뇌실염이 합병된 수두증환자에서 피하터널 조루술 - 증례보고 -

황성남,조재영,박승원,김영백,최덕영,Hwang, Sung-Nam,Cho, Jae-Young,Park, Seung-Won,Kim, Young-Baeg,Choi, Duck-Young 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Thirty nine-year-old man who required urgent shunt operation due to rapidly deteriorating visual acuity suffered from ventriculitis after aneurysmal operation. Daily dose of 20mg of vancomycin and amikyn were given intraventricularly via external ventricular catheter after failure of various kinds of systemic antibiotics. The exit of the catheter was made on the upper chest wall to prevent superinfection. External ventricular drainage could finally be switched to ventriculo-peritoneal shunt and he was discharged with clinical improvement.

제 3 뇌실의 유삭교종 - 증 례 보 고 -

황성남,박승원,김영백,최덕영,김미경,강신광,Hwang, Sung-Nam,Park, Seung-Won,Kim, Young-Baeg,Choi, Duck-Young,Kim, Mi-Kyung,Khang, Shin-Kwang 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

We have recently experienced a third ventricular tumor from a 63-year old woman who presented with paraparesis, voiding difficulty and general weakness. Histopathologic study of the tumor was compatible with recently reported and newly termed chordoid glioma. Clinical behavior of the reported tumors were mostly benign but because of its very close proximity to the hypothalamus, some of the subtotally removed tumors recurred or some of the patients died of postoperative complications. The presenting patient regained normal leg power after removal of the tumor followed by ventriculoperitoneal shunt and discharged on her own feet.

비전형적 MRI 소견을 가진 뇌하수체농양 1례 - 증례보고 -

박상우,황성남,박승원,김영백,최덕영,Park, Sang Woo,Hwang, Sung Nam,Park, Seung Won,Kim, Young Baeg,Choi, Duck Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

A sixty-three year old woman presented with sudden onset of dystonic twitching of the extremities and repeatedly downgrading of consciousness in the midnight. She had no history of medical illness in the past but had been suffered from fatigue recently before the onset of the attack. At admission she was neurologically free including neuro-ophthalmologic examination. MRI showed a high signal T1WI mass in the sella protruding into the suprasellar cistern. Hormonal study revealed low value of T3, T4, LH and FSH. Under the impression of pituitary apoplexy she underwent operation via transcranial route. When the protruding diaphragma sellae was opened, milkish pus spilled out. The thick capsule was biopsied and pus was sent for the study. The results of Gram staining and culture were both negative but pathologic report of the specimen was high infiltration of lymphocytes with few polymorphs.

후방경유 요추 융합수술시 척추후관절낭 손상의 운동역학적 영향

박승원,김영백,황성남,최덕영,권정택,민병국,석종식,Park, Seung Won,Kim, Young Baeg,Hwang, Sung Nam,Choi, Duck Young,Kwon, Jeong Taik,Min, Byung Kook,Suk, Jong Sik 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objectives : Although posterior lumbar fusion operations had been reported to accelerate spinal degeneration, there have been only a few studies for their biomechanical effects. We have studied the change of motion range at the vertebral joint one level above the fusion(UVJ) in pedicle screw fixation group(PSF)(n=13) where facet capsule was destroyed and in posterior lumbar interbody fusion group(PLIF)(n=8) where it was spared. Patients and Methods : The patients were divided into early(3 to 6 months) and late(over 12 months) according to postoperative follow-up period. The flexion, extension and flexion-extension angles(FA, EA, FEA) were measured at the UVJ with pre-operative, early and late post-operative films. Results : Mean age and male to female ratio were $52.7{\pm}9.3$ and 1 : 3.2. Mean follow-up periods were $144.1{\pm}30.0$ and $528.8{\pm}160.3$ days in early and late groups, respectively. The FEA and FA in the late PSF($11.8{\pm}3.1$, $8.5{\pm}2.9$) were significantly greater than pre-operative angles($7.8{\pm}3.9$, $5.1{\pm}3.7$)(p<0.01, p<0.05). All angles in the PLIF showed no significant changes with time. The FEA and FA in the late PSF($11.8{\pm}3.1$, $8.5{\pm}2.9$) were significantly greater than those of the late PLIF($7.6{\pm}2.3$, $3.4{\pm}2.0$)(p<0.01, p<0.001). All angles at early follow-up period were similar between PSF and PLIF. The EA showed no significant change in relation with follow-up period or fusion method. Conclusion : As a result, the facet capsule injury in pedicle screw fixation seems to be related with increased flexion angle or degeneration of the adjacent joint above the fused vertebra in the late phase.

전방 접근법으로 제거한 제2흉추 척삭종 - 증 례 보 고 -

이종원,김영백,박승원,황성남,최덕영,Lee, Jong-Won,Kim, Young-Baeg,Park, Seung-Won,Hwang, Sung-Nam,Choi, Duck-Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Chordomas are rare central nervous system tumors that are found predominantly in the sacrococcygeal(50%) and basiosphenoidal region(35%). Most of the remainder are related to the vertebral bodies and only 1 to 2% of them are known to occur in the thoracic vertebrae. A 15-year-old girl was admitted because of paraparesis. Three months prior to admission, she underwent a lumbar laminectomy at other hospital for the treatment of herniated lumbar disc but paraparesis became rather aggravated after the operation. At admission, MRI showed a low signal T1WI, high signal T2WI mass compressing the cord at T2 vertebral body. The tumor was subtotally removed via costotransversectomy but as the tumor was proven to be a chordoma, a second stage operation via anterior route was followed. At second operation, T2 corpectomy and T1-T3 plate fixation with autogeneous ileac bone graft was performed. Shortly after the operation, preoperative paraparesis disappeared completely and no evidence of tumor recurrence was noticed both clinically and radiologically for next 2 years. Spine surgery at cervicothoracic junction may be technically demanding due to anatomical complexity and hindering large vessels. The authers reviewed this case with special emphasis on the surgical procedure in this region.

요추 고정수술 후 인접척추 운동범위의 변화

여상준,박승원,김영백,황성남,최덕영,석종식,정동규,민병국,Yeo, Sang-Jun,Park, Seung-Won,Kim, Young-Baeg,Hwang, Sung-Nam,Choi, Duck-Young,Suk, Jong-Sik,Chung, Dong-Kue,Min, Byung-Kook 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objectives : Transpedicular screw fixation has become an important method for internal fixation in variety of disorders. However, acceleration of degeneration at the adjacent segment in any follow. The goal of this study is to review the change of motion ranges of vertebral joints adjacent to fused level in lumbar spine. Methods : This study consists of 22 patients with degenerative spinal instability. Treatment of spinal instability includes posterior fusion with transpedicular screw fixation or transpedicular screw fixation with posterior lumbar interbody fusion. The flexion-extension angle(FEA) was measured from dynamic views of lumbar spine taken both at preoperative and post operative period. Results : The FEA of upper vertebral joint adjacent(FEA-u) to a fused L4-5 level was increased(p=0.010). The FEA-u was increased in case of L5-S1 fusion(p=0.025). The change of FEA-u in case of L5-S1 fusion was greater than that in L4-5 fusion(p=0.013). Conclusion : After L4-5 fusion, there seems to be more meaningful increase in FEA of L3-4 than that of L5-S1. The reason may be due to the damage of L3-4 facet joints during the operation, the other possible explanation may be the anatomical stability of L5-S1 vertebral joint. The change of FEA-u of L5-S1 fusion is increased more than that of L4-5 fusion. Because there are compensations in the adjacent vertebrae both above and below the fused L4-5, the compensatory motion in FEA-u of L5-S1 fusion was greater than that of the L4-5 fusion.

연수와 경수에 발생한 수내 신경초종 - 증 례 보 고 -

이종원,박승원,김영백,황성남,최덕영,Lee, Jong-Won,Park, Seung-Won,Kim, Young-Baeg,Hwang, Sung-Nam,Choi, Duck-Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Spinal schwannomas are usually extramedullary intradural tumors and their intramedullary localizations are thought to be extremely rare. A 60-year-old woman complaining spastic quadriparesis, voiding difficulty and dyspnea was admitted. Her cervical MRI revealed an intramedullary mass in the cervicomedullary junction with multiple cyst which extended from lower cervical to C3 spinal cord. The mass showed a low signal on T1WI, high signal on T2WI with an wall enhancement. The patient underwent a suboccipital craniectomy and C1-2 laminectomy and the cystic tumor was totally removed through a midline myelotomy. The tumor was proved as an intramedullary schwannoma by pathologic examination. The Intramedullary presence of a tumor arising from the cells of the nerve sheath is unusual, because the central nervous system fibers do not contain the Schwann cell. There have been several hypotheses, but none has been accepted universally. This rare tumor is considered as a curable benign neoplasm, and an accurate intraoperative diagnosis and surgically total removal are essential.

교모세포종 U-251MG, U-373MG세포주의 Cytokines처리에 의한 세포내 ICAM-1 발현

이종원,권정택,민병국,박승원,김영백,황성남,석종식,최덕영,Lee, Jong-Won,Kwon, Jung-Taek,Min, Byung-Kook,Park, Seung-Won,Kim, Young-Baeg,Hwang, Sung-Nam,Suk, Jong-Sik,Choi, Duck-Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : Despite advances in the understanding of tumor biology and the tumor immunology, there has been no effective treatment. The Intercellular adhesion molecule-1(ICAM-1) has been shown to be important in interaction involving cells of the immune system and to be upregulated in a number of cell culture systems by cytokines, including immune interferon($IFN-{\gamma}$) and tumor necrosis $factor-{\alpha}$($TNF-{\alpha}$). ICAM-1 has been identified as one of the ligands for lymphocyte function-associated antigen-1(LFA-1). The effectiveness of various cytokines to ICAM-1 induction on cultured human glioblastoma cell lines and potential efficacy of immunotherapy were studied. Method : Human glioblastoma cell lines, U-251 MG, U-373 MG were trypsinized and suspended at $1{\times}10^5cells/ml$ and grown on 8 well chamber slide, the cells were incubated in 0.3ml medium alone or medium containing $IFN-{\gamma}$(1000U/ml) or $TNF-{\alpha}$(250U/ml) or $IFN-{\gamma}$ plus $TNF-{\alpha}$ for 6, 12, 24, 48 and 72 hours. The coverslip were then removed and stained with a 1/30 dilution of anti-ICAM-1 antibody. Result : Surface antigen expression of ICAM-1 was increased by incubating glioblastoma cell lines with $IFN-{\gamma}$ and $TNF-{\alpha}$. Combined effect of $IFN-{\gamma}$ and $TNF-{\alpha}$ has induced more ICAM-1 expression on glioblastoma cell lines. Upregulation of ICAM-1 expression in an established glioblastoma cell line was of greater magnitude and more rapid following incubation with $IFN-{\gamma}$ plus $TNF-{\alpha}$. Surface antigen expression of ICAM-1 was increased for up to 48 hours after cytokine treatment on both cell lines(p<0.05). There was no difference on both cell lines(p>0.05). Conclusion : The results of the present study indicate that ICAM-1 expression in glioblastoma cell lines, U-251 MG and U-373 MG, are induced and enhanced after treatment with $IFN-{\gamma}$ and $TNF-{\alpha}$. Combined effect of $IFN-{\alpha}$ and $TNF-{\gamma}$ is stronger and more rapid than $IFN-{\gamma}$ or $TNF-{\alpha}$ alone.

터어키안 상부의 악성 기형종 -증례보고-

강석형 ( Suk Hyung Kang ),여상준 ( Sang Jun Yeo ),박승원 ( Seung Won Park ),황성남 ( Sung Nam Hwang ),민병국 ( Byung Kook Min ) 대한뇌종양학회 2003 대한뇌종양학회지 Vol.2 No.2

Intracranial germ cell tumors are rare lesions that account for 0.3 to 3.4% of all intracranial tumors. Although pure forms are rare, intracranial germ cell tumors are classified into five types:germinomas, teratomas, embryonal carcinomas, endodermal sinus tumors and choriocarcinomas. Teratomas are embryonal neoplasms composed of tissues that are derived from three germinal layers, the endoderm, mesoderm, and ectoderm. They may be solid or cystic and are classified histologically as mature, immature, and malignant. Intracranial teratomas have a predilection for the supratentorial and midline sites, especially pineal area. These are arise commonly in the neonatal period. Advances in neuroradiology and microsurgical techniques now make early diagnosis and successful treatment in many of these patients. We present a rare case of malignant teratoma in suprasellar region of a young boy. A complete excision of the tumor was achieved by pterional approach. Histological diagnosis of the tumor was teratoma with malignant components. The management, pathologic feature and clinical course of this unusual malignancy are discussed with a review of the literatures.

뇌동맥류의 수술중 파열

황성남,박관,김영백,민병국,석종식,최덕영 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.6

Intraoperative aneurysmal rupture can be defined as aneurysmal rupture that takes place during any procedure from the induction of anesthesia to the closing of the wound and may result in a disastrous surgical outcome if not managed properly. The author experienced 11 cases of intraoperative aneurysmal rupture among 134 cases of aneurysm surgeries over the past 7 years at Yong-San hospital. The intraoperative rupture rate was 8% and there was statistically significant higher incidence of rupture in the early operated group. Rupture occured during dissection in 5 cases and during the clipping procedure in 6. The early and late mortality was 27 %, which included one case that could also be attributed to the direct effect of subarachnoid hemorrhage.