ranged from one month to more than 24 months in 221 cases (55.3%) of all. 11) In the cases of ES, the percentages of the improved group including a good recovery and moderate disabled state, and those of the aggravated group including a severe disabled state, vegetative state and death were 85% and 15% respectively according to Hunt grade 1, 2 and 3 at admission. In the case of LS, those of the improved groupand the aggravated group were 90% and 10% respectively, but there were not significant to the surgical outcome with the time difference between early and late surgery (P>0.05). Factors affecting the surgical outcome were rebleeding, clinical vasospasm and past history of hypertension (P<0.05). In conclusion, the decision of operation timing between early and late surgery must be considered according to the preoperative neurological grade with the above mentioned prognostic factors and additional supports of the prospective study.
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