고혈압성 뇌출혈에 대한 임상적 분석 : from Jan. '80 to Sep. '87

오창완,이선호,김현집,한대희 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.3

Three hundreds and sixty eight cases of hypertensive intracerebral hemorrhage, which were diagnosed by brain CT scan, were analyzed. Of them, 308 cases were treated conservatively and the other 60 cases were treated operatively. The incidence was highest in the 6th decade for both male and female. The seasonal distribution showed bimodal distribution with peak incidence in the spring and automn to early winter. The sites of hemorrhage were putamen, subcortex, thalamus, cerebellum and brainstem in descending order of incidence. The analysis of conservative treatment group showed that the factors affecting prognosis were initial consciousness, herniation sign, initial systolic pressure, amount of hemorrhage, site of hemorrhage, age and history of cerebrovascular accident. The prognosis of surgical treatment group showed the better outcome but it was not statistically significant.

청신경초종 수술후 발생한 안면신경 손상의 수술적 치료

오창완,김현집,김동규,한대희 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.4

To evaluate the effectiveness of internal anastomosis and facial-hypoglossal anastomosis, the medical records 27 patients with facial nerve injury in the course of operation for acoustic neurinoma were reviewed. In 8 patients, the interrupted facial nerves were anastomosed at the end of tumor operation, and facial-hypoglossal anastomoses were performed in 20 patients. One patient underwent facial-hypoglossal anastomosis 6 months after internal anastomosis. All the patients had been treated from January 1983 to March 1993 and were followed up for more than 1 year. After primary internal anastomoses, 7 patients resulted in symmertric face at rest and only one failed to show improvement of facial muscle tone. The mean time to the first evidence of facial reinnervation was 5.3 months. In 20 patients with facial-hypoglossal anastomosis, improvement of facial muscle tone was demonstrated in 19 patients and in one patient there was no improvement. Thirteen cases(68%) showed facial symmetry at rest and 5 of them could close their eyes completely. The first evidence of reinnervation was noted between 3 and 12 months after anastomosis with a mean of 6.3 months. The anastomoses were performed between 8 days and 22 months after injury of the facial nerve, and the time to reinnervation after anastomosis was significantly influenced by the duration of nerve injury(P=0.0439). Primary internal anastomosis revealed better recovery of facial muscle function compared with facial-hypoglossal anastomosis(P=0.0299).

뇌 기능해리 현상의 실험적 모델 연구

오창완,김현집,최길수 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.1

To demonstrate the effect of diaschisis in acute unilateral cerebral infarction, the changes of regional cerebral and cerebellar blood flow(rCBF) following experimental occlusion of one middle cerebral artery(MCA) were studied in 15 mongrel cats, following occlusion of left MCA by coagulation using transorbital approach, rCBF's of both MCA territories and both cerebellum were measured simultaneously by the hydrogen clearance technique. Sham operation group consisted of 5 cats, in which transorbital exposure of left MCA was performed and then rCBF's were measured in the same manner as the experimental group without cauagulation of left MCA. After measurement of rCBF for 8 hours at fixed intervals, the animals were sacrificed and immediately thereafter 25 ㎖ of 2% triphenyl tetrazolium chloride(TTC) solution was injected through each common carotid artery. The brain was removed and immersed in 10% buffered formalin solution for two weeks, then the coronal plane through optic chiasm was examined for the cerebral infarction. As results, contralateral MCA territory and both cerebellum showed diaschisis after occlusion of left MCA, and contralateral cerebellar rCBF decreased more, showing characteristics of crossed cerebellar as well as interhemispheric diaschisis. Sham operation group showed no infarction, and in experimental group 40.2±1.3% of the coronal plane through the optic chiasm was infarcted, showing high percentage of infarction with small standard deviation.

Hoffmann반사를 이용한 선택적 척수 후근 절제술을 위한 근전도 기기와 프로그램의 개발 : 척수 신경근 자극시의 근전도 양상에 대한 연구 A Study on the EMG Patterns Generated by Stimulation of the Spinal Nerve Roots

오창완,권성훈,김희찬,왕규창,김현집 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.6

두개강내 해면상혈관종의 임상양상 및 수술적 치료의 효용

오창완,정영섭,김동규,백선하,조병규,왕규창,한대희 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.6

파킨슨씨병 모델 흰쥐에서 줄무늬체 도파민 수용체의 발현에 대한 연구

오창완,한대희,정천기,조사선,박경한,김용식,박찬웅,Oh, Chang-Wan,Han, Dae Hee,Chung, Chun Kee,Cho, Sa-Sun,Park, Kyeong-Han,Kim, Yong-Sik,Park, Chan-Woong 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

This study was designed to investigate the underlying mechanisms for the temporal changes of the striatal dopamine D2 receptors in the rat model of parkinsonism. After injection of the 6-hydroxydopamine into the substantia nigra of adult rats, we measured the receptor binding capacity(Bmax), mRNA and protein of the D2 receptor at 2, 4 and 8 weeks. Following the lesion, mRNA and protein were elevated simultaneously on both sides of the striata. They showed more increase on the normal side at 2 and 4 weeks, and then they were almost equally abundant on both sides at 8 weeks. We also observed their increased production in the diffuse cortical and subcortical regions. The Bmax value also increased bilaterally in both striata, and was higher on the normal side at 2 weeks and then on the lesioned side at 4 and 8 weeks. These findings suggest that production of the striatal D2 receptor is regulated at the transcriptional level in this animal model. They also imply that this control may be mediated through a pathway which can have influence on the whole brain, rather than the local control of the dopamine content alone. The measured functional activity(Bmax) of the D2 receptor was not proportional to the amount of the receptor mRNA and proteins produced. This difference may be explained by the post-translational modification of the receptor proteins, which may be controlled by such factor as the local concentration of dopamine.

Treatment Policy for Patients with Hunt-Hess Grade Ⅳ and Ⅴ SAH

Oh, Chang Wan,Han, Dae Hee 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.12

입원시 상태가 나쁜 뇌동맥류성 지주막하출혈(Hunt-Hess grade Ⅳ-Ⅴ) 환자에 대한 적절한 치료방침을 결정하기 위하여, 1988년 1월부터 1993년 12월까지 본교실에서 치료받은 입원당시 중증인(Hunt-Hess grade Ⅳ-Ⅴ) 지주막하출혈 환자 50례에 대한 의무기록 검토 및 문헌고찰을 실시하였다. 50명의 환자들중 12례에서는 뇌동맥류 경부 결찰을 위한 조기수술(지주막하출혈 발생 후 72시간 이내에 수술)을 실시하였으며, 나머지 환자들에서는 초기에 고식적 치료 실시후 상태가 호전된 경우(19례)에만 수술을 실시하였다. 수술후 모든 환자들은 뇌동맥연축 예방을 위한 적극적인 치료(hypertensive, hypervolemic and hemodilutional therapy)를 받았다. 입원시 신경학적 상태가 상대적으로 양호하였던 환자군(Hunt-Hess grade Ⅳ) 및 뇌출혈이 있었던 환자군은 현저하게 좋은 예후를 보였으며, 뇌실내출혈 및 높은 뇌압상승(뇌실외 배액술 실시후 뇌압이 40㎝ H₂O 이상인 경우)을 동반하였던 환자군의 경우 중증의 합병중 발생율 혹은 사망율이 현저하게 높은 경향을 보였다. 수술시기에 따라서, 조기수술군과 수술을 지연시킨 환자군 사이에 수술중 동맥류의 조기파열 빈도(8% 대 11%), 전반적인 사망율(50% 대 53%) 및 뇌동맥연축의 발생빈도(50% 대 55%) 등은 현저한 차이가 없었다. 그러나 조기수술군에 비하여 수술을 지연시킨 환자군에서 심한 합병증 혹은 사망의 원인이 되는 중증 뇌동맥연축의 발생빈도가 더욱 높았고(25% 대 37%), 재출혈로 인한(29%) 중중 합병증의 발생율이 높은 경향을 보였다. 즉, 조기수술군과 수술을 지연시킨 군의 퇴원시 상태가 양호한 환자들의 비율은 각각 42% 및 21%로 조기수술군이 우수한 성적을 보였다. 따라서, 입원시 상태가 나쁜 동맥류성 지주막하출혈 환자의 치료에 있어서, 뇌간 등 중요 뇌 구조물이 파괴된 경우 혹은 조절이 불가능한 뇌압상승을 동반한 경우 등 명확한 치료불능인 상태를 제외하고는, 뇌동맥류 경부 결찰을 위한 조기수술 후 뇌동맥연축을 예방하기위한 적극적인 치료를 실시하는 것이 가장 적절한 치료 방침인 것으로 판단된다. To settle the controversy over the optimum management straw for patients with poor-grade (Hunt and Hess grade N and V ) aneurysmal subarachnoid hemorrhage, the medical records of 50 patients admitted in poor Hunt and Hess grade have been examined retrospectively with literature review. Twelve patients underwent early surgery for aneurysmal neck clipping, and for the other patients, initial conservative management was done followed by delayed operation for 19 patients who showed stabilization or improvement of neurologic status. All patients were managed by active treatment( hypertensive, hypervolemic and hemodilutional therapy) after aneurysmal neck clipping. Initial findings such as better neurological condition(Hunt and Hess grade W ) and presence of intracerebral hemorrhage were indicators of good prognosis. Patienu, with intmvenmcular hemorrhage and uncontrollably inueased intraaanial pressure(>40 cm HzO after extraventricular drainage) resulted in severe morbidity or mortality. Regarding the timing of surgery, early intervention led to a better outcome with less morbidity(8% vs. 26% ) compared with delaying operation, because of the lower incidence of rebleeding reduced vasospasm and more effective management of delayed ischemia after surgery. The incidence of intraoperative premature rupture and mortality were not significantly influenced by the timing of surgery. It is concluded that, for poor-grade aneurysm patients without a definite evidence of irreversibility such as brainstem failure signs or uncontrollably increased intracranial pressure, early surgery followed by aggressive treatment to prevent cerebral vasospasm is the treatment of choice.

두개외경동맥류:다양한 치료 방법과 치료 결과

최호용,오창완,방재승,권오기,김정은,강현승 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.3

Objective : Extracranial carotid artery aneurysm is a rare vascular disease. In this study, we present our experience with extracranial carotid artery aneurysm and we review the related articles with addressing different treatment options and their results. Me tho ds :Between 2003 and 2011, 11 patients (mean age : 52.7 years) were diagnosed to harbor extracranial carotid artery aneurysms. Five pa-tients underwent various surgeries and 2 patients were treated by endovascular methods. Four patients were managed conservatively. Resul ts : There were no perioperative/periprocedural mortality or morbidity related to the treatment of extracranial carotid artery aneurysms. During follow-up (mean follow-up : 39.3 months), 1 patient died of an unrelated cause and 2 other patients underwent stenting and/or angioplasty due to asymptomatic progressive stenosis of the treated site. Concl usi on : Aneurysm can be treated with low periprocedural risk by utilizing various therapeutic modalities. Long-term follow-up is mandatory to check for stenosis around the treatment site.

중대뇌동맥 근위부(M₁)에 발생한 동맥류 : 임상 특성, 수술 치료 및 중대뇌동맥 분기부의 동맥류와의 비교 Clinical Features, Surgical Treatment and Comparision with Middle Cerebral Artery Bifurcation Aneurysms

정영섭,오창완,한대희 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.8

뇌동정맥기형 환자의 수술후 경련 치료 성적

권오기,오창완,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

This study was intended to investigate the pre- and postoperative profile of seizures in the patients with cerebral arteriovenous malformations(AVM's), and to evaluate various preoperative factors to predict the postoperative occurence of seizures. The patients consisted of 46 consecutive cases with supratentorial AVM's operated on from May 1987 to May 1993. Their mean follow-up duration was 40 months. The pre- and postoperative seizure profiles were similar to each other. The overall incidence of patients experiencing seizure were 50% preoperatively and 52% postoperatively, and the incidence of intractable seizure was 15%, which was the same in both the pre- and postoperative period. The presence of preoperative seizure and large size of AVM were significant indicators of high incidence of postoperative seizures(P<0.05), while other factors such as preoperative intracerebral hemorrhage or embolization showed no significant influence on the occurrence of postoperative seizures. About 70% of the patients with preoperative seizures also had postoperative seizures, while those without preoperative seizures developed new ones only in 35% of the cases postoperatively. The mean size of the AVM's in the group with postoperative seizures was larger than that of the group without postoperative seizures(4.50 vs. 3.02 cm). Regarding postoperative intractable seizures, 57% of the group with preoperative intractable seizures remained intractable postoperatively and groups with preoperatively controlled and groups without seizures demonstrated postoperative intractablity only in 13% and 4% respectively. In conclusion, surgery of AVM's did not change the overall incidence of seizures, both controlled and intractable and patients with preoperative seizures and large sized AVM's had significantly higher possibility of postoperative seizures. Patients with preoperative intractable seizures resulted in control of seizures in 43% after removal of AVM, while 57% remained intractable. Extirpation of epileptic foci, after localization with preoperative study, seems to be needed to improve the outcome of the postoperative seizures.