요추간판탈출증에서 현미경 수술과 경피적 자동수핵제거술에 대한 비교연구

신원한,장재칠,주교성,김범태,최순관,변박장 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1

A retrospective study of operative results were carried out in a series of 164 patients who were performed microdiscectomy and 57 patients performed automated percutaneous lumbar discectomy (APLD) for herniated lumbar discs between January 1, 1990 and June 30, 1996 at the Department of Neurosurgery, Soonchunhyang University Hospital. The operative results were analysed, and the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed. The major results were as follows : 1. Of 164 microdiscectomy cases, 102 were males and 62 were females, mean age was 42.4 years and incidence was the highest in the 5th decade, and of 57 APLD cases, 43 were male and 14 female, mean age was 32.2 years and incidence was the highest in the 3rd decade. 2. The preoperative symptoms and signs were lumbago(98.2%), radiating pain(96.3%), positive straight leg raising test(77.4%), motor weakness(27.4%), claudication(13.4%) & voiding difficulty(2.4%) in microdiscectomy cases, and lumbago(98.2%), radiating pain(98.2%), positive straight leg raising test(70.2%) & motor weakness(17.5%) in APLD cases. 3. Number of operated levels were performed 226 in microdiscectomy and 74 in APLD. The most commonly operated levels of two groups were L4-5 level. 4. Operative results 1) The overall success rates by Prolo's scale were 87.1% in microdiscectomy and 80.7% in APLD, respectively. 2) In younger age group (below 30 years) and in non-compensatory group, success rates were significantly higher in microdiscectomy. 3) As to protrusion and degeneration on MRI, clinical results of moderate protrusion and degeneration of discs in microdiscectomy were statistically significant, and those of mild protrusion and degeneration of discs in APLD were also statistically significant. 4) The most common cause of failure was inappropriate removal of disc material in microdiscectomy and sequestered discs in APLD. According to the above results, there were no differance in overall success rates between microdiscectomy and APLD. But clinical results seem to be influenced by the age, existence of compensation, and by the degree of protrusion and degeneration of discs as prognostic factors. If the selection of operative procedure between microdiscectomy and APLD for herniated lumbar disc is carefully done with clinical and radiologic findings of patients, good outcome might be achieved.

소뇌에 발생한 정맥성 혈관종 1예

변박장,권귀향 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

The author report a case of venous malformation within cerebellar hemisphere presenting of hemorrhage. A 35-year-old male was admitted due to sudden onset of vertigo 1 week before admission. Computed tomography (CT) showed lobar shape intracebellar hemorrhage, subcortical cerebellar hemorrhage. Follow up enhanced CT scan showed a large curbilinear draining vein. conventional angiogram disclosed pathognomomic "caput medusae " or "star cluster" shape venous malformation. After conservative treatment for 2 months, subjective symptoms were near totally recovered.

소뇌에 발생한 결핵성 뇌농양 1례

변박장,문충배,이인수 대한신경외과학회 1978 Journal of Korean neurosurgical society Vol.7 No.2

The authors describe a case of tuberculous abscess of the cerebellum that originating , probably from pulmonary lesion. The development of such a lesion indicates a persistence of infection and an immunological breakdown which may partly have been due to unsatisfactory chemotherapy and protein malnutrition. Tuberculous brain abscess, an encapsulated collection of pus containing viable tubercle bacilli, is quite rare and it is different from tuberculoma in several points. Only five cases of tuberculous abscess have been fully documented and bacteriologically confirmed. The clinical, laboratory, and histopathological findings of those reported cases and the author's have been discussed.

뇌수술 전후의 혈장 AVP 변동에 대한 연구

변박장,이인수 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.1

The author studied the changes of the plasma arginine vasopressin(AVP) levels in 10 brain surgery patient to evaluate the water balance during the postoperative period. The control group was 15 normally hydrated adult subjects. The plasma AVP levels were measured by the radioimmunoassays(RIA). The plasma and urine osmolality was also measured simultaneously using the conventional method. The followings were presented here - in as the results. 1) In control group, the average plasma AVP level was 2.00pg/mL with the range of 0.4 to 5.6 pg /mL. There was relative constant relationship between the plasma AVP and the plasma osmolality. The osmotic threshold was 280.4 mosm/Kg. 2) In preoperative brain surgery group, the plasma AVP level was similar to control group but the range was wider than control group. There was no constant relationship between the plasma AVP level and the plasma osmolality. 3) The plasma AVP levels were markedly increased in the postoperative brain surgery group. The average level was 10.99 pg/mL ranging 0.4 to 47.50 pg/mL. In spite of increased plasma AVP concentration, the plasma osmolality and urine /plasma osmolality (Uosm/Posm) ratios were relatively constant to normal control and preoperative brain surgery group. 4) The relationship between the plasma AVP level and the Uosm/Posm ratio was changed according to the plasma AVP level but above 3.0 pg/mL it was nearly constant.

腰痛의 治療

변박장 한국의학사 1983 診斷과治療 Vol.3 No.11

韓國人 小兒에서 發生한 腦腫瘍 58例에 對한 臨床的 考察

卞博章,林光世 대한신경외과학회 1978 Journal of Korean neurosurgical society Vol.7 No.1

It should be stressed that intracranial tumors in childhood are common. If the leukemia are excluded, intraranial neoplasms are the relatively common type of neoplasms seen in childhood. There are many different kinds of tumor which occur within the cranial cavity. These different tumors grow at different rates of speed and the diversity of location is sufficient so that there is a broad spectrum of different clinical syndromes. However, it is important to recognize the earliest symptoms because of the possibility of operable management and high cure rate on some cases. The author analyzed 58 cases of intracranial neoplasms which were histologically confirmed after operation and autopsy, seen at the Department of Neurosurgery, Jung-Ang University, Sung-Sim Hospital and National Medical Center over the recent several years. These turners were explored surgically and the diagnosis was made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, neuroradiological findings, operative methods and pathology. The author emphasized some interesting points and the followings were presented here-in as the results. 1) Among 58 cases of intracranial neoplasms in Korean children below 15 years old, the most common tumor was astrocytoma (36%), and the next common tumors were craniopharyngioma (15-5%), ependymoma (12%), and medulloblastoma (10.3%) in that orders. It was interesting that 3 cases of tuberculomas were found in recent three years (1975-1977) and all were located in the cerebellum. A 5 years old boy who was operated for 4th. ventricle medulloblastoma confirmed by clinicopathological finding, had another tumor, craniopharyngioma which was found at the postmortem examination. 2) The tumors were occupied on the infratentorial region in 30(51.7%) cases and supratentorial region in 28 (48.3%) cases. The most frequent tumor in supratentorial region was craniopharyngioma and in infratentorial region was cerebellar astrocytoma. And the glioma and medulloblatoma were common in turn. 3) Fifty eight cases comprised 36 males and 22 females with a ratio of 1.5 to 1. The age ranged from 5 months old to 15 years old with the peak in the incidence between 5-11 years of age. 4) The main clinical symptoms and signs were headache (84.5%), vomiting (77.6%), papilledema (67.2%), and cranial nerve dysfunction (62%). It was interesting points that neck stiffness(27.6%) and abdominal pain (15.5%) were frequent complaints which should not overlook for the symptoms of simple gastritis of tuberculous meningitis. 5) The results of operative management obtained as follows with excellent in 4, good in 8, fair in 13, and poor in 9 cases. The overall mortality rate was 41% and recurrence rate was 14% during 5 years follow up.

뇌실질내에 발생한 뇌 동정맥기형 1례

卞博章,崔淳官,李仁洙 순천향대학교 1996 Journal of Soonchunhyang Medical Science Vol.2 No.4

上腕神經叢의 捻除에 對한 症例報告

卞博章,李和東,許琨 대한신경외과학회 1972 Journal of Korean neurosurgical society Vol.1 No.1

A case with avulsion of the brachial plexus following head and neck trauma is described. The use of pantopaque myelography, electromyography, axon reflex test, and sensory nerve conduction test as a diagnostic aid is stressed. The mechanism of avulsion of the brachial plexus following injury and its prognosis are discussed.

신경외과 사망례에 관한 연구

임종현,이경석,변박장 순천향대학교 1993 논문집 Vol.16 No.4

The authors investigated causes of deaths of the expired or discharged moribund at Department of Neurosurgery in Soonchunhyang University Chonan Hospital from January 1989. During this 4-year-period, 273 patients (54.3%) were expired and 230 patients (46.7%) were discharged moribund. Trauma was responsible for 262 patients (52.1%), and 241 patients were due to non-traumatic disorders. Male to female ratio was 2.7:1 in traumatic death and 1.1:1 in non-traumatic death. Trauma was the leading cause of death before 40 years of age, and non-traumatic disorders were the main causes of death above 40 years of age. Head injury occupied 94.3% of traumatic deaths and cerebrovascular disease shared 92.9% of non-traumatic deaths. Interval from onset to arrival was relatively short, being within 6 hours in 80.1%. Most (73.2%) of the patients were comatose on arrival, while 15.5% of them preserved good consciousness. In traumatic deaths, 35.3% were hypotensive (below 100mm Hg, systolic), and 57.3% of non-traumatic deaths were hypertensive(above 160 mm Hg, systolic). Within 1 week after admission, 74.8% were dead. Multiple injuries were common (44.3%) in traumatic deaths. Injury severity score was 1-20 in 7.2%, 20-40 in 79.8%, and above 40 in 12.0%. In traumatic deaths, 63.7% were due to primary lesions, and complications were responsible for death in 34.3%. In non-traumatic deaths, 50.6% were due to primary diseases, and complications were responsible for death in 48.2%. In five traumatic deaths and three non-traumatic deaths, the cause of death was obscure. In traumatic deaths, complications not related to the primary lesion site were common as more than twice as those of primary lesion site. Respiratory complication was the most common one which was not related to the primary lesion site. The ratio of the death/discharge declined from 1988 to 1990, but it was increased in 1991 and 1992. The percentage of deaths at neurosurgical department in this hospital was also increased in 1991 and 1992. We should have special concerns on the head injury and cerebrovascular disease, because these two diseases shared 93.6% of all deaths. We also make every efforts to reduce the rate of complications. Although we could not actually reduce the ratio of the death/discharge, it will be an important work for better medical care that we know the common causes of deaths and preventable complications in this hospital.

탄산가스 레이저 조사에 의한 실험적 뇌부종

변박장 중앙대학교 의과대학 의과학연구소 1984 中央醫大誌 Vol.9 No.1

The author studied the chronological changes in rat brain edema, induced by CO_2 laser irradiation (LI-group), by measuring brain water content. Water content was measured by gas-liquid chromatography (GLC). The changes of water content of laser induced brain edema was compared to that of brain edema produced by bipolar coagulation (BC-group). In both groups, water content increased significantly during the first three days after injury. It returned to nearly normal level on the fifth day, and remained unchanged thereafter. These findings suggested that the laser induced brain damage has a pattern similar ti that of traumatic origin. The clinical and histological findings were correlated well to the changes of water content. The water content of the corresponding area on the opposite side increased in most animals of high intensity LI-group but the increase was minimal. The GLC method was very convenient for determination of the extent of brain edema. Betamethasone was not so effective for brain edema induced by laser irradiation.