두개강내 정상조직과 병소에 따른 Impedance변동에 관하여 : With Brain Stereotaxis

한동로,임좌혁,백승찬,김오룡,지용철,최병연,조수호 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.4

From Nov. 1986 to Sep. 1987, we operated 63 cases of intracerebral hemorrhage and brain tumor with B.R.W. stereotaxic method. Among them, the impedance was checked in 40 cases. Results are as followings. 1) In 89.3% of patients, the impedance of hematoma was 1.5 times higher than the mean cortical impedance, in 57.1% of patients it was 2 times higher, and in 32.1% of patients, it was 3 times higher. 2) In the relationship between impedance and nature of hematoma, the impedance of liquified hematoma was higher than clot. 3) In the relationship between impedance and glasgow coma scale, the impedance of patients who were below 9 in score was higher and who were above 10 in score was lower than the mean cortical impedance. 4) The impedance of the low density area surrounding the lesion was lower than the mean cortical impedance by 73%. 5) In the relationship between impedance of the hematoma lapsed over 12 hours was lower than hematoma before 12 hours. 6) In the impedance of the brain tumor, the impedance of the solid lesion was decreased to 85.7% and cystic lesion was decreased to 48.3% of the cortical impedance.

뇌졸증 환자의 임상적 분석

한동로,도은식,김오룡,지용철,최병언,조수호 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.6

1983년 5월부터 1988년 3월까지 영남대학교 의과대학 신경외과학교실에 입원치료를 받은 634예의 뇌졸중 환자를 임상적 분석을 하여본 결과 다음과 같은 결론을 얻었다. 1) 출혈성 뇌혈관질환이 허혈성 뇌혈관질환에 비해 4배 많았고, 출혈성 뇌혈관질환은 50대, 허혈성 뇌혈관관찰은 60대에 빈발하였다. 2) 허혈성 뇌혈관질환에는 뇌경색이 72.2%로 대부분을 차지하였고, 허혈성 뇌혈관질환은 대부분 보존적치료를 하였고 수술적 치료는 endarterectomy, EIAB를 각각 1예, EDAS가 2예에서 시행하였다. 3) 출혈성 뇌혈관질환에서는 뇌실질내 출혈이 62.8%, 지주막하 출혈이 33.3%, 뇌실내출혈은 3.9%였다. 뇌실질내 출혈의 원인으로는 고혈압이 90.3%로 대부분을 차지하였고, 뇌지주막하 출혈의 원인으로는 동맥류가 54.4%로 가장 많았다. 4) 뇌실질내 출혈의 경우, 혈종의 부위는 피각부 35.1%, 시상부 29.2%, 피질하부 24.8%, 뇌교 5.9%, 소뇌 5.0% 순으로 있었다. 5) 뇌실질내출혈의 경우 뇌정위적 수술을 한 것이 48.6%, 고식적 개두술이 20.4%, 보존적 치료를 한 것이 31%였고, 호전된 경우는 뇌정위적 수술을 한 것이 81.3%, 고식적 개두술이 61.5% 였었다. 6) 뇌동맥류의 위치는 내경동맥이 34.3%, 전대뇌동맥이 33.9%, 중대뇌동맥이 29.5% 순으로 많았다. 7) 뇌동맥류수술의 경우 조기 수술을 한 경우 55.2%, 지연 수술을 한 경우는 92.1%에서 호전되었다. We have treated 634 cases of cerebrovascular disease who admitted to the Yeungnam University hospital form May 1983 to march 1988. The authors analysed the clinical aspects of cerebrovascular disease, and the results are as followings. 1) The hemorrhagic stroke was 4 times more than the ischemic stroke. 2) The hemorrhagic stroke occur most frequently in fifty decade and the ischemic stroke occur in sixth decade. 3) An infarction was most common in the ischemic stroke. 4) The most common cause of intracerebral hemorrhage was hypertension. 5) The most common cause of subarachnoid hemorrhage was aneurysm. 6) The intracerebral hemorrhage occur most frequently in the putamen(35.1%) followed by the thalamus(29.2%), subcortical(24.8%), brain stem(5.9%) and cerebellum(5.0%). 7) The aneurysmal sac was located most frequently in the A-com(28.3%), followed by MCA(26.4%), and P-com(25.5%). The multiple aneurysm occured in 13% of 92 cases.

두개강내 병소의 뇌정위적 생검술에 대한 고찰

한동로,도은식,김오룡,지용철,최병연,조수호 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.5

The introduction of computed tomography in the mid 1970s radically altered the practice of both neuroradiology and steteotactic neurosurgery. Shortly after the introduction of CT, work began on a variety of methods to guide biopsy instruments to brain lesions demonstrated on CT scan. And so, a prototype Brown-Roberts-Wells(BRW) CT stereotactic system was been available to us. We report its utilization in evaluation of less accessible brain lesions using BRW system ; 22 superfical lesions including the motor cortex, 3 brain stem lesions, 5 parasellar lesions, 3 pineal lesions, 3 C-P angle lesions, 3 multiple lesions. There is one complication : intratumoral bleeding. There is no mortality in this series. The diagnostic rate is 88.9%. The indications of BRW of guidance stereotactic biopsy are considered as followings: 1) Adverse medical condition 2) Highly malignant lesions 3) Multiple lesions 4) Lesions near by motor cortex 5) Brain stem lesions 6) Deep seated lesions 7) Small sized lesions

선택적 뇌압하강치료가 내경동맥 폐쇄에 따른 뇌압변동에 미치는 효과

한동로,조수호,배장호,김범대,최병연,김오룡,김성호,이경엽 영남대학교 의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.1

좌우 경동맥을 결찰하여 혈뇌장벽에 변화를 일으킨 백토에서 뇌압하강제(mannitol, steroid) 및 뇌압하강 방법(과호흡)의 효과를 관찰하였다. Mannitol군에서는 steroid군, 과호흡군에 비해 뇌압감소가 통계적으로 유의하게 있었으며, 시간적으로 mannitol 투여 후 25∼30분까지 뇌압이 45%까지 감소하여 지속되었다. Steroid군에서는 mannitol군보다는 뇌압 절대치의 감소폭은 적었지만, 과호흡군 보다 2배 이상의 뇌압감소가 있었고, mannitol군보다 더욱 오랫동안 뇌압감소의 효과가 지속되었다. 과호흡군에서는 mannitol군, steroid군에서보다는 뇌압감소 효과가 적었으나, 과호흡 시행 후 10분까지 13.5∼16.7%의 뇌압감소가 있었고, 그 이후 시간 경과에 따른 더 이상의 뇌압감소 효과는 없었다. Mannitol, steroid, 과호흡군을 모두 시행한 복합치료군에서는 mannitol 및 steroid, 과호흡을 각각 시행한 군에서보다 뇌압 감소가 더욱 현저하게 이루어져 30분까지 48∼52%의 뇌압감소가 있었다. 이상의 결과로 미루어보아 뇌허혈성 뇌졸증 환자에서 mannitol 및 steroid사용과 병행하여 과호흡을 실시함으로써 뇌압감소를 위한 적절한 치료의 지표가 될 것이라 판단다. In order to inquire the most effective management of increased intracranial pressure(ICP), mannitol, steroid and hyperventilation were used in rabbits after ligation or non-ligation of the carotid artery. Mannitol was more effective than steroid and hyperventilation in the degree of the reduction of ICP. The intracranial pressure was decreased 43∼45% for 25∼30 minutes after injection of mannitol. Steroid was less effective than mannitol in the degree of the reduction of ICP. But the time of reduction of ICP was longer, that is, the degree of reduction was 24∼60 minutes after injection of steroid. Hyperventilation is effective in the initial time only, for 10 minutes after hyperventilation. The degree of ICP reduction was 13.5∼16.7% for 10 minutes after hyperventilation. The combined group, that is three kinds of mangenent were used, is the most effective treatment to reduce ICP of ICP. The degree of the reduction of ICP was 42.1∼49.3% for 20 minutes, 47.7∼52.5% for 30minnutes. There was no significant difference between ligation and non-ligation group.

경질성 경화증에서의 상의하 거대 성상세포종

한동로,김오룡,고삼규,배장호,최병연,조수호,박진한,김성호 영남대학교 의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.2

저자들은 발생 빈도가 드물고 상당한 크기의 상의하 거대 성상세포종을 동반하는 결정성 경화증 환자에서 뇌량경유 접근법을 사용하여 좋은 결과를 얻었기에 보고하는 바이다. Tuberous sclerosis is reported rarely and is associated with systemic lesions including central nervous system, skin heart, eye and kidney. Approximately 5-15% of individuals with tuberous sclerosis will develope brain neoplasia, almost invariably subependymal giant-cell astrocytoma (SGCA). We experienced a case of SGCA with tuberous sclerosis operated by the transcallosal approach and report with literature review.

경수 압박으로 인한 척수증 환자에서의 경추강 확장술

한동로,도은식,김오룡,지용철,최병연,조수호 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.2

본 교실에서는 최근 1년간 여러 level에 걸쳐있는 경추부 후종인대 골화증 및 경추강 협착증으로 인한 척수압박 증세가 있는 4명의 환자에서 극돌기 종할법에 의한 경추강 확장술을 시행하여 전례에서 증세의 호전을 보였다. 그러므로 여러 level에 걸쳐있는 경추강 협착증, 척추증 및 후종인대 골화증으로 말미암은 척수압박 증세가 있는 환자에서 경추강 확장술을 시행함으로써 정상적인 구조를 유지시키면서 효과적인 척수강의 확장을 기할 수 있는 좋은 방법이라고 할 수 있다. In an attempt to eliminate some negative aspects of conventional extensive laminectomy, 4 cases of multiple level of cervical compression myelopathy, 1 OPLL(ossification of posterior longitudinal ligament) and 3 cervical stenosis, were treated with a technique of expansive laminoplasty. Operative results in all patients were satisfactory without surgical complications and all patients had a neurological improvement. We suggest that our technique is more effective one for cervical canal enlargement with preservation of stability for treating multiple level of cervical canal stenosis, OPLL, and spondylosis than conventional extensive laminectomy.

자발성 뇌 실질내 출혈에서 뇌정위적 수술의 적용

도은식,한동로,김오룡,지용철,최병연,조수호 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.2

To consider indications of stereotactic evacuation of spontaneous I.C.H., we reviewed 155 patients of spontaneous I.C.H. treated with B.R.W. stereotaxy in recent 2 years form Jan. 1986 to Dec. 1987. And we analysed clinical outcome according to volume of hematoma, anatomical location of hematoma, operation time from attack and initial G.C.S.. We concluded "Indications of stereotactic evacuation of spontaneous I.C.H." as following ; 1) There was no contraindication according to anatomical location of hematoma even if brain stem and posterior fossa. 2) Golden operation time seems to be as early as possible after 6-8 hours from attack. 3) There was no contraindication according to volume of hematoma but there was increased tendency of rebleeding in small thalamic hemorrhage. 4) Low initial G.C.S. was not definite contraindication but final end-result was not so satisfactory. 5) Combined I.V.H. was also good indication, because of low occurrence of postoperative hydrocephalus and early removal of ventricular hemorrhage.

척추질환으로 입원한 환자의 임상적 분석

도은식,한동로,김오룡,지용철,최병연,조수호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.4

11) 전체 척추질환 환자 1080례중, degenerative disease가 749명으로 69.3%, trauma가 265명으로 24.5%, tumor가 28명으로 2.5%를 각각 차지하였다. 2) Degenerative disease 중 disc disease는 1.7:1로 남자에서 더 많았고, degenerative spondylolisthesis는 여자에서 약 3배이였다. 나이별로는 disc disease는 20~40세에서 호발하였고 다른 퇴행성질환의 경우는 40~60세에서 가장 호발하였다. 3) Disc disease의 호발부위로는, cervical은 C5~6(40%), lumbar는 L4~5(79.4%)에서 가장 많았다. 4) Cervical disc disease 환자 총 42명중, 9명에서 operation을 시행하였고, lumbar disc disease 경우 총 643명 중 238명은 laminectomy, 57명에서는 chemonucleolysis를 시행하였다. 5) Degenerative spondylolisthesis 환자 16명 중 9명은 수술로 치료하였고, 이중 6례는 Knodt rod instrumentation을 시행하였다. 6) Trauma환자 265례중 soft tissue injury가 97명(36.6%), 단순한 fracture가 133명(50.1%), cord injury를 동반한 fracture가 35명(13.2%)이었다. 7) Cord injury는 complete injury인 경우는 17례중 15례에서 conservative treatment를 시행하였다. 9) Spinal tumor에서 남녀비는 비슷하였고, 나이는 40~60세에서 호발하였다. 10) 총 28례의 spinal tumor 중 extradural이 23례로서 제일 많았다. 11) Spinal tumor의 pathologic diagnosis는 metastatic carcinoma, vascular tumor 및 neurofibroma가 각각 5례씩이었고, 그외 meningioma 3례, lipoma 2례 등이었다. A total cases of 1080 inpatients of spinal disease in neurosurgical department of Yeungnam University Hospital(YUH) from May 1983 to March 1988 were analysed statistically. 1) Of the total 1080 cases, the vast majority was degenerative disease 749(69.3%), and others were trauma 265(24.5%), tumor 28(2.5%), congenital anomaly 4(0.3%), infection 22(2.0%) and miscellaneous 12(1.1%). 2) In degenerative disease, male to female ratio in disc disease was 1.7 : 1 and in degenerative spondylolisthesis 1 : 3. And frequent age group of disc disease was 20~40(50%) and other degenerative diseases were 40~60(66.6%). 3) Most frequent site of cervical disc disease was C5~6(40%) and lumbar disc disease was L4~5(79.4%). 4) There were 265 patients of trauma, among them, spinal fracture without neruological deficit was 97(36.6%), soft tissue injury was 133(50.0%) and fracture associated with cord injury was 35(13.2%). 5) In 28 cases of spinal tumors, the most frequent site was extradural space 23(82.1%).

천막하부 자발성뇌출혈의 뇌정위적 수술법 : 제2부 : 자발성 소뇌출혈에 대한 천막경유 흡입술 Part Ⅱ : Transtentorial Stereotatic Approach for Spontaneous Intracerebellar Hemorrhage

조수호,한동로,도은식,김오룡,지용철,최병연 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.3

The Broun-Robert-Wells(BRW) stereotactic system has many advantages in the supratentorial spontaneous intrcerebral hemorrhage(ICH), but it has less accessibility to the spontaneous cerebellar hemorrhage by stereotactic suboccipital approach. To overcome this disadvantage, we have tried to treat stereotactically three patients of spontaneous intracerebellar hemorrhage thorugh tentorium using BRW stereotaxis and gradual irrigation with urokinase(UK). This new approach has been used successfully under the local anesthesia with satisfactory postoperative neurological results. We present a detailed technique of this approach.

소아 신경외과 질환의 임상적 분석

배장호,한동로,도은식,고삼규,김오룡,지용철,최병연,조수호 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.6

The authors analyzed pediatric(under 15-year of age) neurosurgical disease patients admitted to the Department of Neurosurgery of the Yeungnam University Hospital during the 6-year period from May 1983 to April 1989. The results were as follows : 1) Among the total 5,007 neurosurgical admission cases during this period, pediatric cases were 573(11.4%). 2) The total pediatric cases consist of traumatic(80.1%), tumor(5.9%), congenital anomaly (3.1%), infection(3.1%), vascular anomaly(2.1%) and miscellaneous(5.6%) lesions. 3) The male to female ratio was 1.67 : 1 in trauma. 4) The most common age of trauma are 3 to 8 years. 5) The incidence of trauma was relatively common in spring and autumn. 6) The traffic accident is most common cause of pediatric trauma. 7) The contusion case with GCS 9 to 15 revealed good result. 8) 23.1% of 108 intracranial hematoma had no skull fracture. 9) Mortality in trauma was relatively low(1.8%) compared to adult.