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실험적 외상성 뇌손상모델에서 외상 후 저체온과 MgSO<sub>4</sub>의 효과
한성록,현동근,박종운,하영수,김준미,Han, Seong Rok,Hyun, Dong Keun,Park, Chong Oon,Ha, Young Soo,Kim, Joon Mee 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10
Objective : Traumatic brain injury including diffuse axonal injury has been shown to result in a decrease in brainfree magnesium concentration, an endogenous inhibitor of calcium entry into neuron, that is associated with the development of neurological motor deficits. The goal of this study is to establish the therapeutic window during which the therapy with $MgSO_4$ and/or hypothermia improve damaged neurons by TUNEL stain. Method : Moderate brain injury was induced in 64 adult Sprague-Dawley rats, weighing 350 to 450gm each, by using a simple weight-drop device(Marmarou model). The animals were randomly assigned to four groups(sixteen rats each, a control group, a group treated with $MgSO_4$, a group treated with hypothermia, and a group treated with $MgSO_4$ and hypothermia) and the rats in each group were sacrificed and studied after 12 hrs, 24 hrs, 1 wk, and 2 wks after insult. In hypothermic group, these rats were subjected to hypothermia after injury, with their rectal temperatures maintained at $32^{\circ}C$ for 1 hour. After 1-hour period of hypothermia, rewarming to normothermic level was accomplished over 30-minute period. In the groups treated $MgSO_4$, hypothermia and $MgSO_4$ were subsequently treated with $MgSO_4$($750{\mu}moles/kg$) infused intra-muscularly at 30 minutes after trauma. Result : In all treated groups, a significant reduction in TUNEL positive cells was found in comparison with the control group each time(p<0.001). Between treatment groups, No differnce was seen 12hrs, 24hrs, and 1wk. However, hypothermic group treated with or without $MgSO_4$ showed more significant reduction in apoptotic cells than group treated with $MgSO_4$ 2 weeks after trauma(p<0.05). However, hypothermic group treated with $MgSO_4$ showed no significant reduction in apoptotic cells compared with hypothermic group(p>0.05). Conclusion : These findings suggest that both hypothermia and $MgSO_4$ significantly improve pathological changes. Otherwise simultaneously $MgSO_4$ and hypothermia treatment groups is failed to provide additional neuroprotection. These results may be relevant to the design of future clinical trials of therapeutic hypothermia and $MgSO_4$ for traumatic brain injury.
한성록 ( Seong Rok Han ),윤상원 ( Sang Won Yoon ),이기택 ( Gi Taek Yee ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Sohn ),이동준 ( Dong Joon Lee ),황충진 ( Choong Jin Whang ) 대한뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1
Objective:Atypical meningiomas(AMs) are difficult tumors to manage. The authors evaluate local control and survival after primary surgery for patients with AMs. Methods:Of the 108 meningioma patients surgically treated between 2000 and 2005, pathologically proven 10 AMs were reviewed. Mean follow-up periods were 35.9(range, 7-68) months. Results:Four(40%) had local recurrences during the follow-up, of which 1(14%) of 7 gross total removal and 3(100%) of 3 subtotal removal. The mean time to recurrence was 33.8 months. The overall 3-year local control rates were 70%. All patients were survived during follow-up period. Seven(70%) patients were treated Novalis radiosurgery. 3 patients had residual tumors and 4 patients had recurrent tumor. Conclusion:The aim of treatment for AMs is to resect totally as possible. Radiosurgery for remnant or recurrent AMs could be considered as adjuvant therapy, although further study is mandatory.
한성록 ( Seong Rok Han ),이기택 ( Gi Taek Yee ),윤상원 ( Sang Won Yoon ),손문준 ( Moon Jun Sohn ),황충진 ( Choong Jin Whang ) 대한뇌종양학회 2004 대한뇌종양학회지 Vol.3 No.2
Hemangioblastomas are solid or cystic benign vascular tumors that may arise anywhere in the body. Solid hemangioblastomas can be difficult to treat surgically because of their hypervascularity and reqirement for circumferential dissection. Recently, We experienced a huge solitary solid hemangioblastoma in the cerebellopontine angle. The tumor was safely resected totally. We report the case with review of literatures.
한성록(Seong Rok Han),윤상원(Sang Won Yoon),이기택(Gi Taek Yee),최찬영(Chan Young Choi),손문준(Moon Jun Sohn),이동준(Dong Joon Lee),황충진(Choong Jin Whang) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2
Pituitary adenomas are very common neoplasms, constituting between 10 and 20% of all primary brain tumors. Historically, the treatment armamentarium for pituitary adenomas has included medical management, microsurgery, and fractionated radiotherapy. More recently, radiosurgery has emerged as a viable treatment option. We present a case of giant pituitary adenoma, treated two staged microsurgery and Novalis radiosurgery, which managed postoperative remnant pituitary adenoma successfully.
중추 신경계에서 발생한 비정형 기형/횡문근양 종양 -증례보고-
한성록 ( Seong Rok Han ),윤상원 ( Sang Won Yoon ),이기택 ( Gi Taek Yee ),손문준 ( Moon Jun Sohn ),주미 ( Mee Joo ),황충진 ( Choong Jin Whang ) 대한뇌종양학회 2004 대한뇌종양학회지 Vol.3 No.2
Atypical teratoid/Rhabdoid tumors(AT/RT) are aggressive neoplasm that afflict infants and young children and are the new entity among malignant pediatric brain tumors. These tumors show similar histological and radiological features to primitive neuroectodermal tumor-medulloblastoma(PNET-MB). So, these tumors have been misdiagnosed previously as PNET-MB. Separation of these two tumor types is crucial. Because the prognosis of a patient with an AT/RT is worse than that of a PNET-MB despite aggressive surgical treatment with or without adjuvant chemotherapy and radiation therapy. Recently, we experience a 5-month girl with a primary intracranial AT/RT in the posterior fossa. We report the case with a special emphasis on the differential diagnosis from PENT-MB.
측두엽의 표재성 수술 지표들과 심부 구조들과의 관계 : 백질 신경 섬유 해부 기법에 의한 연구
최찬영(Chan Young Choi),한성록(Seong Rok Han),윤상원(Sang Won Yoon),이기택(Gi Taek Yee),황충진(Choong Jin Whang) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1
This study was designed to examine the relationships of deep internal structures to the superficial surgical landmarks important to temporal lobe surgery using fiber dissections. The frontotemporal region was dissected by applying Klingler’ s fiber dissection technique to ten formalin-fixed human cerebral hemispheres. The dissections were performed under a microscope and imaged in the photographs. Several useful measurements to be needed in the temporal lobe surgery were also quantified. Several white matter fiber tracts in the frontotemporal region were constructed in an intricate pattern, just like a network. Most of the specimens, the anterior edge of the optic radiation reached almost the tip of the temporal horn and was located an average of 31.4mm (range, 28-34mm) behind the temporal pole and an average 12.2mm (range, 10-16mm) behind the limen insulae. The relationships of the superficial surgical landmarks (limen insulae, temporal pole, inferior circular sulcus) to the deep internal structures of the temporal lobe (esp. optic radiation) are discussed in this paper. Applying the anatomical knowledge from this study to the surgical plan will contribute to more precise surgery for the various pathological conditions in the frontotemporal region.
김성진 ( Sung Jin Kim ),한성록 ( Seong Rok Han ),윤상원 ( Sang Won Yoon ),이기택 ( Gi Taek Yee ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Sohn ),이동준 ( Dong Joon Lee ),김한성 ( Han Seong Kim ),황충진 ( Choong Jin Whang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.2
Despite multimodal therapy, glioblastoma multiforme(GBM) is associated with a poor prognosis with a median survival of less than 1 year. GBM with long-term survival over 5 years is rare, and no definite markers of better prognosis have been identified till date. We present two patients who were diagnosed a frontal GBM and a cerebellar GBM respectively. Both patients were survived for more than 5 years, who had been treated with surgery, Novalis radiosurgery and chemotherapy. We also discussed prognostic factors who were long term survival with GBM.
유남훈 ( Nam Hoon Yoo ),한성록 ( Seong Rok Han ),윤상원 ( Sang Won Yoon ),이기택 ( Gi Taek Yee ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Sohn ),황충진 ( Choong Jin Whang ) 대한뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.2
Object£ºLateral ventricular tumors are rare lesion of the central nervous system. We conducted a retrospective study of patients with these lesion treated on surgically. Methods£ºTotal 9 cases of lateral ventricular tumors, who underwent operative removal between 2001 and 2004 at our hospital were reviewed. There were 3 cases located in the trigone, 3 in the frontal horn, and 3 in the ventricular body. Tumors were removed by various surgical approaches according to the location of tumors. Transcortical approach was used in 7 patients, and transcallosal approach was used in 2 patients. Results£ºTotal resection was performed in 6 patients. Surgical complications included epidural hematoma, subdural hygroma, intracranial hemorrhage, and seizure. Seven patients were achieved good recovery. Conclusion£ºTo improve surgical outcome and to avoid complications, proper knowledge of intraventricular anatomy and selection of an appropriate surgical approach are needed.
임상 : 두개저 수막종에 대한 노발리스 방사선수술의 임상 결과 분석
안상현 ( Sang Hyun Ahn ),손문준 ( Moon Jun Sohn ),윤상원 ( Sang Won Yoon ),한성록 ( Seong Rok Han ),최찬영 ( Chan Young Choi ),이동준 ( Dong Joon Lee ),이채혁 ( Chae Heuck Lee ),황충진 ( C Jin Whang ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2
Objective:Stereotactic radiosurgery is becoming an important surgical treatment option in neurosurgical field. Optimal treatment protocol and proper clinical applications could minimize early and late toxicity associated with the radiosurgical treatment. This study is to analyze the clinical results of Novalis radiosurgery for skull base meningioma. Methods:Between Nov. 2001 and Jan. 2006, 43 patients underwent radiosurgery using Novalis shaped beam surgery unit. Male to female ratio was 13:30(1:2.3) with the mean age of 54.2 year-old(range 28-73 year-old). Total of 36 lesions were included to analyze dosimetric data and volume changes during the follow-up period. Median of follow up period was 26.8 months(range 2-60 months). The dosage prescriptions were determined on the basis of tumor volume, location, and proximity to optic nerve and brainstem. Results:13 lesions were treated in a single session but 23 lesions were irradiated in fractionation. The mean initial tumor volume of a single session and fractionated radiosurgery was 4.4±4.0 cm3 and 22.4±18.4 cm3, respectively, while follow- up tumor volume following radiosurgery was significantly decreased to 3.1±4.5 cm3 and 13.4±12.3 cm3, respectively( p<0.05). Overall local tumor control rate was 97.2%(35 lesions);however, there was no radiation related toxicity during the follow up periods. Conclusion:Novalis radiosurgery for skull base meningiomas offers an effective local tumor control in using either single session or fractionated irradiation. With advent of modern radiosurgical treatment and developed optimal clinical protocol, we could successfully treat this surgically difficult tumor to control including larger tumors and tumors adjacent to sellar & parasellar regions.
안상현 ( Sang Hyun Ahn ),최찬영 ( Chan Young Choi ),한성록 ( Seong Rok Han ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2
Intra-axial tumors of the brain stem that growing into the cerebellopotine angle exophytically have been rarely reported in adult. Differentiation of the intra-axial tumors from the extra-axial tumors occurring in the cerebellopontine angle can be difficult due to the similarity of the clinical and radiological features. We describe a rare case of pontine anaplastic astrocytoma in adult with ventrolateral exophytic growth from the pons that presented as a cerebellopontine angle mass. Clinico-radiological features that distinguish this rare lesion of the exophytic pontine glioma from cerebellopontine angle mass were discussed also.