전방 또는 전측방 흉수 종양 수술에서 후측방도달법

조경석,박춘근,성재훈,허필우,박춘근,백민우,김달수,강준기 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.5

완전뇌허혈후 재관류시에 국소뇌혈류, 체성감각유발전위 및 신경학적 회복에 대한 Mannitol과 Thiopental의 효과

박춘근,이상원,박영섭,최승진,허필우,정동섭,강준기,최창락 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

The cardiopulmonary bypass or cerebral circulation arrest is often used in the treatment of complex aneurysm or of arteriovenous malformation to decrease the risk of intraoperative aneurysm rupture. Although experimental studies have suggested that some drugs may protect the brain from ischemic injury, there are limitations in maintaining cerebral perfusion arrest without incurring neurologic deficits due to the initiation of detrimental processes including excitotoxic neuronal injury, activation of phospholipases, influx of calcium, and generation of damaging free radicals. The purpose of this study is to determine wheter mannitol or thiopental has any favorable effects on the recovery of neurologic deficits and on the regional cerebral blood flow(rCBF), somatosensory evoked potential(SEP) and electroencephalogram(EEG) in cats which underwent 15 minutes-complete global ishcemia-reperfusion. The complete global ischemia was produced in 38 cats by temporary intrathoracic occlusion of the innominate artery and the subclavian artery following ligation of bilateral mammary arteries and simultaneous induction of hypotension. The cats were allocated randomly to one of 4 treatment groups : (1) control group, 8 cats received equal volume of saline solution : (2) thiopental group, 10 cats received 45㎎/㎏ thiopental intravenously, (3) mannitol group, 10 cats received 2g/㎏ mannitol intravenously, (4) combined mannitol and thiopental group, 10 cats received equal dose of mannitol and thiopental intravenously. The drugs were administrated in a equally divided dosage before and after the ischemic episode. The results were as follos : 1) Eight animals which received saline showed the severe postischemic hypoperfusion and poor recovery of SEP and EEG, and 6 of them died within 6 hours after the ischemia. 2) Ten thiopental-treated animals also showed the severe postischemic hypoperfusion and poor recovery of SEP and EEG, and 6 of them died within 6 hours the ischemia. 3) Both mannitol-and combined treated groups showed early recovery of EEG, good recovery of SEP and EEG without the severe postischemic hypoperfusion, and 7 of 10 mannitol-treated animals and 8 of 10 combined treated animals were significantly recovered in all parameters. There were not significant differences in all parameters between the mannitol-and combined treated groups. 4) Thirty-four of 38 animals involved in this 15 minutes-ischemia resulted in the severe neurologic deficits inspite of treatment with mannitol, thiopental or both of them. These results suggest that, in cats, mannitol treatment is effective but not thiopental in preventing severe neurologic injury following complete global ischemia and the duration of complete ischemia should be far less than 15 minutes.

LY341122, a Novel Inhibitor of Lipid Peroxidation, Reduces Focal Ischemic Brain Damage in Rats After Middle Cerebral Artery Occlusion

Huh, Pil-Woo,Belayev, Ludmila,Zhao, Weizhao,Clemens, J.A.,Panetta, J.A.,Busto, Raul,Fernandez, G.,Ginsberg, Myron D. 가톨릭대학교 2000 Bulletin of The Catholic Research Institutes of Me Vol.28 No.-

Introduction : LY341122 [2-(3,5-di-t-butyl-4-hydroxyphenyl)-4-(2-(4-methylethylam inomethyl-phenyloxy)ethyl) oxazole is a potent inhibitor of lipid peroxidation and a free radical scavenger, which has been shown to protect against global ischemia and traumatic brain injury in rats. The purpose of this study was to examine the effect of LY341122 on ischemic injury in a highly reproducible model of middle cerebral artery occlusion (MCAo) in rats. Methods : Male Sprague-Dawley rats (270-330g) were anesthetized with halothane and subjected to 120 min of temporary MCAo by retrograde insertion of an intraluminal nylon suture (1) coated with poly-l-lysine (2) through the external carotid artery into the internal carotid artery and MCA. The drug (LY341122; n=19) or vehicle (PBS, n=10) was administered i.v. (5 or I0mgf/kg bolus and 5 or 10mg/kg/h infusion for 20 h starting 1h or 2h after onset MCAo). Heating lamps were used to maintain rectal and temporalis muscle temperatures at 37 to 37.5℃. Mean arterial blood pressure (MABP), plasma glucose and blood gases were repeatedly measured. The neurological status was evaluated during occlusion (60 min) and daily for 3 days after MCAo; a grading scale of 0-12 was employed, as previously described (2). Three days after MCAo, brains wereperfusion-fixed and infarct volumes and brain edema were determined. (Data in figures represent mean values ± S.E.M.) Results : Rectal and cranial (temporalis muscle) temperatures, MABP, plasma glucose and blood gases in the 29 animals of this study showed no significant differences between groups. LY341122 significantly improved The neurological socre compared to vehicle at 24h, 48 and 72h after MCAo (5mg/kg [2h]; 10mg/kg [1h] and 10mg/kg [2h], Fig.1) Treatment with LY341122 significantly ) reduced total (cortical and subcortical) corrected infarct volume in all treated groups compared tovehicle rats (Fig. 2). When considered separately, cortical infarct volume was significantly reduced by treatment with drug in the LY341122 10mg/kg [1h] and LY341122 10mg/kg [2h] groups compared to vehicle rats(14.7 ± 95 vs. 106.8 ± 20.9㎣, and 36.9 ± 20.1 vs. 106.8 ± 20.9㎣, respectively; p<0.005 and p<0.04). Cortical infarct areas were also significantlysmaller in treated rats than in the vehicle groups at multiple coronal levels (Fig 3, 4). Striatal infarct volume was significantly reduced by treatment with LY341122 in the LY341122 10mg/kg [1h] group compared to the vehicle groups (23.7 ±3.4 vs. 63.2 ±6.7㎣,p<0.004). Conclusions : These results suggest that LY341122, when administered in a dose of 5 or 10mg/kg at 1 or 2 hours after MCA occlusion, confer neuroprotective effects on neurological score and infarct volume compared to vehicle-treated rats. It is important to note that this neuroprotective effect of LY341122 was demonstrated with postischemic administration. (Journal of Cerebral Blood Flow and Metabolism [Suppl. 1]19:S186, 1999)

Intracranial Atherosclerotic Disease; Current Options for Surgical or Medical Treatment

Huh, Pil-Woo,Yoo, Do-Sung The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.42 No.6

Recently, intracranial atherosclerosis has become a major cause of ischemic stroke, appearing more frequently in Koreans than Caucasians. Symptomatic or asymptomatic intracranial atherosclerosis is a disease that could recur readily even during the treatment with anti-platelet agents. When the symptoms develop, ischemic stroke can not be recovered readily. Therefore, aggressive treatments such as endovascular therapy and bypass surgery are required in addition to medical treatment for the intracranial artery stenosis. Recent intracranial stenting and drug eluting stenting have shown as very advanced effective therapeutic modalities. Nevertheless, until now, a randomized controlled study has not been conducted. Regarding bypass surgery, since the failed EC-IC bypass surgery study performed 20 years ago, extensive studies on its efficacy has not been conducted yet, and thus it has to be performed strictly only in hemodynamically compromised patients. Unless breakthrough drugs that suppress the progression of intracranial atherosclerosis and the formation of thrombi, and facilitate the regression of the arterial stenosis, the treatment concept of the recovery of the blood flow of stenotic arterial territory by mechanical recanalization or bypass surgery would be remained for the prevention as well as treatment of ischemic stroke caused by intracranial atherosclerosis.

The Effect of Hypertension and Increased Infratentorial Intracranial Pressure on the Frontal cortesx, Pontine cerebral blood flow and Auditory Evoked Postentials in expermental Cat Models

Huh, Pil-Woo,Kang, Joon-Ki Catholic Medical Center 1995 Bulletin of the Clinical Research Institute Vol.23 No.1

뇌전산화 단층촬영을 이용한 41예의 뇌정위생검상 수술전 CT 소견과 조직소견의 비교분석

허필우,김문찬,강준기,송진언 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.2

CT guided stereotactic biopsies were carried out in 41 patients with tumorous CT findings during past 2 years. In 27 tumorous CT conditions impressed as glioma, meningioma, metastatic ca, chondroma, germinoma and craniopharyngioma, 16 cases were disclosed correctly in preoperative clinicalradiological diagnosis comparing with pathological diagnosis confirmed by means of stereotactic biopsy, but other 11 cases, showed the preoperative diagnostic error which pathological diagnosis were infarction, cryptical AVM, abscess, granuloma, and tumors such as lymphoma, oligodendroglioma, GBM, chordoma. Among 12 granulomatous CT lesions 3 cases showed preoperative diagnostic error, which were confirmed infarction, multiple sclerosis by pathological diagnosis. The pathological findings of 2 vascular lesions that were impressed as infarction and old hematoma were confirmed as granuloma and GBM. The error of preoperative clinical- CT diagnosis was 39% of total 41 patients. The advantage of preoperative stereotactic biopsy is to confirm the correct histological diagnosis, while it can help the patient and surgeon for the planning of further proper therapy.

후두와의 뇌압상승과 혈압의 증가가 전두엽 뇌피질과 뇌교 혈류 및 청각유발전위에 미치는 영향

허필우,정동섭,나형균,박춘근,강준기 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7

Patients with extra~axial mass lesions of the posterior fossa frequently demonstrate signs of brainstem dysfunction These dysfunctions may be induced by the change of regional cerebral blood flow and electrophysiological statatus as well as mechanical compression and distortion of the brainstem frontal cortical regional cerebral blood flow (rCBF). pontine rCBF. brainstem auditory evoked potentials(AEPs). infratentorial intracranial pressure(infratentorial ICP)and mean arterial blood pressure(MABP) were recorded before and after expansion of an infratentorial epidural balloon in anesthetized experimental cat models After the elevation of MABP during the increased infratentorial ICP. frontal cortical and potine rCBF, AEPs were recorded every 30minutes The results suggest that the elevating the MABP to improve cerebral perfusion pressure before irreversible change occures in the brain may preserve cerebral function We conclude that if the volume of the space in the posterior fossa that is occupied by the mass can be estimated brain damage from low rCBF and brain compression due to intracranial hypertension can be prevented by the elevation of MABP before irreversible damage of the brain occures

실험적 뇌수종시 뇌실확장에 대한 체성감각 유발전위 변화

허필우,조병일,이재수,조경석,정철구,박춘근,백민우,김문찬,김달수,강준기,최창락 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.2

We investigated the somatosensory evoked potentials(SEPs) changes and subsequent changes of the ventricular enlargement in different stages of kaolin-induced hydrocephalus. 8 week-old fifty five cats weighing 900g to 1300g, were studied in this experiment. These animals were divided into 2 groups ; a normal control(5 cats), kaolin-induced hydrocephalic groups(50 cats). The kaolin-induced hydrocephalic groups was subdivided into 5 subgroups of 10 cats each ; kaolin induced 1,2,4,6 and 8 weeks hydrocephalic groups after an intracisternal injection of the kaolin. At the each stage of the kaolin-induced hydrocephlalic animals, the following parameters were obtained : somatosensory evoked potentials(SEPs) and the size of enlargement of the ventricles at the each stage of 1, 2, 4, 6 and 8 weeks after intracisternal kaolin injection. The results were as follows : 1) A significant elevation of the intracranial pressure(ICP) was observed in 2 weeks after kaolin injection and peak valus(ICP : 10.2±0.9 ㎜Hg) in 4 weeks after kaolin injection. 2) The mean latencies of these wave components in somatosensory evoked potentials(SEPs) responses were 6.27±0.12 msec in Po, 8.41±0.25 msec in No, and 12.55±0.36 msec in P₁and he mean central conduction time(P₁-Po) was 6.10±0.16 msec in the normal control animals. 3) Changes of amplitude and latency in SEPs were more porminent in 4 weeks after kaolin injection and progressively prolonged latencies of each wave components and CCT were resulted in 6 and 8 weeks after kaolin injection. 4) In hydrocephalic animals, the size of the ventricle(septum pellucidum(SP)-caudate nucleus(CN) distance) was moderately increased to 5.19±0.43 ㎜ in 1 week after kaolin injection and continued to increase in maximum size up in the 4th week after injection. However there was no further increase in ventricular size after 4th weeks. 5) A close correlation was found between SEPs and ventricular enlargement at the each stage of kaolin-induced hydrocephalic animals. In conclusion, it is assumed that the detection of SEPs in hydrocephalus is a quite valuable prognostic tool to evaluate the functional integrity of the nerve conduction system near the paraventricular area which might be involved ventricular enlargement.

고혈압성 피각출혈 환자에서 신경학적 상태의 변화에 따른 치료의 결과 분석

허필우,박영섭,정동섭,이길송,최승진,박춘근,이상원,최창락 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

One hundred and twenty four patients with hypertensive putaminal hemorrhage were analyzed by time course. All patients were brought to the emergency room within 3 hours after the ictus. Seventy three patients were conservatively treated and 51 patients operatively. The neurologic condition of each patient was evaluated by means of the Glasgow coma scale(GCS) score every 1 hour. CT scan of the brain of these patients were taken within 6 hours after the ictus. Clinical severity of the putaminal hemorrhage was graded as rapid deterioration, slow deterioration, and non deterioration by the CT and neurological status. A precise time course analysis of putaminal hemorrhage were compared with the conservative group and surgical group in a 7 hospital day period. Outcome was assessed 6 months later based on the degree of functional recovery(DOFR). The overall mortality was 16.1% and surgical mortality was 13.7%. Surgical treatment for the rapidly deteriorating patients appears to be beneficial when compared with the slowly deteriorating patients. Outcome of the non deteriorating patients didn't show any differences in the quality of life regardless of treatment modality.

급성 및 만성 요통에 대한 Mucoril 치료효과

이일우,허필우,조태훈,김문찬,강준기 최신의학사 1988 最新醫學 Vol.31 No.4