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김용주(Yong Joo Kim),황용순(Yong Soon Hwang),유수정(Su Jeong You),강훈철(Hoon-Chul Kang),박상근(Sang Keun Park),고태성(Tae-Sung Ko) 대한소아신경학회 2006 대한소아신경학회지 Vol.14 No.1
목 적: 간질 수술의 경험을 사례별로 분석하여 간질 수술의 효과와 안정성을 살펴봄으로써, 난치성 소아 간질에서 간질 수술이 조기에 적절히 시행되는데 도움이 되고자 한다. 방 법: 2003년 9월부터 2005년 3월까지 상계백병원 간질센터에서 간질 수술이 시행된 난치성 소아 간질 환아 21명을 대상으로 하였다. 치료적 절제술과 고식적 뇌량 절개술을 시행한 환아들을 따로 나누어 임상 양상, 간질 구분, 병인, 수술 방법, 예후 및 부작용을 살펴보았다. 결 과: 치료적 절제술을 시행한 15명 중 10명(67.0%)에서 Engel 구분 I, 3명(20.0%)에서 Engel 구분 II의 성적을 보였으나, 뇌염 이후 다국소성 간질 소견을 보였던 1명에서는 수술 후 호전이 없었다. Sturge-Weber 증후군으로 섬주위반구절개술을 시행받았던 1명은 수술 후 저산소성 허혈성 뇌손상이 발생하였다. 그 외에 수술로 인한 부작용으로는 기억력 감소, 경색, 일시적 반부전마비, 억제이상, 시야 결손이 있었다. 고식적 전체 뇌량 절개술을 시행한 6명에서는 추적 기간 중 최종적으로 1명이 90% 이상, 4명에서 50-75%의 간질 횟수 감소를 보였으며, 1명에서는 수술 후 변화가 없었다. 뇌량 절개술 시행 후 2명에서 일시적인 무언증과 실조증을 보였으나 한달 이내 모두 회복되었다. 결 론 : 간질 수술은 난치성 간질에 대한 치료 방법들 가운데 가장 확실한 예후를 담보할 수 있을 뿐만 아니라 발달의 회복을 고려할 때, 가능한 조기에 시행되어야 할 것으로 생각된다. 하지만 수술에 따른 부작용과 수술 실패 가능성을 염두에 두고, 항상 신중한 자세에서 평가가 이루어져야 함을 경험할 수 있었다. Purpose : This study aimed to reveal the benefits and the safety of surgical treatment in children with refractory epilepsy by reviewing our experiences on a case-bycase basis. Methods : Twenty one patients who underwent epilepsy surgeries from September, 2003 to March, 2005 at Sanggye Paik Hospital were included. Data including clinical features and surgical outcomes were filed up through 2 years. Results : The profiles of the 15 patients who underwent curative epilepsy surgeries were as follows. Characteristically, one patient had dual epilepsy including mesial temporal lobe epilepsy. Two patients had infantile spasms with cortical dysplasia, both of whom underwent epilepsy surgeries in early infancy. Also, there is a patient who underwent a re-operation, while another one patient had an epileptic focus in the insular lobe. Two patients were diagnosed Sturge-Weber syndrome, and three patients had nonlesional or lesional multilobar epilepsies. Furthermore, the surgical outcomes can be classified such as Engel class I in 10(66.7%) patients, class II in 3(20.0%) patients while one patient failed to obtain any seizure reduction after surgical treatment. In addition, palliative total corpus callosotomies were tried in 6 patients. But only one patient showed seizure reduction of more than 90%, while 4 patients exhibited 50-75% seizure reduction and the other one did not have any changes in seizure frequency. We also experienced various kinds of unwanted events such as memory deterioration (1), vascular infarction (1), hypoxic insult (1), transient hemiparesis (2), dysinhibition (1) and visual field defects (3). Most of neuroimaging studies were highly concordant to the ictal scalp and intracranial EEGs. Concl usi on : Epilepsy surgery can be an effective therapeutic modality in localization related intractable childhood epilepsies. However, we should consider various surgical complications and carefully evaluate the epileptogenic and functionally eloquent areas.
조용운,문재곤,황용순,박인석,전병찬,김한규,Cho, Yong Woon,Moon, Jae Gon,Hwang, Yong Soon,Park, In Suk,Jeon, Byung Chan,Kim, Han Kyu 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5
Objective : In neurosurgical practice, it has been generally accepted that when the dura is opened, it should be watertightly closed, and traditionally non-watertight closure has not been performed. We clinically tried non-watertight closure, analyzed the frequency of CSF leakage and evaluated the possible clinical application of non-watertight closure. Methods : After classifying our cases with supratentorial and infratentorial approach, we tried non-watertight and watertight closures and compared the results. We also analyzed the cases with or without dural graft. Results : In supratentorial approach, the rate of cerebrospinal fluid leakage noted in non-watertight closure was similar to that of watertight closure. In infratentorial approach, except microvascular decompression(MVD), the rate of cerebrospinal fluid leakage in non-watertight closure was higher than that of watertight closure. Dura graft application did not seemed to influence the cerebrospinal fluid leakage. Conclusion : Since the frequency of cerebrospinal fluid leakage was not higher in non-watertight closure than that of watertight closure, non-watertight closure can be applied in supratentorial approach. In infratentorial approach, non-watertight closure may be applied in surgery with relatively short dural incision, such as MVD. However, non-watertight closure doesn't seem to be appropriate in surgery that requires wide dural incision, such as skull base surgery.
손찬영,박상근,신형식,김태홍,황용순,김상진,Son, Chan Young,Park, Sang Keun,Shin, Hyung Shik,Kim, Tae Hong,Hwang, Yong Soon,Kim, Sang Jin 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9
Athke's cleft cysts are believed to be derived from remnants of Rathke's pouch, a dorsal invagination of the stomodeum. Although these cysts are characteristically small, asymptomatic and intrasellar in location, they occasionally provoke symtoms with enlargement to compress surrounding structures. It is characteristically lined by stratified squamous epithelium with keratinization on a layer of connective tissue. The cells of the anterior pituitary lobe, from which pituitary adenomas develop, are also formed by the proliferation of the anterior wall of Rathke's pouch. Thus, Rathke's cleft cyst and pituitary adenomas are considered to have a common ancestry. We report a rare case in which the preoperative diagnosis was pituitary adenoma, but the pathologic diagnosis was a combination of a Rathke's cleft cyst and a coincidental pituitary adenoma.
두개골을 침범한 Langerhans' Cell Histiocytosis - 증례보고 -
손찬영,박상근,김한성,신형식,황용순,김상진,Son, Chan Young,Park, Sang Keun,Kim, Han Sung,Shin, Hyung Shik,Hwang, Yong Soon,Kim, Sang Jin 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1
Langerhans' cell histiocytosis is a rare disease showing proliferation of histiocytes in multiple organ system. Bone lesions are the most common radiolologic manifestation of Langerhans' cell hysticytosis. Extraskeletal sites of Langerhans' cell hystiocytosis involvement include the skin, lymph nodes, thymus, lungs, central nervous system, liver, pancrease, spleen, and bowel. The authors have experienced a case of Langerhans' cell histiocytosis which involved the skull. A 3-year-old female presented with soft tissue mass on right periorbital area. Plain skull X-ray showed punched out bone lesion. Computed tomography showed non-enhancing osteolytic lesion on right frontal skull. Histologic findings of an excised mass revealed pathologic features of Langerhans' cell histiocytosis.
김진용,박상근,김한성,신형식,황용순,김상진,Kim, Jin Yong,Park, Sang Keun,Kim, Han Sung,Shin, Hyung Shik,Hwang, Yong Soon,Kim, Sang Jin 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8
Although the most commonly encountered orbital tumor is metastatic tumor, adenocarcinoma of stomach metastasized to the optic nerve is rarely reported. The authors discuss a rare case of metastatic adenocarcinoma of left optic nerve with a review of literature. A 44-year-old man presented with decreased visual acuity of left eye for 3 months. Neurologic examination revealed left optic neuropathy. On MR imaging, a homogenously wellenhanced mass surrounding left optic nerve around optic canal was noticed. The X-rays and the whole body bone scan sho-wed multiple bony metastasis. Subtotal removal was performed via combined subfrontal and pterional approach and metastatic adenocarcinoma from the stomach was confirmed histologically. Postoperative course was uneventful, but there was no improvement of visual acuity.
중증 외상성 뇌부종 환자에서 양측 전두-측두부 감압적 개두술의 의의
신형식,김진용,김태홍,황용순,김상진,박상근,Shin, Hyung Shik,Kim, Jin Yong,Kim, Tae Hong,Hwang, Yong Soon,Kim, Sang Jin,Park, Sang Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9
Objective : The treatment of malignant posttraumatic brain swelling remains a frustrating endeavor for neurosurgeon. Mortality and morbidity rates remain high depite advances in medical treatment of increased intracranial pressure. If conventional therapy fails in patients suffering from intracranial hypertension, there is only small number of second-tier option left including decompressive craniectomy. The role of decompressive craniectomy in posttraumatic brain swelling remains controversial. We assessed the efficacy and indications of decompressive craniectomy. Methods : The authors performed decompressive bifrontotemporal craniectomy in 22 patients with malignant posttraumatic brain swelling. Epidural pressure monotoring was performed in all patients. The clnical data and surgical outcomes were reviewed retrospectively. Result : The favorable outcome(GOS score 4-5) was 59%(13 of 22 patients), whereas the mortality rate was 32% (7 of 22 patients). Two patients(9%) remained in severely disabled state. Increased rate of favorable outcome was seen in the patients who had 8 or more of GCS score at admission and exhibited B wave in ICP monitoring and who showed steady state or slow deterioration in clinical course. Conclusion : If conservative therapy fails, decompressive bifrontotemporal craniectomy should be considered in the management of malignant posttraumatic brain swelling before irreversible ischemic brain damage occur.