중대뇌동맥류의 수술적 치료의 합병증

안재성,권병덕 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

TCD를 이용한 뇌사의 판정기준

권양,김창진,임승철,권병덕,황충진 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.4

It is generally known that demonstration of absence of cerebral blood flow is necessry to confirm brain death. Transcranial Doppler(TCD) is an accurate method of monitoring the blood flow velocities of the cerebral vessels. We performed transcranial doppler(TCD) examinations on 15 patients in brain death. Anterior criculation was examined through the temporal window or transorbiral window and basilar arteries were examined through the suboccipital window. All of the patients fulfilled the criteria for determination of brain death by clinical criteria, EEG and/or Brainstem Auditory Evoked Response(BAER) or clinical criteria alone, were mechanically ventilated. A TCD waveform abnormality consisting of reversed diastolic components was found in all brain death patients. The net flow veloicties of <10 ㎝/sec were present in all brain death patients. TCD may be a rapid and convenient alternative to cerebral angiography for confirming brain death when institutional protocols require such comfirmation.

Time-Course and Severity of Cerebral Vasospasm in the "Double-SAH" Canine Model

Kwun, Byung Duk,Peterson, John W.,Zervas, Nicholas T. 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.9

지주막하 출혈 후 발생하는 중요한 합병증인 뇌혈관 연축의 발생기전을 연구하기 위하여 개발된 개에서 "Two-hemorrhage" 모델의 뇌혈관조영상의 시간경과에 따른 변화를 분석하였다. 전신마취와 정상적인 탄산가스 분압상태에서 개의 기저부에 제1차 출혈(급성기 모델)과 제2차 출혈(만성기 모델)을 시행한 후 72시간 후에 뇌혈관 촬영을 하여 출혈전 상태와 비교하여 뇌혈관 연축의 정도를 통계처리하였다. 급성기 모델에서는 경도(10% 미만)의 혈관 수축이 발현되나 제2차 출혈로 만든 만성기 모델에서는 대부분의 동물에서 중등도(35%) 이상의 혈관 여축이 나타났다. 혈관 연축의 정도에 따른 통계학적 분포 분석에 의하면 아마도 혈관연축의 병리란 기전은 여러 요소가 복합적인 기전에 의하여 발생할 것이라는 것을 시사해주며 이러한 Two-hemorrhage 모델은 치료약재를 시험하거나 병태생리를 연구하는 데 기초 자료가 된다.

Surgical Result for Ruptured Anterior Circulation Aneurysms in Elderly Patients

Kwun, Byung Duk,Kim, Jung Hoon,Whang, C. Jin 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.5

많은 저자들은 노령환자들에서 뇌동맥류 수술후 결과가 불량하다고 보고한 반면, 또 다른 저자들은 이들 노령환자들에서도 수술 후 좋은 결과를 얻었다고 보고하였다. 이에 저자들은 조령환자들에서 파열된 전방순환동맥류의 수술결과를 확인하기 위하여 1989년 6월부터 1994년 5월까지 파열된 전방순환동맥류로 본원 신경외과에 입원하여 수술적 치료를 받았던 66세 이상의 환자들을 대상으로 수술결과에 영향을 미칠 수 있는 여러 요인들을 분석하여(the clinical grading, the location of aneurysms, the multiplicity, the presence of the angiographic vsospasm, the development of the symptomatic vsospasm, the presence of the hypertension, Fisher's grade Ⅳ, and the timing of surgery), 그 결과를 65세 이하의 환자들과 비교하였다. 두군간의 전반적인 수술결과는 의미있는 차이를 보이지 않았으며, location 와의 다른 요인들은 수술결과에 영향을 미치지 않았다. 경증 지주막하출혈 환자(Hunt and Hess Grade Ⅰ,Ⅱ)들의 경우 연령 및 수술시기와 관계없이 수술결과는 상당히 양호하였으며, 따라서 노령이라하더라도 경증 지주막하출혈 환자들의 경우 조기수술의 가능하였고 그 성적이 좋았다. 저자들은 단지 노령이라는 이유만으로 수술적응증에서 제외되는 것은 부적당하다고 생각되며, 수술결과에 가장 영향을 미칠 수 있는 요인은 연령이 아니라 수술전 환자상태라고 생각한다. In order to define the surgical result for ruptured anterior circulation aneurysms in the elderly. 59patients(from June 1989 to May 1994)whose age was 66years of age or older were analyzed. The factors which might influence the outcome were statistically compared between those aged 66 years or older (elderly patients group : 413 patients : 87.5% ); the clinical grading, the location of aneurysms, the multiplicity the presence of the angiographic vasospasm. the presence of the hypertension. Fisher's grade Ⅳ (intracerebral hemorrhage or intraventricular hemorrhage). and the timing of surgery. Overall outcome between two groups was not different singificantly. and many factors did not affect the outcome except the location Surgical outcome in good grade patients(Hunt and Hess Grade Ⅰ,Ⅱ) was excellent regardless of age and timing of surgery. "Early surgery in the elderly?" The answer was Yes especially in good grade patients. We conclude that surgical outcome for ruptured anterior ciculation aneruysms in the elderly does not seem to be directly affected by age. so elderly patients need not therefore be excluded from the benefits of surgery just because of their chronolgical age. It is principally the patient's condition during the acute stage that determine the surgical outcome.

Cerebral Vasospasm after Experimental Subarachnoid Hemorrhage in the Canine Model: Evidence for the Role of Immunological Reactivity

Kwun, Byung-Duk,Peterson, John W. 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.2

개의 혈관연축 실험모델에서 자가혈액과 이종혈액을 주입하여 단기간내의 혈관조영상의 반응을 검사하였다. 자가혈액 주입 동물에서는 72시간내에 약 15% 정도의 미약한 혈관연축을 보였으나 이종혈액을 주입한 경우에는 40% 이상의 심한 수축을 보였다. 혈액용해의 정도에 대한 실험관 측정과 개의 연구 부위에 형성된 혈종의 모양을 살펴보았을 때 혈관연축의 증가는 용혈산물의 유출과 직접적인 관련이 있을 것으로 보인다. 심한 혈관연축의 발현시각과 척수액내에 혈장단백의 유출의 실험적 상관관계는 BBB의 파괴와 혈관주위의 세포분해인자의 유입을 시사하며 이러한 면역학적 반응이 지주막하 출혈에 있어서 혈연축의 지연성 발현에 한 몫을 하는 것이다.

Dandy-Walker Cyst 2례 보고

권병덕,고영초,조병규,최길수 대한신경외과학회 1982 Journal of Korean neurosurgical society Vol.11 No.1

Dandy-Walker cyst is a rare disease causing hydrocephalus as a result of congenital outlet obstruction of the fourth ventricle. The clinical and C-T findings in two cases of the Dandy-Walker cyst which were confirmed through posterior fossa exploration are described. The patients were an infant and a girl aged 8 months and 16 months, who had presented signs of increased intracranial pressure for relatively short periods before admission. Brain C-T scan showed a generalized hydrocephalus with a large CSF-filled cystic space in the posterior fossa, indicating a defect of cerebellar vermis. Arachnoid cyst, megacisterna magna, ependymal cyst, and porencephalic cyst should be included in differential diagnosis and brain C-T scan alone is not sufficient in pathologic differentiation Posterior fossa exploration and cystic membrane excision were done in both cases with simultaneous ventriculo-peritoneal shunt in the latter case.

C-T상 뇌종양과 혼동하기 쉬운 병소

권병덕,고영초,이현구,최길수 대한신경외과학회 1982 Journal of Korean neurosurgical society Vol.11 No.1

As more experience with computed tomography(C.T) is acquired, it is becoming apparent that differential diagnosis based on C.T appearances can be difficult. Many different pathologic processes can have similar enhancement patterns. We present 10 patients who underwent operation under the impression of brain tumor by C.T and angiogram but proved to have non-neoplastic lesions. The importance of careful evaluation of the history before offering a final opinion based on the C.T findings cannot be overemphasized. The clinician must be aware of the limitations and pitfalls associated with the computed tomography.

뇌폐흡충증으로 진단된 뇌농양 1례 보고

권병덕,황성남,최길수,지제근 대한신경외과학회 1979 Journal of Korean neurosurgical society Vol.8 No.2

Cerebral paragonimiasis, occurring as an extrapulmonary infestation, is one of the important intracranial lesions in Korea. In this paper we report a case of cerebral paragonimiasis which showed very similar C-T findings to pyogenic brain absence and was verified by pathologic research. Though we don't have much experiences in the diagnosis of the cereal paragonimiasis with C-T Scan, we found out some differences between pyogenic abscess and that due to cerebral paragonimiasis in several aspects.

Doppler Ultrasound를 이용한 뇌기적 동맥의 혈류속도 측정 : Examination Technique and Normal Values in Korean

권병덕,권양,임승철,황충진 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.3

We present the examination technique and normal values of flow velocity from intracranial basal cerebral arteries for a recently developed pulsed Doppler system operating at 2 MHz emitting frequency. Peak systolic, peak diastolic, and mean flow velocity values are analyzed from fast-Fourier transformed(FFT) Doppler spectra at selected depths for 50 presumed normal subjects ranging in age from 18 to 73 years. Interindividual variation is high for peak flow but moderate for mean flow velocity values, which hence are more likely to discriminate normal from abnormal. Flow velocity values within the posterior cerebral attery(PCA) and the basilar artery(BA) are significantly lower than in the anterior cerebral artery(ACA) and the middle cerebral artery(MCA), which is also unique in the showing significantly decreasing values with increasing age. Calculated mean flow velocities are 61±14㎝/s in the middle artery(MCA) and 51±14㎝/s in the anterior cerebral artery(ACA), and 45±11㎝/s in the posterior artery(PCA) through the temporal window and 43±14㎝/s in the basilar artery through the subocciptal window and 15±5㎝/s in the opthalmic artery and 47±13㎝/s in the internal carotid artery(ICA) through the transorbital window. A new scanning system is introduced, which we suggest will reduce interindividual variations and improve the accurate separation of nearby vessels, which are major causes of the comparatively large standard deviations at present.

대뇌 세망세포육종 1예

곽동근,권병덕,최선길,강성구,김철우 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.4

A case of histologically proved primary reticulum cell sarcoma is presented. A female patient with headache and left hemiplegia was proved to have reticulum cell sarcoma after surgery. The tumor was single in the frontal cortex and showed peculiar contrast enhancement pattern on computed tomogram. Near-total extirpation was verified by post-operative CT.