재발된 고혈압성 뇌실질내 출혈

배학근,정두신,도재원,이경석,윤일규 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

외상후 발작의 위험인자에 대한 조사

이재학,배학근,윤석만,도재원,이경석,윤일규,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Risk Factors for Posttraumatic Seizure The authors evaluate the risk factors for posttraumatic seizures. this prospective study was performed in a series of 470 head injured patient from January 1996 to Decomber 1998. The patients who were dead within 1 week of injury or children from 3 years old and under were excluded. There were 358 male and 112 female with a mean age of 35.2±22.8 years (range, 4-88 years). The results were as follows : 1). Of the 470 patients, pasttraumatic seizure occurred in 48 patients(10.2%): early seizure in 28(6%) and late seizure in 20 patients(4.2%). 2). The clinical risk factors for posttraumatic seizure were poor consciousness at admission, presence of brainstem herniation signs, poor GCS score, and posttraumatic amnesia more than 24 hours after trauma(p<0.001). 3). The radiological risk factors for posttraumatic seizure were subdural hematoma(p<0.001), intracerebral hematoma (p<0.02), mutiple intracranial CT lesions(p<0.001), or delayed lesions on follow-up CT scans(p<0.001). the incidence of seizure increased according to the severity of diffuse brain lesion(p<0.001), and the seizure rate in mass lesion was higher than that in diffuse lesion(p<0.001). 5). Hypoxia and coagulopathy had a statistically significant influence on posttraumatic seizure(p<0.05). Hypoxia had a infuence on occurrence of late seizure(p<0.05). 6). The incidence of posttraumatic seizure signiticantly increased in surgical group compared with coservative group(p<0.001) and significantly increased in patient who underwent decompressive craniectomy compared with those who underwent craniotomy(p<0.001) 7). Preventive administration of antiepileptic drugs decreased the incidence of early seizure, but did not affect on the reduction of late seizure. 8). Multivariate logistic regression analysis showed the subdural hematoma, GCS score, delayed lesion, and intracerebral hematoma in order of importance for seizure risk. in conclusion, the risk factors affecting on the occurrence of seizure were clinical status at admission, CT lesions, and severity of diffuse brain inJury. Considering that hypoxia affected on the late seizure, it is necessary to detect and treat it immediately after trauma. In addition, the patients who underwent decompressive craniectomy should be carefully followed to evaluate the risk of late seizure. Even though preventive administration of antiepileptic drugs had a tendency to decrease the incidence of early seizure, it is unclear whether administration of antiepileptic drugs can reduce the incidence of posttraumatic seizures. Prospective study will be needed in the selected patients.

60세 이상 환자의 척추수술

윤석만,이경석,도재원,배학근,윤일규 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Objective: Advances in surgical technique, anesthesia and perioperative patient management, coupled with the rapid increase in the population of patients reaching their 60s or older, have led to a signiticant rise in spinal precedures. The objective of this study was to evaluate frequency of the disease, surgical results and postoperative complications of the aged patients who underwent spinal surgeries. Methods : We reviewed all spinal procedures for spinal lesions including degenerative diseases, trauma, tumor and others in patients aged 60 years or older between January 1 1994 and October 1 1998(56 men and 26 women), retrospectively. Final outcome was assessed by telephone interview with the patient or the family in 67.1%(55/82). Results : There were 56 male patients and 26 female patients. There were 57 cases of degenerative diseases, 14 cases of trauma, 5 cases of metastaisis, 4 cases of infection and 2 cases of others. According to the level of surgical procedures, there were 20 cases fo cervical spine, 8 cases of thoracic spine, 54 cases of lumbar spine. Postoperaive complications included the following(17/82): 7 dural tears, 2 sepsis, 2 nerve root injury and 6 others. There were no operation-related deaths. During follow up period, ten patients(12.2%) had died, 45 patients(54.9%) were contacted and 27 patients(32.9%) could not be located. Mean follow up period for the 45 patients contacted was 26.1±15.7 months. Of the 45 persons contacted, 34(75.6%) reported improvement, 6(13.3%) no change and 5(11.1%) aggravation of their preoperative symptoms. Conclusion: Spine surgery in patients aged 60 years or older has higher complication rate compare to the younger but it is reasonable to consider the surgical procedures even in the elderly if it is needed. We should give attention not to tear the dura during the surgical procedures, especially in the elderly.

자발성 뇌지주막하 출혈 환자에서 최초 뇌실 크기의 임상적 의의

신일영,윤일규,윤석만,도재원,이경석,배학근,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

The purpose of this study is to invesetigate the clinical significance of initial enlargement of ventricle in the patients who had aneurysmal SAH. Of the total 821 patients with aneursmal SAH who were registerd in SAH data bank system between 1989-1999, 307 patients who had been already measured in the size of ventricle at the time of admission, were studied retrospectively. The size of ventricle was calculated by bifrontal index. Normal size of ventricle was defined as 30% or less, mild enlargement was defined as 31 to 39%, and moderate enlargement of vertricle was defined as more than 39% in bifrontal index. The sizes of ventricle using bifrontal index were analysed according to the age, sex, blood pressure, consciousness at admission, medical history of hypertension, location of ruptured aneurysm, Fisher's grade on CT(computerized tomography) scan at the time of admission, cerebral vasospasm, intraventricular hemorrhage (IVH), performance of external ventricular drainage (EVD), and prognosis at discherge. Chi-square test and ANONA were used in the statistical evaluation. The results were as follows : 1) Of the 307 patients, 235(76.5%) had a mild to moderate enlargement of ventricle at the time of admission (more than 30% in bifrontal index). 2) The size of ventricle was enlarged according to the increase of age (p<0.05). 3) In the patients who had ruptured aneurysm on anterior cerebral artery, the size of ventricle significantly increased and showed a higher incidence in mild enlargement compared with moderate enlargement of ventricle (p<0.05). 4) The size of ventricle increased in th patients who had IVH and the EVD was more frequently performed in th patients who had the enlarged ventricle associated with IVH (p<0.05). 5) In the patients who had high Fisher's grade, the size of ventricle had a tendency to increase, but there was no statistical significance. 6) In the patients who had poor prognosis, the size of ventricle had a tendency to increase, but there was no statistical significance. Conclusively, the initial size of ventricle was enlarged in th aged patients, ruptured aneurysm on anterior communicating artery, high FIsher's grade, patients associated with IVH. Considering those factors, prediction for the enlargement of ventricle size may help to treat the patients suffering aneurysmal SAH.

Primitive Neuroectodermal Tumor Arising from the Cerebellum : A Case Report 증례보고

Bae, Hack Gun,Lee, Kyeong Seok,Han, Dong Suk,Yun, Il Gyu,Lee, In Soo,Yang, Seung Ha 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.1

16개월된 소아에서 소뇌반구에 발생한 원시 신경외배엽성 종양 1례를 경험하여 문헌고찰과 함께 보고한다. 제거된 종양은 간충조직이 풍부하였고, 특이한 세포분화성을 보이지 않았다. We report a 16-month-old male with a primitive neuroectodermal tumor of the cerebellar hemisphere. This tumor consisted of undifferentiated cells resembling germinal or matrix cells of the embryonic neural tube and prominent mesenchymal component.

Outcome Following Diffuse Brain Injury in Children

Bae, Hack Gun,do, Jae Won,Lee, Kyeong Seok,Yun, Il Gyu,Lee, In Soo,Bae, Won Kyong 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.8-9

두부외상후 뇌전산화단층촬영상(CT) 종괴병변이 없는 소아환자 연속 100례를 대상으로 예후를 분석하였다. 대상 환자는 모두 15세 이하로 외상후 6시간이상 글라스고우 혼수계수가 8이하였다. 예후는 회복 27%, 중등도장애 17% , 중중장애 15%, 식물상태 2 % , 사망 39% 였다. 내원당시 글라스고우 혼수계수 5이하인 환자의 대부분은 사망하였다(81.9%). 내원당시 CT상 미만성뇌종창 소견은 53례에서 보였으며, 이중 27례(50.9%)에서 사망하였다. 예후에 나쁜 영향을 미치는 요인들로는 : 1) 내원당시 글라스고우혼수계수 5이하(p<0.05), 2) 저산소증(PaCO₂<60 ㎜Hg, p<0.05), 3) 뇌기저골절(p<0.005), 4) 폐 혹은 복부손상을 동반한 경우(p<0.005), 5) 미만성뇌종창(p<0.01), 6) 내원당시 CT상 뇌지주막하출혈, 뇌실내출혈 혹은 미량의 뇌경막하혈종이 있는 경우(p<0.05)였다. 연령, 성별, 두개골원개(skull vault) 골절, 두부를 제외한 다른 신체부위 골절 등은 예후에 영향을 미치지 못했다. 외상후간질이나 추적 CT상 나타난 지연성뇌병변은 불량한 예후를 나타내는 소견은 아니었다. 뇌량, 뇌기저핵부, 시상부, 혹은 상소뇌각 부위에 소량의 출혈 소견, 소위 말해 미만성뇌측색손상의 전형적인 CT 소견은 23례에서 나타났으나, 소아의 중증미만성뇌손상군에서는 불량한 예후를 반영하는 소견은 아니었다

Prepontine Chordoma without Bone Involvement : Case Report 증례보고

Bae, Hack Gun,Ohata, Kenji,Katsuyama, Junsuke,Hakuba, Akira 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.1

뇌교에 유착된 매우 드문 경막내 척색종 1례를 보고한다. 5년간의 추적기간 동안 광범위 종양절제에도 불구하고 두차례 재발했으며, 마지막으로 재발된 종양은 gamma knife로 치료되었다. 방사선 치료 1년후 검사한 핵자기공명 촬영상 뇌교부 종양은 감소된 반면, 천막열공 상부로 새로운 경막내 척색종이 보였다. 골밀도 뇌전산화단층 촬영상 두개골침범의 소견은 보이지 않았다. 두개골침범없는 경막내 척색종이 비교적 양성의 성격을띄운다 하더라도, 본증례의 재발양상은 뇌교와의 유착 및 종야의 뇌세포 침윤으로 인해, 두개골을 침범하는 고전적 척색종과 같은 aggressiveness를 보였다. 종양의 장기간 재발방지를 위한 보조적치료로 방사선치료가 요망된다. Presented here is an extremely rare case of intradural extraosseous chordoma with tenacious adhesion to the pons. During the 5 years' follow-up period, the tumor has recurred locally twice in the prepontine region despite radical excisions and final irradiation with gamma knife. Magnetic resonance image obtained 1 year after radiosurgery demonstrated a new intradural mass growing above the tentorial hiatus, whereas the mass within the pons was markedly reduced. High resolution computed tomographic scan showed no evidence of bone involvement. Even though intradural location without bone involvement is a relatively benign occurrence, the recurrent pattern suggests and aggressiveness that correlates classic chordoma because of its invasion to the pons. Adjuvant radiotherapy will be required in this case for a long-term control.

Hypertensive Intracerebral Hemorrhage Associated with Unruptured Intracranial Saccular Aneurysms : Report of Three Cases 3례 보고

Bae, Hack Gun,Do, Jae Won,Lee, Keong Seok,Bae, Won Kyung,Yun, Il Gyu,Byun, Bark Jang 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.5

미파열 뇌동맥류를 동반한 고혈압성 뇌내출혈 3례를 보고한다. 3례 모두 초기병변은 피각부출혈로서, 전대뇌동맥의 형성부전이 있는 측으로 출혈이 있었다. 뇌동맥류는 뇌내출혈 반대측을 공급하는 뇌혈관을 따라 위치했다. 뇌동맥류 발생 원인이 혈행역학적 긴장(hemodynamic stress)으로서, 연령 및 고혈압과의 관계를 고려해 볼때, 고혈압성 뇌내출혈 환자에서 뇌동맥류 동반은 흔히 예상될 수 있는 병변이나, 아직 이에 대한 보고가 없다. 고혈압성 뇌내출혈 환자에서 미파열 뇌동맥류 동반에 대한 주의 및 이에 대한 추적조사가 요망된다.

뇌혈관촬영상 잠재성 전교통동맥류 3례 : 3 Cases

배학근,도재원,이경석,윤일규,변박장,배원경 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

The authors report three cases with angiographically occult anterior communicating artery aneurysm. One patient showed a pericallosal artery aneurysm on initial angiogam. However, ruptured aneurysm turned out to be a anterior communicating artery aneurysm, whereas pericallosal artery aneurysm revealed to be unruptured at operation. Another patient, who had no visible aneurysm on three complete angiographic examinations, was operated because of recurrent episode of subarachnoid hemorrhage. A thrombosed aneurysm of anterior communicating artery was discovered in operation. The remaining one patient, who had a suspicion of anterior communicating artery aneurysm on computerized tomography and repeat angiography, has died because of rebleeding after discharge without operation. These cases illustrate the occasional failure of angiography in the detection of aneurysms and the need to have a high index of suspicion of an aneurysm in cases with negative angiogarphy.

요추부 경막외 수막종 1예

배학근,이인수,이동화 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.1

A 27-year-old female with low back pain and paresthesia on the left lower extremity had been treated. Lumbar myelography showed total block of the dye column at the L3 vertebral body level with a brush border. After myelography, total laminectomy on the L3 and L4 vertebrae was done. The result of operation and biopsy revealed an extradural meningioma of angioblastic type. 9 days after the surgery all neurological deficits were completely recovered.