고위의 전교통동맥 동맥류에서의 Pterional Approach와 Interhemispheric Approach의 수술적 비교 분석

박강화,조철민,김형동,Park, Kang Hwa,Jo, Chul Min,Kim, Hyung Dong 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : The purpose of this study is to evaluate and compare surgical results of pterional(fronto-temporal) approach and interhemispheric approach for the high positioned anterior communicating artery aneurysm with our surgical experience. Methods : During the period between May 1990 and May 2001, 263 anterior communicating aneurysms were treated at the department of neurosurgery of Dong-A university hospital. Among them, 175 patients were operated by same operator. Thirty six out of the 175 cases were high positioned anterior communicating artery aneurysms located more than 15mm above the anterior clinoid process. Results : Pterional approaches were applied in 32 cases and interhemispheric approaches were applied in 4 cases of total 36 cases of the high positioned anterior communicating artery aneurysms. The 32 cases of pterional approach resulted in Good Recovery 20/32(63%), Moderate Disability 6/32(19%), Severe Disability 4/32(12%) and Dead 2/32(6%), and 4 cases of interhemispheric approach resulted in GR 3/4(75%) and MD 1/4(25%). Relatively, pterional approach showed poorer result on high positioned anterior communicating artery aneurysm located more than 19mm above the anterior clinoid process with GR 5/13(39%), MD 3/13(23%), SD 3/13(23%) and Dead 2/13(15%). Conclusion : Interhemispheric approach is preferable to pterional approach for certain cases of high positioned anterior communicating artery aneurysm located more than 19 mm above the anterior clinoid process because it provides adequate orientation to the regional anatomy, less retraction of frontal lobe and preservation of the olfactory tract and gyrus rectus without any surgical complications.

Surgical Experience of Paraclinoidal Aneurysms

강형곤,조철민,허재택,Kang, Hyung Gon,Jo, Chul Min,Huh, Jae Teack The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.2

목 적 : Paraclinoidal aneurysm은 두개강내 내경동맥 근위부에서 후교통동맥 기시부까지 생기는 뇌동맥류를 말한다. 이들 동맥류의 수술의 기술적인 문제는 근위혈관의 지혈과 안전한 동맥류로의 접근 및 뇌동맥류 경부의 완전한 노출을 고려해야 한다. 저자들은 최소침윤법의 개념으로 수술의 효율성에 대해서 관심을 가지고 수술하였다. 대상 및 방법 : 저자들은 과거 4년간 171명의 뇌동맥류 수술환자를 경험하였으며 그중 10명의 paracliniodal aneurysm환자를 수술하였고 10명중 2명은 비파열된 동맥류를 가지고 있었다. 평균 연령은 47세 였으며 전부 여자 환자였다. 그중 3명의 환자는 proximal posterior carotid artery에서 기원하였으며 4명의 환자는 carotid-ophthalmic artery에서 기원했고 나머지 3명은 superior hypophyseal artery에서 기원하였다. 결 과 : 전례에서 결찰술을 시행했으며 수술결과는 매우 양호했으며, 이들 중 뇌수두증이 있었던 1례를 제외하고 신경학적인 결손과 사망한 환자는 없었다. 시력장애증상은 4명의 환자에서 호소했지만 그중 2명은 수술후 회복되었고 나머지 2명은 더 이상 악화되지는 않았다. 결 론 : 최근 저자들의 경험에 비추어 볼 때, 수술전 진단적 혈관조형술의 정교함이 크기와 무관하게 모든 paraclinoidal aneurysm의 분류에 도움이 된다고 생각하며, 이러한 분류가 각각의 동맥류에 따른 수술적 접근을 용이하게 함으로서 대부분의 환자에서 시각능력 향상뿐만 아니라 좋은 수술결과를 초래 할 수 있고 불필요한 수기를 배제함으로서 수술시간도 단축될 수 있을 것으로 사료된다. Objective : Paraclinoidal aneurysms termed that aneurysms arising from proximal internal carotid artery(ICA) between the site of emergence of the carotid artery from roof of the cavernous sinus and origin of the posterior communicating artery(PCoA). These aneurysms pose conceptual and technical surgical problems with regard to acquisition of proximal control and safe intracranial exposure. The efficiency of surgical technique according to the location of paraclinoidal aneurysm was studied for minimal exposure. Materials and Methods : Over the past four years, the authors treated surgically 171 cases of cerebral aneurysm, among them ten patients were paraclinoidal aneurysms with two patients unruptured aneurysms. Mean age was 47 years old, and all patients were female. Three patients were proximal posterior carotid artery wall aneurysms(one large, one giant), four patients carotid-ophthalmic artery aneurysms and three patients superior hypophyseal artery aneurysms. Results : There could be done clip in all cases, there were no deaths and no complication. And no patient developed sustained neurological deficits including visual function except hydrocephalus in one case. Four patients complained of visual disturbance but two patients had recovery after postoperation and two patient were not longer to bad. Conclusion : Our recent experience suggests that preoperative scrutiny of diagnostic angiography allows classification of all paraclinoidal aneurysms regardless of size and surgical technique which this classification has focused on operative approaches unique to each aneurysm projection was helpful to improve the operative outcome with good visual function and to shorten the operative time.

다이어프램 방식 탱크를 적용한 연료시스템 성능해석

박정배(Jeong-Bae Park),김성환(Sung-Hwan Kim),조철민(Chul-Min Jo),김영신(Young-Shin Kim) 한국추진공학회 2021 한국추진공학회 학술대회논문집 Vol.2021 No.11

저체온 및 순환정지를 이용하여 모야모야 병이 동반된 뇌기저 동맥 첨부의 복합성 뇌동맥류 수술

조철민,허재택,하상수,우종수,이수일 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.5

Giant and complex aneurysm of the posterior circulation can pose several technical challenges with high operative morbidity. Recent advances in cardiac surgery have raised interest in the technique of deep hypothermic circulatory arrest for the management of giant and complex intracranial aneurysms of posterior circulation. The criteria for selecting patients for this procedure can be based on a preoperative analysis of available studies that suggests high risk with standard intervention. Using the technique of deep hypothermic circulatory arrest, we have successfully operated on a case of complex basilar tip aneurysm with MoyaMoya disease resulting in no significant neurological complications. We therefore suggest that patients with giant and complex intracranial aneurysms of posterior circulation might benefit from the use of deep hypothermic circulatory arrest technique.

원인불명의 자발성 뇌지주막하 출혈의 치료대책

조철민,김형동,김기욱,최휴진,김규홍 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

It is well Known that the prognosis of spontaneous SAH(subarachnoid hemorrhage) of undetermined cause is generally favorable. Yet. the natural history and pathogenesis of SAH of undetermined cause remain controversial and patients management is largely empirical. 42 cases of non-traumatic SAH of undetermined cause of a total of 415 cases of SAH treated during a 5-year period(1991-1996) were available for this stydy. What should be done when angiography is negative after SAH? This study was undertaken to present a more definitive menagement in preventing rebleeding after SAH of undetermined cause. This study show that explorative craniotomy for aneurysmal operation is warranted. despite negative cerebral panangiograms. if the patient manifests the classical signs and symptoms of SAH and definite subarachnoid blood in CT(computed tomogram) or durect kynbar oybctyre and any suspicious lesions in cerebral panangiography. particularly the ACoA(anterior communicating artery) region.

단순포진 바이러스에 의한 국소적 뇌간뇌염 치험 1례 : 증례보고 A Case Report

조철민,김기욱,김형동,최휴진 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7

Focal brainstem encephalitis dus to Herpes simplex virus is a very rare infectious disease. occurs with a freaquent of 1-2 million population per year. A 3 years old girl is dsscribed with infection due to Herpes simplex virus causing brainstem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responsed to Herpes simplex virus. The clinicopathological features. radiological findings. labaratories and brainstem biopsies are discussed in the context of the literature.

내경-후교통동맥류 환자에서의 동안신경마비

김규홍,김형동,김기욱,최휴진,조철민 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7

Internal carotid-posterior communicating artery aneurysms are frequently related to third nerve palsy which is reversible after the clipping of aneurysm. The authors had analyzed 61 cases in 52 patients who have posterior communicating artery aneurysm and evaluated the factors affecting the development of third nerve palsy and its recovsry after clipping of the aneurysm. The results are followings. 1) Oculomotor nerve palsy was noticed in 10 patients(16.4%) among 61 cases of posterior communicating artery aneurysm. of which 6 had complete and 4 had partial patsies. 2) Posterolateral inferior direction of the aneurysm seemed to be closely related to the development of ophthalmoplegia. 3) Development of ophthalmoplegia was not related to the clinical status of the patient on admission. but to the amount of subarachnoid hemorrhage on initial CT scan and size of the aneurysm. 4) Preoperative degree of third nerve palsy and the timing of operation are not definitely related to the recovery of ophthalmoplegia. 5) The recovery of third nerve palsy are normalization of ptosis. normalization of EOM limitation and normalization of pupiliary change in order.