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장재칠,조성진 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
The most important complications encountered by achondroplastic dwarfs are neurological problems related to a narrowed spinal canal. The author report a rare case of cervico-thoraco-lumbar stenosis in achondroplasia. A 44-year-old woman was presented with paraparesis and hypesthesia below T5 bermatone. Only decompressive laminectomy was performed without fusion at thoracic and lumbar area. Neurological symptoms improved after surgery.
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장재칠,신원한,배학근,김범태,최순관,변박장 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11
A retrospective study of predictors determining outcome was carried out in a consecutive series of 104 patients, who had suffered from diffuse brain injury between December 1989 and April 1995, at the Department of Neurosurgery. Soonchunhyang University Hospital. The clinical, laboratory and radiological factors affecting the outcome in patients were analyzed and correlation between the factors and Glasgow outcome scale were statistically assessed. The major results were as follows : 1) Significant predictors of poor outcome were old age, time interval within 5 hours from onset to admission, full dilated pupils or anisocoria, lower Glasgow coma scale, seizure, body temperature above 38℃, Pa02 below 70㎜Hg, blood sugar above 160㎎/㎗, platelet count less than 100,000/㎣. prothrombin time less than 80%, lesions in more than 2 locations on CT & MRI and operative cases. Glasgow coma scale, age and temperature were demonstrated as the most significant predictors among the above factors by discriminant analysis. 2) Sex, kind of accidents, associated injuries, systolic blood pressure, pulse rate, respiration rate, PaCO_(2), base excess, serum sodium, bleeding time, coagulation time, and skull fracture were not significant influences on the outcome. According to the above results, the predictors of poor outcome should be considered as factors in assessing prognosis for treatment of diffuse brain injury.
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후두동맥에 발생한 외상성 동맥류 : 증례보고 Case Report
장재칠,신원한,김범태,최순관,변박장,이동화 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7
Reported below is a case of traumatic aneurysm of the occipital artery. A 17-year-old man was referred to our hospital with a 2×2×1 cm sized pulsatile mass in the left occipital area which had progressively increased in size during the 25 days after blunt trauma. External carotid angiogram revealed a aneurysm of the left occipital artery. The occipital artery was ligated proximal and distal to the aneurysm and the aneurysm was removed. Pathological examination confirmed a partially thrombosed pseudoaneurysm.
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Mini-Transthoracic Supradiaphragmatic Approach to the Thoracolumbar Junction
장재칠,박형기,도재원,Jon Park 대한척추신경외과학회 2010 Neurospine Vol.7 No.4
Anterior reconstruction with instrumentation of the thoracolumbar junction(TLJ) offers: 1) the biomechanical advantage of immediate restoration of the load-bearing anterior column and 2) the ideal biological milieu for an optimal arthrodesis. The authors describe the mini-transthoracic supradiaphragmatic(MTTS) approach to the TLJ. Its technical feasibility is compared with that of the traditional transdiaphragmatic and thoracoscopic supradiaphragmatic approaches to this area of the spine. This technique was performed in 21 patients from 2004 to 2006. There were no surgical mortalities. The MTTS approach without the use of a thoracoscope was successfully employed in this study to treat patients with various lesions located at the TLJ. The diaphragmatic opening, even at its smallest diameter, provides excellent views of the operative field and avoids the significant morbidities associated with the traditional transdiaphragmatic approach.
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Review of Stereotactic Radiosurgery for Intramedullary Spinal Lesions
박형기,장재칠 대한척추신경외과학회 2013 Neurospine Vol.10 No.1
Stereotactic radiosurgery (SR) represents an increasingly utilized modality in the treatment of intracranial and extracranial pathologies. Stereotactic spine radiosurgery (SSR) uses an alternative strategy to increase the probability of local control by delivering large cumulative doses of radiation therapy (RT) in only a few fractions. SSR in the treatment of intramedullary lesions remains in its infancy - this review summarizes the current literature regarding the use of SSR for treating intramedullary spinal lesions. Several studies have suggested that SSR should be guided by the principles of intracranial radiosurgery with radiation doses placed no further than 1-2mm apart, thereby minimizing exposure to the surrounding spinal cord and allowing for delivery of higher radiation doses to target areas. Maximum dose-volume relationships and single-point doses with SSR for the spinal cord are currently under debate. Prior reports of SR for intramedullary metastases, arteriovenous malformations, ependymomas, and hemangioblastomas demonstrated favorable outcomes. In the management of intrame- dullary spinal lesions, SSR appears to provide an effective and safe treatment compared to conventional RT. SSR should likely be utilized for select patient-scenarios given the potential for radiation-induced myelopathy, though high-quality literature on SSR for intramedullary lesions remains limited.
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요추간판탈출증에서 현미경 수술과 경피적 자동수핵제거술에 대한 비교연구
신원한,장재칠,주교성,김범태,최순관,변박장 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1
A retrospective study of operative results were carried out in a series of 164 patients who were performed microdiscectomy and 57 patients performed automated percutaneous lumbar discectomy (APLD) for herniated lumbar discs between January 1, 1990 and June 30, 1996 at the Department of Neurosurgery, Soonchunhyang University Hospital. The operative results were analysed, and the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed. The major results were as follows : 1. Of 164 microdiscectomy cases, 102 were males and 62 were females, mean age was 42.4 years and incidence was the highest in the 5th decade, and of 57 APLD cases, 43 were male and 14 female, mean age was 32.2 years and incidence was the highest in the 3rd decade. 2. The preoperative symptoms and signs were lumbago(98.2%), radiating pain(96.3%), positive straight leg raising test(77.4%), motor weakness(27.4%), claudication(13.4%) & voiding difficulty(2.4%) in microdiscectomy cases, and lumbago(98.2%), radiating pain(98.2%), positive straight leg raising test(70.2%) & motor weakness(17.5%) in APLD cases. 3. Number of operated levels were performed 226 in microdiscectomy and 74 in APLD. The most commonly operated levels of two groups were L4-5 level. 4. Operative results 1) The overall success rates by Prolo's scale were 87.1% in microdiscectomy and 80.7% in APLD, respectively. 2) In younger age group (below 30 years) and in non-compensatory group, success rates were significantly higher in microdiscectomy. 3) As to protrusion and degeneration on MRI, clinical results of moderate protrusion and degeneration of discs in microdiscectomy were statistically significant, and those of mild protrusion and degeneration of discs in APLD were also statistically significant. 4) The most common cause of failure was inappropriate removal of disc material in microdiscectomy and sequestered discs in APLD. According to the above results, there were no differance in overall success rates between microdiscectomy and APLD. But clinical results seem to be influenced by the age, existence of compensation, and by the degree of protrusion and degeneration of discs as prognostic factors. If the selection of operative procedure between microdiscectomy and APLD for herniated lumbar disc is carefully done with clinical and radiologic findings of patients, good outcome might be achieved.
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