재발성 뇌실내출혈을 일으킨 경연수접합부 동정맥기형 - 증례보고 -

이상원,최창화,차승헌,박동준,송근성,이영우,Lee, Sang Weon,Choi, Chang Hwa,Cha, Seung Heon,Park, Dong June,Song, Geun Sung,Lee, Young Woo 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Cervicomedullary junction arteriovenous malformation(AVM) is extremely rare. The authors present a case of a cervicomedullary junction AVM in a 31-year-old woman presenting with recurrent intraventricular hemorrhage (IVH). Magnetic resonance imaging revealed the AVM(of a size of approximately $2{\times}2.5{\times}4cm$) extending from a lower medulla to C2-3 level. Vertebral angiography demonstrated a tightly coiled vascular mass with multiple feeders (radiculomedullary arteries) and irregular-shaped aneurysm at distal part of feeder originating at right C-1 level. The patient underwent superselective embolization of upper nidus and the aneurysm. The pertinent literature is reviewed, and diagnostic and therapeutic implications are discussed.

삼차신경통에 대한 미세혈관감압술의 효과

김성훈,최창화,Kim, Sung-Hoon,Choi, Chang-Hwa 대한신경외과학회 2005 Journal of Korean neurosurgical society Vol.37 No.5

Objective: The microvascular decompression(MVD) for trigeminal neuralgia(TN) is known as an effective surgical technique. But the failed MVD cases have been reported in long term follow-up studies. This study is to evaluate the efficacy of MVD through our operative techniques, offending vessels in operative field, failed cases with the review of the literatures. Methods: We analyzed total 63 cases of TN which underwent MVD from 1955 to 2003 according to characters of pain, operative findings, operative results related to causative vessel compression and operative method, progonotic factor. Statistical analysis was performed using paired t-test with SPSS Ver 11.0. Results: In TN, the most common offending vessel was superior cerebellar artery(45.0%). In compression group of nerve root by offending vessel, the cure rate was 91.7%. However, the cure rate of the contact group was 64.7% and the cure rate of the negative group was 37.5%. There was no statistical significance between the degree of compression by vessel and the operative result(p=0.076). In 51 cases with MVD only, the cure rate was 84.3% and in 3 cases with PSR only, 42.8% and in 2 cases with PSR(partial sensory rhizotomy) with MVD, 50.0%. TN recurred in 7 cases within the follow-up period and reoperations(PSR) were added in 2 cases of them. Conclusion: This study shows that MVD provided a high rate of success with a minor risk of complications, which has been regarded as the most safe and effective procedure for trigeminal neuralgia. Additional MVD in recurred TN by severe adhesion of teflon showed poor outcome. But, revisional operation(PSR) in recurred TN showed relatively good outcome. PSR should be considered for treatment of recurrent TN after MVD.

뇌동맥류 파열 환자의 수술후 인지기능과 기억력장애에 관한 연구

김병주,최창화,김대진,Kim, Byung Joo,Choi, Chang Hwa,Kim, Dae Jin 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objectives : The mortality rate of subarachnoid hemorrhage(SAH) has been reduced recently due to refinement of microsurgical technique and improved perioperative management. Also, many survivors of SAH show excellent neurological recoveries. However, we found that a high proportion of the survivors do not fully regain their premorbid status in cognitive and memory function. Object of this study is to evaluate which factors might influence on cognitive and memory impairment in ruptured aneurysmal SAH patients. Methods : In this prospective study, a series of 66 patients with aneurysmal subarachnoid hemorrhage(SAH) from 1996 to 1998, most of whom had a "good" or "fair" neurological outcome, were assessed with various tests of cognition and memory function. All patients underwent clipping operation by pterional approach. Right side approach was performed in 16 case and left 21 cases. K-WAIS(Korean-Wechsler Adult Intelligence Scale) was used as method of cognition and memory function test. The time interval between SAH and assessment varied between 4 months and 8 months, averaging 6.2 months. Statistical analyses were carried out for each test score to see whether aneurysm site(A-com : non A-com), route of approach, age and sex, vasospasm, Hunt-Hess grade and Fisher CT group at admission, Glasgow Outcome Scale(GOS) at discharge affect cognitive and memory function. Results : Aneurysm site was not shown to be associated with performance on any test, and the initial grade (Hunt-Hess grade, Fisher CT group) of SAH and vasospasm had only minimal predictive values. The grade at discharge( GOS) was proved to be the best predictor of impairment of cognition and memory function within 1 year after operation. Conclusion : The authors conclude that the diffuse effects of SAH are more important than focal neuropathology in relation to cognitive impairment in this group of patients.

기초 : 뇌종양에서 진단적 지표로서의 Telomerase의 활성과 그 조절 기전에 관한 연구

조창원 ( Chang Weon Cho ),최창화 ( Chang Hwa Choi ),차승헌 ( Seung Heon Cha ),김철민 ( Cheol Min Kim ) 대한뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.2

Objective￡ºTelomerase is the ribonucleoprotein complex which elongates telomeric repeats(TTAGGG)n and appears to play an important role in cellular immortalization. The almost exclusive expression of telomerase in tumor cells, and not in most normal cells, offers an exciting opportunity for therapy by inhibiting its function. In order to know the possibility of telomerase activity as a diagnostic marker for prediction of prognosis in brain tumors, telomerase activity was investigated in and cell lines. Patients and Methods￡ºThe surgical specimens from 34 patients with of brain tumors were analyzed by TRAP assay for access telomerase activity. And the mechanism of regulation on telomerase activity in brain tumor was investigated by RT-PCR analysis of catalytic subunit of telomerase gene, hTERT, and c-myc oncogene in five cell lines. To investigate more factors involved in carcinogenosis in malignant brain tumors, gene expression analysis with Atlas human cDNA expression array was conducted in two glioblastoma cell lines, A172 and U373MG. Results￡ºMalignant brain tumors have high activity of telomerase. This means telomerase activity can be used as a marker for malignant brain tumor. The catalytic subunit of telomerase, hTERT, were coamplified with c-myc oncogene in brain tumors with high activity of telomerase. This finding suggest the possibility of c-myc as a regulatory factor on telomerase function. Atlas human cDNA expression array profiles of two cell lines showed common expression of 27 genes which were known as genes involve during carcinogenesis. Among 27 genes, there were four genes of cell cycle or growth regulators, one intermediate filament marker, three genes for apoptosis, two genes for DNA damage repair, three receptor genes, four genes for cell adhesion and motility, one gene for angiogenesis, one genes of invasion regulators, one gene belong to Rho family of GTPases, and seven genes of growth factors and cytokines. Conclusion￡ºThis study suggest that c-myc might be a possibile upstream regulator of telomerase activity in brain tumors and that 27 genes might involve the carcinogenosis of malinant brain tumor especially in glioblastoma.

뇌실질내출혈을 동반한 중대뇌동맥류 파열 환자의 예후 인자

이원창,최창화,Lee, Won Chang,Choi, Chang Hwa 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : The purpose of this study was to investigate the prognostic factors in patients who suffered an intracerebral hemorrhage(ICH) due to a ruptured middle cerebral artery(MCA) aneurysm. Methods : Among 148 case of ruptured MCA aneurysm, ruptured MCA aneurysm with ICH was compared with ruptured MCA aneurysm alone. According to factors, the prognosis in these two groups was analyzed. Prognosis was evaluated postoperatively by applying Glasgow Outcome Scale(GOS) at discharge. Prognostic factors were evaluated with Chi square test, Mann-Whitney test and ANOVA test with differences being considered significant for value less than 0.05. Results : Ruptured MCA aneurysm alone revealed better consciousness on admission and final outcome than those combined with ICH. Ruptured MCA aneurysm alone showed 74% in H-H grade I, II and 82% in GOS I, II. But ruptured MCA aneurysm with ICH showed 63% in H-H grade IV, V and 52% in GOS IV, V. Age, sex, lesion site, aneurysmal size, temoporary clipping time, interval to operation, operative approach were statistically not significant in prognosis(p>0.05). But H-H grade on admission(p<0.05), complication(esp. cerebral infarction)(p<0.05), preoperative ICH volume and site(p<0.01), preoperative midline shifting(p<0.01), remained ICH volume(p<0.05) showed significance statistically. Conclusion : Prognostic factors are helpful to neurosurgeon to estimate clinical and neurological outcome postoperatively. We suggest that the good prognostic factors in ruptured MCA aneurysm with ICH were good H-H grade on admission, cerebral infarction(-), preoperative ICH volume <25cc, temporal and intrasylvian ICH, preoperative midline shifting <5mm, remained ICH volume <10cc.

자발성 지주막하출혈 후 발생하는 수두증에 대한 단락술의 필요성 및 예후에 관한 분석 - 뇌실외배액술의 기간, 일일배액량 및 총배액량과 예후관계 -

이원창,최창화,Lee, Won Chang,Choi, Chang Hwa 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.

삼차신경통과 반측안면경련에서 CISS 영상의 진단적 유용성

이동훈,이상원,최창화,Lee, Dong Hoon,Lee, Sang Weon,Choi, Chang Hwa 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objectives : Trigeminal neuralgia and hemifacial spasm are caused by vascular compression of the REZ(root entry or exit zone) of the 5th and the 7th cranial nerve. Preoperative detection of neurovascular compression is essential for accurate diagnosis, appropriate treatment, and the good operative results. Three dimensional Fourier Transformation-Constructive Interference in Steady State(3DFT-CISS) images are known to give good contrast between CSF, nerve, and vessels. We applied a 3DFT-CISS imaging technique for the preoperative evaluation of patients with these diseases and estimated the diagnostic accuracy and usefulness of this study. Methods : A series of 71 patients with trigeminal neuralgia and hemifacial spasm were treated by microvascular decompression. Among them 34 patients with trigeminal neuralgia and 24 patients with hemifacial spasm had preoperative CISS images. We compared the radiologic finding with the operative finding, and analysed the diagnostic usefulness of 3DFT-CISS imaging. Results : The sensitivity of CISS images of detecting the neurovascular compression was 90.3% in trigeminal neuralgia and 100% in hemifacial spasm. There were one false-positive and three false-negative cases in trigeminal neuralgia, and one false-positive case in hemifacial spasm. The accuracy in diagnosing the causative vessel was 73.5% in trigeminal neuralgia and 83.3% in hemifacial spasm. Conclusion : CISS image is very useful diagnostic tool for preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia and hemifacial spasm. No additional neuroradiologic examination other than CISS image and MRA is needed for preoperative evaluation of patients with trigeminal neuralgia and hemifacial spasm.

뇌실-복강 단락 원위도관의 심장내전위 - 증례보고 -

김병주,차승헌,박동준,송근성,최창화,이영우,Kim, Byung Joo,Cha, Seung Heon,Park, Dong June,Song, Geun Sung,Choi, Chang Hwa,Lee, Young Woo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Ventriculoperitoneal(V-P) shunt has been used as a popular method for surgical treatment of hydrocephalus. But complications such as infection, mechanical obstruction and failure of flow rate sometimes make painful stress to neurosurgeons and patients. Of particular, migration of distal V-P shunt catheter to extraperitoneal space has rarely been reported. Even rarer is intracardiac migration of distal V-P shunt catheter. Authors report a such case and discuss the possible mechanism and preventive method.

전두골에 발생한 콜레스테롤 육아종 1례 - 증례보고 -

이상원,차승헌,박동준,송근성,최창화,이영우,Lee, Sang Weon,Cha, Seung Heon,Park, Dong June,Song, Geun Sung,Choi, Chang Hwa,Lee, Young Woo 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Cholesterol granuloma of frontal bone is a rare disease which usually occurs at the lateral part of the supraorbital ridge. This expanding lesion grows slowly and extends into the orbit and anterior cranial fossa. The most common symptom is proptosis. This granuloma is composed of a granulomatous reaction surrounding cholesterol crystals. Surgical treatment involves aspiration of contents and stripping or curettage of the lining which is highly successful. We experienced a case of cholesterol granuloma of frontal bone with huge intracranial extension, which was cured by surgical removal. The clinical features, radiologic, and pathologic finding were discussed and the pertinent literatures were reviewed.

소뇌교각부 비청신경초종종양 환자의 임상특성과 예후분석

손동욱 ( Dong Wook Son ),최창화 ( Chang Hwa Choi ),차승헌 ( Seung Heon Cha ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Non-acoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. The author analysed various clinical characteristics and surgical result of 24 non-acoustic tumor of cerebellopontine angle to determine their distinctive diagnostic features, the surgical difficulties and outcomes and follow-up results. Methods:A retrospective analysis of clinical notes identified 24 patients with non-acoustic tumours of the cereelopontine angle. Data were extracted regarding presenting clinical features, histopathotogical data after surgical resection, surgical morbidity and mortatity, and clinical outcome(mean 36 months follow up). Results:The study group comprised 12 meningiomas(50%), 7 epidermoid cysts(29%), 3 trigeminal schwannom, 1 primitive neuroectodermal tumor, and 1 meastatic tumor. In patients with meningiomas, symptoms differed considerably from patients presenting with vestibular schwannomas. Cerebellar signs were present in 30% and hearing loss in only 25%. After surgical resection, normal facial nerve function was preserved in 80% of cases. For the meningioma patients, the success rate of of operation(good result) was 90%, any cranial nerve deficit was combined in 10% of patient, and the mortality was 0%. In the epidermoid group, fifth, seventh, and eighth nerve deficits were present in 100%, 14%, and 14% respectively. There were no new postoperative facial palsies. There was one perioperative death from pneumonia and meningitis and the rest(85%) showed good oucome in epidermoid patient. Overall, there were no recurrences requiring reoperation. Conclusion:Patients with non-acoustic lesions of the cerebellopontine angle often present with different symptoms and signs from those found in patients with schwannomas. Hearing loss is less prevalent. Cerebellar signs and facial paresis are more common as presenting features. Non-acoustic tumours of cerebellopontine angle can usually be resected with facial nerve preservation.