안와상 접근법

신규만,송준혁,김명현 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.3

Objective : The approaches for skull base lesions should allow excellent visualization, minimized working distance and avoid brain retraction. We consider the supraorbital approachto be the approach of choice for orbital, anterior and middle cranial fossae lesions. Thetechnique of procedure is described and reviewed its advantages. Material & Methods : the authors reviewed the eleven cases which were operated bysupraorbital approach and one case which were operated by supraorbital bifrontal approach,from May 1992 to May 1996. Results : Eleven patients(four cases of tuberculum sellae meningiomas, one case of pituitarymacroadenoma, two case of suprasellar germinoma, one case of cavernous hemangioma in theorbit, two cases of huge size of craniopharyngiomas, one case of optie and oculomotor nervepalsy due to compound fiacture of orbit) were cured or improved with the supraorrbtal andsupraorbito-bifrontal approsch. But one case of suprasellar germinoma died. Conclusions : The supraorbital approach is preferred in lesions of orbital, anterior and middlecranial fossae, because it minimize brain retraction, shorten the distance of the target of lesionsand provide multiple pathways for dissection of the lesions. Also this approach may combinewith other skull base approaches.

해면상 혈관종의 치료

신규만,송준혁 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.2

Objective : The purpose of this study is to evaluate the clinical informations(symptoms, pathophysiologic phenomena, other associated vascular malformation and outcome) in order to define the guide of the management. Material & Methods : The authors reviewed the 54cases which were diagnosed by the high-resolution MRI and supplemented by computed tomography, from 1991 to 1996. The patho-physiologic phenomena of the CMs were classified into three groups by the finding of MRI. Surgical outcome was analysed according to the type of lesions, clinical variables, and indication of surgical management. Results : The mean patient age was 33.2 years, and the locations of CMs are in the cere-brum in 38 cases, basal ganglia/thalamus in 5 cases, brain stem in 16 cases, orbit in 2 cases and the spinal cord in 1case. Symptomatic hemorrhage were 25 patients(46%), seizure reported 16 patients(30%) and focal neurologic deficit 7(13%). Incidental cases were founded in 6 patients(11%) and their main complaints were headache. In 71% of the patients, the lesions were solitary and multiple in 29%. The 7 patients had coexisting venous angiomas. The A group had 24 patients(44%), B group 16 patients(30%) and the C group 14 patients(26%). Twenty nine patients who were asymptomatic or incidentally discovered lesions(6 patients) were treated conservatively. Twenty five patients(15 hemorrhage, 8 patients of intractable seizure and 2 patients of progressive neurologic deficits) underwent surgery. Conclusion : This study suggest that surgical extirpation of the lesions is an effective management in accessible lesions, overt hemorrhage, medical intractable epilepsy and pro-gressive worsening focal neurologic deficits. Objective : The purpose of this study is to evaluate the clinical informations(symptoms,pathophysiologic phenomena, other associated vascular malformation and outcome) in order todefine the guide of the management. Material & Methods : The authors reviewed the 54cases which were diagnosed by the high-resolution MRl and supplemented by computed tomography, from 1991 to 1996. The patho-physiologic phenomena of the CMs were classified into three groups by the finding of MRI.Surgical outcome was analysed according to the type of lesions, clinical variables, and indicationof surgical management. Results : The mean patient age was 33.2 years, and the locations of CMs are in the cere-brum in 33cases, basal ganglia/thalamus in 5cases, brain stem in 16cases, orbit in 2cases andthe spinal cord in case. Symptomatic hemorrhage were 25patients(46%), seizure reported 16patients(30%) and focal neurologic deficit 7(13%). Incidental cases were founded in 6 patients(11%) and their main complaints were headache. In 71% of the patients, the lesions weresolitary and multiple in 29%. The 7 patients had coexisting venous angiomas. The A group had24 patients(44%), B group 16 patients(30%) and the C group 14 patients(26%). Twenty ninepatients who were asymptomatic or incidentally discovered lesions(6 patients) were treatedconservatively. Twenty five patients(15 hemorrhage, 8 patients of intractable seizure and 2patients of progressive neurologic deficits) underwent surgery. Conclusion : This study suggest that surgical extirpation of the lesions is an efffctivemanagement in accessible lesions, overt hemorrhage, medical intractable epilepsy and pro-gressive worsening focal neurologic deficits.

전교통동맥 동맥류의 조기수술

신규만,송준혁,김명현,최혜영 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.4

Objectives : The timing of aneurysm surgery has been a topic of major neurosurgical controversy. Aneurysmal rebleeding is the most cataclysmic and disabling event following initial subarachnoid hemorrhage. Thus, early surgical obliteration of aneurysm eliminates the potential for rebleeding during the highest risk period. Method : The results of operation for the twenty-three patients who had admitted to neurosurgical departments, Mokdong hospital and undergone surgery within the 24-72 hours after initial rupture of these aneurysms from October, 1993 to August, 1996, were reviewed. Results : Twenty-three patients underwent craniotomy for clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemic, and hemodilution therapy. The outcome was excellent in 10(43%), good in 3(13%), poor in 5(22%) and death in 5(22%). The mean age was 57.7 and the ratio of male to female was 13:10. The outcome according to Hunt-Hess(H-H) grade was followings. H-H grade 1 was 2(%) and all excellent outcome, H-H grade 2 24(61%) and the outcome were excellent in 8(35%), good in 1(4%), poor in 2(9%), death in 3(13%), H-H grade 3 was 6(26%) and good in 2(9%), poor in 2(9%), death in 2(9%), and H-H grade 4 was 1(4%) and the outcome was poor in 1(4%). The outcome according to grading system of Fisher was followings. Grade 2 was 6(26%), and the outcome was excellent in 5(22%) and death in 1(4%). The grade 3 was 14(61%) and excellent in 5(22%), good in 2(9%), poor in 3(13%), and death in 1(4%). The grade 4 was 3(31%) and good in (4%) and poor in 2(9%). The variations in anterior communicating complex were followings. The both A_1 equal in 6(26%), left A_1 dominancy was 1(4%), right A_1 atresia was 13(57%) and left atresia was 3(13%). Conclusions : The most favorable outcomes and lowest mortality rate were patients of H-H grade 1 group. The surgical results of alert patients with early surgery should even further improve as compared to delay surgery. However, patients who present in poor medical condition at the time of operation were still indicated delay surgery.

뇌동맥류 파열 후 뇌지주막하 출혈로 인한 신경학적으로 불량한 환자에 대한 급성기 수술의 성적

신규만,김명현,송준혁,김성학 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.2

Objective: Despite of recent advances in pharmacological treatment and improvement surgical and anesthetic techniques, subarachnoid hemorrhage(SHA) from ruptured intracranial aneurysms with poor clinical grades still carries unacceptably high morbidity and mortality rates. Recently surgery for aneurysmal SAH with poor clinical grade has increased interest. Method : The authors experienced 57 patients with poor clinical grade (Hunt and Hess grade Ⅳ-Ⅴ) after ancurysmal SAH. Among them 25 patients were treated with immediate CSF drainage via ventriculostomy, blood pressure control, early angiography(except 3 patients) and surgery within 12 hour of admission. The outcomes of patients were categorized using a four-tiered scale : 1) independent and working 2) impaired but independent 3) severly impaired and dependent 4) dead Results : The average age was 48(13-75) and the male to female ratio was 7:18 in surgical group. The average time to admission and surgery was 12 hours or less among the 25 patients. Among them 9 cases were dead, 2 cases were severly impaired and dependent, 3 cases were impaired but dependent, and 11 cases were independent and working. In this patient all cases, exception one could be ligated with a clip. Conclusion : The above results suggest that the acute aggressive surgery based on appropriate selection in poor aneurysmal SAH patients can reduce of the mortality.

실비우스 수도를 경유한 뇌낭미충 낭종의 이주 -증례 보고-

김정훈,송준혁,김명현,박향권,김성학,신규만,박동빈 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.4

두개강내 정맥기형들과 동반된 안와내 해면상 혈관종 1례

조도상,송준혁,김명현,박향권,김성학,신규만,박동빈 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.6

가토의 뇌동맥류 모형에서 모동맥 및 동맥류 협자에 따른 동맥류 내압의 변화 :기초 연구

김은영,송준혁,김명현,박향권,김성학,신규만,박동빈 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.4

지방척수수막류 14례의 임상 분석 : Clinical Analysis of 14 Cases

이정호,신규만,김명현,송준혁,박향권,김성학,박동빈 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

Lipomyelomeningocele is the most common malformation leading to spinal cord tethering. Nonetheless, these lesion continues to pose a challenge in patient management. The purpose of this study was to identify the clinical feature, candidate for surgical repair, and outcome of lipomyelomeningocele in young children and adults. We studied the magnetic resonance images and/or lumbar myelo-CT of lipomyelomeningocele performed between January 1987 and September 1995 at our institutions and reviewed the pertinent medical records and radiologic studies to determine clinical feature, surgical candidate, and outcomes of these patients. Of the 14 cases(11 female and 3 males) studied, the most common factor that caused these patients to seek help was the cosmetic effect of the mass on their back, followed by urinary incontinence, and weakness of lower extremities. The patients' age ranged from 2 months to 21 years(mean, 5.0 years). All the patients underwent immediate surgical management that consisted of removal of lipoma, untethering of the cord, and complete dural sac repair. Follow up for these patients ranged from 6 to 82 months(median, 54 mo). None of the patients that underwent surgical correction before the emergence of neurological deficit had ever developed neurological deficits at the end of the follow up. However a few of the patients, despite presented with neurological deficits or urinary incontinence at the time of surgery, improved significantly. In conclusion, early detection and prophylactic surgery is imperative to prevent permanent neurological deficits and urinary dysfunction.

상 요추 추간판 탈출증의 수술적 치료

조태현,송준혁,김명현,박향권,김성학,신규만,박동빈 梨花女子大學校 醫科大學 醫科學硏究所 2000 EMJ (Ewha medical journal) Vol.23 No.3

Objectives : Lumbar disc herniations at the L1-L2, L2-L3, and L3-L4 level are rare. The purpose of this study is to observe the variable clinical finding of upper lumbar disc herniations and to provide proper treatment modality. Patients and Methods : Between 1998 Jan. and 1999 Dec., seventeen patients with upper lumbar disc herniations who were undergone surgery in our institute were retrospectively evaluated. Patients were evaluated based on following factors : age, sex, aggravating factor, symptoms and signs type of disc herniation, type of surgery, and outcome of post-surgery. Results : The incidence of lumbar disc herniation at the level of L1-2, L2-3 and L3-4 is 6.1% with declining frequency as the level ascends. The peak age incidence is 6th decade in both sex. Preoperative symptomes and signs are variabe. In sixteen cases, posterior approach was done. In these cases, twelve cases were performed microscopic partial hemilaminectomy, and four cases with spinal stenosis were performed total laminectomy and posterior screw fixation with bone fusion. In one case, lateral extracavitary approach was done. In results of operation, fourteen cases showed more than good grade(82%). Conclusion : The age incidence of lumbar disc herniations at the level of L1-2, L2-3 and L3-4 older than lumbar disc herniations at the lower level of L4-5 and L5-S1. The signs and symptoms are variable. In our cases, most of the patients were performed posterior approach with microscopic partial hemilaminectomy except the patients combined spinal stenosis. One case was performed a lateral extracavitary approach because the risk of the cord and cauda equina injuries. The prognosis of upper lumbar disc herniations after treatment with only microscopic partial hemilaminectomy and diskectomy is comparable with the prognosis of lumbar disc herniations at the lower level.

후궁성형술로 치료한 경추 척수병증 환자에서 방사선학적 소견이 예후에 미치는 영향

김석준,송준혁,김명현,박향권,김성학,신규만,박동빈 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.7