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박현선,조경기,정상섭,Park, Hyeon-Seon,Cho, Kyung-Gi,Chung, Sang-Sup 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1
Although various methods had been reported for reanimination of facial nerve palsy, interposition nerve graft remains superior to other methods if there is a wide gap to be bridged. Dott described a excllent facial nerve reconstruction by sural nerve graft bypassing petrous bone. But his method needs two surgical fields and is performed in two stages. Authors desribe a traumatic facial nerve palsy treated by one stage facial nerve reconstruction that is performed in one surgical field by using a great auricular nerve interposition graft and bypass the petous bone.
박현선,이재환,김진영,신용삼,주진양,허승곤,이규창,Park, Hyeon Seon,Lee, Jae Whan,Kim, Jin Young,Shin, Yong Sam,Joo, Jin Yang,Huh, Seung Kon,Lee, Kyu Chang 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6
Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.
TCD를 이용한 두개강내 동맥류의 예후 예측 가능한 New Scale(NS) Score System
박상훈,박종운,박현선,현동근,하영수,Park, Sang Hoon,Park, Chong Oon,Park, Hyeon Seon,Hyun, Dong Keun,Ha, Young Soo 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.8
Objective : By conducing a review of clinical outcomes for patients with aneurysm treated using current microneurosurgical techniques and intensive care unit management, we speculated that grading systems based only on clinical condition or CT finding after admission failed to provide a significant stratification of outcome between individual grades of patients, because these systems did not include the factor for postoperative vasospasm. We hypothesized that postoperative blood flow velocity could have a significant impact on outcome prediction for patients surgically treated for intracranial aneurysms. Methods : We conducted a analysis on patient- and lesion-specific factors that might have been associated with outcome in a series of 55 aneurysm operations performed with measurements of blood-flow velocity with transcranial Doppler ultrasonography(TCD). In the new scale(NS) score system, 1 point is assigned additionally for the case with Hunt and Hess(H-H)/World Federation of Neurological Surgeons(WFNS) Grade IV or V, Fisher Scale(FS) score 3 or 4, aneurysm size greater than 10mm, patient age older than 60 years, blood-flow velocity higher than 120cm/sec, and posterior circulation lesion. By adding the total points, a 6-point scale score(score 0-6) is obtained. Results : Age of patient, size of aneurysm, clinical condition(H-H grade and WFNS), FS score, and blood flow velocity(TCD 1day after operation) were independently and strongly associated with long-term outcome. When NS scores were applied to 55 patients with at least 6 months follow-up, the correlation of individual scores with outcome was strongly validated the retrospective findings. Conclusion : It was speculated that TCD could be used to assess postoperative vasospasm and to monitor noninvasively the patients with aneurysmal SAH. This NS score system is easy to apply, divide patients into groups with different outcome, and is comprehensive, allowing for more accurate prediction of surgical outcome.
축추-환추간 경관절 나사못 고정술 치료의 결과 및 합병증
최준웅,윤승환,박형천,박현선,김은영,하윤,Choi, Jun-Woong,Yoon, Seung-Hwan,Park, Hyung-Chun,Park, Hyeon-Seon,Kim, Eun-Young,Ha, Yoon 대한신경외과학회 2005 Journal of Korean neurosurgical society Vol.37 No.3
Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.
중증 뇌손상 환자에서 뇌동정맥 산소함유량차이와 지연성 뇌경색 발생과의 관계
윤승환,조준,문창택,장상근,박형천,박현선,김은영,Youn, Seung-Hwan,Cho, Joon,Moon, Chang-Taek,Chang, Sang-Keun,Park, Hyung-Chun,Park, Hyeon-Seon,Kim, Eun-Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4
Objective : This study was performed to evaluate the relationships among intracranial pressure(ICP), cerebral perfusion pressure(CPP), and cerebral arteriovenous oxygen difference($AVDO_2$) which were used as parameters of adequacy of cerebral blood flow to support cerebral metabolism after severe head injury and also to examine the association between delayed cerebral infarction and outcome. Material and Method : The authors studied the ICP, CPP and $AVDO_2$ before and after treatment on 34 head-injured patients from June 1996 to December 1997 and examined the association with the change of an ICP, CPP and $AVDO_2$ following treatment and the development of delayed cerebral infarction. Sixteen patients underwent craniotomy for hematoma evacuation and eighteen patients received mannitol to decrease ICP. Results : The development of delayed cerebral infarction was demonstrated in 3(42.9%) out of 7 patients in no improvement group and 13(48.1%) out of 27 patients in improvement group with an increased ICP following treatment. Also, the development of delayed cerebral infarction was demonstrated in 8(50%) out of 16 patients in no improvement group and 8(44.4%) out of 18 patients in improvement group with a decreased CPP following treatment. The association with changes of ICP and CPP following treatment and development of delayed cerebral infarction was not statistically significant(p>0.01). However, 11(78.6%) out of 14 patients who demonstrated an increase in $AVDO_2$ and 5(25%) out of 20 patients who demonstrated a decrease in $AVDO_2$ following treatment developed delayed cerebral infarction. No improvement(reduction) in $AVDO_2$ following treatment was significantly associated with the development of delayed cerebral infarction(p<0.01). All of 16 patients with delayed cerebral infarction showed poor prognosis. Conlcusion : The change of $AVDO_2$ rather than those of ICP and CPP was considered more important factor for the development of the delayed cerebral infarction and poor outcome.
김형중 ( Hyoung Joong Kim ),김세혁 ( Se Hyuk Kim ),김순기 ( Soon Ki Kim ),윤승환 ( Seung Hwan Youn ),박현선 ( Hyeon Seon Park ),김은영 ( Eun Young Kim ),박형천 ( Hyung Chun Park ) 대한뇌종양학회 2003 대한뇌종양학회지 Vol.2 No.2
Congenital glioblastomas have been rarely reported in the literatures and known to have a higher propensity to cause intratumoral hemorrhage compared to pediatric brain tumors. We report a case of definite congenital glioblastoma, which was not detected by endovaginal fetal sonography until 35+1 weeks gestation and presented with intratumoral hemorrhage after birth. Brain CT and MRI scan showed a intracranial mass with internal hemorrhage and small portion of contrast enhancement. If the rapid growing intracranial lesion with internal hemorrhage is detected by fetal sonography or MRI late in gestation, a congenital malignant tumor as well as vascular malformations should be considered.
전두동골절 수술 후에 발생한 점액낭종에 의한 안구돌출증
김진욱(Jin-Wook Kim),하윤(Yoon Ha),윤성환(Seung-Hwan Yoon),현동근(Dong-Keun Hyun),박현선(Hyeon-Seon Park),박형천(Hyung-Chun Park),박종운(Chong-Oon Park),김은영(Eunyoung Kim) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.1
Mucoceles arise from the gradual accumulation of mucus material caused by obstruction of the sinus ostium. They may enlarge sufficiently to compress orbital or intracranial structures. We present a case of severe exophthalmos caused by frontal sinus mucocele developed after operation for frontal sinus fracture. At initial operation for depressed fracture of the anterior wall of left frontal sinus, all frontal sinus mucosa was extirpated and the space was obliterated with bovine artificial bone. The fractured pieces of the bone were replaced and fixed with titanium mesh and screws. The reason for the delayed development of mucocele in this patient was the unintentionally remained sinus mucosa and blockage of the natural drainage pathway by bone graft. Exophthalmos was relieved after surgical drainage of mucocele, resection of mucosa as much as possible and recreation of drainage pathway by the removal of grafted bovine bone. This case reminds surgeons that natural drainage pathway of sinus should be kept intact whenever possible, otherwise a mucocele may develop even many years after operation.