골화를 동반한 만성 경막외혈종 - 증례보고 -

심규원,장종희,장진우,박용구,김태승,정상섭,Shim, Kyu Won,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Kim, Tai Seung,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

We report a case of 15 year-old female patient with a ossified chronic epidural hematoma. She had had head trauma 10 weeks previously and conservative care for delayed onset epidural hematoma at other hospital. Ossification was identified about 4 weeks after head injury and then progressed rapidly. We removed the chronic epidural hematoma with thick capsule and newly formed bone. The mechanism of the ossification associated with cephalhematoma and chronic subdural hematoma is reviewed and discussed.

두개강내 수막종에 대한 감마나이프 방사선수술

심규원,장종희,최재영,장진우,박용구,정상섭,Shim, Kyu Won,Chang, Jong Hee,Choi, Jae Young,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11

Objective : To analyze the radiosurgical results of intracranial meningiomas after Gamma Knife radiosurgery (GKS) and to assess the possible factors related to the outcome and complications in treating meningiomas. Patients and Methods : We retrospectively reviewed the clinical and radiological data in 179 patients(194 lesions) treated with GKS for intracranial meningiomas between May 1992 and October 2000. Radiosurgical responses were categorized as shrinkage, stasis and enlargement, and we defined the shrunken and static group as a radio-logical control. A Cox proportional hazards model was used to evaluate the correlation between the radiosurgical outcomes and various factors such as location and size of tumor, age and gender of patients, relation to venous sinus, pre-GKS degree of edema, treatment modality, radiosurgical parameters, and pathologic findings. Results : Patients were grouped into skull base meningiomas(57.7%), non-skull base tumor including convexity, parasagittal, and falx meningiomas(37.1%), and others(5.2%) according to the location of tumors. The mean maximum dose and the margin dose of tumor was 30.0Gy(19-45Gy) and 15.1Gy(9.5-24.5Gy), respectively. The mean volume of the tumors was 9.4cc(0.003-45.0cc). The radiologic control rate was 97.1%. The radiation induced imaging change with or without neurologic deficit was the most common complication(23.6%). There were seen mostly in convexity, parasagittal, and falx meningiomas which were deeply embedded in cortex. Conclusion : GKS for intracranial meningioma seems to be safe and effective treatments. However, GKS should be considered very cautiously in non-skull base tumor such as convexity, parasagittal, or falx meningiomas with regards to patient's age and general condition, size and location of tumor, pattern of embedding into cortex, presenting symptoms and patient's preference.

임상 : 악성 뇌종양에서 Gliadel® Wafer의 효용성; 예비 보고

심규원 ( Kyu Won Shim ),박영석 ( Young Seok Park ),김정희 ( Jong Hee Chang ),장종희 ( Jung Hee Kim ),최중언 ( Joong Uhn Choi ),김동석 ( Dong Seok Kim ) 대한뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.2

Introduction:Adjuvant systemic chemotherapy increases survival for malignant glioma patients. However, it is unable to effectively cross the blood-brain barrier and have unacceptable systemic toxicities, and the short exposure time of tumor tissue to chemotherapeutic agents. Consequently, many researchers have tried to develop innovative local treatments that bypass the blood-brain barrier and allow for direct treatment in the central nervous system(interstitial chemotherapy). Recently, Gliadel® wafer containing carmustine(BCNU) was approved for the interstitial chemotherapy. We present our initial experience in using interstitial chemotherapy as a strategy to treat malignant brain tumors. Materials and Methods:We analyzed the clinical feature, MRI figures, KPS score, and progression-free survival in 13 malignant brain tumor patients treated with interstitial chemotherapy using Gliadel® wafer from Sep 2004 to Dec 2006. There were 6 glioblastomas, 4 anaplastic astrocytomas, and 3 poorly differentiated carcinomas. Each patient has different treatment histories before and after insertion of Gliadel® wafer. Out of 3 metastatic brain tumors, 2 were recurred after gamma knife surgery. Old patient with huge cystic metastatic tumor refused other kind of chemotherapy. So we inserted Gliadel® wafer after grossly total removal of tumor without any other treatment. Three anaplastic astrocytomas and three glioblastomas recurred after surgery or biopsy, followed by concomitant radiation and Temodal chemotherapy. Three glioblastomas and one anaplastic astrocytoma were treated with interstitial chemotherapy using Gliadel® wafer at the first surgery followed by concomitant radiation and Temodal® chemotherapy. Results:There was not any complication related to interstitial chemotherapy using Gliadel® wafer during follow-up (follow up duration:mean - 10 months, range -3~20 months). Three patients were dead 8, 11 and 12 months after after insertion of Gliadel® wafer(2 anaplastic astrocytomas and 1 glioblastoma). Follow-up MRI of 2 glioblastoma patients revealed tumor regrowth 3 and 19 months after insertion of Gliadel® wafer. The others are alive. The survivals showed the good performance status. Conclusion:This would be the brief preliminary report about the local control of the highly infiltrative brain tumor. Because the local progression or recurrence is still problematic combination of interstitial chemotherapy using Gliadel® wafer and systemic chemotherapy with Temodal® or other anticancer agents could improve patient`s survival without increasing additional systemic toxicity.

외과적 뇌질환을 가진 학령기 아동의 수술 전 정서적 불안정감과 어머니의 양육스트레스에 관한 예비연구

원주식(Joosik Won),엄소용(Soyong Eom),김동석(Dong-Seok Kim),심규원(Kyu Won Shim),송동호(Dong-Ho Song) 대한소아청소년정신의학회 2010 소아청소년정신의학 Vol.21 No.3

Objectives:This study was conducted to compare emotional problems in children with neurosurgical diseases prior to surgery as well as levels of parenting stress experienced by mothers of children treated with surgery and those without surgery. The goals was to provide a basis on which comprehensive treatment interventions could be established. Methods:Subjects included 78 elementary school children who visited the Department of Pediatric Neurosurgery as well as their mothers. The Children’s Depression Inventory (CDI) and the Revised Children Manifest Anxiety Scale (RCMAS) were administered to children. The Parenting Stress Indexs (PSI) and Beck Depression Inventory (BDI) were administered to their mothers. Results:The children with neurosurgical diseases showed higher levels of depression prior to surgery. In their mothers, parenting stress was relatively higher and parenting competence was lower. In particular, for those children who underwent surgery, depression was significantly higher. Specifically, they exhibited more negative expectations, and negative self-image. In mothers of children who underwent surgery, depression was significantly higher. Conclusion:Our results suggest higher levels of emotional distress and parental stress in children who undergo neurosurgical operations and their mothers, respectively. Based on this, the necessity for surgical and comprehensive psychological intervention is suggested.

외상성 두부 손상 아동의 인지기능 특성 및 어머니의 양육스트레스에 관한 예비연구

오미령 ( Mi-ryung Oh ),심규원 ( Kyu-won Shim ),김동석 ( Dong-seok Kim ),박은경 ( Eun-kyung Park ),염인선 ( In-sun Yeom ),신의진 ( Yee-jin Shin ),엄소용 ( So-yong Eom ) 한국영유아아동정신건강학회 2012 영유아아동정신건강연구 Vol.5 No.1

본 연구의 목적은 외상성 두부 손상 아동의 인지 기능과 양육스트레스에 대한 임상적 특성을 파악 하는 것이었다. 이를 위해 한국판 웩슬러 아동용 지능검사, Rey-Kim 아동용 기억검사, 전산화된 주의력장애 진단 시스템(시각), 한국판 부모양육 스트레스검사를 사용하였다. 서울소재 대학병원에 외 상성 두부 손상을 주호소로 내원한 만 6세에서 15세에 해당하는 아동 중 심리평가에 의뢰된 아동 66명과 보호자 66명을 대상으로 자료를 수집하여 분석한 결과, 두부 손상으로 내원한 아동의 지능 평균은 평균 수준에 해당하였고, 기억 능력 평균은 평균하 상단 수준에 해당하고 있어 지능수준에 비해 통계학적으로 유의미한 수준의 저하가 시사되었다. 주의력의 경우 부주의, 충동성, 반응시간 표준편차의 영역의 평균 자체가 비정상 범위에 속하고 있으며, 과반수이상이 비정상 범위에 포함 되는 것으로 나타났다. 의식 소실의 유무로 집단을 나누어 비교해본 결과 의식 소실 경험의 아동은 전체 지능 및 동작성 지능에서 유의미한 저하를 보였으나 기타 영역에서는 두 집단의 차이가 나타나지 않았다. 어머니의 양육 스트레스 검사 결과 과반수이상이 정상 범위를 벗어나는 스트레스에 해당하고 있어 임상적으로 도움이 필요한 스트레스를 경험하고 있는 것으로 나타났다. 하위 영역 중 양육 유능감, 아동에 대한 기대, 자녀와의 애착, 역할의 제한의 영역에서 상대적으로 증가된 스트레스를 보이고 있었다. 의식 소실의 여부에 따라서는 통계적으로 의미 있는 차이를 보이지는 않았다. 이러한 두부 손상 아동들의 특성을 고려하여, 의학적 서비스와 더불어 학습 치료적 개입, 부모교육 프로그램 등과 같은 심리학적 서비스의 통합적 개입 계획 수립이 필요함이 시사되었다. The purpose of this study is to investigate the clinical characteristics of cognitive function and parenting stress found in children with traumatic brain injuries. This study was conducted using Korean-Wechsler Intelligence Scale for Children, Rey-Kim Memory Test for children, attention deficit hyperactivity disorder diagnostic system, and Korean Parenting Stress Index. Subjects were 66 children with traumatic brain injuries at the age of six to fifteen who had visited hospitals in Seoul and their guardians. The result showed that intelligence of the children with traumatic brainin juries was at the average level and their memory function was lower than the average level, indicating that memory function might relatively decline. In the case of visual attention, the standard deviation of inattention, impulsivity, and reaction time was higher than the T score. The result also showed that more than half of the subjects were placed in the higher threshold. The subjects were divided into two groups based on whether they had ever experienced loss of consciousness. Comparison of the two groups found that the children who had experienced loss of consciousness showed significantly lower levels of Full Scale Intelligence Quotient and Performance Intelligence Quotient. However, no significant difference was found in the remaining domains. More than half of the subjects’ mothers experienced parenting stress that was higher than the normal level. Considering the characteristic of the children with traumatic brain injury, it is required that an integrated intervention plan for psychological services such as supportive therapy for family and programs for parent education should be provided in addition to medical services.

신경외과적 뇌질환을 지닌 영유아 어머니의 양육 스트레스

주봉림 ( Bong-lim Joo ),심규원 ( Kyu-won Shim ),김동석 ( Dong-seok Kim ),송동호 ( Dong-ho Song ),신의진 ( Yee-jin Shin ),엄소용 ( So-yong Eom ) 한국영유아아동정신건강학회 2010 영유아아동정신건강연구 Vol.3 No.1

본 연구의 목적은 신경외과적 뇌질환을 지닌 영유아 어머니의 양육 스트레스와 정서적인 문제점을 파악하여 이를 경감시켜 주고, 나아가 의료진과 함께 영유아 치료에 적극적인 개입을 할 수 있도록 하는 여건을 만들어 주고자 함이다. 대상에는 신경외과적 뇌질환을 지닌 영유아 65명, 어머니가 포함되어 있으며, Parenting Stress Index(PSI) and Beck Depression Inventory(BDI)를 실시하여 전반적인 정서적 스트레스 수준을 평가하였다. 연구결과, 임상적으로 양육스트레스 수준이 증가되어 있었고 우울감은 경미한 수준으로 증가되어 있었다. 총스트레스 영역을 보면, 과반수 이상이 비정상 범주에 해당하는 스트레스를 경험하는 것으로 나타났으며, 부모영역에 비하여 아동영역과 유능감에서 스트레스가 증가되어 있었다. 특히 수술적 치료를 받은 영유아 어머니는 총 스트레스, 아동영역이 수술적 치료를 받지 않은 영유아 어머니에 비하여 증가되어 있었다. 발달지연 영유아 어머니를 대조군으로 연구한 결과, 발달지연 영유아 어머니가 경험하는 수준만큼 스트레스를 경험하고 있지는 않았다. 다만 기분, 유능감, 애착, 건강, 우울에서 집단 간의 차이가 나타나지 않았고, 유의미한 수준에 이르지 않으나 발달지연 영유아 어머니보다 우울감의 점수가 더 높은 경향을 보였다. 본 연구는 신경외과적 뇌질환을 가진 영유아의 어머니의 양육스트레스가 증가되어 있으며 특히 양육효능성 결여가 두드러지고, 이에 따른 우울감을 주된 문제로 제시하였다. 결과적으로 신경외과적 뇌질환을 가진 영유아의 어머니에게 적극적인 부모교육을 통한 정신과적 개입이 필요하다는 자료를 제시하였다는데 의의가 있다. The study was conducted to examine emotional problems and parenting stress in mothers of infants, who visited the department of pediatric neurosurgery, to reduce them and provide the basis on which comprehensive interventional treatment could be performed to treat the children. For 65 infants who visited the department of pediatric neurosurgery and mothers of 35 mentally retarded infants, Parenting Stress Index (PSI) and Beck Depression Inventory (BDI) were administered and the overall stress level was evaluated. Among mothers of infants who visited the department of neurosurgery, the level of parenting stress was clinically high and depressive symptoms were found to be at the level of a mild severity. In terms of total stress (TS), more than half of the subjects were found to experience stress categorized as an abnormal range. Total stress (TS) and child domain (CD) were higher in mothers of infants who underwent surgical treatments than mothers of infants who were treated conservatively. The scores indicating depressive symptoms among mothers of infants who underwent surgical treatments were found to be relatively high as compared with mothers of developmentally retarded infants although they were not statistically significant. The increased parental distress of mothers with infants having neurosurgical diseases was analyzed and discussed. Particularly, mothers of infants with neurosurgical diseases had a low level of competence and mild depression. The necessity of surgical and comprehensive psychological interventions would be suggested.

신경외과 질환 환아의 삶의 질

안보영 ( Bo-young Ahn ),심규원 ( Kyu-won Shim ),김동석 ( Dong-seok Kim ),신의진 ( Yee-jin Shin ),엄소용 ( So-yong Eom ) 한국영유아아동정신건강학회 2010 영유아아동정신건강연구 Vol.3 No.2

본 연구의 목적은 신경외과적 질환을 진단받은 학령기 아동의 삶의 질에 대한 임상적 특성을 파악하는 것이었다. 이를 위해 한국판 웩슬러 유아용 지능검사(K-WIPPSI), 한국판 웩슬러 아동용 지능검사 (K-WISC-III)와 한국판 삶의 질 검사(The Korean translation of the Pediatric Quality of Life inventoryTM 4.0 Generic core Scales)를 사용하였다. 서울소재 대학병원에 신경외과 질환을 주호소로 내원한 만 6세에서 15세에 해당하는 학령기 아동 중 심리평가에 의뢰된 환아와 보호자 59명을 대상으로 자료를 수집하여 분석한 결과, 신경외과 질환 환아의 삶의 질은 일반 또래 학령기 아동에 비해 낮은 수준이었지만, 만성질환 환아의 삶의 질과는 유사한 수준으로 나타났다. 또한 아동이 지각한 삶의 질과 부모가 지각한 아동 삶의 질 전체 평균 간에는 유의미한 차이가 없었으며 부모와 학령기 아동 모두 대인관계 기능에서의 만족도를 가장 높게 보고하였고, 학습 기능의 만족도가 가장 낮은 것으로 보고하였다. 대상자의 성별과 연령에 따라 삶의 질에는 유의미한 차이가 나타나지 않았지만, 지능과 수술적 처치 같은 임상적 변인에 따라 유의미한 차이가 나타났다. 전체 집단에서 가장 높게 나타났던 대인관계 기능에 서의 만족도가, 수술적 처치를 받은 환아군에서는 환아와 부모 모두에게서 수술적 처치를 받지 않은 환아와 부모에 비해 유의미하게 낮게 나타났으며 학업기능에 대한 만족도 역시 낮게 나타났다. 신체 기능과 정서적 기능에서는 수술적 처치 여부에 따른 유의미한 차이는 나타나지 않았다. 이러한 신경외과 질환 아동들의 특성을 고려하여, 의학적 서비스와 더불어 사회성 증진 훈련, 학습 치료적 개입, 부모교육 프로그램 등과 같은 심리학적 서비스의 통합적 개입과 계획 수립이 아동의 삶의 질을 높이는데 의미있는 과정임이 시사되었다. The purpose of this study is to understand the features of the quality of life of school children who visited the department of pediatric neurosurgery. Fifty-nine school children, aged from 6 to 15, and their parents completed the Korean version of the Pediatric Quality of Life inventoryTM 4.0 Generic core Scales (PedsQLTM 4.0). The Korean-Wechsler Preschool and Primary Scale of Intelligence (K-WPPSI) or Korean-Wechsler Intelligence Scale for Children (K-WISC-III) was administered to all the children. Children with neurosurgical diseases reported lower quality of life than the normal control group. Also, children who experienced neurosurgical operations showed significantly lower social and school functioning. Meanwhile, no significant difference was found in terms of physical and psychological functioning between children with neurosurgical operations and without operations. The results of the study support previous studies. Not only neurosurgical treatment itself but also more comprehensive psychological intervention was suggested.

신경외과 질환 아동에서 보이는 주의력 문제와 주의력 평가의 유용성

김경미 ( Kyung-mi Kim ),심규원 ( Kyu-won Shim ),김동석 ( Dong-seok Kim ),엄소용 ( So-yong Eom ) 한국영유아아동정신건강학회 2012 영유아아동정신건강연구 Vol.5 No.2

본 연구에서는 신경외과에 내원한 아동의 주의집중력 문제점을 파악하고, 나아가 관련된 전문가와 의료진을 포함한 치료팀이 함께 인지· 학습 치료적 개입을 할 수 있는 기반을 마련하는 기초자료를 제공하고자 하였다. 또한 객관적 주의력 검사 결과와 부모 보고식 설문 평가 결과를 비교하여 임상 장면에서 사용되고 있는 주의력 평가 도구의 유용성에 대해 고찰하는데 목적을 두고 있다. 신경외과에 내원한 평균 수준 이상의 지적 능력을 가진 아동 60명을 대상으로 지능 검사와 전산화 된 주의력 검사를 실시하였고, 어머니를 대상으로 주의력 관련 부모 보고식 설문 평가를 실시하여 전반적인 주의력 문제 수준을 평가하였다. 그 결과, 신경외과적 질환을 가진 아동들은 평균 이상의 지능 수준을 갖고 있더라도 약 50% 이상이 주의집중력의 문제를 보이고 있었고, 이는 전체 지능과 부적 상관을 보였다. 또한 주의력 검사와 지능 검사의 주의력 관련 하위 영역들과의 상관관계는 유의미하지 않아, 지능 검사만으로 주의력 문제를 감지하는 것에는 한계가 있었다. 아동의 주의력 검사와 부모 보고식 설문 평가의 상관관계를 살펴 본 결과, 유의미한 상관관계가 성립되어 부모 보고식 검사들과 함께 시행하는 유용성을 보여주었다. 그러나, 주의력 검사 결과와 부모 보고식 설문 평가의 일치율을 분석해 본 결과, 실제 아동이 보이는 주의력 문제가 부모 보고식 설문 평가를 통해 감지되는 것은 기대 수준에 미치지 못하였다. 결과적으로 평균 이상의 지능을 가진 신경외과적 질환을 갖고 있는 아동들의 주의력 문제는 실제 신경 심리 평가를 통해 드러나는 문제에 비해 외부에서 관찰되는 면이 부족한 것으로 나타났다. 따라서 본 연구에서는 주의력 문제에 대한 정확한 평가에 있어 아동을 대상으로 한 신경심리학적 주의력 검사의 중요성과 필요성이 지지되었다. This study is intended to understand and alleviate attention problems of children who visited a neurosurgery department as well as help intervention for treatment by medical teams. It also aims to review usefulness of the instruments to assess attention in the clinical environment by comparing an objective attention test and a parent survey report. An intelligence test and a computerized attention test were administered to 60 children who visited the neurosurgery department and whose intelligence quotient was average or above, and the general attention problem level was measured by a parent survey report for mothers. We found that above 50% of the children who had neurosurgical diseases had attention problems even though they had above average intelligence. The full scale IQ showed a negative correlation with the attention problem. No significant correlation was found between the attention test and sub-domains of the attention area of the intelligence test, implying that there was a limitation to detect attention problems only by an intelligence test. A significant relationship was found between the attention test of the children and the parent survey report, which points to usefulness of administering an attention test together with a parent survey. However, the low concordance rate between the attention test and the parent survey showed that attention problems of children were not detected sensitively by the parent survey, implying that attention problems of children who have neurosurgical diseases and whose intelligence quotient is above average are less revealed by external observation than neurosurgical assessments. Therefore, we support necessity and significance of objective attention tests for accurate evaluation of attention problems.

Development of the Facility Monitoring System for the Korean National Parks

Ju-Hee Lee(이주희),Kyu-Won Shim(심규원) 한국산림휴양복지학회 2002 한국산림휴양학회지 Vol.6 No.4

안면부 CT 영상에서 U-Net 구조의 개선된 스킵 연결을 사용한 안와 분할

안진서(Jinseo An),이민진(Min Jin Lee),심규원(Kyu Won Shim),홍헬렌(Helen Hong) 한국컴퓨터그래픽스학회 2023 컴퓨터그래픽스학회논문지 Vol.29 No.2