재발하였거나 수술적 제거가 불가능한 뇌수막종에 대한 Hydroxyurea 치료 - Preliminary Report -

이정환,김오룡,김성호,배장호,최병연,조수호,Lee, Jeong-Hwan,Kim, Oh-Lyong,Kim, Seong-Ho,Bae, Jang-Ho,Choi, Byung-Yon,Cho, Soo-Ho 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

1988년 1월부터 1997년 12월까지 본 교실에 내원하여 뇌수막종으로 진단받고 수술요법을 실시한 87례 중, 완전제거 후 재발한 경우와 부분적 절제후 방사선 치료를 받은 4례를 대상으로 hydroxyurea를 이용해 치료한 결과를 분석하였다. 남자가 1례, 여자가 3례이었으며 연령 분포는 23세에서 55세였다. 조직학적으로 3례가 meningothelial type이었으며 1례는 angiomatous type이었다. 3례에서 소뇌교각부에 발생하였으며 1례에서 해면정맥동에 발생하였다. 모든 환자들은 수술적 치료를 시행받았으며 3례의 환자에서 방사선 치료를 시행하였다. Hydroxyurea를 20mg/kg/day용량으로 투여하였으며 평균 추적관찰기간은 34개월이었다. 치료기간중 4례에서 종양이 줄어든 예는 없었으나 종양이 성장하지는 않았다. 삼차신경통 증상이 있던 1례는 증상 호전 되었으며 수술적 치료를 3차례 받았던 1례에서 두개골절제부위에 팽창되어 있던 뇌는 축소되어 두개강내로 복귀되었다. 혈액학적 부작용으로 백혈구 수치가 1례에서 감소되었으나 2주정도 복용을 중단한 후 다시 수치는 회복되었고 다른 심각한 부작용은 나타나지 않았다. 저자들은 뇌수막종 환자중, 수술후 재발한 경우와 불완전 제거를 시행한 경우 보조적 치료방법으로 hydroxyurea의 사용하여 종양크기의 감소는 없었으나 성장을 억제할 수 있었으며 앞으로 오랜 기간 추적관찰과 많은 증례에 대한 분석을 함으로써 뇌수막종 치료의 보조 방법으로 hydroxyurea를 이용할 수 있을 것으로 생각된다. Objectives : The present study was performed to analyze results of hydroxyurea treatment for unresectable and recurrent meningiomas as adjuvant chemotherapeutic agent. Material and Methods : Among 87 cases of meningioma patients who treated surgically between Jauary 1988 and December 1997 in our department, unresectable and recurrent cases were 4 cases. Histologically, 3 cases were meningothelial type, 1 case was angiomatous type. Tumor orgin was cerebellopontine angle(CPA) in 3 cases, cavernous sinus in 1 case. Three of 4 cases received radiation treatment. All patients received a daily dosage of 20mg/kg/day of hydroxyurea. Hematological monitorning was performed monthly and tumor measurement was assessed by MR imaging before treatment and every 6 months. Mean follow-up period was 34 months. Rerults : All cases showed no enlargement of tumor mass without any shrinkage. Trigeminal neuralgia in 1 case was improved and external herniation of brain on craniectomy site in 1 case was shrunken. None of the patients had any serious side effects. White blood cell count fell below $3000/{\mu}l$ in 1 case, but recovered 2 weeks later with cessation of medication. Conclusion : Hydroxyurea stopped cell growth by triggering the apoptotic cascade. Our preliminary data indicate that hydroxyurea provides adjuvant medical treatment in patients of unresectable and recurrent meningiomas

뇌지주막 낭종의 치료결과 분석

이정환,김오룡,김성호,배장호,최병연,조수호,Lee, Jeong-Hwan,Kim, Oh-Lyong,Kim, Seong-Ho,Bae, Jang-Ho,Choi, Byung-Yon,Cho, Soo-Ho 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : The present study was performed to analyze treatment results for 22 cases of arachnoid cyst and to have appropriate surgical method in our department. Material and Methods : We performed a retrospective study in 22 cases in 11 years between 1989 to 2000 that could be followed up. The analysis was based on the results of patients age, sex distribution, developed area, clinical symptom, treatment method, and complication. Results : The age range of cyst development was between 7 months to 60 years with the average age of 21 years. As for sex distribution, 20 were male and 2 were female, with significantly more cyst development in males than females. Thirteen cases were developed in the sylvian fissure, 3 cases in the posterior fossa, 4 cases in the cerebral convexity of the supratentorial area, 1 case in the suprasella and 1 case in interhemiphere. Those cases with the sylvian fissure involvement included 6 cases of Type I, 4 cases of Type II, and 3 cases of Type III. As for the distribution according to hemisphere, more arachnoidal cysts were seen in the right hemisphere. The most common clinical symptom was headache, followed by seizure and speech disturbance. As for the treatment method in 22 cases, surgery was performed in 17 cases and conservative treatment in 5 cases. Fenestration was performed in 14 cases. 13 cases of them showed good outcome, and 1 case with delayed development showed no improvement. Cyst-peritoneal shunt was done in 2 cases. Both fenestration and cyst-peritoneal shunt were done in 1 case. Conclusion : Patients who perforemed fenestration were showed good outcome with few complication. We concluded that fenestration is the most appropriate surgical method for arachnoid cyst.

경접형골동으로 수술한 뇌하수체 선종의 치료성적

전우열,김오룡,김성호,배장호,최병연,조수호,Jeon, Woo-Youl,Kim, Oh-Lyong,Kim, Seong-Ho,Bae, Jang-Ho,Choi, Byung-Yon,Cho, Soo-Ho 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11

Objective : Transsphenoidal approach(TSA) has been used as useful operative method for pituitary tumor but is still controversal in case of cavernous sinus invasion or severe suprasellar extension. This study was performed to evaluate the surgical result, recurrence, effect of adjuvant treatment, especially in cases of suprasellar extension or cavernous sinus invasion. Material and Methods : We studied 56 cases of surgically treated pituitary adenoma that we were able to follow up, treated by TSA from 1993 to 1998. There were 24 cases of suprasellar extension and 11 cases of cavernous sinus invasion. The medical records and radiological findings were reviewed. Surgical results including hormonal function and recurrence rates were analyzed according to extent of tumor invasion. Mean follow-up period was 19.1 months. Results : Tumors with suprasellar extension were removed totally in 54%, whereas total tumor removal was possible only in 38% with cavernous sinus invasion. Overall of recurrence rate was 14% and recurrence rate was 25% in suprasellar extension and 9% in cavernous sinus invasion. In cases of both suprasellar extension and cavernous sinus invasion, tumors that were treated by TSA and radiation showed recurrence rate of 7%, whereas those treated by surgery alone showed 28% of recurrence. Conclusion : Transsphenoidal approach is safe and useful operative method for pituitary adenoma and adjuvant therapy including radiation therapy is effective means to decrease the recurrence in cases of suprasellar extension or cavernous sinus invasion.

아급성기 경막하 혈종 치료시 천공술 후 urokinase를 이용한 혈종배액술

김민수 ( Min Su Kim ),김성호 ( Seong Ho Kim ),김오룡 ( Oh Lyong Kim ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.1

clinical deterioration, which eventually necessitates surgery. The purpose of this study is to investigate the feasibility and safety of burr hole drainage using urokinase for management of patients with subacute subdural hematoma (SASDH). Methods: Nine patients with SASDH were treated by burr hole drainage using urokinase. Under local anesthesia a catheter was inserted into the hematoma through a burr hole. Burr hole drainage was followed by hematoma thrombolysis with instillation of urokinase (10,000 units) every 12 hours. Drainage was discontinued when a significant decrease of hematoma was observed on cranial computed tomography. Results: The patients’ median age was 70 years (range, 62-87). The median Glasgow Coma Scale score before surgery was 15 (range, 11-15). Drainage was successfully performed in all patients. All patients had Glasgow Outcome Scale scores of 5 at discharge. There was no surgery-related morbidity or mortality. Conclusion: A burr hole drainage using urokinase could be a safe, feasible and effective minimally invasive method with low morbidity in treatment of selected patients with SASDHs.

백서의 가역성 및 비가역성 뇌허혈 모형의 실험적 고찰

송광철,최병연,김성호,배장호,김오룡,조수호,Song, Kwang Chul,Choi, Byung Yon,Kim, Seong Ho,Bae, Jang Ho,Kim, Oh Lyong,Cho, Soo Ho 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Objective : The purpose of our experimental study was to analysis the advantages and disadvantages in the reversible and irreversible cerebral ischemic models with rats by staining with Neutral Red(NR) solusion, 2% 2,3,5-triphenyltetrazolium chloride(TTC) and Hematoxylin & Eosin(H & E). Methods : We have measured the range of cerebral infarction in the rat to get a suitable ischemic model along the object of study with and without craniectomy. With craniectomy, 9 rats were sacrificed for irreversible cerebral ischemic model by means of ligation at proximal(group I) and distal(group II), and coagulation at proximal(group III) middle cerebral artery. Also, 6 rats were sacrificed for irreversible(group IV) and reversible(group V) cerebral ischemic model using nylon thread without craniectomy. The sizes of infarction were measured by staining the coronal sections of the brain with NR solusion, TTC and H & E. Results : There are no difference of physiological parameters comparing the each group. Cerebral infarction was not observed in group II, but it's volume was largest in group IV. Disadvantages of craniectomy group(I, II, III) are the long duration of operation and cortical damage by procedure. It's advantage is confirmation of the middle cerebral artery occlusion and cessation of blood flow through the operative microscope. In case of ischemic models using nylon thread (group IV, V), it is hard to identify the interruption or recirculation of blood flow through the middle cerebral artery, but the advantage is the simplicity of operative technique which reduces the operation time and minimizes the cerebral damage due to craniectomy. Therefore, it seems important to set up the reversible and irreversible ischemic models by carefully considering advantages and disadvantages listed above. Conclusion : TTC staining seems to be effective since it reflects the histological damage sufficiently and quickly. It is hoped that researches focused on ischemic penumbra, which became popular recently, will be further carried on with use of NR staining, optical microscope and electron microscope.

백서의 가역성 뇌허혈 모형에서 재관류 시간에 따른 뇌경색 크기의 변화

정병우,최병연,조수호,김오룡,배장호,김성호,Jung, Byoung Woo,Choi, Byung-Yon,Cho, Soo-Ho,Kim, Oh-Lyong,Bae, Jang-Ho,Kim, Seong-Ho 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objective : The purpose of the present study was to determine the appropriate time of clinical intervention by observing and analyzing the changes in the size of infarct, penumbra and cerebral edema and the extend of neurological deficit due to reperfusion damage according to time in a reversible cerebral ischemic model of reperfusing blood flow after inducing ischemia by maintaining middle cerebral artery occlusion for 2 hours(h) in rats. Methods : The rats were divided according to reperfusion time into control group(0 h reperfusion time) and experimental groups(0.5, 1, 2, 3, 4, 5, 6, 12, and 24 h of reperfusion time). Results : Changes in the size of infarction due to reperfusion damage were 0.93, 1.48 and 1.16% at 0.5, 1 and 2 h after reperfusion, respectively, and although a statistical significance was not present compared to 1.35% of the control group, damages increased drastically up to 6 h(6.64%), and the size increased were 6.65 and 6.78% at 12 and 24 h, respectively. Also there was no significant difference after 6 h up to 24 h in the size of infarction. In the areas where infarction occurred, reperfusion damage increased significantly with time in cortex than in subcortex. Accordingly, the size of penumbra area also showed a statistically significant decrease from 2 h up to 6 h after reperfusion, and 6 h after reperfusion, the area almost disappeared, becoming permanent infarction. Thus, reperfusion damage showed a significant increase from 2 h up to 6 h after reperfusion, and became steady thereafter. As for the mean ratio of the extend of cerebral edema, the control group and reperfusion 0.5 h group were 1.073 and 1.081, respectively ; up to 2 h thereafter, the ratio decreased to 1.01 but increased again with time ; and in reperfusion 12 h and reperfusion 24 h, the ratios were 1.070 and 1.075, respectively, showing similar size with that of control group. As for neurological deficit scores, the score of the control group was 2.67, that of reperfusion 2 h was 2, those of reperfusion 3 h and 6 h groups were 3.2 and 3.8, respectively, and those of reperfusion 12 h and 24 h groups were 4.2 and 4.6, respectively. Thus, as for the test results, the neurological deficit increased with time 2 h after reperfusion, and in reperfusion 12 and 24 h groups, almost all the symptoms appeared. Conclusion : As shown in these results, although the changes in the size of infarction due to reperfusion damage did not increase up to 2 h after reperfusion in the experimental groups compared to the control group, damage increased significantly thereafter up to 6 h, and the size remained about the same from 6 h to 24 h after reperfusion, becoming permanent infarction ; thus, the appropriate time of intervention according to the present study is at least 6 h before after maintaining reperfusion, including the time of cerebral artery occlusion.

다분절 경추 유합 및 내고정 수술결과

전우열,배장호,정병우,김성호,김오룡,최병연,조수호,Jeon, Woo-Youl,Bae, Jang-Ho,Jung, Byoung-Woo,Kim, Seong-Ho,Kim, Oh-Lyong,Choi, Byung-Yon,Cho, Soo-Ho 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : The purpose of the present study was to examine neurologic changes, fusion rate and degree of kyphosis from the surgical results of those patients who underwent multi-level anterior interbody fusion and internal fixation. Methods : Among 63 cases of the patients who received multi-level anterior interbody fusion and internal fixation in 5 years between 1995 to 1999 at the neurosurgery department, we performed a retrospective study in 52 cases that could be followed up with dynamic view imaging ; the results were compared and analyzed. The analysis was based on the results of history taking, physical findings and radiologic findings, and Odom criteria were used to classify those cases with neurologic changes. Results : Among those 52 cases in whom the follow-up was possible for at least a year and dynamic view imaging was possible, bone fusion was seen in 93% of the trauma cases and 95% in the non-trauma cases and overall bone fusion was observed in 94% of the cases. Bone fusion was seen in 93% of the autobone cases, 95% of the allobone cases, and 94% of the Mesh cases. Radiologic changes were observed by comparing the lateral view after surgery ; kyphosis was seen in 53% of the autobone cases, in 70% of the allobone cases, and in 35% of Mesh cases ; in 45% and 60% of the non-trauma cases and trauma cases, respectively ; and in 55% of the 2 level fusion cases and 46% of the 3 level fusion cases. Neurologic changes classified according to Odom criteria showed excellent result in 48% of all the cases, good in 23%, fair in 4%, and poor in 25%. Conclusion : Even those cases with multi-level fusion, a high fusion rate could be obtained by performing anterior interbody fusion and internal fixation ; those cases with kyphosis were related more with the presence or absence of posterior compartment injury rather than the fusion level ; and those trauma cases showed not much difference in the fusion rate compared with non-trauma cases but had a high possibility of kyphosis.

지역기상이 노인외상에 미치는 영향

김정호 ( Jung Ho Kim ),도병수 ( Byung Soo Do ),이삼범 ( Sam Beom Lee ),이성훈 ( Sung Hoon Lee ),시종원 ( Jong Won Si ),이재영 ( Jae Young Lee ),김오룡 ( Oh Lyong Kim ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Purpose: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. Methods: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. Results: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. Conclusion: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation. (J Korean Soc Traumatol 2006;19:97-104)

뇌 손상 정도 및 전두엽 손상 유무에 따른 외상성 뇌 손상 환자의 주관적 정신병리

김경근(Kyoung-Keun Kim),주열(Yeol Joo),김진성(Jin-Sung Kim),이종범(Jong-Bum Lee),김오룡(Oh-Lyong Kim),서완석(Wan-Seok Seo),배대석(Dai-Seg Bai),구본훈(Bon-Hoon Koo) 대한생물치료정신의학회 2010 생물치료정신의학 Vol.16 No.1

외상성 뇌손상(traumatic brain injury;이하 TBI)환자에서 외상의 심각도와 전두엽 손상 여부에 따른 정신과적 증상에 대해 알아보기 위해 1998년 7월부터 2008년 10월까지 TBI 환자 110명을 대상으로 연구를 시행하였다. 이들을 손상의 심각도에 따라 경도 뇌손상군(mild TBI, 이하 MTBI)과 중등도 뇌손상군(moderate TBI, 이하 MOTBI)으로 나누고, 이를 전두엽 손상 유무에 따라 각각 전두엽 손상군(frontal lobe injury, 이하 FLI)과 비전두엽 손상군(non-frontal lobe injury, 이하 NFLI)으로 구분하였다. 각 군에 대해 병록지 자료 수집 및 SCL-90-R과 MMPI를 시행하였다. SCL-90-R에서 뇌 손상이 심한 경우 정신증 척도가 높고 증상을 더 많이 호소하는 경향을 보였으나 전두엽 손상 유무에 따라서는 차이가 없었다. MMPI의 경우에는 경조증 척도가 뇌손상의 심각도와 전두엽 손상 여부 간의 상호작용이 나타났다. 따라서 뇌손상의 정도가 증가하는 경우 인지기능의 저하에 따른 경조증 증상에 대한 주의가 필요하다. Objectives:The objective of this study was to investigate the subjective psychopathology in patients with traumatic brain injury according to their severity and existent of frontal lobe injury. Methods:S110 patients with traumatic brain injury were selected for study. After classifying patients into mild traumatic brain injury(MTBI) group and moderate traumatic brain injury(MOTBI) group with Glasgow Coma Scale score, each group was subdivided into frontal lobe injury(FLI) group and non frontal lobe injury(NFLI) group. Psychological tests were administered using Korean Wechsler adult intelligence scale(K-WAIS), Symptom checklist 90 revised (SCL-90-R) and Minnesota multiphasic personality inventory(MMPI). Results:Psychoticism score and positive symptom distress level in SCL-90-R was higher in MOTBI group than MTBI group. There was significant interaction between injury severity and existent of frontal lobe injury in hypomanic scale score of MMPI. Conclusion:Careful evaluation of psychotic and affective symptoms are warranted for TBI patients with increasing severity and existent of frontal lobe injury.

백서의 가역성 뇌허혈 모형에서 저체온의 효과와 적용시기

최병연,정병우,송광철,박진한,김성호,배장호,김오룡,조수호,김승래,Choi, Byung-Yon,Jung, Byung-Woo,Song, Kwang-Chul,Park, Jin-Han,Kim, Seong-Ho,Bae, Jang-Ho,Kim, Oh-Lyong,Cho, Soo-Ho,Kim, Seung-Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Objective : We studied to clarify the effective time zone of mild hypothermic neural protection during ischemia and/or reperfusion after middle cerebral artery occlusion. Methods : In a reversible cerebral infarct model which maintained reperfusion of blood flow after middle cerebral artery occlusion for two hours, the size of cerebral infarction, cerebral edema and the extent of neurological deficit were observed and analyzed for comparison between the control and the experimental groups under hypothermia($33.5^{\circ}C$). The temporalis muscle temperature was reduced to $33.5^{\circ}C$ by surface cooling for two hours during middle cerebral artery occlusion for study group I. The following groups applied hypothermia for two-hour periods after reperfusion : group II(0-2 hours), group III(2-4 hours), and group IV(4-6 hours). They were rewarmed to $36.5^{\circ}C$ until sacrified at 2, 4, 6, 12, and 24 hours after reperfusion. Control group was maintained at normothermia without hypothermia. Results : In the experimental groups with hypothermia, the average value of the size of cerebral infarction($mean{\pm}SD$) was $1.97{\pm}1.65%$, which was a remarkable reduction over that of the control, $4.93{\pm}3.79%$. In the control, a progressive increase was shown in the size of infarction from point of reperfusion to 6 hours after reperfusion without further changes in size afterward. Intra-ischemic hypothermia(group I) prevented ischemic injury but did not prevent reperfusion injury. Group II examplified the most neural protective effect in comparison to the control group and group IV(p<0.05). The cortex was more vulnerable to reperfusion injury than the subcortex. Mild hypothermia showed more neural protective effects on the cortex than subcortex. Conclusion : The most appropriate time zone for application of mild hypothermia was defined to be within four hours following reperfusion.