중증 미만성 축색손상 환자의 MRI소견 및 임상적 고찰

김한겸 忠南大學校 1993 국내석사

The distribution and extent of traumatic lesions were evaluated with MRI in 31 patients with diffuse axonal injuries(DAI). Author also analized patients with diffuse axonal injury, clinically. The patients with DAI revealed statistically significant lower incidence of lucid interval, fracture of the skull, and intracranial hematoma. Combined injuries, intracrnial hematomas, and distribution of lesions were poor prognostic factors of DAI. Diffuse axonal injury is most commonly involved in the white matter of the frontal and temporal lobes, and the splenium of the corpus callosum. Patients with lesions in brainstem and cerebellum revealed worst prognosis. In our studies, the sensitivities of the imaging techniques for diffuse axonal injuries were 7.3% with CT scan, 75.6% with TIWI, and with 97.6% in T2WI of MRI, respectively. Author concluded that MRI has clear advantages over CT in evaluating diffuse axonal injuries.

젊은 연령층과 고령층에서 발생하는 뇌동맥류의 임상적 비교연구

전용선 忠南大學校 1996 국내석사

Four hundred patients with cerebral aneurysms confirmed by cerebral angiography were classified into two age groups, that is, one aged 39 years or younger (Young aged group: 51 patients, 12.8%), and another aged 65 years or older (Old aged group: 45 patients, 11.3%). A comparison was done in clinical characteristics and overall management outcome in two groups. In Young aged group, the female-to-male ratio was 2.2:1. but, women was predominant by five times in old aged group. Anterior communicating artery aneurysm is most common site(43.1%) in young aged group, but, in old aged group, posterior communicating artery is most common(33.3%). The most common symptom is headache in both group, and the hypertension is more frequent in young aged group(45.5%) than old aged group(33.3%). Surgery was performed in 43 patients(84%) in younger group, and 37 patients(82.2%) in elderly group. Young aged group was more a lot of, numbers of good outcome(91%) than old aged group(70%).

성인 뇌손상 환자에서 혈청 및 뇌척수액 IL-6 치의 변화

申東益 한림대학교 2000 국내석사

Cytokines may have involved in the pathophysiology of traumatic brain injury(TBI) in adults. Interleukine-6(IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants. The objective of this study was to determine whether serum IL-6 and cerebrospinal fluid(CSF) IL-6 levels were elevated at the time of admission after head injury and to correlate serum IL-6 and CSF IL-6 levels wi th severity of head injury measured by the Glasgow Coma Scale(GCS) score and intracranial pressure(ICP). Twenty one patients with GCS score between 4 and 14(mean=9) were observed for 3-5 days after head injury. The highest level of serum IL-6 was found on admission day 1(8.2±4.9 pg/ml; normal level is less than 0.4 pg/ml±O.2pg/ml) and then it decreased to 4.O±3.6pg/ml on day 5. Serum IL-6 levels decreased significantly faster in patients with 24-hour GCS scores of 8 through 11 compared with patients wi th 24 hour GCS score<8. Patients had markedly elevated CSF IL-6 levels on admission compared with controls(46.6±4.2pg/ml vs <20.6±5.8pg/ml). This studies indicated that patients with severe head injury had markedly elevated serum and CSF IL-6 levels wi thin 24 hours of head injury. which decreased over time. Serum IL-6 levels were significantly more elevated in the patients with low GCS and increased ICP. This study demonstrates that serum and CSF IL-6 levIes correlate with severity of traumatic brain injury and warrants further evaluation to determine the exact role of IL-6 in injury repair in the brain. 본 연구에서는 성인 외상성 뇌손상 환자 혈청 및 뇌 척수액의 IL-6 수치가 뇌손상 초기에 정상보다 증가되어 있었고 시간의 경과에 따라 감소하였다. 의식수준이 낮을수록 혈청의 IL-6가 높게 나타났으며 뇌척수액의 IL-6는 혈청의 IL-6보다 의미있는 증가를 보였다. 그리고 두개강 내압이 높을 수록 IL-6는 더욱 증가를 보였다. 또한 IL-6의 수치는 임상적 호전의 정도에 따라 감소함을 보였다. 이 사실은 IL-6가 뇌손상을 받은 환자의 급성기 반응에서 매개체로 중요한 역할을 한다는 사실을 시사해 주고 있다. 뇌손상 환자에서 IL-6의 구체적 역할을 규명하기 위하여는 추후 지속적인 연구가 필요할 것으로 사료된다.

소아와 성인간의 급성 경막외 혈종환자의 임상적 특성비교

최우진 忠南大學校 1996 국내석사

512 epidural hematoma cases were treated in Chungnmn National University Hospital Neurosurgery Department, between 1986 and 1995: 79 were children(1-15 years) and 433 were adults(16-83 years). The authers attempt to outline the various clinical chacteristics and significant prognostic factors of epidural hematoma which are different in children and adults. The result confirm that children with traumatic epidural hematoma are less likely to have incidence from head trauma, associated extracranial injury, skull fracture, temporal located hematoma, and immediately surgery, but are more likely to have high score of preoperative GCS, prompt pupil response, conservative treatment, short duration of coma, good outcome. Causes of injury by motor-vesicular accident and associated intradural lesion are not significant different rate in children and adults Compared with prognostic factors, cause of injury, hematoma amount and bleeding point on surgery are significant prognostic factors in adults, but are not prognostic factors in children In same score of preoperative GCS and same duration of coma, highly severe neurologic states ( below 7 of GCS, both dilated fixed pupil ) have bad outcome in children as well as adults without significant difference. Clinical index of preoperative GCS and pupillary response that have been used in decision of operation time is different in children and adults. Though children are performed delayed operation, observing GCS and pupillary response, have good outcome. Otherwise, adults need operation in good GCS and pupillary response as possible as, because of rapid progression.

자발성 뇌실질내 출혈 환자에서 혈종 증가에 영향을 미치는 요인에 대한 분석

李龍默 忠南大學校 1998 국내석사

In order to evaluate the risk factors of hematoma enlargement in spontaneous intracerebral hemorrhage(ICH), 214 cases of intracerebral hemorrhage diagnosed with brain CT scan between June, 1995, and July, 1998, were reviewed with clinical status, past medical histories, laboratory finding, CT scan findings and treatment modalities. In 27 patients(12.6%), the second CT scan showed an enlarged hematoma. Age, sex and site of hematomas were not related to hematoma enlargement. A long interval(<6 hours) between the onset and 1st CT scan strongly reduced risk of hematoma enlargement, The incidence of hematoma enlargement significantly increased with past histories of hypertension, cerebral infarction and ICH. The analysis also demonstrated the following independent factors predisposed to enlargement: initial high systolic blood pressure, high serum total protein, low serum albumin, low serum sodium, prolonged prothrombin time > 14 sec, activated partial thromboplastin time > 29.5 sec, irregular hematoma shape, combined intraventricular hemorrhage. Prognosis in the hematoma enlargement group showed high mortality(38.1%) and poor result. In conclusion, patients with histories of hypertension, cerebral infarction and ICH, prolonged coagulation time, irregular hematoma shape and intraventricular hemorrhage in CT scan should be observed closely for at least six hours after onset. thus, early surgical therapy of large hematoma may decrease the mortality and morbidity in spontaneous intracerebral hemorrhages

경증 두부 손상 후 발생한 지연성 악화에 대한 임상 분석

崔勝源 忠南大學校 1998 국내석사

We retrospectively studied 366 consecutive patients during 3-year period who presented with mild head injury(GCS score in the 13 to 15 range). Of 51(13.9%) patients with delayed deterioration, 13 died(25.5%), 38(74.5%) had favorable outcome. Statistically correlated factors with delayed deterioration were age, initial symptom or sign, laboratory finding including coagulopathy, electrolyte imbalance, hyperglycemia, and presence of subdural hematoma in initial brain CT. 28(54.9%) of patients with delayed deterioration underwent neurosurgical intervention and 229(72.1%) of patients without delayed deterioration were treated conservatively. Sex, GCS score on deterioration and characteristics or site of new lesion in subsequent brain CT on deterioration were statistically correlated with prognosis of delayed deteriorated patients.

교모 세포종 환자의 여명에 관련된 인자에대한 임상적 연구

禹元喆 忠南大學校 1998 국내석사

The prognosis for patients with glioblastoma is dismal. Although many patients have a rapid progressive course and early death, few patient survive for an extended period of time. In order to identify the factors associated with survival, glioblastoma patients, who were diagnosed between Jan. 1988 and Mar. 1998, studied from medical records. The variable factors were examined for their relationship with survival: age at the time of diagnosis, gender, length and duration of neurological symptoms, preoperative neurological state (karnofsky score), extent of surgical resection, location of tumor, reoperation, postoperative radiation therapy. There were 24 male and 16 female patients, with a mean age 51 years. The mean duration of survival period is 51 weeks, three(7.5%) of the 20 patients identified survived at least 2 years, twenty-seven(67.5%) patient underwent gross total resection. Nine(22.5%) patients received second operation and had a mean calculated survival from the time of reoperation of 42 weeks. Twenty-eight(70%) received postoperative radiation therapy. Various levels of tumor dose were used, but the planned was 6,000 rad over 7 weeks in most cases. The following factors were associated with patient survival by t-Test, one-way ANOVA(P<0.05): postoperative radiation therapy, reoperation. Other factors were not significant statistically. Among the factor, reoperation and postoperative radiation therapy was the most important in our present series.

다른 외상성 두개강내 병변이 동반된 외상성 뇌실질내 혈종의 임상분석

최진호 忠南大學校 1996 국내석사

180 cases of traumatic intracerebral hematoma(TICH) among 1,633 head injury in-patients diagnosed with brain computed tomography in the department of neurosurgery, Chungnam National University hospital from Jan. 1990 to Jun. 1996. were classified into two TICH groups, that is, TICH group with other intracranial lesions and TICH group without other traumatic intracranial lesions. The results were summarized as follows; 1) The incidence of TICH was 11.0% and percentage of TICH with other traumatic intracranial lesions among 180 cases of TICH was 66.7% 2) Compared with TICH group without other traumatic intracranial lesions, TICH group with other traumatic intracranial lesions showed worse initial level of consciousness, abnoaml pupillary reflex, more frequent delayed traumatic intracerebral hematomas, much amount of hematoma, more performed surgery and worse outcome. 3) In TICH group with other traumatic intracranial lesions, the factors affecting prognosis were initial GCS score, pupillary reflex, amount of hematoma and treatment modality 4) In TICH group without other traumatic intracranial lesions, the factors affecting prognosis were initial GCS score, pupillary reflex, amount of hematoma and delayed traumatic intracerebral hematoma(DT-ICH). 5) In the condition of 12-15 of GCS score, nomal pupillary reflex, absence of DTICH, and amount of hematoma below 10cc, the presence of other traumatic intracranial lesions was important prognostic factor. 6) The overall mortality was 27.7% but in TICH group with other traumatic intracranial lesions, the mortality was 35.0% and in TICH group without other traumatic intracranial lesions, 13.3%. 7) In the 120 cases, TICH coexisted with other brain lesions, most frequently with intraventricular hemorrhage(IVH), followed by ipsilateral SDH and contralateral SDH.

線型加速器를 利用한 腦動靜脈奇形의 放射線 手術의 評價

이성열 (李成烈) 啓明大學校 大學院 1999 국내석사

청신경초종에 대한 감마나이프 방사선 수술

윤선근 인제대학교 일반대학원 2017 국내석사

목적 : 방사선수술의 치료는 신경학적기능을 보존하고 종양성장을 억제하는 데 있으며 본 연구는 청신경초종의 감마나이프수술의 결과를 분석하였다. 대상 및 방법 : 1994년 10월부터 2013년 12월까지 215 례의 청신경초종환자를 감마나이프방사선수술을 시행하였고 이중 162 례에서 방사선학적 및 임상적 추적이 가능하였다. 감마나이프방사선수술전 개두술 및 종양제거술이 30 례에서, 뇌실복막산트술이 2례에서 시행되었고, 초기 증상으로 두통이 56례, 현훈 39례, tinnitus 42례를 보였고 정상안면신경기능(하우스백만 1등급)이 120례(74%), 2등급이 19례, 3등급이 16례, 4등급이 5례를 보여주었으며 남녀비는 1:3, 평균 종양의 용적은 7.0 cm3, 종양의 변연부선량은 14.3 Gy. 평균중심부선량은 27 Gy가 조사되었다. 결과 : 평균 62개월을 추적조사하여 87례(53.3 %)에서 종양의 감소, 56례(34.6%)에서 종양의 안정, 3례(1.2%)에서 처음에 종양이 작아지다가 성장을 보였으며 5례(3%)에서 처음에 커지다가 작아져 148례(91.3%)에서 종양조절을 보였다. 감마나이프방사선수술후 2례에서 일시적인 안면신경마비를, 1례에서 일시적인 삼차신경신경병증을, 2례에서 일시적인 청력저하를 보였다. 감마나이프방사선수술후 뇌실복막산트술이 7례에서 시행되었고 16례의 내이도종양에서는 7례(43.8 %)에서는 종양의 감소, 9례(56.3 %)에서는 안정을 보였고 14례의 낭종을 동반한 종양중 8례(57.1%)에서 종양의 감소, 2례에서 안정, 4례(28.5%)에서 종양이 재발하였다. 결론 : 감마나이프방사선수술은 수술후 잔존한 뇌종양이나 정상청력을 보존하고 있는 내과적질환이 동반된 환자에서 사용될 수 있고, 작거나 직경 3 cm 이하의 청신경초종, 내이도청신경초종, 일부 낭종이 동반된 청신경초종에서 효과적인 치료방법이다. Gamma Knife Radiosurgery for Vestibular Schwannoma Sun Geon Yoon, M. D. (Director : Prof. Moo Seong Kim, M. D., Ph. D.) Department of Medicine, Graduate School Inje University Objective : The goals of radiosurgery include preservation of neurological function and prevention of tumor growth. We document the results of gamma-knife radio-surgery for vestibular schwannoma. Method & Objective:215 patients underwent stereotactic radiosurgery for vestibular schwannoma from October, 1994 to December, 2013. 162 of these patients were followed up for radiological and clinical evaluation. As pre-Gamma-Knife modality, surgical resection were done in 30 patients,and V-P shunt in 2 patients. Initial symptoms were headache(n=56), dizziness(n=39), tinnitus(n=42). While normal facial function(House-Brackmann grade 1 was present in 120 patients(74%), other patients showed grade 2 function in 19, grade 3 function in 16,and grade 4 function in 5. The Gardner/Robertson scale was used to code hearing function. Male to female ratio was 1:3. Mean tumor volume was 7.0 cm3. Mean dose delivered to the tumor margin was 14.3 Gy,and mean maximal dose was 27 Gy. Results:Mean follow-up duration of 62 months. 87 showed decrease(53.3%) in size, 56 patients(34.6 %) stationary, 3(1.2%) initial decrease follow up increase, 5(3%) initial increase follow up decrease, and 148 patients(91.3%) were well controlled. Two patients experienced transient facial neuropathy, one transient trigeminal neuropathy and two transient hearing deterioration. After Gamma-Knife radiosurgery, ventriculoperitoneal shunt was done in 7 patients. In 16 intracanalicular tumors, 7 showed decrease(43.8 %) in size, 9 patients(56.3 %) stationary. 14 vestibular schwannomas with cyst, 8 showed decrease(57.1 %) in size, 2 patients stationary, 4(28.5 %) increased. Conclusions: Gamma-knife radiosurgery can be used to treat postoperative residual tumors as well as in patients with concomitant medical problems in patients with preserved hearing function. Gamma-knife radiosurgery is safe and effective method to treat small, medium sized(less than 3cm in extracanalicular diameter), intracanalicular vestibular schwannoma, associated with low rate of cranial neuropathy. In vestibular schwannomas with cyst, GammaKnife radiosurgery is effective except almost cystic tumor. KEY WORDS : Vestibular schwannoma ∙ Radiosurgery ∙ Gamma Knife surgery ∙ Hearing function