수술 중 뇌동맥류 파열에 대한 임상 분석

백원철,고현송,김윤,Baek, Won-Cheol,Koh, Hyeon-Song,Kim, Youn 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : Intraoperative rupture of an intracranial aneurysm can interrupt a microsurgical procedure and jeopardize the patient's chance to favorable outcome. The purpose of this study was to analyse and evaluate intraoperative aneurysmal rupture and render ideal prevention and management to intraoperative rupture. Patients and Methods : The authors retrospectively analysed the results of 609 patients who underwent cerebral aneurysm surgery from January 1991 to December 2000. Results : 1) Intraoperative aneurysmal rupture occurred in 73 of 609 consecutive aneurysm surgery, so the incidence was about 12.0% and it was relatively lower than other reports. 2) Aneurysms arising from anterior communicating artery appeared more prone to intraoperative rupture. 3) The size of aneurysm and timing of operation didn't influence intraoperative aneurysmal rupture and temporary clipping didn't reduce the incidence of intraoperative aneurysmal rupture. 4) Intraoperative aneurysmal rupture occured during three specific periods : (1) dissection stage in 61%, (2) clip application stage in 29 %, (3) predissection stage in 10%. 5) In the patients with intraoperative aneurysmal rupture, surgical outcome was relatively good and there was no significant difference in outcome compared with unruptured group. Conclusion : Our suggestion for prevention methods of intraoperative aneurysmal rupture are as follows : 1) minimal brain retraction, 2) sharp and careful aneurysmal neck dissection, 3) gentle clipping with proper clip selection etc. Management methods after intraoperative aneurysmal rupture are as follows : 1) strong aspiration of bleeding point, 2) rapid application of temporary and/or tentative clip, 3) following rapid dissection of neck and proper clip application, 4) use of encircling clip etc.

자발성 뇌실질내 출혈 환자에서 혈종 증가의 위험 인자에 대한 분석

이용묵,고현송,염진영,김성호,송시헌,김윤,Lee, Yong-Mook,Koh, Hyeon-Song,Youm, Jin-Young,Kim, Seong-Ho,Song, Shi-Hun,Kim, Youn 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objective : The purpose of this study was to evaluate the risk factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). Methods : A series of 214 ICH patients diagnosed by brain CT scan in our neurosurgery department from June 1995 to July 1998 were reviewed with clinical status, past medical histories, laboratory findings, CT findings and prognosis. Results : In 27 patients(12.6%), the second CT scan showed an enlarged hematoma. Age, sex, and site of hematoma were not related to hematoma enlargement. A long interval(>6 hours) between the onset and the 1st CT scan strongly reduced the incidence of hematoma enlargement. The incidence of hematoma enlargement significantly increased in patients with previous history of hypertension, cerebral infarction and ICH. This analysis also demonstrated the following independent factors predisposed to hematoma enlargement : initial high systolic blood pressure, high serum total protein, low serum albumin, low serum sodium, prolonged prothrombin time(>14 sec) and activated partial thromboplastin time(>29.5 sec), irregular hematoma shape, and combined intraventricular hemorrhage. Prognosis in the group of hematoma enlargement showed high mortality(48.1%) and poor outcome. Conclusion : Patients with previous history of hypertension, cerebral infarction and ICH, and with high systolic blood pressure, prolonged coagulation time, irregular hematoma shape and intraventricular hemorrhage in CT scan should be observed carefully. And, early surgical therapy of large hematoma and meticulous control of blood pressure may decrease the mortality and morbidity in patients with spontaneous ICH.

뇌동맥류 파열에 의한 지주막하 출혈 후 수두증 발생의 위험 인자에 대한 임상 연구

최정재,고현송,조준희,김선환,염진영,송시헌,김윤,Choi, Jeong-Jae,Koh, Hyeon-Song,Cho, Jun-Hee,Kim, Seon-Hwan,Youm, Jin-Young,Song, Shi-Hun,Kim, Youn 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Objective : The authors analyzed the incidence, the cause and the prognosis of hydrocephalus following aneurysmal subarachnoid hemorrhage to evaluate the risk factors of hydrocephalus and to provide the proper treatment method for hydrocephalus following aneurysmal subarachnoid hemorrhage. Methods : The 505 cases of subarachnoid hemorrhage followed by aneurysmal surgery from January 1990 to May 1999, were divided into shunt group and shunt-free group and we were reviewed for the clinical status, Fisher's grade, brain CT findings and prognosis. Results : The incidence of acute hydrocephalus was 37.2% of patients and 18.9% to developed chronic hydrocephalus. Shunt surgery due to chronic hydrocephalus was required in 6.5% of patients. We found following variables were significantly related to shunt-dependent hydrocephalus : high Hunt-Hess and Fisher grade, initial CT findings of intraventricular hemorrahge, posterior circulation aneurysm, preoperative rebleeding, delayed ischemic deficits, and initial high ventricular size index. There were no statistically significant relationships between shunt-dependent hydrocephalus and patient age or sex, timing of operation. The previous hypertension was not related to shunt dependent hydrocephalus. Prognosis in shunt group showed poor result. Conclusion : The risk factors of hydrocephalus following aneurysmal subarachnoid hemorrhage are high Hunt-Hess grade, high Fisher's grade, aneurysms of posterior circulations, preoperative aneurysmal rebleeding, delayed ischemic deficits, initial CT findings of intraventricular hemorrahge and initially increased ventricular size. The patients with these factors should the carefully observed and managed accordingly due to poor prognosis related to hydrocephalus requiring shunt operation.

반복적인 소뇌 출혈로 발현한 후두와 모세혈관 확장증 - 증례보고 -

이용묵,고현송,조준희,염진영,송시헌,김윤,Lee, Yong-Mook,Koh, Hyeon-Song,Cho, Jun-Hee,Youm, Jin-Young,Song, Shi-Hun,Kim, Youn 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Hemorrhage due to capillary telangiectasia is rare. We report a case of capillary telangiectasia presenting with repeated cerebellar hemorrhage in a 38-year-old male. To our knowledge this is the first case of repeated cerebellar hemorrhage from the capillary telangiectasia. At the first operation, we removed hematoma only, but rebleeding occurred repeatedly in the same area. Finally, we evacuated the recurrent hematoma and vascular mass of capillary telangiectasia at the second operation under surgical microscope. Based on the findings of this case and a review of the literature, we conclude that capillary telangiectasia can be the cause of the massive repeated hemorrhage.

뇌량 주위 동맥 근위부에 발생한 외상성 뇌동맥류 - 증례보고 1예 -

우원철,송시헌,고현송,염진영,김성호,김윤,Woo, Won Cheol,Song, Shi Hun,Koh, Hyeon Song,Yeom, Jin Young,Kim, Seng Ho,Kim, Youn 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Traumatic aneurysm is a rare complication of head trauma. Unfortunately, it is rarely recognized until their presence is heralded by delayed deterioration or intracranial hematoma, etc,. Early diagnosis and surgical treatment are most important for good outcome. We recently encountered a patient who developed a pericallosal aneurysm after major trauma. With a high index of suspicion about traumatic aneurysm, brain MRI and MRA were performed. Definitive diagnosis was made by transfemoral carotid angiography, revealing a aneurysm of the right proximal pericallosal artery. The aneurysm was explored through right interhemispheric approch. A $15{\times}15mm$ sized traumatic aneurysmal sac, located in proximal portion of right pericallosal artery was noted. It was dissected from the falx of cerebri and its neck was clipped. The postoperative course was uneventful. Traumatic intracranial aneurysm should be suspected in any patient who deteriorates after the trauma. Early recognition and prompt treatment are warranted in this setting. Definitive surgical treatment of all traumatic intracranial aneurysm is recommended.

교모세포종 환자의 여명에 관련된 인자 분석

우원철,송시헌,고현송,염진영,김성호,김윤,Woo, Won Cheol,Song, Shi Hun,Koh, Hyeon Song,Yeom, Jin Young,Kim, Seong Ho,Kim, Youn 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objectives : The Objective of this study was to analyze the prognostic factors affecting survival in the patients with glioblastomas. Methods : We retrospectively studied 55 consecutive patients with glioblastomas who were admitted to neurosurgery department from January 1988 to March 1998. Fifteen pateients were excluded from the analysis because of follow-up loss and surgical motality. There were 24 male and 16 female patients, with a mean age of 51 years. Surgery consisted of biopsy in 4(10.0%) patients, subtotal resection in 9(22.5%) patients and gross total resection in 27(67.5%) patients. Nine(22.5%) patients received second operation. Twenty-eight(70%) received postoperative radiation therapy. Various levels of radiation dose were used, 6,000 rad over 7 weeks in most cases. The variable factors were examined for their relationship with survival ; age at the time of diagnosis, gender, duration of neurological symptoms, preoperative neurological state(Karnofsky performance score), extent of surgical resection, location of tumor, reoperation, and postoperative radiotherapy and chemotherapy. Result : The mean survival time was 55 weeks, three(7.5%) of the 40 patients survived more than two years. Survival time with biopsy only cases was 24 weeks, for those with subtotal resection 43 weeks, and for those with gross total resection 67 weeks. A mean survival time from the time of reoperation was 42 weeks. Statistically significant survival factors in glioblastoma were extent of surgical resection, postoperative radiotherapy and reoperation. Summary : Results of our series support the views that the extent of surgery, reoperation and postoperative radiation are important prognostic factors. We also recommend radical tumor removal, postoperative radiotherapy and reoperation, if possible.

신경초종과 유사한 아령형 형태의 상부경추 골외 척추척삭종 1례 - 증례보고 -

백원철,염진영,김선환,고현송,송시헌,김윤,Baek, Won-Cheol,Youm, Jin-Young,Kim, Seon-Hwan,Koh, Hyeon-Song,Song, Shi-Hun,Kim, Youn 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

The authors report a case of an extremely rare extraosseous chordoma in the upper cervical spine of a 70-year-old woman, which occupied the intradural and extradural portions, simultaneously. She underwent the operation with C2,3 total laminectomy and grossly total removal and postoperative radiation therapy. Extraosseous chordoma was very rare in the literatures. In addition, it was the first reported case of the extraosseous chordoma occupeid the intradural and extradural portions, simultaneously. And extraosseous chordoma must be distinguished from ecchordosis physaliphora, which is benign nature, usually asymptomatic.

연수의 낭종성 혈관아세포종 1예 -증례보고-

김선환 ( Seon Hwan Kim ),송시헌 ( Shi Hun Song ),고현송 ( Hyeon Song Koh ),염진영 ( Jin Young Youm ),김윤 ( Youn Kim ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1

Hemangioblastomas of the medulla oblongata are benign vascular neoplasms that malignantly locate. Most of tumors are solid and cystic natures are extremely rare in medulla oblongata. We experienced a cystic hemangioblastoma located in medulla oblongata and successful treated by surgical excision. A 47-year-old man with a 3-months history of paresthesia on left upper extremity and trunk. MRI revealed a cystic mass with enhancing small nodule on dorsal portion of medulla oblongata. Using a suboccipital craniectomy the tumor was totally removed. The authors report a rare case of cystic hemangioblastoma in medulla oblongata and review the literatures.

CoCl₂ 처리로 유도된 hypoxia상태에서 세포자살과 ER stress에 관련된 인자의 발현

Seon-Hwan Kim(김선환),Hyon-Jo Kwon(권현조),Hyeon Song Koh(고현송),Shi-Hun Song(송시헌),Kisang Kwon(권기상),O-Yu Kwon(권오유),Seung Won Choi(최승원) 한국생명과학회 2010 생명과학회지 Vol.20 No.12

PC12 세포에서 CoCl₂에 의한 hypoxia 유도는 HIF1 alpha의 상승 발현으로 확인하였다. 이때 apoptosis의 유도는 genomic DNA의 fragmentation과 apoptotic body는 Hoechst 염색으로 확인되었고, ER luminal chaperone의 발현 및 ER stress signal에 관여하는 ER membrane kinase인 IRE1, PERK, ATF6의 발현도 확인되었다. 이들이 apoptosis로 연결되는 고리 역할을 하는 IRE1-XBP1 mRNA splicing, PERK-eIF2 alpha, ATF6 protein cleavage도 반응하는 것으로 확인되었다. 위의 결과는 신경세포의 hypoxia상태는 ER stress signal pathway를 거쳐서 apoptosis가 된다는 것을 증명한 것으로 신경세포의 hypoxia치료를 위한 기초 자료가 될 것으로 생각한다. Cobalt(Ⅱ) chloride, a chemical compound with the formula CoCl₂, has been widely used in the treatment of anemia, as a chemical agent for the induction of hypoxia in cell cultures, and is known to activate hypoxic signaling. However, excessive exposure to cobalt is associated with several clinical conditions, including asthma, pneumonia, and hematological abnormalities, and can lead to tissue and cellular toxicity. It is also known to induce apoptosis. One of the questions was that of whether CoCl₂ might induce apoptosis via endoplasmic reticulum (ER) stress in neurons. To address this question, first, the level of DNA fragmentation was measured for assay of apoptotic rates using CoCl₂ with neuron PC12 cells. After confirmation of apoptosis inductions, under the same conditions, the expression levels of ER stress associated factors [ER chaperones Bip, calnexin, ERp72, ERp29, PDI, and ER membrane kinases (IRE1, ATF6, PERK)] were examined by RT-PCR and Western blotting. These results indicated that apoptosis is induced through activation of ER membrane kinases via ER stress. In conclusion, during induction of apoptosis through CoCl₂-induced hypoxia in neuron PC12 cells, ER membrane kinase of IRE1 was dominantly up-expressed, and, consecutively, TRAF2, which has been suggested to be one of the links connecting apoptosis and ER stress, was strongly up-expressed.

후두개와 수술 후 경막 하 콜라겐 매트릭스 이식술의 뇌척수액 유출 방지에 대한 효용성

정은오(Eun-Oh Jeong),김선환(Seon-Hwan Kim),임정욱(Jeong-Wook Lim) 권현조(Hyon-Jo Kwon),최승원(Seung-Won Choi),고현송(Hyeon-Song Koh),염진영(Jin-Young Youm),송시헌(Shi-Hun Song) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Objective : Complete protection from CSF(cerebrospinal fluid) leakage after posterior fossa surgerywas difficult, although many variable methods has been performed. Collagen matrix is product toprotect dura defect and prevent CSF leakage. The authors performed collagen matrix underlay graftand identified effectiveness of this technique for CSF sealing.Methods : The authors evaluated 92 posterior fossa surgery used fibrin glue, polyethylene glycol(PEG) sealant, fibrinogen based collagen fleece, collagen matrix between January 2006 andDecember 2015. CSF leakage incidence according to use of variable dura sealing materials wasassessed.Results : CSF leakage occurred 8 cases(8.7%) in 92 posterior fossa surgery. CSF leakage didn’toccur in 42 cases underwent collagen matrix underlay graft. Cases of fibrin glue, polyethyleneglycol(PEG) sealant, fibrinogen based collagen fleece had effect of CSF leakage block, howeverdidn’t have significant difference according to use of this materials.Conclusion : Collagen matrix underlay graft after posterior fossa surgery didn’t have complicationsuch as chemical injury and infection and had effect of CSF sealing.