경추부 후종인대 골화증의 외과적 치료

최세환,나형균,이길송,안명수,최창락,송진언 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

We have operated on 40 patients with radiculopathy and myelopathy with cervical ossification of posterior longitudinal ligament(OPLL) within recent 4 years. The age of patient at operation was from 4th decade to 8th decade, with the largest number in the 6th decade. Three times more men than women were affected. The surgical technique was selected in most cases on the basis of radiological findings. 26 patients underwent anterior approach by transuncal discal approach(TUD) and vertebrotomy. 14 patients underwent posterior approach by laminectomy and widening laminoplasty. Outcome of operation was generally good. Of 40 patients, 32 cases were in the excellent or good results. A short duration of symptoms before operation was associated with better results, but there not influenced by the age of the patients. In selection of operative method, we suggest that 1) Anterior approach is a better method in case of the patient whose lesion is limited at one of two levels without any narrow spinal canal, 2) In case having a lesion more than two levels and especially accompaning multiple canal stenosis, posterior approach may be effective, and widening laminoplasty is a better method than extensive laminectomy which could be complicated with postoperative spinal instability, scar formation at operation area, and abnormal curvature of the cervical spine.

두개저 종양에 대한 확대 경기저 개두술

나형균,지철,최창락 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

The extensive transbasal approach by Kawakami is a mOdifkation of the transbasal approach of Derome. This approach. an en bloc bilateral osteotomy of the orbital roofs and frontal sinus following an ordinary bifrontal craniotomy improves the exposure of midline lesions of the anterior and middle skull base. while minimizing the need for frontal lobe retraction. The authors present 5 cases operated on via this approach. The tumor diagnosis of 5 cases was 3 cases of tuberculum sellae meningioma 1 case of astrocytoma and 1 case of craniopharyngioma. In two patientdcases with localized lesions in the midline). the extensive transbasal approach was used alone, in the remaining three(cases with far lateral extension to the temporal base). it was combined with other skull base approachs. Our experience in 5 cases and the advantage of this approach are described.

삼차신경통에 대한 고주파응고술 및 감압술의 병용치료 효과에 대하여

조경근,나형균,안명수,최창락,송진언 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.1

Percutaneous radiofrequency rhizotomy of the gasserian ganglion was performed in 150 patients. The average age of group was 55 years, and woman made up 61.1 percent of the patients. The pain was localized on the right in 58.7%. The most common divisions of the trigeminal nerve involved was the maxillary and mandibular divisions. The results of radiofrequency rhizotomy has been very satisfactory in 80.7%. Recurrant rate has been observed in 14.7%. Postoperative complications was noticed in 30%, but most were subsided within 2 weeks. Our results indicate that the radiofrequency rhizotomy is an excellant method of the treatment of trigeminal neuralgia in the selected cases Therefore we suggest that the rediofrequency rhizotomy is initially the procedure of choice for the trigeminal neuralgia but in recur or no response cases to radiofrequency rhizotomy, microvascular decompression is the second choice of treatment of the tngeminal neuralgia.

척추골 전전위증의 외과적 치료

박해관,나형균,이길송,최창락,송진언,안명수 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.4

We have operated on 13 Patients with Spondylolisthesis over recent 3 years. The age of Patient was from 4th decade to 7th decade, with the largest number in 6th decade. The method of operation were Posterior lumbar interbody fusion(PLIF) in 7cases, anterior interbody fusion in one case, Hrrington application in one cases, Facet joint reconstruction with wiring in one case, PLIF+Harrington in one case, and Roy-Camille Pedicular screw in 2cases. The result of operation were considered excellent in 8 cases, fair in 4cases and poor in one case. On the selection of operating method for the patients with spondylolisthesis, we suggest that. 1) In cases of the isthmic type or dysplastic type without disc protrusion, one method among bilateral intertransverse fusion, fixation by wiring or Harrington rod application could be used. 2) In case that extensive laminectomy is needed such as associated with spinal stenosis or disc protursion, PLIF is considered to be good method. 3) If displacement is severe(especially in case of severe unstable spine due to spinal trauma), pedicular screw could be placed because it can reduce and immobilize the displaced spine. 4) In cases of simple spondylolysis or mild spondylolisthesis with isthmic defect, if symptom is continued, bone graft in the defect are and fixation by wiring is good method.

요천추부 추간판 탈출증의 진단 및 치료효과를 판정하는데 있어서 Dermatomal Somatosensory Evoked Potentials의 의의

이길송,나형균,안명수,최창락,송진언 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.3

We recorded dermatomaly somatosensory evoked potentials(DSSEPs)in 30 healthy subjects and 50 patients with a herniated lumbosacral disc. DSSEPs normally consists of three negative peaks, N_(38) N_(55) N_(75) and N_(42) N_(59) N_(78) by bilateral stimulation of L_(5) and S₁ dermatome, respectively. In the patient group, both first & second peak of DSSEPs are often abnormal whereas the third peak tends to remain normal. Of the 20 patients who underwent laminectomy, 17 (85%) patients demonstrated positive findings of the lesion corresponding to myelographic finding. However, 19(95%) patients of the 20 surgical cases showed operative findings identical with DSSEPs. Follow -up study with DSSEPs in the patients of 20 surgical cases and 30 cases treated with either RF rhizotomy or physiotherapy resulted in returning to normal waveform from abnormal one. In comparing to other electro-diagnostic test, DSSEPs are more valuable noninvasive diagnostic tool in the evaluation of herniated lumbosacial disc.

Cervical Lesion 환자에서 수술전, 후의 Short Latency SEP의 의의

김명식,나형균,안명수,최창락,송진언 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.1

We performed the short latency somatosensory evoked potentials (SEP) following median nerve stimulation in 50 normal subjects and 24 patients with cervical lesions. The sites of recording electrodes were erb's point, C_(7) spinous process, C₂ spinous process and sensory cortical area representing the hand. Results of the short latency SEP after median nerve stemulation in 50 normal subjects were as follows: Erb's potential : 10.2±0.8 C_(7) " : 13.2±0.8 C₂ " : C_(7)±0.8 C_(z) " : 19±1.0 Results of the short latency SEP after median nerve stimulation in 24 patients with cervical lesions were as follows. 1) Patients with mild cervical lesions : 15 patients in this group had delayed the latency of C₂. 2) Patients with moderate to sever cervical lesions: 5 patients in this group had delayed the latency of C_(7) or Erb's point. 3) Patients with fracture- dislocation of cervical vertebrae: 2 patients in this group had no responses. 4) Two patients with mild cervical lesions had normal ranges of the latencies. Therefore we suggest the efficiency of the short latency SEP in the diagnosis and evaluation of the patient's prognosis with cerical lesions.

원발성 난소 주 유암종 1 예

노용호,박준제,이채원,최창록,강정오,소영환 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Primary trabecular carcinoid tumor of the ovary is an very rare ovarian tumor, behaving like a tumor of low malignant potential. It mostly occurs in women between 20 and 50 years of age and constitutes less than 1 % of all carcinoid tumors. Ovarian carcinoid tumor is frequent coexistence of mature or immature teratoid components. Ovarian carcinoids, without other teratomatous components, are solid, grey-yellow tumors, usually well-encapsuled and slightly lobulated. When other teratomatous components coexist, cystic and semicystic foci are seen. In the younger patient, the treatment is unilateral salpingo-oophorectomy, while in the postmenopausal patient bilateral salpingo-oophorectomy and hysterectomy is the treatment of choice. Chemotherapy or radiotherapy was not needful. Authors have experienced a case of primary trabecular carcinoid tumor of the ovary in a 17 year-old woman, and report with a brief literature review.

자궁경부에 발생한 낭종성 자궁내막종 1 예

김영주,이정형,하정호,최창록,강정오 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

Cervical endonetriosis with cystic change is extremely rare lesion. We experienced one case of cervical endometriosis in 33 year old woman, who had no symptoms, so we reprot the case and brief review of literatures.

각종 뇌질환 환자의 진단에 있어서 Single Photon Emission CT(SPECT)와 Topographic EEG의 의의

권성오,나형균,이길송,안명수,최창락,송진언,이성용 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.3

Authors measured cerebral blood flow(CBF) with single photon emission computed tomography (SPECT) in 43 patients with various kinds of cerebral lesions and the finding of CBF was compared to those of CT scan and topographic EEG. Of 43 patients, 14 cases were cerebral vascular insufficiency, 6 were cerebral infarction, 4 intracerebral hematoma, 2A-V malfromation, 1 moy moya disease, 8 brain contusion, 4 seizure disorder, 3 brain tumor, and one case was hydrocephalus. In measurement of rCBF, two dimensional method using radioactive isotope, Xe-133 or Kr-85 had several limitations. Recently a new radiopharmaceutical(Technetium HMPAO), ideal for SPECT was reported. Therefore SPECT of three dimensional method was widely used in measurement of CBF. After advent of CT scan, clincal use of conventional EEG was less attention, but topographic representation of the EEG data was considered beneficial in correcting the previous problems in the conventional EEG. The results were as follows : 1) Of 43 patients with brain lesions, SPECT and topographic EEG were appeared to be better method than CT scan in the diagnosis and follow-up study in patients with cerebrovascular insufficiency, mild brain contusion and seizure disorder. 2) Seizure focus could be found on SPECT and topographic EEG in patient with focal seizure who was showed to be normal on CT scan of the brain. 3) SPECT and topographical EEG might be useful tools for the diagnosis and follow-up study in patients with functional derangement rather than anatomical abnormality of the brain for example, repeated TIA, focal seizure, and dementia.

외상성 안면신경 마비 환자에 있어서 안면신경관 감압술의 의의

조성환,나형균,이길송,안명수,최창락,송진언 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.2

Of 9 patients with facial paralysis following closed head injury, 6 cases were treated operatively at neurosurgical department of Catholic Medical College in recent 2 years. 8 of 9 cases were male and 4 cases were third decade. Three cases were showed immediate onset and 6 cases were delayed paralysis. Associated symptoms and signs were temporal bone fracture : 8 cases battles sign : 6 cases, C.S.F. otorrhea : 5 cases, hearing impairment : 4 cases, epidural hematoma : 2 cases, and brain contusion : 1 cases. We have used the Schimer test, the Stapedius reflex test and Electrogustrometry to determine the topographic site of lesion and also have used to nerve stimulator and E.M.G. to determine the extent of nerve involvement. Outcome of the operated patients was generally good. Of 6 patients who underwent facial canal decompression, 5 cases were excellent or good results and one was fair. We suggest that 1) Facial paralysis of the immediate onset, especially coinciding with C.S.F. otorrhea or temporal bone fracture should be treated by operative exploration of the facial nerve as soon as the patients general condition has stabilized. 2) The patient who has temporal bone fracture, C.S.F. otorrhea or battles sign should be closely observed for the delayed development of facial paralysis. 3) In case of delayed type of facial weakness, it is better to be decompressed as soon as possible when the paralysis is dense, but close observation with percutaneous nerve excitability test for several days is recommended when the paralysis is partial. If the weakness is progressive or axonal degeneration is suspected on percutaneous nerve excitability test, decompression of the facial nerve might be considered for the patient.