척수 종양 654예의 임상 분석(1973-1999)

최우진,정천기,조병규,김현집,Choe, Woo Jin,Chung, Chun-Kee,Cho, Byung-Kyu,Kim, Hyun Jib 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.8

Objective : The spinal cord tumors(including vertebral tumors) are increasingly diagnosed and operated due to development of refined diagnostic and therapeutic tools. It is necessary to re-evaluate clinical features and surgical results of spinal cord tumors with increasing cases and developing treatment modalities. The authors reviewed the spinal cord tumor cases to evaluate their clinical characteristics. Material and Methods : The retrospective review of 654 cases of spinal cord tumors between 1973 and 1999 was done. The clinical features, pathological analysis and surgical results were analyzed and compared to the literature. The results of the study are analyzed with a more detailed consideration of each of major pathologies : neurogenic tumors, meningeal tumors, neuroepithelial tumors, and metastatic tumors. Results and Conclusion : The spinal cord tumor was most common in the 5th decade of age(145 cases, 22.1%) and 78 cases(11.9%) were found in children under 15 years of age. The ratio of male to female was 1.2 : 1. The pathologic diagnosis was neurogenic tumor in 266 cases(40.7%), neuroepithelial tumor in 131(20.0%), metastatic tumor in 118(18.0%), and meningeal tumor in 94(14.4%) in the order of frequency. The tumor was located most frequently in the thoracic area(36.5%) and in the intradural extramedullary space(38.1%). The most common initial presentation was pain(40.1%) and the mean duration for presentation to operation was 14.8 months. The total or gross total removal was possible in 404 cases(61.7%) and the surgical result on the postoperative one month was recovery or improvement in 424 cases(64.8%), stationary in 188(28.7%), progression in 42(6.4%). As a surgical complication, there was a spinal deformity(12 cases), wound infection(5 cases), aspiration pneumonia(5 cases) etc. Neurogenic tumors and menigiomas showed good surgical results, whereas neuroepithelial tumors(except ependymoma) and metastatic tumors showed relatively poor prognosis.

척수내 종양과 감별을 요하는 비종양성 척수증 : 수술로 확진된 8례의 후향적 분석

김기정,정천기,심기범,김현집,Kim, Ki-Jeong,Chung, Chun-Kee,Sim, Ki-Bum,Kim, Hyun-Jib 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Objective : It is difficult to differentiate intramedullary spinal cord tumors preoperatively from non-neoplastic pathologies in patients presenting as non-compressive myelopathies in magnetic resonance imaging(MRI). In this report, the authors reviewed nonneoplastic intramedullary spinal cord lesions preoperatively diagnosed as tumors and discussed their clinical and radiological characteristics and usefulness of surgical intervention. Methods : From January, 1985 to January, 1999, authors experienced eight non-neoplastic pathologies mimicking intramedullary spinal cord tumors and analysed their medical records, radiological findings and histopathological specimens retrospectively. Results : There were five males and three females and the duration of symptoms were from two to 20 months(mean, 9.8 months). The location of lesions were four cervical, one cervicothoracic and three thoracic. All patients manifested sensory abnormality, seven motor weakness, and six bladder symptom. All cases had swollen spinal cords and increased signal intensities in spin-echo sequences. Six cases showed contrast enhancement : four cases were focal and two diffuse. Under the impression of intramedullary tumors, the patients were operated upon. Final diagnoses on the base of clinical and pathologic finding were : three subacute necrotizing myelopathies, two multiple scleroses, two myelopathy of unknown etiology. One case showed no gross abnormality in surgical field in spite of adequate exposure of the lesion, so biopsy was not performed. In that case, postoperative MRI revealed spontaneous resolution of the lesion. Conclusion : MRI is invaluable diagnostic tool in screening myelopathies. However, its high sensitivity and lack of specificity make difficulty in preoperative differential diagnosis of non-compressive myelopathies. Although no surgical morbidity occurred in our series, we sometimes failed to confirm definite diagnosis even with biopsy. In such a circumstance, long-term follow up is needed.

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.

흉추강 협착증의 수술적 치료 결과와 예후인자에 관한 분석

장웅규,정상기,김동윤,정천기,김현집,Chang, Ung Kyu,Chung, Sang Kee,Kim, Dong Yoon,Chung, Chun Kee,Kim, Hyun Jib 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objective : To describe the underlying causes, surgical results, and prognostic factors in thoracic stenosis causing myelopathy, retrospective analysis for 28 cases of thoracic stenosis with surgery was performed Materials & Method : Twenty-eight patients(male, 15 ; female, 13) who underwent decompressive surgery for thoracic stenosis between 1987 and 1997 were analyzed. The mean age was 49 and the mean follow-up was 30.6 months. Statistical analysis with $SPSS^{(R)}$ was performed. Chi-square test was used for the analysis of relationship between subjects and multivariate analysis with general linear model was used to find prognostic factors. Result : Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was done in 23 cases, anterior decompression in four cases, and combined decompression in one case. Ossification of ligamentum flavum was found in 18 cases, facet hypertrophy in 13, ossification of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively, 16 patients improved functionally and 4 patients worsened. The group of which initial symptom duration was less than two years showed better result(p=0.003). The group with sufficient decompression and no additional proximal stenosis had better outcome(p=0.002, p=0.001). Conclusion : Chronic myelopathy caused by thoracic stenosis can be reversible with appropriate decompression.

척수 혈관모세포종의 임상 분석

이대규,최우진,김동윤,이철희,정천기,김현집,Lee, Dae Kyu,Choe, Woo Jin,Kim, Dong Yoon,Lee, Chul Hee,Chung, Chun Kee,Kim, Hyun Jib 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11

Objectives : The authors present a retrospective analysis of 14 patients treated for spinal cord hemangioblastoma (SCH) between Dec. 1986 and Mar. 2000. This study was conducted to evaluate and compare the difference of the functional outcomes associated with the extent of surgical removal of SCH. Methods : Eleven patients were male and three patients were female. Their mean age was 37.2 years that ranged from 19 to 62 years. Preoperative magnetic resonance(MR) imaging of the spine was performed in all cases, and preoperative angiography in eleven cases. They were followed from 15 months to 161 months(median follow-up period, 47 months), and we investigated the change of neurological symptoms and functional outcomes with radiological features, especially on MR imaging. Results : Six patients were accompanied by von Hippel-Lindau disease, and three of them had multiple CNS tumors. Thirteen patients had intramedullary tumor, and the remaining one had extradural. Syringomyelia around the tumor was observed in ten cases. All patients underwent surgical removal, and gross total removal(GTR) was achieved in ten cases. Preoperative embolization was performed in four cases. In four patients who were treated with preoperative embolization, intraoperative loss of blood was minimal and GTR was possible. One patient developed a transient swallowing difficulty postoperatively without permanent postoperative neurological deficits. In three of four patients in whom GTR was not possible, their functional outcomes were worsened postoperatively. The functional status at discharge was improved in seven patients, stationary in four patients, and worse in three. At the last follow-up(15-161 months), one of four patients who had been stationary at discharge showed improvement but, the rest did not show any change. All patients who showed neurological improvement were patients with GTR, and the patients with GTR had significant better outcome than those without GTR(p=0.015). Conclusion : Surgical treatment, and especially, GTR is considered as treatment of choice for spinal cord hemangioblastoma. Preoperative embolization may prevent intraoperative bleeding and improve surgical outcome.

경추 손상 후 뇌척수액 유출에 대한 관리

이수언 ( Soo Eon Lee ),정천기 ( Chun Kee Chung ),장태안 ( Tae Ahn Jahng ),김치헌 ( Chi Heon Kim ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period. Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma. Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission. Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.

사람 혈청 트란스페린수용체의 단클론 항체를 이용한 방사면역측정과 철영양상태의 진단

김승렬(Kim Seung Ryul),정천기(Chung Chun Kee),한정호(Han Jung Ho),채범석(Tchai Bum Suk) 韓國營養學會 1996 Journal of Nutrition and Health Vol.29 No.9

엔트로피 기반 ECoG 신호를 이용한 손과 팔꿈치 움직임 추론

김기현,차갑문,이기원,정천기,신현출,Kim, Ki-Hyun,Cha, Kab-Mun,Rhee, Kiwon,Chung, Chun Kee,Shin, Hyun-Chool 한국전기전자학회 2013 전기전자학회논문지 Vol.17 No.4

In this paper, a method of estimating hand and elbow movements using electrocorticogram (ECoG) signals is proposed. Using multiple channels, surface electromyogram (EMG) signals and ECoG signals were obtained from patients simultaneously. The estimated movements were those to close and then open the hand and those to bend the elbow inward. The patients were encouraged to perform the movements in accordance with their free will instead of after being induced by external stimuli. Surface EMG signals were used to find movement time points, and ECoG signals were used to estimate the movements. To extract the characteristics of the individual movements, the ECoG signals were divided into a total of six bands (the entire band and the ${\delta}$, ${\Theta}$, ${\alpha}$, ${\beta}$, and ${\gamma}$ bands) to obtain the information entropy, and the maximum likelihood estimation method was used to estimate the movements. The results of the experiment showed the performance averaged 74% when the ECoG of the gamma band was used, which was higher than that when other bands were used, and higher estimation success rates were shown in the gamma band than in other bands. The time of the movements was divided into three time sections based on movement time points, and the "before" section, which included the readiness potential, was compared with the "onset" section. In the "before" section and the "onset" section, estimation success rates were 66% and 65%, respectively, and thus it was determined that the readiness potential could be used. 본 논문에서는 Electrocorticogram(ECoG) 신호를 이용하여 손과 팔꿈치의 움직임을 추론하는 방법을 제안한다. 환자로부터 다수의 채널을 이용하여 표면 근전도 신호와 ECoG 신호를 동시에 취득하였다. 추론하는 동작은 손을 쥐었다 펴는 동작과 팔꿈치를 안으로 굽히는 동작이며, 외부 자극에 의해 동작을 수행하는 방법 대신 환자의 자유의지에 의해 동작을 수행하게 하였다. 표면 근전도 신호를 이용하여 동작을 수행한 운동 시점을 찾고, ECoG 신호를 이용하여 동작을 추론한다. 각 동작의 특징을 추출하기 위하여 ECoG 신호를 전체 대역을 포함한 ${\delta}$, ${\Theta}$, ${\alpha}$, ${\beta}$, ${\gamma}$ 총 6개의 대역을 나누어 정보 엔트로피를 구하고, 최대우도추정법을 사용하여 동작을 추정하였다. 실험 결과 감마대역의 ECoG를 사용할 경우 다른 대역을 사용할 때 보다 높은 평균 74%의 성능을 보이며, 다른 대역보다 감마 대역에서 높은 추정 성공률을 보였다. 또한 운동 시점을 기준으로 3개의 시간 구간으로 나누어 준비전위를 포함하는 'before' 구간과 'onset' 구간을 비교하였다. 'before' 구간과 'onset' 구간에서 추정 성공률은 각각 66%, 65%로 준비전위를 이용할 수 있다는 것을 알 수 있었다.

측두엽 간질에성 발작기 뇌관류 SPECT의 간질병소 국소화 성능

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),김은실(Eun Sil Kim),장기현(Kee Hyun Chang),이상건(Sang Kun Lee),정천기(Chun Kee Chung) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.3

N/A Anterior temporal lobectomy has become a widely used resective surgery in patients with medically intractable temporal lobe epilepsies. Prerequisites of this resection include the accurate localization of the epileptogenic focus and the determination that the proposed resection would not result in unacceptable postoperative memory or language deficits. The purpose of this study was to evaluate the performance of ictal SPECT compared to MRI findings for localization of epiletogenic foci in this group of patients. 11 patients who had been anterior temporal oral lobectomy were evaluated with ictal 99m-Tc-HMPAO SPECT and MRI. MRI showed 8/11(73%) concordant lesion to the side of surgery and ictal SPECT also showed 8/11(73%) concordant hyperperfusion. In 3 cases with incorrect or nonlocalizing findings of MRI, ictal SPECT showed concordant hyperperfusion. In 2 cases confirmed by pre-resectional invasive EEG, MRI showed bilateral and contralateral lesion but ictal SPECT showed concordant hyperperfusion. 3 delayed injection of ictal SPECT showed discordant hyperperfusion. Thus, ictal SPECT was a useful method for localizing epileptogenic foci in temporal lobe epilepsies and appeared complementay to MRI.

전두엽 간질에서 F - 18 - FDG PET 의 간질병소 국소화 성능 ; 육안 판독과 SPM 에 의한 분석

김유경(Yu Kyeong Kim),이동수(Dong Soo Lee),이상건(Sang Kun Lee),정천기(Chun Kee Chung),여정석(Jeong Seok Yeo),정준기(June Key Chung),이명철(Myung Chul Lee) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.3

N/A Purpose: We evaluated the sensitivity of the F-18 FDG PET by visual assessment and statistical parametric mapping (SPM) analysis for the localization of the epileptogenic zones in frontal lobe epilepsy. Materials and Methods: Twenty-four patients with frontal lobe epilepsy were examined. All patients exhibited improvements after surgical resection (Engel class I or II). Upon pathological examination, 18 patients revealed cortical dysplasia, 4 patients revealed tumor, and 2 patients revealed cortical scar. The hypometabolic lesions were found in F-18 FDG PET by visual assessment and SPM analysis. On SPM analysis, cutoff threshold was changed. Results: MRI showed structural lesions in 12 patients and normal results in the remaining 12. F-18 FDG PET correctly localized epileptogenic zones in 13 patients (54%) by visual assessment. Sensitivity of F-18 FDG PET in MR-negative patients (50%) was similar to that in MR-positive patients (67%). On SPM analysis, sensitivity decreased according to the decrease of p value. Using uncorrected p value of 0.05 as threshold, sensitivity of SPM analysis was 63%, which was not statistically different from that of visual assessment. Conclusion: F-18 FDG PET was sensitive in finding epileptogenic zones by revealing hypometabolic areas even in MR-negative patients with frontal lobe epilepsy as well as in MR-positive patients. SPM analysis showed comparable sensitivity to visual assessment and could be used as an aid in the diagnosis of epileptogenic zones in frontal lobe epilepsy. (Korean J Nucl Med 200135:131-141)