The Contributory Factors of CSF Shunt Failure

김영돈,황성규,황정현,성주경,함인석,박연묵,김승래,Kim, Young Don,Hwang, Sung Kyoo,Hwang, Jeong Hyun,Sung, Joo Kyung,Hamm, In Suk,Park, Yeun Mook,Kim, Seung Lae The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.1

목 적 : 뇌실 복강간 단락술 부전의 기여인자를 조사 및 분석하여 뇌실 복강간 단락술의 합병증 및 재수술의 가능성을 줄이는 데에 목적이 있다. 대상 및 방법 : 1995년 1월부터 1998년 12월까지 본원에서 뇌실 복강간 단락술을 시행 받은 237명의 수두증 환자를 후향적 방법으로 고찰하여 뇌실 복강간 단락 부전의 기여인자 및 단락기 생존율을 통계학적으로 분석하였다. 결 과 : 수두증의 원인은 종양, 출혈, 감염, 선천성 기형, 정상 뇌압 수두증, 외상 등이었다. 68명의 환자에서 109회의 재수술이 이루어졌다. 재수술의 이유는 폐색, 근위부 카세타의 위치이상, 감염 등이었다. 단락기 생존율은 1년, 2년, 3년에 각각 77.1%, 75.4%, 74.1%이었다. 10세 이하의 환자에서 재수술의 빈도가 통계학적으로 의의 있게 높았다. 그리고 수두증의 원인에 따라서 통계학적으로 의의 있게 재수술의 빈도 차이가 있었다. 결 론 : 대부분의 뇌실 복강간 단락 부전은 술후 1년내에 발생하였다. 환자의 나이 및 수두증의 원인이 뇌실 복 강간 단락 부전의 주요 기여인자였다. To investigate contributory factors of CSF shunt failure, 237 patients, who underwent shunt placement from January 1995 to December 1998 at our hospital, were reviewed retrospectively. The causes of the hydrocephalus were tumor, hemorrhage, infection, congenital anomaly, normal pressure hydrocephalus, trauma and others. One hundred nine revisions of CSF shunting were done during follow up periods. The causes of shunt revisions were mechanical obstruction, malposition, infection and others. The contributory factors of CSF shunt failure and shunt survival rate were analyzed using SPSS. The shunt survival rate at 1, 2 and 3 years after procedure was 77.1%, 75.4%, 74.1% respectively. In the young age group below 10 years old, postinfectous hydrocephalus was the most common high risk factor for shunt revision. In conclusion, the most shunt failures developed in the first year after surgery and the age and causes of the hydrocephalus were major determinant factors of shunt revision.

Sequential ¹H MR Spectroscopy(MRS) Studies of Kaolin-Induced Hydrocephalic Cat Brain

김명진,황성규,황정현,장용민,김용선,김승래,Kim, Myung Jin,Hwang, Sung Kyoo,Hwang, Jeong Hyun,Chang, Yongmin,Kim, Yong Sun,Kim, Seung Lae The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.11

목 적 : 실험적으로 유발된 고양이 수두증 모델을 통하여 양자 자기공명 분광상의 수두증에서의 임상적 적응과 경시적 뇌 대사산물의 변화를 규명하는데 목적이 있다. 대상 및 방법 : 30마리의 고양이에서 뇌대조내에 kaolin을 주입후 수두증을 유발한후 양자 자기공명 분광상을 이용하여 kaolin 주입전, 주입후 1, 3, 7, 14, 21, 28일째에 주요 대사산물인 N-acetyl aspartate(NAA), creatine(Cr), choline (Cho), lactate(Lac)의 분광상을 분석하였다. 결 과 : 30마리의 고양이에서 모두 수두증이 유발되었고, 급성기에 NAA/Cr비가 감소하는 소견보였으며, 1마리에서 lactate peak이 관찰되었다. 만성기(>14 days)까지 생존한 4마리의 고양이에서 NAA/Cr비의 증가가 관찰되었으며 이는 임상적 증상의 회복과 상응하는 결과를 나타내었다. 결 론 : Kaolin 유발 수두증모델에서 양자 자기공명 분광상은 급성기의 진단적 정보의 제공과 수두증에서의 뇌대사 및 생화학적 결과를 반영해 준다. 그리고, 급성기에서 lactate peak없이 NAA/Cr비의 감소와 만성기의 NAA/Cr비의 회복은 수두증으로인한 뇌실질의 손상이 신경세포 자체보다는 축색손상을 의미한다. 급성기말까지 초기 NAA/Cr비 감소가 회복없이 lactate peak이 동반되는 경우는 불량한 예후인자가 된다. 만성기의 NAA/Cr비의 정상화는 NAA/ Cr비의 감소를 보이는 뇌피질위축의 경우와의 감별진단에 실마리를 제공한다. Objectives : The aim of this study is to evaluate the sequential metabolic changes in experimental hydrocephalus and the clinical applicability to the diagnosis and prognosis of hydrocephalus using proton MR spectroscopy. Methods : Hydrocephalus was experimentally induced in 30 cats(2-3kg body weight) by injecting 1ml of sterile kaolin suspension(250mg/ml) into the cisterna magna. Proton MRS was performed with a 1.5 T MRI/MRS unit (Vision Plus, Siemens) at pre-treatment and at 1, 3, 7, 14, 21, and 28 days after the kaolin injection. PRESS(TR/TE=1500/270msec) technique was employed. The major metabolites which include N-acetyl aspartate (NAA), creatine(Cr), choline(Cho), and lactate(Lac) were quantitatively analyzed and the relative concentrations ratios were evaluated. Multislice $T_2$-weighted images were also obtained using fast spin echo sequence(TR/TE= 2500/96msec) to monitor the morphologic changes along with progression of hydrocephalus. Results : Hydrocephalus was successfully induced in all 30 cats. Twenty five cats died within 3 days and one at the end of the second week. In all animals, the NAA/Cr ratios initially decreased during the acute stage. In 4 surviving cats, the NAA/Cr ratios initially decreased during the acute stage(<14 days) and then gradually increased to the prekaolin level as follows : pre-kaolin($1.49{\pm}0.04$), day 1($1.11{\pm}0.07$), day 7($1.17{\pm}0.04$), day 14($1.40{\pm}0.03$), day 21 ($1.46{\pm}0.06$), day 28($1.43{\pm}0.03$). These levels were relatively well correlated with the symptomatologic improvement. Lactate peak, which reflects the evidence of ischemia, did not appear throughout the entire period except in one case which expired at the end of the second week. Conclusions : The NAA/Cr ratio of the sequential proton MRS in kaolin-induced hydrocephalic cats reflects a metabolic aspect of the hydrocephalus at each stage. A decreased NAA level at the early stage is from both neuronal and axonal damage which may provide diagnostic information in the acute stage of hydrocephalus. In addition, the initial fall of NAA/Cr ratio and recovery in the late stage, when no lactate peak emerges, may suggest that the main insult of the parenchyma is not to the neuron itself but to the axon, which may be related to a good prognosis. However, emergence of the lactate peak and unrecoverable NAA/Cr at the end of the acute phase may be a poor prognostic factor. In the chronic stage, recovery of NAA/Cr ratio may provide a diagnostic clue for the differentiation between hydrocephalus and cortical atrophy.

자발성 척수내혈종 - 증례보고 -

황정현,성주경,황성규,함인석,박연묵,김승래,Hwang, Jeong Hyun,Sung, Joo Kyung,Hwang, Sung Kyoo,Hamm, In Suk,Park, Yeun Mook,Kim, Seung Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Hematomyelia is an extremely rare condition that cause severe neurological symptoms. We reported 4 cases of spontaneous hematomyelia, two cases of cavernous angioma and two cases of hematoma. In all patients, the clinical course was progressive ; motor and sensory abnormalities below the lesion and voiding difficulties were the common presenting symptom complex. The preoperative diagnosis was made by magnetic resonance imaging and the all patients underwent surgical exploration. Complete removal of hematoma was done in 3 patients and complete evacuation after aspiration of hematoma were performed in one patients. Neurological function did not worsen postoperatively in any patients. The early diagnosis with magnetic resonance imaging and immediate surgical treatment of the hematoma and the associated vascular malformation are considered to be the best way to halt the progression of the disease.

뇌동맥류 수술 환자에서 급성 수두증 병발후 단락술이 요하는 만성 수두증 합병의 임상적 및 형태학적 비교

신용환,황정현,함인석,성주경,황성규,박연묵,김승래,Shin, Yong Hwan,Hwang, Jeong Hyun,Hamm, In Suk,Sung, Joo Kyung,Hwang, Sung Kyoo,Park, Yeun Mook,Kim, Seung Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objectives : The incidence of acute hydrocephalus(AHC) after aneurysmal subarachnoid hemorrhage reported as 13-31%. The AHC resolves spontaneously in some cases(simple AHC), but about 30% of the AHC progresses to shunt-dependent hydrocephalus(SDHC). The aim of this study was to understand clinical predisposing factors causing SDHC with performing differential clinical analyses between 2 subgroups, the simple AHC and the progresed SDHC. Methods : The 250 surgically treated patients with aneurysmal SAH over last two years were evaluated. Forty four patients(17.6%) of them showed the AHC. Of theses 37 cases were retrospectively analyzed, excluding 7 patients who died within 2 weeks after hemorrhage attack. Of the 37 AHC cases, 21 patient(56.8%) were complicated with the simple AHC, and 16 cases(43.2%) were progressed SDHC. Results : The older age(p<0.05), poor clinical grade(p=0.03), larger amount of SAH in perimesencephalic cistern on CT scan(p=0.005) were significantly related to the SDHC. No significant difference was noted in aneurysm location, multiplicity, rebleeding, hypertension and Fisher grade between 2 subgroups. Conclusion : Of the total 37 AHC, the simple AHC was 56.8% and the progressed SDHC 43.2%. The older age, poor clinical grade, large amount of SAH in perimesencephalic cistern were significant predisposing factors causing the SDHC. The large amount of SAH in perimesencephalic cistern is the single most important predisposing factor developing the progressed SDHC.

임상 : 폐암에서 전이된 단일 병소 뇌종양 환자에서의 감마나이프 방사선수술

우현진 ( Hyun Jin Woo ),박성현 ( Seong Hyun Park ),황성규 ( Sung Kyoo Hwang ) 대한뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1

Objective:Stereotactic radiosurgery has become a valued management choice for patients with brain metastases. This study was performed to assess the efficacy of GKS(Gamma knife radiosurgery) in patients with solitary brain metastasis. Methods:From May 2005 to Dec 2007, fourteen patients(8 men and 6 women) with solitary cerebral metastatic lesion underwent GKS. The mean age was 61 years(49-74). All patients had Karnofsky performance status(KPS) score of 70 or better. The maximum diameter of the single brain metastasis was less than 3 cm. Overall survival was retrospectively analyzed by using Kaplan Meier method and variables associated with survival were evaluated by univariate analysis. Results:The mean volume of solitary brain metastatic lesions was 6.1 cc(0.5-24.5). The median marginal dose was 20 Gy(10-23). Median follow-up period was 40 weeks. Overall median survival was 32 weeks(4-88) from GKS. Local control rate was possible for 77% of the lesions. At the last follow-up, 12 patients(86%) were alive and 2 patients(14%) died from systemic causes. Age(<65 years, p=0.003) and high KPS score(>80, p=0.024) were favorable prognostic factors in univariate analysis. Conclusion:GKS has significantly reduced the mortality from brain metastasis by effectively accomplishing local tumor control in patients with solitary brain metastasis from lung cancer.

시로신경교종의 자기공명영상 소견 ` Tumor Streaking `

권정윤(Jung Yoon Kwon),최율제(Yul Je Choi),김인택(In Taek Kim),황성규(Sung Kyoo Hwang) 대한안과학회 1994 대한안과학회지 Vol.35 No.9

임상 : 대장암의 뇌전이 환자에서 감마나이프 방사선 수술의 임상적 고찰

김민석 ( Min Seok Kim ),박성현 ( Seong Hyun Park ),황정현 ( Jeoung Hyun Hwang ),황성규 ( Sung Kyoo Hwang ),함인석 ( In Suk Hamm ),박연묵 ( Yeun Mook Park ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Objective:The purpose of this study was to evaluate results following Gamma knife radiosurgery(GKS) for patients with metastatic brain tumor from colorectal cancer and to identify prognostic factor for survival. Methods:Between January 2005 and December 2007, we evaluated 22 brain metastases from colorectal cancer in 10 consecutive patients who underwent GKS at our institute. The medical records of these patients were reviewed retrospectively and survival analysis was performed. Results:Brain metastases occurred concurrently with lung metastases(5 cases, 50%), and liver metastases(2 cases, 20%), otherwise single brain metastases were found in 3 cases. Between the diagnosis of primary cancer and brain metastases, the mean interval was 142 weeks. The mean survival time after GKS was 31 weeks. Number of tumor was a significant prognostic factor(p=0.023). Conclusion:As brain metastases of the colorectal cancer usually represent as a late complicaion of the systemic disease, an effective low-morbidity technique for controlling brain metastases is required. GKS satisfies these criteria in treating brain metastases from colorectal cancer and therefore provides patients with a better quality of their remaining life.

임상 : 청신경초종에 대한 감마나이프 방사선수술의 합병증

이동현 ( Dong Hyun Lee ),박성현 ( Seong Hyun Park ),박재찬 ( Jae Chan Park ),황정현 ( Jeong Hyun Hwang ),윤경혁 ( Kyung Hyeok Yoon ),황성규 ( Sung Kyoo Hwang ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Objectives:The treatment of vestibular schwannoma(VS) is challenging due to a high morbidity rate after microsurgery. On the other hand, gamma knife radiosurgery(GKRS) is regarded as an alternative treatment method for VS due to its low morbidity rate. The authors retrospectively analyzed the complications of GKRS to evaluate the therapeutic usefulness of GKRS in VS. Methods:Complications were analyzed retrospectively in 33 cases of VS treated by GKRS at our hospital from March 2005 to May 2008 in terms of patient age, prescription dose, and tumor size, Results:Major complications, such as, signs of increased ICP or ataxia developed in 4 patients, and all had a tumor volume of more than 10 ml. Three of the four were treated by subtotal tumor resection. Hydrocephalus developed in four patients, and two underwent ventriculo-peritoneal shunt placement. Conclusion:Early complications of GKRS in cases with a large VS were significant. Our results support a treatment strategy of subtotal tumor removal followed by scheduled radiosurgery or fractionated radiosurgery for the manage-ment of large VS.

플라스틱관을 대용한 뇌실질내 혈종 제거술

황성규,함인석,김승래 慶北大學校 醫科大學 1988 慶北醫大誌 Vol.29 No.2

심부 뇌혈종 부위의 접근을 요하는 개두술시 견고한 자가뇌견인장치로써 정상뇌 조직을 견인하여 수술 접근로를 유지시키는 대신에 소독된 적절한 구경을 가진 유연한 플라스틱관을 병소의 심부깊이 만큼 잘라서 이를 혈종 접근 경로에 삽입함으로써 뇌실질의 절개면이 균등하게 견인되어 수술 조작 경로를 확보 유지하며 혈종제거도 용이함은 물론 절개된 뇌실질로 부터의 출혈도 지혈 시킬 수 있었다. 아울러서 혈종제거 조작시에 발생될 수도 있는 뇌손상도 피할수 있는 이점 등을 경험 할 수 있었다. A flexible transparent plastic tube using as brain retractor has been designed to remove the deep intracerebral hematoma, which can be easily available in the operation room and made simply. It gives good operative field to the surgeon with easy access to the site of intracerebral hematoma. This method causes less damage on the brain tissue than using classic brain retractor and another merit is to control bleeding from incised brain opening by continuous equal pressing of the tube.

뇌의 재관류손상에서 bcl-2와 ba 발현양상과 apoptosis의 상관관계

황성규,손윤경,성주경,변승엽,함인석,김승래 경북대학교 병원 2003 경북대학교병원의학연구소논문집 Vol.7 No.1

Background: Delayed neuronal injury strikes more damage on the survived neurons at the time on the injury. The apoptosis is known to play a major role in the pathogenesis of the second neuronal injury. Prevention of the secondary neural injury is another very important target to save the neuron in stroke. In this regards, authors conducted this experiment to elucidate the chronological changes of the apoptosis in association with the expression of bel-2-and bax. Material and Methods : Middle cerebral arteries of Spraque.Dawley rats weighing 300-400 gm were occluded for 2 hours using 4-0 nylon intro-duced-from the external carotid arteries. Light microscopic examination, TUNEL, and immuno histochemistry for cel-2 and were performed at 3 hours, 1 and 3 days, and 2 weeks after reperfusion. Results : most severe infarction were found at one day after reperfusion, thereafter progressively decreased. Apoptosis examined by TUNEL appeared from 3 hours after reperfusion, persisted for 3 days, and decreased thereafter. Expression of bcl-2 and bax paralleled the course of the apoptosis. Conclusion : Delayed neuronal injury due to apoptosis progresses for more than 3 days after the reperfusion. Appropriate measures in the early stage can contribute to prevent the neuronal injury after stroke.