토끼의 뇌혈관 연축 모델에서 혈관확장제 및 혈관수축제에 대한 기저동맥의 감수성 변화

백선하,한대희,Paek, Sun Ha,Han, Dae Hee 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : This experiment is aimed at clarifying the characteristics of spasmodic basilar arteries in the rabbits of subarachnoid hemorrhage(SAH) with observation of vascular response to nitric oxide(NO) and endothelin-1. Material and Methods : Seventy-nine New Zealand white rabbits were divided into 4 groups : control(n=17), sham operation(n=13), postictal-2-day(n=25), and postictal-7-day group(n=24). Rabbits in the postictal-2-day group and postictal-7-day group underwent transfemoral vertebral angiography 2 days and 7 days after SAH respectively. A vascular ring of spasmodic basilar artery was harvested and suspended in organ chamber($37^{\circ}C$) to observe isometric tension changes in response to NO and endothelin-1 under both high(95% $O_2$/5% $CO_2$) and low(95% $N_2$/5% $CO_2$) $O_2$ tension. To investigate the vascular response to NO, acetylcholine from $10^{-7}M$ to $3{\times}10^{-4}M$ concentration was applied to basilar artery ring precontracted with histamine $10^{-6}-10^{-5}M$ in the organ chamber. The vascular response to endothelin-1 was observed by applying endothelin-1 from $10^{-11}M$ to $3{\times}10^{-8}M$ concentration into organ chamber. Results : Seven of 15 live rabbits which underwent angiography 2 days after SAH, were confirmed to develop vasospasm($64.3{\pm}11.2%$) whereas seven of 13 live rabbits which underwent angiography 7 days after SAH, were confirmed to develop vasospasm($64.9{\pm}10.9%$). In all groups, hypoxia significantly reduced the vascular relaxation of basilar arteries to NO. However, hypoxia made no influence on the vascular contraction of basilar arteries to endothelin-1 in all groups. In vascular relaxation of basilar arteries to NO under high $O_2$ tension between groups, the maximum relaxation of basilar arteries in the postictal-7-day group was significantly reduced compared to the postictal-2-day group. In vascular contraction of basilar arteries to endothelin-1 under high $O_2$ tension between groups, the maximum contraction of basilar arteries in the postictal-7-day group was significantly reduced compared to the postictal-2-day group. Conclusions : This experiment suggests that the characteristics of vascular response to NO and endothelin-1 in the spasmodic basilar arteries of rabbits observed 2 days after SAH is different from those observed 7 days after SAH.

추체사대 수막종의 수술과 관련하여 뇌 정맥조영상의 의미

황승균,곽호신,백선하,오창완,이상형,김동규,김현집,정희원,Hwang, Sung-Kyun,Gwak, Ho-Shin,Paek, Sun Ha,Oh, Chang-Wan,Lee, Sang Hyung,Kim, Dong Gyu,Kim, Hyun Jib,Jung, Hee-Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.10

Objective : A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of $Labb{\acute{e}}$ in surgical removal of petroclival meningiomas. Patients and Methods : The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent & equal on both sides), Type B(confluent & non-dominant on tumor side), Type C(confluent & dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of $Labb{\acute{e}}$ was analyzed with respect to its draining point and its collaterals to other superficial veins. Results : Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of $Labb{\acute{e}}$, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. Conclusion : For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of $Labb{\acute{e}}$.

감마나이프수술 환자의 만족도 및 재원일수에 대한 고찰

정상순,정현태,백선하,김동규,Jeong, Sang Soon,Chung, Hyun-Tai,Paek, Sun Ha,Kim, Dong Gyu 한국의료질향상학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : Since a Gamma Knife had been installed on December 1997, 405 patients have been treated until December 1999 at department of neurosurgery of Seoul National University hospital. The authors analyzed results of a work to improve satisfaction of Gamma Knife surgery patients and to reduce hospital length of stay. Methods : To understand main discontent of patients, a pre-survey was performed from October 1998 to December 1999 using a questionnaire. By Analyzing 93 questionnaire received from 234 patients, pain on frame application, explanation before surgery, waiting time before surgery, waiting time before medical procedure were main discontent factor and overall satisfaction ratio was 71.0%. To improve satisfaction ratio, several quality improvement activity works were designed and applied to 123 patients during the period between January 2000 and September 2000. The same questionnaire were analyzed. Works to reduce the patient hospital LOS were devised and applied during the same period. Results : The overall satisfaction ratio of Gamma Knife radiosurgery patients was increased to 83.7%(P=0.10). The main factor to improve satisfaction ratio was to reduce waiting time(P=0.05) and improvement of discomfort during the surgery(P=0.06). The average LOS was reduced from 3.1 to 2.7 days(P=0.003). Conclusion : As a result of quality assurance activities, the overall satisfaction ratio of patients was improved and LOS was reduced. The pain during frame application was remained as a main discontent factor and a further study is required to reduce this pain.

한국에서의 시신경 수막종 환자의 임상 양상 및 치료 결과

이은경,김성준,백선하,김동규,김일한,곽상인,Eun Kyoung Lee,Seong-Joon Kim,Sun Ha Paek,Dong Gyu Kim,Il Han Kim,Sang In Khwarg 대한안과학회 2011 대한안과학회지 Vol.52 No.1

Purpose: To evaluate the clinical features and treatment results of optic nerve sheath meningioma (ONSM) in Korean patients. Methods: The present retrospective noncomparative case series was comprised of 10 eyes of 10 patients with a diagnosis of ONSM who were treated between 1997 and 2010 at the Seoul National University Hospital. Results: The mean age at presentation was 47.9 years. Two males and 8 females participated in the study. Decreased vision and proptosis were the most common presenting symptoms. On imaging, the most common pattern was tubular. The most common histopathologic pattern was a meningothelial type. Two patients who were observed maintained good vision during the follow-up period and showed a slow progression of the tumor. Two patients out of 3 who underwent surgical management presented significant visual loss and complications. Three patients in the gamma-knife surgery (GKS) group showed no significant changes in visual acuity after treatment; however, tumor growth was halted. Two patients who underwent 3-dimensional conformal radiotherapy (3D-CRT) presented improvement in their visual acuity or visual field, and tumor growth was halted. Conclusions: Management should be conservative in most cases because of the slow and indolent growth pattern of ONSM. However, 3D-CRT can be considered as an initial treatment in patients with progressive visual deterioration and having still higher possibility of vision maintenance. GKS can be indicated in patients with progressive visual deterioration and a rare possibility of visual recovery. Surgical indications for ONSM are limited and must be carefully considered for each patient. J Korean Ophthalmol Soc 2011;52(1):74-85

성장호르몬분비 뇌하수체 선종 80예의 수술성적 및 예후 인자의 분석

김정은,정희원,곽호신,백선하,김동규,최길수,Kim, Jeong Eun,Jung, Hee-Won,Gwak, Ho-Shin,Paek, Sun Ha,Kim, Dong Gyu,Choi, Kil Soo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Objectives : The surgical results of 80 patients with growth hormone(GH)-producing pituitary adenoma were analyzed retrospectively to evaluate the clinical manifestations and to determine which preoperative factors significantly influenced the surgical outcome. Patients and Methods : The patients consisted of 39 men and 41 women and the age of patients at the time of initial operation ranged from 17 to 67 years(mean age, 40.5 years) Between January 1990 and June 1996, 77 patients underwent transsphenoidal surgery and 3 patients underwent craniotomy for GH-producing pituitary adenoma at our institution. Preoperative administration of octreotide was performed in 18 patients. Surgical control was defined as a postoperative serum basal level of GH less than 5ng/ml. A logistic regression model was used for univariate and multivariate analysis. Probability value of less than 0.05 was considered as statistically significant. Results : The most common presenting symptom was acromegaly, followed by headache, visual disturbance, and fatigability. Visual symptoms were present in 39% of the patients. Diabetes mellitus was associated in 24 patients and hypertension in 12. Preoperative mean basal level of GH was 93.2ng/ml(range 72-500ng/ml) which was closely related with tumor size(p<0.05). Grade II by Hardy's classification was the most common radiological type. Preoperative octreotide treatment significantly reduced the level of GH(p<0.05), but not enough to induce endocrinological remission. One patient died of cerebral infarction after craniotomy. The most common surgical complication was transient diabetes insipidus. The symptom of the earliest improvement after surgery was paresthesia and tightness of the hand and foot, followed by headache and easy fatigability. The preoperative visual symptom was improved in all patients. The patients who had hypertension or DM experienced alleviated symptoms in 67% and 92%, respectively. The overall rate of endocrinological remission was 44%. By multivariate logistic regression analysis, the size of tumor, extrasellar extension, and extent of removal were significant prognostic factors for endocrinologial remission. Conclusion : Early detection of a small tumor without extrasellar extension followed by a complete resection is highly recommended in order to achieve endocrinological cure of GH-producing pituitary adenomas.

두개강내 척삭종 및 연골육종 : 수술 및 방사선 치료의 효능

정영섭,곽호신,정희원,박홍준,백선하,김동규,김현집,Chung, Young-Seob,Gwak, Ho-Shin,Jung, Hee-Won,Park, Hong-Jun,Paek, Sun Ha,Kim, Dong Gyu,Kim, Hyun Jib 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Introduction : The management of chordomas and chondrosarcomas in the skull base is difficult due to the critical location, locally aggressive nature, and high recurrence rate. The authors present the effectiveness of surgical removal and radiation therapy on survival and tumor recurrence. Material and Methods : Thirty cranial base chordomas and chondrosarcomas from 23 patients(14 patients with chordomas and 9 patients with chondrosarcomas) were operated in our institution between 1985 and 1998. There were 15 men and 8 women, with a mean age of 40.7 years. The largest diameter of tumors ranged from 15 to 70mm (mean 41.5). The extent of surgical removal was subtotal or total in a half(15 operations). In nineteen operations, tumors were removed by conventional approaches and skull base approaches were applied in 11 operations. Postoperative radiation therapy was performed in 16(70%) patients. The mean duration of follow up is 50 months(1- 156 months). Results : The 3- and 5-year survival rates(YSR) of overall patient are 75% and 67%, respectively. The analysis showed that 1) skull base approach to chordomas and chondrosarcomas showed a tendency to remove more portion of the tumors(p=0.058) but leave more frequent incidence of new deficits(p=0.047) : 2) larger tumor diameter af-fected the extent of removal(p=0.028) : 3) the extent of removal seemed to be the determining factor for overall survival and recurrence-free survival(the 5-YSR and RFSR of subtotal or total removal group are 92% and 80% vs. 40% of partial removal or biopsy group) : 4) conventional radiation therapy improved patient survival(5-YSR of patients who received RT is 76% whereas 5-YSR of those who didn't receive RT is 43%) but failed to prolong long-term recurrence-free survival. Conclusion : The extent of removal and postoperative radiation therapy are determining factors of patients' survival in skull base chordomas and chondrosarcomas. However, none of these factors significantly influenced the survival in multivariate analysis. Aggressive surgical removal of more than subtotal resection combined with postoperative radiation therapy seems to be the choice of therapy in the management of these tumors.

수막 혈관주위세포종의 임상상, 치료 및 장기 추적 결과

이준호,황승균,곽호신,백선하,김동규,김현집,정희원,Lee, June-Ho,Hwang, Sung-Kyun,Gwak, Ho-Shin,Paek, Sun Ha,Kim, Dong Gyu,Kim, Hyun Jib,Jung, Hee-Won 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objectives : Meningeal hemangiopericytoma is a rare tumor. Clinical and radiological features are similar to those of an ordinary meningioma. But its biological behavior is quite different from those of a meningioma as it brings profuse bleeding in the operation field, frequent recurrence and metastasis to other systemic organs even in the case of gross total resection. In order to find out the prognostic factors and to compare longterm outcome after various treatment modalities, the authors reviewed consecutive 20 operated cases of meningeal hemangiopericytoma to characterize their clinical features, surgical outcomes and effectiveness of the radiation therapy. Methods : Twenty patients with a hemangiopericytoma were treated between 1982 and 1999 in our department. They are composed of 13 patients of hemangiopericytoma and 7 patients who were initially diagnosed as angioblastic type meningioma and then confirmed as a hemangiopericytoma after review of their previous histopathology slides. The mean follow-up period was 99 months(1-256 months). The long-term outcomes after various treatment modalities were evaluated according to recurrence-free survival and image follow-up. Recurrence-free survival curves are compared between the patient groups according to the extent of removal and radiation therapy. Results : There were 10 cases of recurrence and 4 cases of distant metastases ; lung, liver and femur(2 cases) respectively. The 5-year recurrence rate was 37%, while the 10-year recurrence rose to 77%. There was also statistically significant difference of median recurrence-free survival between the completely-resected group(Simpson grade 1 or 2) and partially-resected group(Simpson grade 3 or 4 or 5) ; 137 months compared to 47 months, respectively(p=0.009). The median recurrence-free period after subtotal resection of tumor and postoperative radiotherapy was 47 months compared to 117 months of the patients who underwent gross total resection of tumor and did not receive radiotherapy. But radiation therapy alone did not show significant difference in recurrence-free survival. Marked tumor volume reduction and easy removal of tumors without bleeding were found in 2 recurred cases. Conclusion : The extent of tumor resection and presence of metastasis are the most important factors related to long-term outcome of the patients with hemangiopericytoma. Radiation therapy after the first operation did not have a role in extending the recurrence-free survival, but it affected favorably to decrease the size of residual mass and intraoperative bleeding during the second operation.

뇌반구에 위치한 양성신경교종의 악성전환에 대한 임상적 연구

조근태,곽호신,정희원,백선하,정영섭,김동규,조병규,Cho, Keun-Tae,Gwak, Ho-Shin,Jung, Hee-Won,Paek, Sun-Ha,Chung, Young Seob,Kim, Dong Gyu,Cho, Byung Kyu 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Introduction : It has been reported that the survival of low-grade glioma patients depends upon the time of malignant transformation. The authors presents the clinical analysis of histologically proven trasformed gliomas. Materials and Method : A total 92 patients who were consecutively treated and histologically confirmed hemispheric low-grade gliomas between 1980 and 1998 were analyzed and followed. All cases meet the criteria of WHO glioma classification of grade II. Results : The mean follow-up period was 73 months. Twenty two among 92 cases(24%) were histologically proven to be transformed into malignant ones. The mean time to transformation was 56 months. The 5-year and 10-year survival rates of the transformed group were 66% and 30% respectively and significantly different from the survival rates of the non-transformed group(p=0.0018). Among clinical factors at presentation, the initial tumor volume had a tendency to be larger in the transformed group than that of the non-transformed group and became significant when it was divided into more than $30cm^3$ or not(p=0.02). Among therapeutic factors, the extent of removal had no influence on the rate of malignant transformation. But postoperative radiation therapy were more frequently given to the pre-transformed group than the non-transformed group and the frequency was significantly different(p=0.02). Conclusions : The authors had found that the initial tumor volume and radiation therapy could be clinical prognostic factors for the malignant transformation of low-grade gliomas.

Telomerase 과발현을 이용한 신경줄기세포유래 세포치료제의 확립

홍석호 ( Seok Ho Hong ),백선하 ( Sun Ha Paek ),왕규창 ( Kyu Chang Wang ) 한국조직공학과 재생의학회 2005 조직공학과 재생의학 Vol.2 No.3

Since the evidences that neural stem cells (NSCs), either endogenous or exogenous, actively participate in regenerative process after destructive pathology in the (CNS) were given, various therapeutic strategies of cell-based regeneration has been introduced and attempted. While neurally-committed progenitor cells or NSCs are theoretically suitable for repairing CNS after injury, the acquirement of sufficient cells remains to be overcome for clinical applications. We propose clonal expansion of NSCs in vitro using telomerase overexpression as a practical means for obtaining NSCs for therapeutic purpose, and discuss their usefulness and limitations from the clinical viewpoint.

성인 두개인두종 연속 100예의 장기 치료 성적

방재승,정희원,김동규,곽호신,백선하,정영섭,홍승관,Bang, Jae Seung,Jung, Hee-Won,Kim, Dong Gyu,Gwak, Ho-Shin,Paek, Sun Ha,Chung, Young Seob,Hong, Seung-Koan 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objectives : The authors present a retrospective analysis of 100 consecutive adult patients harboring craniopharyngiomas who underwent microsurgical resection between 1981 and 1999 to assess the long-term outcome of surgical treatment and to determine the most optimal management strategy. Methods : The extent of surgical removal was divided into four categories ; GTR(gross total removal), RSTR(radical subtotal removal), STR(subtotal removal),and PR(partial removal). The median follow-up period was 50 months(4-198). CT scan and/or MR imaging and hormonal status were evaluated to the last follow-up. Results : Visual disturbance was the most common presentation, which was improved in 42 cases and aggravated in 19 cases following the operation. Hypopituitarism was detected in 56 patients preoperatively, 82 during the immediate postoperative period, and 76 at the last follow-up. Improvement of pituitary function was not observed in any of these patients. Twenty of 100 patients showed recurrence at the mean of 27 months(3 to 196). The median progression-free survival(PFS) time of all patients was 145 months and 5-year PFS rate was 74%. Five-year PFS rate of GTR or RSTR group(71%) was significantly higher than that of STR or PR group(30%)(p=0.01). Postoperative radiation therapy significantly prolonged the PFS from 94 months in non-radiation group to 182 months(p=0.002). However, there was no statistical difference in number of patients who required hormonal replacement therapy between radiation and non-radiation group. Conclusion : Visual disturbance can be improved by early diagnosis and surgical decompression. GTR or RSTR in selected patients is considered a proper surgical strategy. Post-operative radiation therapy for residual tumors must be considered, although the ideal timing of radiation therapy is to be determined.