뇌실-복강간 단락술에서 Proximal Catheter의 정확한 측뇌실내로의 위치를 위한 Shunt Guiding Kit의 개발

신용삼,김세혁,장호열,배주용,Shin, Yong Sam,kim, Se-Hyuk,Zhang, Ho Yeol,Bae, Ju Yong 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.8

Object : To treat hydrocephalus by ventriculo-peritoneal shunt operation, the correct positioning of the proximal catheter in the ventricle is very important. The purpose of this study was to develop the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle in the ventriculo-peritoneal shunt operation. Materials and Methods: The "shunt guiding kit" is made of tungsten alloy and it consists of one frame, two screws and one guider. Through the guider, the proximal shunt catheter operates by mechanically coupling the posterior burr hole to the anterior target point. Results: We have treated three hydrocephalus patients with use of the "shunt guiding kit", and achieved good location of proximal shunt catheters. Conclusion: We developed the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle, and this would be very useful for preventing ventriculo-peritoneal shunt malfunction and preventing possible brain injury during the procedures.

술중 풍선 확장을 이용한 일시적 근위부 결찰과 흡입, 감압술을 실시한 내경동맥의 거대동맥류 결찰 - 증례보고 -

원근수,신용삼,박한준,이성운,윤수한,조기홍,조경기,Weon, Keun Soo,Shin, Yong Sam,Park, Han Jun,Lee, Seung Un,Yun, Su Han,Cho, Ki Hong,Cho, Kyung Gi 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Apatient, 51 years old woman, had suffered form headache and decrease of visual acuity. She had $3{\times}3cm$ sized giant aneurysm originated in cavernous and clinoid portion of left ICA(C4,C5) in the cerebral angiography. Before craniotomy, left CCA was exposed and 6F double lumen catheter was inserted in left ICA through the sheath. Pre-operative angiography was done. balloon catheter was positioned at the petrous portion of ICA. Eyebrow approach was done and giant aneurysm was exposed. The proximal blood flow was controlled with balloon dilatation and suction and decompression was tried, then multiple clips were applied. The loss of distal blood flow under intra-operative angiography was notified after clipping. The position of clips were repositioned to preserve blood flow & the rich flow was confirmed at distal part of clipping. In the post-operative cerebral angiography, the same finding was shown.

뇌지주막하 출혈 후 뇌혈관 연축에 대한 동맥내 Papaverine 주입의 치료효과

신준재,이재환,신용삼,허승곤,김동익,이규창,Shin, Jun Jae,Lee, Jae Whan,Shin, Yong Sam,Huh, Seung Kon,Kim, Dong Ik,Lee, Kyu Chang 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objective : To clarify the benefits and therapeutic effects of intra-arterial papaverine infusion on the symptomatic cerebral vasospasm, we analyzed the results of treatment in 32 patients retrospectively. Methods : A total of 510 patients underwent surgical clipping or endovascular intra-aneurysmal treatment for ruptured intracranial aneurysm between May, 1996 and June, 1999. The delayed ischemic deficit(DID) was developed in 90 of 510 patients. Of these 90 patients, 32 developed symptomatic vasospasm inspite of using modest "3H therapy". The brain CT scan was taken before the intra-arterial infusion of papaverine. The 32 patients underwent 42 intra-arterial papaverine infusion. The symptomatic vasospasm was divided into three groups : deterioration of mental status(Group 1), appearance of a focal neurologic deficit(Group 2), or both(Group 3). We measured Glasgow Coma Scale(GCS), arterial diameters, and cerebral circulation time(CCT) at the time of pre- and postangioplasty. Results : The number of patients in group 1, 2 and 3 were 26, 7, 9 respectively. Eighteen cases showed improvement of GCS more than 2 scores, 16 more than 1, and 8 showed no change of GCS. Average cerebral circulation time(CCT) was decreased ranging from 0.0%-67.5%, and arterial diameters were increased in 21 cases ranging from 1 to 4 folds. Conclusion : Intra-arterial papaverine infusion seemed to have therapeutic effects on symptomatic vasospasm by improving the neurological signs and increasing the arterial diameter. We suggest that intra-arterial papaverine infusion would be an useful adjunctive therapeutic modality in symptomatic vasospasm.

경추 척추강내의 악성신경피막종 - 증 례 보 고 -

김혁준,조기홍,신용삼,윤수한,조경기,Kim, Hyeok Joon,Cho, Ki Hong,Shin, Yong Sam,Yoon, Soo Han,Cho, Kyung Gi 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Malignant peripheral nerve sheath tumor(MPNST, primary malignant schwannoma) within the spinal canal is very rare. The prognosis of MPNST in the spinal canal is very poor due to the tendency of perineural spread, dissemination throughout subarachnoid space and local recurrance. This report details the authors' experience on the case of primary malignant spinal schwannoma with review of the literatures and other studies.

수두증을 동반한 거대두개증 환아에서 격자술을 이용한 One Stage Reduction Cranioplasty - 증례보고 -

원근수,윤수한,신용삼,조기홍,조경기,Weon, Keun Soo,Yoon, Soo Han,Shin, Yong Sam,Cho, Ki Hong,Cho, Kyung Gi 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Reduction cranioplasty is one of the treatment modality among many treatment options for macrocephaly with hydrocephalus. The most previous techniques of reduction cranioplasty have some disadvantages such as difficult airway maintenance, pressure sore due to modified prone position, severe venous infarct due to obstruction of venous blood flow and large amount of bleeding from the dissection of superior sagittal sinus to obtain bone fragment needed. A 28-month-old girl had extreme macrocephaly. She couldn't control head rotation and keep sitting position. The operation was performed at supine position with adequate exposure of entire calvarium and the hinge was made in occipital bone fragment that covered posterior part of superior sagittal sinus. Bleeding volume and the other complications were decreased and acceptable reduction was achieved with this method.

Threaded Fusion Cage(TFC)를 이용한 최소 침습적 요추체 후방융합술

김혁준,조기홍,신용삼,윤수한,조경기,Kim, Hyeok Joon,Cho, Ki Hong,Shin, Yong Sam,Yoon, Soo Han,Cho, Kyung Gi 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : In general, to perform posterior lumbar interbody fusion(PLIF), it has been used more invasive procedure than simple discectomy. However we try to perform PLIF with TFC with smaller invasion almost same as in simple discectomy. This study is about its procedure and clinical results. Materials and Methods : The authors retrospectively analyzed 43 cases of minimally invasive PLIF with TFC from July 1998 to May 2000. Operative procedure, operative complication, change of disc height, blood loss, ambulation time, hospitalization period, clinical success rate, and bony fusion rate were analyzed. Results : 40 patients were capable to walk on the 2nd day of the post-operation. The average hospitalization period is 5.6 days. The average blood loss was 0.19L/level with no transfusion or wound drainage. The height of disc changed from 8.84mm to 13.54mm. Clinical success rate is 95% when evaluated by the Prolo's scale. The complication was delayed wound infection(2) and transient paresthesis(1). The bony fusion was shown in 17 patients (94.4%) out of 18 patients who passed one year. Conclusion : As a result of minimally invasive PLIF, pain was decreased and early ambulation and short hospitalization was possible. Complication was similar or lower than other studies, and the bony fusion rate and clinical success rate were also similar during follow-up.

골다공증성 척추체 압박골절에 대한 경피적 척추성형술시 자기공명영상과 골 주사 검사의 의의

김세혁,이완수,서의교,신용삼,장호열,전평,Kim, Se Hyuk,Lee, Wan Su,Seo, Eui Kyo,Shin, Yong Sam,Zhang, Ho Yeol,Jeon, Pyoung 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objective : Percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain in the patients with osteoporotic vertebral fractures. The purpose of this study is to estimate the value of preoperative radiologic studies in the localization of symptomatic vertebrae and to determine the factors which can influence on the clinical results. Materials and Methods : We retrospectively reviewed the clinical and radiologic data of 57 vertebrae in 30 patients underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Inclusion criteria was severe pain(McGill-Melzack score 3, 4 or 5) associated with the acute vertebral fractures and absence of spinal nerve root or cord compression sign. Acute symptomatic vertebral fracture was determined by the presence of signal change on MR images or increased uptake on whole body bone scan. Results : Pain improvement was obtained immediately in all patients and favorable result was sustained in 26 patients(86.7%) during the mean follow-up duration of 4.7 months(5 complete pain relief, 21 marked pain relief). Those who underwent vertebroplasty for all acute symptomatic vertebrae had significantly better clinical result than those who did not. Further vertebral collapse and eventual bursting fracture occurred in 1 vertebra which showed intradiskal leakage of bone cement and disruption of cortical endplate on postoperative CT scan. Conclusion : Preoperative MR imaging and whole body bone scan are very useful in determining the symptomatic vertebrae, especially in the patients with multiple osteoporotic vertebral fractures. To obtain favorable clinical result, the careful radiologic evaluation as well as clinical assessment is required. Control of PMMA volume seems to be the most critical point for avoiding complications.

두개강내 내배엽성 동종양(Endodermal Sinus Tumor)

임용철,조경기,이성운,박한준,신용삼,윤수한,조기홍,Lim, Yong Chull,Cho, Kyung Gi,Lee, Seong Un,Park, Han Jun,Shin, Yong Sam,Yun, Soo Han,Cho, Ki Hong 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Objective : Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. Material and Methods : Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin($20mg/m^2$), etoposide($100mg/m^2$) and bleomycin($15mg/m^2$) as well as external beam radiation therapy. We compared the management problems for these tumors. Result : In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. Conclusion : Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.

고령군 뇌동맥류 환자의 치료

박현선,이재환,김진영,신용삼,주진양,허승곤,이규창,Park, Hyeon Seon,Lee, Jae Whan,Kim, Jin Young,Shin, Yong Sam,Joo, Jin Yang,Huh, Seung Kon,Lee, Kyu Chang 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.

임상 : 성장 호르몬 분비 뇌하수체 선종 환자의 수술적 치료 결과

목영준 ( Young Jun Mok ),임용철 ( Yong Cheol Lim ),신용삼 ( Yong Sam Shin ),윤수한 ( Soo Han Yoon ),조기홍 ( Ki Hong Cho ),조경기 ( Kyung Gi Cho ) 대한뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.2

Objective:Control of growth hormone(GH) and insulin-like growth factor-I(IGF-I) levels are important in patients with GH-secreting adenomas because they are indicators of biochemical control of GH-secreting adenomas characterized by serious cardiovascular and metabolic complications. Surgical treatment is usually considered as the first choice of treatment in GH-secreting adenomas. In this study, we evaluated the efficacy and safety of surgical treatment with GHsecreting pituitary adenoma. Methods:We have reviewed medical records, radiologic findings, and endocrinologic evaluations of patients with GHsecreting pituitary adenoma who were treated by surgery between 1996 to 2004. Results:Twenty eight cases of GH-secreting pituitary adenoma(15 males and 13 females) have underwent surgery in our institute. The twenty eight cases included 22 patients with macroadenoma and 6 patients with microadenoma. Preoperative GH levels ranged between 1.77 and 82 μ/L(mean 20.7±14.3 ng/ml) and preoperative IGF-I levels ranged from 424 to 1710 ng/ml(mean 905.3±374.96 ng/ml). And the maximum diameter of tumors were between 4 mm and 70 mm. Twenty six patients were operated by transsphenoidal surgery and 2 patients underwent transcranial surgery. Gross total resection was achieved in 25 of the 28 cases. All patients` serum GH levels after oral glucose tolerance test(oGTT) decreased after surgery. Surgical cure after surgery(mean GH <2 μ/L and a nadir value after oGTT of <1 μ/L) was founded in 13 patients(8 of 22 macroadenoma and 5 of 6 microadenoma). No cases of mortality or major immediate postoperative complications were observed. Conclusion:Surgical treatment is safe and effective and we suggest the surgery could be a primary treatment not only for GH-secreting microadenoma but also for macroadenoma with cavernous sinus invasion.