뇌동맥류성 지주막하 출혈후의 지연성 뇌허혈성 변패에 있어서 체성감각 유발전위반응검사

허승곤,박종운,박용구,정상섭,서정호,이규창 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.2

Somatosensory evoked potentials(SEPs) reflect the functional integrity of the central neural pathways, and as such may be used to assess function that remains during variety of cerebral insults. To evaluate the utility of SEPs during cerebral ischemic deterioration due to aneurysmal subarachnoid hemorrhage, SEPs were measured in 43 patients with subarachnoid hemorrhage, among them 24 patients had no cerebral ischemic deterioration (group 1) and 19 patients had cerebral ischemic deterioration(group 2). In group 1, central conduction time(CCT) were measured on the day of admission(CCTl), the seventh day(CCT2), and the twenty-first day(CCTS) after aneurysmal rupture. In group 2, CCT were measured on the day of admission(CCTl), during(CCT2)and after resolution (CCT3) of cerebral ischemic deterioration. CCT2 of the both cerbral hemispheres were different significantly between two group(p=0.01). In group 2, there was stastically significant difference between CCT1 and CCT2(p<0.01), and significant correlation between clinical grade and CCT was noted, especially in grade Ⅲ, and Ⅳ. Therefore it is suggested that the central latencies of the SEPs are seemed to be a sensitive tools as indicators of the onset and extent of a cerebral ischemic deterioration due to aneurysmal subarachnoid hemorrhage.

실험적 뇌지주막하 출혈에서 칼슘길항제 Nimodipine이 대뇌피질 혈류에 미치는 영향

허승곤,이규창 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.4

The effect of the calcium antagonist nimodipine on the feline cerebral cortical blood flow in experimentally induced subarachnoid hemorrhage(SAH) was studied. Cerebral cortical blood flow was measured in the middle cerebral arterial territory at specified intervals by the hydrogen clearance method. SAH was induced 25 cats by a slow injection of fresh autogenous arterial blood into the cisterna magna. Twenty-five cats were divided into 5 groups of 5 cats each according to the timing of the cerebral cortical blood flow measurements after SAH ; immediate(Group la, lb), 24 hours(Group 2), 48 hours(Group 3) and 7 days (Group 4). Cerebral cortical blood flow decreased by 55.5%, 39.2%, 41.4% and 38.3% from pre-SAH levels in each group respectively. During nimodipine infusion(1㎍/㎏/min) cerebral cortical flow increased by 89.0%, 51.8%, 87.5% and 24.5% from pre-nimodipine infusion levels in each group respectively. Mean arterial blood pressure(MABP) after cisternal blood injection increased by 6.5% from pre-SAH levels, and MABP during nimodipine infusion decreased by 15.4% from pre-Nimodipine infusion levels. The calcium antagonist nimodipine increased cerebral cortical blood flow significantly in experimentally induced SAH without considerable change of MABP. Results are considered promising for trials in the treatment and prevention of cerebral ischemia caused by vasospasm following SAH.

뇌하수체 결핵종 1예 보고

허승곤,김순철,조경기 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.2

A case of pituitary tuberculoma in a 53-year-old male is reported. His clinical complaints included headache and right ptosis. Endocrinological studies showed hypopituitarism. Radiologic studies showed enlargement of the sellar turcica. Removal of the tumor resulted in resolution of his neurological symtoms and signs.

중대뇌동맥의 미세해부

허승곤 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

뇌기저핵 및 시상에 발생한 자발성 뇌내출혈에 대한 임상적 고찰

허승곤,김순철,조경기,김광명 대한신경외과학회 1982 Journal of Korean neurosurgical society Vol.11 No.2

The author analyzed 169 cases of spontaneous intracerebral hemorrhages at the basal ganglia and thalamus, who had been admitted to Jeonju Presbyterian Medical Center from 1975 to 1979. Intracerebral hematoma was confirmed by angiography and the amount of hematoma was divided as small, medium or large according to the angiographic cvidence. Among the 169 cases, 145 cases underwent appropriate medical or surgical treatment. 63 cases were treated conservatively and 82 cases were operated; 22 cases of frontal approach, 51 cases of temporal approach, and 9 cases of extraventricular drainage of clot. Results obtained are as follows: 1. The common prediection age group was from the fifth to the seventh decades, which was 90.5% of all cases. The ratio of male to female was about 2 to 1. 2. putaminal hemorrhage was 65.1%, and thalamic hemorrhage was 16.6%. 3. Angiographic evidence of arteriosclerosis was seen in 86.4%. 4. The worse prognostic factors were related to age(over 65), site and size of hematoma, and mental state on admission. 5. With conservative management 49.2% were improved, 6.3% not improved, 44.4% moribund or dead. 6. With surgical treatment 58.5% were improved, 3.7% not improved, 37.8% moribund or dead. 7. Microsurgical temporal approach proved to have the following advantages over frontal approach. (1) Better outcome was found in this approach(64.7% vs 54.4%) (2) The distance to the hematoma was closer in temporal approach, and so total removal of hematoma and complete control of bleeding sources with less surrounding structural damages were possible. 8. Early operation seems to be more effective than delayed operation in the cases of large hematoma with deteriorating neurological signs.

뇌동맥류 수술시기와 방법에 따른 Shunt수술의 빈도 뇌동맥류 파열 514예 분석

공민호,신용삼,허승곤,김동익,이규창,공민호,신용삼,허승곤,이규창 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.4

뇌동맥류 환자의 수술시기에 대한 연구

이광수,허승곤,이규창,정남,박경우,조경기 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.1

The optimum timing of surgery for ruptured intracranial aneurysms still remains controversial. In order to compare the total management outcome between early and late surgery a retrospective analysis was carried out. Of 159 patients, 97 patients were selected according to the entry criteria and were divided into two groups ; group Ⅰ(46 pts.) was early surgery planned patients and group Ⅱ(51 pts.) was late surgery planned patients. The results obtained are as follows ; 1) The incidence of a good recovery for the early surgery planned group was 74%, and that of the late surgery planned group was 67%, but there was no statistically significant difference between two groups. 2) The incidence of a delayed ischemic deficit was 24% for the early surgery planned group, and 29% for the late surgery planned group, with no statistically significant difference. But, the incidence of rebleeding was 2% for the early surgery group, and 14% for the late surgery planned group, so there was a statistically significant difference here. 3) The total management outcome of the early and late surgery planned group was similar, but early surgery was advantageous for the prevention of rebleeding.

비동맥류성 자발성 지주막하 출혈을 예측할 수 있는 뇌전산화 단층촬영 소견

조용은,허승곤,서정호,이규창 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5

Fourty-seven patients with non-aneurysmal spontaneous subarachnoid hemorrhage were reviewed retrospectively. Attention was directed to the distribution and amount of subarachnoid hemorrhage on computerized tomography scans. Though the hemorrage could be distributed in all cisterns, the frequency and amount of hemorrhage were higher in infratentorial cisterns than in supratentorial cisterns. Among infratentorial cisterns, the hemorrhage was distributed to cisterns around the brainstem mainly and it had a predilection for interpeduncular cistern. Also the telangiectasia of thalamoperforating artery might be one of the causes of non-aneurysmal spontaneous subarachnoid hemorrhage.

개두술과 Interstitial Brachytherapy 후 두피에 전이된 다형성 교아종

장태안,허승곤,박경우,정남,신문수 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.10-11

Extracranial metastasis of glioblastoma multiforme is still rare with or without relation of previous surgery. The patient who had a history of the craniotomy & stereotactic interstitial brachytherapy for the management of glioblastoma multiforme was presented with low back pain initially and multiple scalp nodule was noticed on 10th hospital day. Follow up brain CT had no evidence of tumor reccurrence and biopsy of these nodules revealed a histopathologic picture similar to that of primary glioblastoma multiforme and positive for GFAP stain. Authors reviewed the literature & reported this unusal case.

뇌동맥류 파열후 동반되는 수두증에 대한 임상적 고찰

김동석,허승곤,최중언,이규창 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.6

The aim of this study was to evaluate the incidence and the management of hydrocephalus following ruptured intracranial aneurysms. The authors analyzed 233 patients with aneurysmal subarachnoid hemorrhage(SAH) during the last two years retrospectively. The results are summarized as follows. Eighty patients(35.9%) showed ventricular dilatation on a brain CT scan. Twenty-five patients(11.2%) required shunt surgery. Hydrocephalus was closely related to the amount of hemorrhage and the location of the ruptured aneurysm. Two of 9 patients with acute hydrocephalus, who were managed by extraventricular drainage(EVD) before definite aneurysm surgery, rebled. The shunt surgery was done before aneurysm surgery in 16 patients and rebleeding occurred in 3 patients. Redioactive isotope(RI) cisternography diagnosed communicating hydrocephalus in 11 patients and the lumboperitoneal shunt was performed in those cases. It is concluded that hydrocephalus following aneurysmal SAH is the communicating type, an indication for shunt surgery could be determined by RI cisternography, and lumboperitoneal shunting seems to be the best treatment of choice to avoid rapid decompression of the ventricles and to protect the already compromised cerebral hemisphere. Decompression of the ventricles before aneurysmal surgery should be avoided whenever possible.