두개강내 척삭종 및 연골육종 : 수술 및 방사선 치료의 효능

정영섭,곽호신,정희원,박홍준,백선하,김동규,김현집,Chung, Young-Seob,Gwak, Ho-Shin,Jung, Hee-Won,Park, Hong-Jun,Paek, Sun Ha,Kim, Dong Gyu,Kim, Hyun Jib 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Introduction : The management of chordomas and chondrosarcomas in the skull base is difficult due to the critical location, locally aggressive nature, and high recurrence rate. The authors present the effectiveness of surgical removal and radiation therapy on survival and tumor recurrence. Material and Methods : Thirty cranial base chordomas and chondrosarcomas from 23 patients(14 patients with chordomas and 9 patients with chondrosarcomas) were operated in our institution between 1985 and 1998. There were 15 men and 8 women, with a mean age of 40.7 years. The largest diameter of tumors ranged from 15 to 70mm (mean 41.5). The extent of surgical removal was subtotal or total in a half(15 operations). In nineteen operations, tumors were removed by conventional approaches and skull base approaches were applied in 11 operations. Postoperative radiation therapy was performed in 16(70%) patients. The mean duration of follow up is 50 months(1- 156 months). Results : The 3- and 5-year survival rates(YSR) of overall patient are 75% and 67%, respectively. The analysis showed that 1) skull base approach to chordomas and chondrosarcomas showed a tendency to remove more portion of the tumors(p=0.058) but leave more frequent incidence of new deficits(p=0.047) : 2) larger tumor diameter af-fected the extent of removal(p=0.028) : 3) the extent of removal seemed to be the determining factor for overall survival and recurrence-free survival(the 5-YSR and RFSR of subtotal or total removal group are 92% and 80% vs. 40% of partial removal or biopsy group) : 4) conventional radiation therapy improved patient survival(5-YSR of patients who received RT is 76% whereas 5-YSR of those who didn't receive RT is 43%) but failed to prolong long-term recurrence-free survival. Conclusion : The extent of removal and postoperative radiation therapy are determining factors of patients' survival in skull base chordomas and chondrosarcomas. However, none of these factors significantly influenced the survival in multivariate analysis. Aggressive surgical removal of more than subtotal resection combined with postoperative radiation therapy seems to be the choice of therapy in the management of these tumors.

경동맥 내막 절제술 : 19례의 임상 경험

김재용,오창완,정영섭,권오기,한대희,Kim, Chae-Yong,Oh, Chang-Wan,Chung, Young Seob,Kwon, O-Ki,Han, Dae Hee 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objective : Stroke is leading cause of death and more importantly it is cause of serious disability. The effective treatment of acute ischemic stroke still remains a challenge to modern medicine. Recent clinical trials have shown that carotid endareterctomy(CEA) provide overwhelming benefits compared with medical therapy in preventing subsequent stroke for symptomatic carotid stenosis. For the asymptomatic ones, the data are less compelling, but highly suggestive that CEA do have benefits in properly selected patients. Materials and Methods : To investigate the clinical manifestations of carotid stenosis and results of CEAs, authors analyzed retrospectively 19 CEAs in 16 patients from June 1986 to June 1999. Age of patients ranged from 55 to 76 years(median, 66) and male to female ratio was 14 to 2. The duration of follow-up was 1 to 144 months (median, 26). All of CEAs were done on the side of stenosis more than 80% and bilateral CEAs were done in three. Six CEAs were performed in asymptomatic patients. Results : Seventeen of 19 CEAs showed excellent results and complication rate was low although ipsilateral ischemic stroke occurred in two. Conclusion : CEA may be a valuable surgical treatment for ischemic stroke caused by carotid stenosis and also for prevention of stroke of asymptomatic patients with carotid stenosis.

전적출후 재발한 소아 두개인두종의 재발인자에 대한 분석

김승기,왕규창,정영섭,심기범,조병규,Kim, Seung-Ki,Wang, Kyu-Chang,Chung, Young Seob,Sim, Ki-Bum,Cho, Byung-Kyu 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objectives : A substantial number of craniopharyngiomas recur despite gross total excision. The purpose of our study was to investigate pattern of recurrence and to verify prognostic factors for recurrence after gross total excision of craniopharyngiomas in children. Methods : A series of 36 patients with craniopharyngiomas were reviewed. All patients had undergone gross total excision and none of them received radiotherapy after initial surgery. Fifteen were girls and twenty-one were boys, with a mean age of 7.3 years(range, one to 15 years). The mean follow-up period was 52 months(range, one to 149 months). Recurrence was noted in 14 patients within 83 months(mean 31.4 months). Results : The overall three-year recurrence free survival rate was 65%, and the five-year recurrence-free survival rate was 55%. Regular neuroimaging follow-up at six to 12-month intervals detected tumor recurrence of a smaller size before symptoms developed(p<0.05). At the first surgical procedure, the optic nerve/chiasm(n=23) was the most common adhesion site. The most frequent sites of recurrence were the optic nerve/chiasm(n=6) and the pitiutary fossa(n=6). Tumor location was the single significant clinical predictor of recurrence. The five-year recurrence-free survival rate was 39% for those who had an intrasellar tumor component and 81% for those who did not (p<0.05). Conclusion : Craniopharyngiomas with intrasellar components should be followed cautiously and regular followup of patients should be emphasized, even when the tumors are totally resected.

뇌동정맥기형의 혈관조영 검사상 출혈위험 인자

권오기,한대희,정영섭,오창완,한문희,Kwon, O-Ki,Han, Dae Hee,Chung, Young Seob,Oh, Chang Wan,Han, Moon Hee 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objective : The authors reviewed 280 cases with intracranial arteriovenous malformations(AVMs) to identify risk factors of hemorrhage. Patients and Methods : From 1983 to 1997, a total 280 patients with AVMs were treated. Among them, 64% had a history of hemorrhage. Angiograms were retrospectively analyzed with particular attention to the size of the AVM, venous drainage, the location of the AVM and presence of associated aneurysm or varix. These characteristics were statistically analysed in relation to occurrence of hemorrhage. Results : A single variate analysis demonstrated that small size(p=0.0003), deep venous drainage(p=0.025) and periventricular location(p<0.0001) had a strong positive correlation. Associated aneurysms and varices were not found as hemorrhagic risk factors. A multivariate analysis revealed that the size of the AVM was most significant hemorrhagic factor(p=0.0003) followed by deep venous drainage(p=0.025). AVMs with small size and deep venous drainage bled more frequently regardless of their locations. Conclusion : These data would be useful in identifying patients at higher risk for developing hemorrhage of intracranial AVMs.

뇌반구에 위치한 양성신경교종의 악성전환에 대한 임상적 연구

조근태,곽호신,정희원,백선하,정영섭,김동규,조병규,Cho, Keun-Tae,Gwak, Ho-Shin,Jung, Hee-Won,Paek, Sun-Ha,Chung, Young Seob,Kim, Dong Gyu,Cho, Byung Kyu 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Introduction : It has been reported that the survival of low-grade glioma patients depends upon the time of malignant transformation. The authors presents the clinical analysis of histologically proven trasformed gliomas. Materials and Method : A total 92 patients who were consecutively treated and histologically confirmed hemispheric low-grade gliomas between 1980 and 1998 were analyzed and followed. All cases meet the criteria of WHO glioma classification of grade II. Results : The mean follow-up period was 73 months. Twenty two among 92 cases(24%) were histologically proven to be transformed into malignant ones. The mean time to transformation was 56 months. The 5-year and 10-year survival rates of the transformed group were 66% and 30% respectively and significantly different from the survival rates of the non-transformed group(p=0.0018). Among clinical factors at presentation, the initial tumor volume had a tendency to be larger in the transformed group than that of the non-transformed group and became significant when it was divided into more than $30cm^3$ or not(p=0.02). Among therapeutic factors, the extent of removal had no influence on the rate of malignant transformation. But postoperative radiation therapy were more frequently given to the pre-transformed group than the non-transformed group and the frequency was significantly different(p=0.02). Conclusions : The authors had found that the initial tumor volume and radiation therapy could be clinical prognostic factors for the malignant transformation of low-grade gliomas.

성인 쿠싱병의 치료성적과 예후인자

박철기,황승균,곽호신,유헌,정영섭,백선하,김동규,정희원,김성연,홍승관,Park, Chul-Kee,Hwang, Sung Kyun,Gwak, Ho-Shin,Yoo, Heon,Chung, Young Seob,Paek, Sun Ha,Kim, Dong Gyu,Jung, Hee-Won,Kim, Seong Yeon,Hong, Seung Kuan 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Objectives : The authors analyzed the surgical series of Cushing's disease to evaluate the proper treatment policy and to verify the possible prognostic factors. Material and Methods : Of 50 patients diagnosed as Cushing's disease and operated at Department of Neurosurgery of our institute between 1988 and 1999, 48 patients with available medical records were analyzed retrospectively. Mean follow-up period was 48 months(3 to 109 months). Preoperative diagnosis was made after evaluating the patients with multiple-stage endocrinological studies and 31 selective patients were evaluated with inferior petrosal sinus sampling(IPSS). Magnetic resonance imaging(MRI) and/or high resolution computerized tomography(CT) was done in all patients. A total of 51 transsphenoidal adenomectomy(TSA) were performed including 3 revision for initial surgical failure cases. Remission was decided on the basis of both endocrinological criteria and clinical status. Radiation and/or ketoconazole therapy were applied to failed cases. For the verification of prognostic factors, the authors evaluated the statistical significance of multiple variables over remission rate by chi-square test. Result : Sensitivity of IPSS for central localization was 93.5% which was better than that of MRI(87.5%). But for lateralization, it was 72.4% for IPSS versus MRI 90.5%. Success rate of TSA was 82%(42/51) and recurrence rate was 9%(4/48). When including adjuvant treatments for surgically failed cases, overall success rate was 89.6% and all of 3 reoperated cases(TSA) due to recurrence were successful. Significant complication occurred in 7.8%(4/51) after TSA including hypopituitarism, diabetes insipidus, and visual loss. Non-existence of tumor in MRI and prolonged symptom duration(>3 years) were significant prognostic factors. Conclusion : TSA can be considered as initial treatment for Cushing's disease. In surgically failed cases, multiple treatment modality may improve the overall outcome and repeated TSA for recurrent cases seem to provide similar success.

성인 두개인두종 연속 100예의 장기 치료 성적

방재승,정희원,김동규,곽호신,백선하,정영섭,홍승관,Bang, Jae Seung,Jung, Hee-Won,Kim, Dong Gyu,Gwak, Ho-Shin,Paek, Sun Ha,Chung, Young Seob,Hong, Seung-Koan 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objectives : The authors present a retrospective analysis of 100 consecutive adult patients harboring craniopharyngiomas who underwent microsurgical resection between 1981 and 1999 to assess the long-term outcome of surgical treatment and to determine the most optimal management strategy. Methods : The extent of surgical removal was divided into four categories ; GTR(gross total removal), RSTR(radical subtotal removal), STR(subtotal removal),and PR(partial removal). The median follow-up period was 50 months(4-198). CT scan and/or MR imaging and hormonal status were evaluated to the last follow-up. Results : Visual disturbance was the most common presentation, which was improved in 42 cases and aggravated in 19 cases following the operation. Hypopituitarism was detected in 56 patients preoperatively, 82 during the immediate postoperative period, and 76 at the last follow-up. Improvement of pituitary function was not observed in any of these patients. Twenty of 100 patients showed recurrence at the mean of 27 months(3 to 196). The median progression-free survival(PFS) time of all patients was 145 months and 5-year PFS rate was 74%. Five-year PFS rate of GTR or RSTR group(71%) was significantly higher than that of STR or PR group(30%)(p=0.01). Postoperative radiation therapy significantly prolonged the PFS from 94 months in non-radiation group to 182 months(p=0.002). However, there was no statistical difference in number of patients who required hormonal replacement therapy between radiation and non-radiation group. Conclusion : Visual disturbance can be improved by early diagnosis and surgical decompression. GTR or RSTR in selected patients is considered a proper surgical strategy. Post-operative radiation therapy for residual tumors must be considered, although the ideal timing of radiation therapy is to be determined.

뇌 관련 신경외과 수술 시 Mobile CT의 임상적 적용과 유용성 평가

김희정(Hee Jeong Kim),전진수(Jin Sue Jeon),이숙희(Suek Hee Lee),박성배(Sung Bae Park),손영제(Young Je Son),양희진(Hee Jin Yang),정영섭(Young Seob Chung),이상형(Sang Hyung Lee) 대한CT영상기술학회 2012 대한CT영상기술학회지 Vol.14 No.2

목적 두부전용 이동형 CT인 Mobile CT scan을 pre., intra., postoperative imaging scan으로 분류하고 이를 뇌 관련 신경외과 수술에 선택적으로 적용하여 Mobile CT scan의 그 적용성과 임상적인 유용성에 관하여 알아보고자 한다. 대상 및 방법 보라매병원 신경외과에 내원하여 2010년 8월부터 2011년 12월까지 뇌 관련 신경외과 수술을 받은 환자 총 296명을 대상으로 수술 및 환자의 상태에 따라 Mobile CT scan을 pre., intra., postoperative imaging scan으로 분류하고 scan protocol은 brain noncontrast와 contrast를 이용하여 선택적으로 시행하였으며 신경외과 전문의의 자문을 얻어 실제적으로 획득되는 임상적 가치 및 유용성을 평가하였다. 결과 Mobile CT의 preoperative imaging scan은 환자의 수술 직전 뇌 상태 확인과 응급수술을 요하는 환자의 수술 계획을 위한 base image를 획득할 수 있었고, intraoperative imaging scan은 intraoperative events를 monitoring하고 병변 및 brain의 새로운 위치와 병변의 제거 정도 등의 수술 진행 정보를 제공하였다. Postoperative imaging scan에서는 수술 직후 수술 부위의 이상 소견 여부를 확인할 수 있었다. 결론 뇌 관련 신경외과 수술 시 적용한 Mobile CT의 pre., intra., postoperative imaging scan은 수술 계획의 진행 정도 확인과 뇌 및 환자 상태를 실시간으로 monitoring할 수 있어 효과적으로 환자 안전 및 수술의 정확성과 성공률을 높이는데 유용할 것으로 사료된다. I. Purpose Portable Computed Tomography, Mobile CT scan is classified into pre., intra., postoperative imaging scan. It would be applied selectively to discoverits application and clinically usability. II. Object and Method The subject of this experiment was based en 296 patients who visited department of neurosurgery, Boramae Medical Center from August 2010 to December 2011. I classified Mobile CT scan into pre., intra., postoperative imaging scan and conducted scan protocol by using noncontrast and contrast selectively and they were evaluated by advice of neurosurgical specialist. III. Result Preoperative imaging scan of Mobile CT could obtain brain status and base image of patients, who need emergency operation, before operation. Intraoperative scan could monitor intraoperative events with offering progressive information of brain and also could shaw removal degrees of lesions, In postoperative case, it could confirm abnormality opinion of surgery areas, IV. Conclusions Pre., intra. and postoperative imaging scan of Mobile CT are useful for confirming progress of operation plan, monitoring of brain with patients’ status in neurosurgical operation associated with brain. In my opinion, selective application of Mobile CT scan could be used effectively for caring patients, raising accuracy and success rate of operations.

중대뇌동맥 근위부(M₁)에 발생한 동맥류 : 임상 특성, 수술 치료 및 중대뇌동맥 분기부의 동맥류와의 비교 Clinical Features, Surgical Treatment and Comparision with Middle Cerebral Artery Bifurcation Aneurysms

정영섭,오창완,한대희 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.8

실험적 중대뇌동맥 폐쇄에 의한 뇌경색시 국소 조직 수분 함량과 이온 농도의 측정 및 Nimodipine 투여시 변화에 대한 연구

정영섭,김현집,정희원,조병규,최길수,한대희 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.1

The evolution of infarction in the rat middle cerebral artery(MCA) occlusion model was examined by atomic absorption spectrometric measurements of Na, K and Ca concentrations in brain tissue samples. At 2.4, 6, 8, and 24 hours after MCA occlusion and sham occlusion the brain tissue samples were obtained. Tissue water concentrations were estimated from dry-wet weight measurement The effects of nimodipine(2pghcglmin for 10 min) administered intra-venously at 4 hours(Gmup A), 6 hours(Group B), and 8 hours(Gmups C) a h MCA occlusion were investigated on both the size of infarction and tissue water. Na, K, and Ca concentrations at 24 hours. The results were as follows : 1) Normal concentrations of water, Na, y and Ca averaged 0.793± O.OO%d, 54.06± 4.18 μmole , 81.04± 3.44 μmole, and 35.78± 0.712 pole/gm wet weight At the infarct site by 24 hours, the changes of tissue water and ionic concentrations were conspicuously evident so that water increased by more than 10% (P<0.005), Na increased by more than 120% (P<O.OOS>, K decrea-sed by more than 75%(P<0.005), and Ca increased by more than 200%(P<0.005). 2) The remarkable shifts of Na, K, and Ca concentrations occurred at 4-6 hours so that 60-85% of the ionic shifts developed by 6 hours This characteristics of chronological ionic changes correlated well With the findings of 2% lTC staining during the evolution of infadon. Water concentrations increased rapidly at 2-4 hours so that nearty 80% of water shift developed by 4 hours. 3) In group A(administered at 4 hours), nimodipine treatment siginficantly reduced both the ionic shifts at the infarct site and the size of infarction compared with non-treated rats(P<0. 05). 4) In group B(administered at 6 hours), nimodipine treatment did not significantly reduce the ionic shifts but did reduce the size of infarction compared with non-treated rats(P<0.05>. In group C(administered at 8 hours), nimodipine treatment significantly reduced neither the ionic shifts nor the size of infarction. In summary it was concluded that the propive changes in tissue water and ionic concentrations developed at the infarct sites and the critical period of the changes was between 4 and 6 hours, and nimodipine treatment was effective when administered within 4 hours. The results sugsested that measurement of tissue ionic concentrations could be used as an alternative method for assessing tissue damage and a reliable method to quantify the tissue damage. This method may be useful for determining the time window for therapeutic protocol. as well as for evaluating therapeutic effects.