경추 질환의 전방 경유 수술법후 구음 장애 : Consideration for Prevalence and Prevention

박향권 梨花女子大學校 醫科大學 醫科學硏究所 1998 EMJ (Ewha medical journal) Vol.21 No.3

During the period from Sep.,1993 to Dec.,1997, in a series of 148 patients with anterior cervical fusions on using a modified Smith-Robinson technique, long-term follow-up results complete with historical evaluation or laryngeal examination were obtained in all patients. The visualization of the underlying pathology was adequate through magnification of the operating microscope in the anterior approach. The complications were analyzed on the basis of 157 operative cases in 148 patients treated surgically right sided approach with variable underlying pathologies. The most common complication was a postoperative hoarseness in 8(5%), but risks and complications of the procedure were few in spite of right sided approach. Measures to minimize the incidence of vocal cord paralysis include careful surgical techique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.

환추축성 불안정성(Atlantoaxial Instability)에 대한 후방 CI-2 Transarticular 나사못 고정법

박향권 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.3

The atlantoaxial joint is a complex structure which facilitates rotation of the head on the neck. The transverse atlantal ligament is essential to retain the odontoid process of C2 in the anterior part of the C1 ring. Disruption or laxity of the transverse ligament, some odontoid process fracture result in atlanloaxial instability. In case of instability, stabilization is desirable to relieve pain and reduce the risk of neural damage. The isolated atlantoaxial instability with normal occipitoatlantal joint is generally treated by a monosegmental fusion The standard fmation for C1-2 instability is posterior wiring using the Gallie, Brooks technique or their modifications. The most recent and innovative development in the evolution of upper cervical spine fixation is the use of C1-2 transarticular screw fixation. The transarticular screw fixation technique can be employed in situations where the posterior arch of C1 is absent or fractured and standard wiring techniques risk posterior subluxation of C1 on C2, or for congenital odontoid anomalies and multiple failures of standard wiring techniques. The transarticular screw fixation of the atlantoaxial join6 with posterior bone grafting provides good fixation and is biomechanically superior to wiring methods. This paper presents the comparison of posterior fixation methods and the detailed introduction of posterior C1-2 transarticular screw fixation technique.

퇴행성 경추 질환의 임상 및 MRI소견 분석

박향권 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.2

Objectives : The multifactorial character of cervical spondylotic myelopathy indicates a probable onset and progression of this disease as well as a diversity of clinical manifestations. Patients admitted with the clinical symptomatology of a progressive myelopathy associated with radiologic findings compatible with spondylotic degeneration of the cervical spine and who manifest appropriate neurophysiological abnormalities should be considered as candidates for surgical treatment. For several decades, both anterior and posterior spinal decompressive procedures have been performed who are generally being informed before the operation that the aim of surgery is to stabilize their neurologic condition and that actual improvement often cannot be expected. Method : A retrospective analysis of 42 patients admitted to the Dongdaemoon hospital utilizing MRI, CT in small amount to make diagnosis and surgical indication of degenerative cervical spine lesions was undertaken. Almost all patents were taken T1 Weighted Image(T1W1),T2 Weighted Image(T2W1) and gradient echo image on 1.5 Tesla unit. All patients could be evaluated the extent and degrees of disc hemiation, osteophytes and cord compression. Results : A focal area of High-Signal-Intensity(HSI) was observed on T2W1 in 15 patients with myelopathy predominantly. HSI was diminished postoperatively in the patients who improved clinically , remained and unchanged who didn't improve. Conclusion : In this study, MRI with high resolution images I the initial procedure of choice of degenerative cervical spine lesion was important on the decision making of the patients, Furthermore hight signal of the spinal cord by the compressive lesions appear to be an important indicator for predicting prognosis of patients with myelopathy.

잠재성 뇌 동·정맥 기형

박향권,김성학,박동빈,신규만 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.3

Five cases presenting with hemiparesis, disturbed consciousness, and visual dimness gave no history suggestive of subarachnoid or intracerebral hemorrhage. Carotid angiograms were performed, and in each case failed to demonstrate a vascular malformation. The CT scans in five cases showed intracerebral hematoma that could suggest vascular malformation as a diagnostic possibility. Surgical exploration was done in each case and pathological features revealed a arteriovenous malformation in each specimen.

실험적 뇌경색에 대한 Mannitol 및 Methylprednisolone의 효과

박향권,김성학,신규만 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.4

The object of this investigation was to study the effects of mannitol and high dose of methylprednisolone (MP) upon evolution of cerebral infarction in cats after acute left middle cerebral artry (MCA) occlusion and following reperfusion. The acute occlusion of left proximal MCA of thirty cats for 2, 4 and 6 hours respectively were accomplished by applying the Heifetz clip through the retroorbital extradural approach and followed by 2 hours of recirculation. Fifteen cats were untreated as a control group and the fifteen cats were given a combination of mannitol (2g/㎏) and MP (15㎎/㎏) at 30 minutes after occlusion initially, and then every one and a half hour. Results of morphologic examination of the brain demonstrated that intreated cats undergoing 2-hour or 4-hour occlusion mannitol and MP improved the ischemic edema and infarction, but in treated cats undergoing 6-hour occlusion they had little protective effect in ischemic brain injury (swelling, neuronal damage and hemorrhagic infarction). Electronecephalography (EEG) in cats undergoing 2-or 4 -hour occlusion showed more increasing activities and voltage than in untreated groups, but in cats undergoing 6-hour occlusion low voltage and slow waves with poor activity, i.e, generally suppressed pattern, were observed and were not significantly different between treated and untreated groups. Our experimental studies of the therapeutic beneficial effects of mannitol and MP were observed in cats of 2-or 4 -hour occlusion of MCA with 2 hour recirculation. Therefore, it was suggested that mannitol and MP will prolong the period of potential reversibility of cerebral ischemia following reperfusion within 4 hours of ischemia.

Moya Moya 질환 치험 3예

박향권,김성학,박동빈,신규만 梨花女子大學校 醫科大學 醫科學硏究所 1986 EMJ (Ewha medical journal) Vol.9 No.2

Moya Moya disease is a rare chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. This disease has distinct angiographic features. These include 1) Either marked stenosis or complete occlusion of the distal internal carotid arteries. 2) Poorly visualized anterior and middle cerebral arteries at their proximal portions. 3) Well developed fine vascular networks at the base of the brain. These features are peculiar findings of this disease and the clue of the occlusion and its collateral circulation. Authors reported 3 cases of moya moya disease is discussed.

백서에서 후지 허혈 및 재 관류간 신경혈류

박향권,박동빈 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.4

Animal models of peripheral nerve ischemia have yielded variable results. The question of whether postischemia re-estableshment of blood flow to the nerves auguments injury has not been examined. To study this question, the ipsilateral common iliac and femoral arteries were occluded with arterial snares for 3 hours in rats. C14-butanol tissue distribution was then used to measure blood flow in both sciatic and posterior tivial nerve trunks during occlusion and reperfusion. Clinical limb function was graded serially, with the undisturbed contralateral limb serving as the study control. Nerve blood flow was reduced throughout the ischemic period and was only 20% of the control value in the posterior tibial nerve. All rats had functional impairment with an average limb function score of 7.5(normal score<2). During reperfusion period, blood flow in the distal sciatic and posterior tibial nerves was approximately double that of control nerbes at 2 hours. At 21 hours, tibial nerve blood flow was still twice that of the control nerve, but flows in the distal sciatic nerve were unchanged from control levels. Clinically, limb function improved progressively after reperfusion. It was concluded that nerve ischemia is attended by a relatively prolonged hyperemic flow response during reperfusion

일차 전방경유 경추수술에 실패한 환자들의 임상분석

박향권 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.1

Recently, postoperative results of cervical spondylosis, disc herniation, tumor, and ossiication of posterior longitudinal ligament(OPLL) after anterior cervical surgeries have been improving due to new kinds of medical imaging, electrophysiological examinations, improved operative equipment, and improved surgical technique. However, occasional unsatisfactory cases needing a secondary operation remain. The author analyzed and developed strategies for multioperated cervical cases : all patients had two or more operations. From Sep. 93 to Aug. 98, 167 anterior cervical surgeries with fusions were performed in Dept. of Neurosurgery, Tong Dae Moon hospital. The author experienced 11 cases(6.6%) of failed anterior cervical surgeries and fusions : 8 men and 3 women. Initial diagnosis was 1 spondylosis, 2 cervical traumas, 3 disc herniations, and 5 cases of ossification of posterior longitudinal ligament. These multioperated cases were classified by the following cases : hardware-related complications, graft-related complications, and others. These groups were analyzed, and the resulting surgical strategies, including indications and techniques of anterior surgery, are described. The results of this study indicates that in order to reduce the need for multioperated cases, initial skillful surgical techniques and proper understanding of cervical spinal anatomy are necessary.

경추 척수병증의 수술적 치료

박향권,박동빈,박형천,신규만 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

Patients admitted with the clinical symptomatology of a progressive myelopathy associated with radiologic findings compatible with spondylotic degeneration of the cervical spine and who manifest appropriate neurophysiological abnormalities should be considered as candidates for surgical treatment. The authors have undertaken a study of 20 patients who had received decompressive surgicalprocedures and possible follow up studies for CSM, which was defined as a myelopathy related to osteophytic overgrowth and ossification of posterior longitudinal ligament(OPLL) in the cervical spinal canal causing impingement upon the spinal cord from Sep. 93. to Aug. 1995. It was concluded with the following results. 1) man was exclusively prevalent in most cases. 2) age at surgery : There was a signigicant negative correlation between the age at surgery and the recovery rate 3) original cause of compression : There was no signigicant difference between the CSM and OPLL 4) the involved level : three level involvement was the most common(8cases), followed by two level(6 cases), four level(3 cases), and single level(2 cases). There was no correlation between the preoperative Harsh scale and the number of the involved level. 5) recovery rate : excellent(Grade 0.1). 12 cases(60%), good(Grade Ⅱ, ⅢA). 4 cases(20%), poor(Grade Ⅲc, Ⅳ, Ⅴ) 4 cases(20%).

전방접근법에 의한 척수병증의 치료

박향권,박동빈 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.4

저자들은 1993년 3월 부터 1995년 8월까지 본 이대부속 동대문병원 신경외과에서 추체 제거술을 통한 척수병증을 수술한 환자중 원격추적이 가능하였던 12례를 대상으로 조사하였다 전례 모두 남자환자였으며 60대가 4명(33%)를 차지하였고 경미한 외상으로 발생한 경우는 5례(42%)였으며 원인질환의 경우 경추증이 9례(75%)였다. 원격추적기간 회복정도는 수술전 신경학적 손상 정도가상당히 중요한 인자로 Grade I의 5례, Grade Ⅱ의 1례에서 excellent한 결과를 보였고 Grade Ⅳ1의 2례 및Grade Ⅳ2 1례는 회복이 되지 않았다. 연령에서는 젊은나이 일수록 경과가 좋았고 excellent군증 5례(42%)가50대이하였고 fail을 보인 군은 수술전 신경학적 손상이심했고 70세 이상이었으며 전체적으로 회복정도는 12례중 7례(58%)에서 excellent군이었고, 2례(17%)는good, poorl레, fail 2례로 작은 모집단이지만 비교적 양호한 결과를 보였다. The degenerative process of cervical spondylosis through acquired narrowing of the spinal canal or segmental hypermobility of the spinal column, either singularly or in combination, mayresult in injury to the spinal cord or supportive vasculature. The mutifactional character of cervical spondylotic myelopathy(CSM) indicates a probable onset and progression of this disease aswell as a diversity of clinical manifestations. Although it is recognized that a number of factors,mostly vascular, may contribute to the pathogenesis of CSM, surgical procedures performed forthis condition decompress the spinal cord on the premise that mechanical compression is a major, if not pirmary, causative factor. For several decades, both anterior and posterior spinal decompressive procedures have beenperformed on CSM patients, who are generally being informed before the operation that theaim of surgery is to stabilize their neurologic condition and that actual improvement often cannot be expected. Over the past 10 years, radical cervical cord decompression via corpectomy has been reportedas being more effective than conventional surgery for CSM. The authors have undertaken a study of 12 patients who underwent anterior decompreuivecorpectomy procedures for CSM, which was defined as a myelopathy related to osteophyticovergrowth and ossification of posterior longitudinal ligament(OPLL) in the conical spinal canal causing impingement upon the spinal cord from Mar, 93 to Aug. 95 at Dong Dae MoonHospital, Department of Neurosurgery. The result was fo11owing : man was prevalent in allcases, prognosis was strongly correlated with age, preoperative neurological state and 7 cases(58%) resulted in excellent group.