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Spinal Extradural Arachnoid Cyst
우준범,손동욱,강경택,이준석,송근성,성순기,이상원 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2
A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.
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주의력결핍과잉행동장애에 동반된 틱장애의 신경생물학과 약물치료
우준범,김지훈 한국정서행동장애학회 2018 정서ㆍ행동장애연구 Vol.34 No.2
Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent disorder in children and adolescents, and about 70% of ADHD have other comorbid dirorders. The most common comorbid disorder of ADHD is tic disorder, and 60∼70% of ADHD have tic disorder simultaneously. Pharmacological treatment is very important in treatment of ADHD . and many researches reported that pharmacological treatment was effective to treat core symptoms of ADHD. The major drugs for treating ADHD are Methyphenidate as psychostimulant, Atomoxetine as non-stimulant, tricyclic antidepressants, and alpha agonists. However psychostimulant can make worse tic symptoms in 10% of those with case with ADHD and tic disorder simultaneously. Therefore, we discuss the neurobiology that is a basic knowledgy in the phamacological treatment of ADHD and also discuss the effective pharmacological treatment in ADHD and comorbid tic disorder. 주의력결핍과잉행동장애는 소아청소년기 정신질환 중 가장 흔한 질환이며 약 70%에서 다른 정신과 질환을 동반한다. 동반질환 중 가장 흔한 질환은 틱장애로 전체 주의력결핍과잉행동장애가 있는 소아청소년의 약 60∼70%에서 틱장애를 동시에 가지고 있다. 이러한 높은 동반률은 주의력결핍과잉행동장애와 틱장애가 신경생물학적으로 유사한 양상을 가지고 있을 가능성을 시사한다. 주의력결핍과잉행동장의의 치료에 있어 약물치료는 매우 중요한 부분을 차지하며 여러 연구에서 핵심증상의 치료에 매우 효과적인 것으로 보고되고 있다. 주의력결핍과잉행동장애의 치료에 주로 사용되는 약물은 정신자극제인 메틸페니데이트 제재와 비정신자극제인 아토목세틴, 삼환계항우울제들, 그리고 알파 효현제들이다. 그러나 틱장애가 동반된 주의력결핍과잉행동장애에서 정신자극제의 사용시 약 10%에서는 틱증상을 악화시킬 수 있으므로 약물치료 시 주의가 필요하다. 따라서 본 연구에서는 주의력결핍과잉행동장애의 약물치료의 근간이 되는 신경생물학에 대해 알아보고 틱장애와 동반 시 효과적인 약물치료에 대해 논하고자 한다.
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Radiation-induced change after Gamma Knife radiosurgery for cerebral arteriovenous malformations
이학수,김해유,이선일,우준범,진성철,김무성 대한정위기능신경외과학회 2023 대한정위기능신경외과학회지 Vol.19 No.1
ObjectiveRadiation-induced change (RIC) on magnetic resonance imaging after Gamma Knife radiosurgery (GKRS) for cerebral arteriovenous malformations (AVMs) is not rare. We reviewed patients who underwent GKRS for AVMs and analyzed the results and factors associated with RIC. MethodsWe reviewed 189 patients who underwent GKRS for AVMs between October 2002 and August 2017. All patients were followed up for at least 3 years. This study included 111 males and 78 females (mean age, 39.63 years; range, 3-79 years). Nineteen patients underwent pre-GKRS embolization. Seventy-six patients had ruptured AVMs and 113 had unruptured AVMs. We analyzed obliteration and RIC occurrence rates. Several demographic and clinical factors were analyzed to determine the influence of AVM obliteration on RIC occurrence. ResultsThe overall obliteration rate (OR) was 72.49% (137/189) at the final follow-up. The actuarial OR was 55.5% 36 months after GKRS. The overall RIC occurrence rate was 28.04% (53/189), and the actuarial RIC occurrence rate was 26.8% 24 months after GKRS. The OR showed a statistically significant difference according to AVM rupture (p<0.01) and sex (p<0.01). The RIC occurrence rate was significantly associated with AVM rupture (p<0.01), lesion volume (p=0.04), and treatment volume (p=0.03). Other factors showed statistically non-significant relationships. ConclusionThe overall OR after GKRS for AVMs was comparable to the results of other previous reports. RIC is a common postoperative outcome following GKRS for AVMs. In this study, the OR was higher in ruptured AVMs and male patients, whereas RIC occurred more frequently in larger and unruptured AVMs. KEY WORDS: Radiation, Radiosurgery, Arteriovenous malformations
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