척수원추(脊髓圓錐)에 발생한 척수내 농양(脊髓內膿瘍)1례 보고

강준기,이영근,송진언 최신의학사 1970 最新醫學 Vol.13 No.11

A case of intramedullary abscess on the conus medullaris was reported and the literature was reviewed. This 25-year-old Korean male who suffered from paraparesis and urinary difficulty following back pain and spastic weakness in the lower limbs of 7 year's duration, was admitted to the Catholic Medical Center on Dec. 18, 1969. On admission, neurological examination revealed spastic paresis of the left leg, sensory loss below the Til level, urinary difficulty and positive ankle clonus & Babinski sign. Plain X-ray of the spine showed widening of the interpedicular distance of the 1st and 2nd lumbar vertebrae with sclerotic change of the pedicle of the 1st lumbar vertebra on A-P view. Pantopaque myelogram revealed round partial obstruction with expanding cord shadow at the lower border of the 1st lumbar vertebra. Total laminectomy extending from T12 to L3 was performed and a dorsal median incision into conus medullaris was made and evacuated caseous necrotic discharge 30cc in amount so conus medullaris was seen to be surrounded with thin external membrane as if it is hollow tubular appearance. Following operation, neurological deficits did not improved.

수막척수류의 뇌수막류 조기봉합수술에 대한 예후 : Report of Three Operative Cases

강준기,송진언,이상룡 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.2

A child born with spinal dysraphism and encephalocele faces the multiple and serious hazards of meningitis, hydrocephalus, paralysis and deformity of the lower limbs, and urinary bladder paralysis. The improvement in surgical management, and the advent of the shunt device for the control of hydrocephalus have so greatly altered the immediate prognosis that even a child with an extensive myelomeningocele must be considered to have a good chance of survival. We have presented a case of myelomeningocele, and two cases of meningoencephalocele and immediate repair techniques, and prognosis. 1) Surgical repair should be undertaken urgently, if possible within the first 48 hours of life and its role was the preservation of motor, sensory and intellectual function. 2) Carefully dissected the nerve filaments from the sac and replaced them into the dural canal and excised the functionless filament for prevention of spine deformity. 3) Shunt surgery should be considered before operation or immediate postoperation, in situation of huge meningoencephalocele.

안와내측사골동을 이용한 뇌하수체종양제거술 : 치험 2예 Report of Two Operative Cases

강준기,송진언,민병석 대한신경외과학회 1982 Journal of Korean neurosurgical society Vol.11 No.2

transethmoidal approach 수술 방법으로 치험한 말단 비대증 2예를 소개하면서 본 수술방법의 장단점을 논하였으며, 아울러 다른 통로를 통한 transsphenoidal surgery와 비교하였다. Since the turn of the century surgeons were proposed many procedures for exposure of the hypophysis cerebri of the operations proposed, two principal routes have been selected to reach the sella, first the intracranial, and second, the extracranial transsphenoidal. A variety of transnasal approaches have been used to gain access to the sella turcica. Each of these approaches requires crossing the sphenoid sinus, hence the transsphenoidal designation of these methods. Since the growth and refinement of microsurgery as a distinct surgical discipline there has been a coincidental maturation of transsphenoidal microsurgical techniques for the management of the hormone secreting microadenoma. The present paper reviews the historical events leading to the current methods of transsphenoidal pituitary surgery. Detailed descriptions of each method are given, with advantages and disadvantages of each. The author's experience in the mangement of 2 acromegalic patients with the transethmoidal approach are presented. The purpose of this paper is to focus recount the historical events leading to author's present method of pituitary surgery and to present the advantages and disadvantages as well as a procedural description for the transethmoidal approach to the sella turcica.

실험적 중대뇌동맥폐쇄후 Rheomacrodex 및 혈압변화의 영향

강준기,이춘장,성태경,조태훈,송진언,김선무 대한신경외과학회 1978 Journal of Korean neurosurgical society Vol.7 No.2

An experiment was planned to observe the histopathological alteration with administration of the Rheomacrodex and blood pressure changes in induced cerebral infarct after occlusion. Eighty well developed cats, weighing 2.3 to 3.5kg, were used in this experiment. The right MCA was exposed through temporal approach and the proximal part of the MCA was occluded with a silver clip. The animals were divided into 4 groups : The control group was comprised of 20 cats with occlusion of the right MCA alone, Rheomacrodex-treated group was comprised of 20 cats after occlusion of right MCA, induced hypotension and hypertension groups consisted in each 20 cats following occlusion, of the MCA. The animals were sacrificed at intervals of 3 hours. 6 hours, 24 hours, 1 week and 2 weeks respectively after occlusion of the MCA. The animals were studied for clinical deficits and histopathological changes of the cerebral infarct according to the time courses. The results obtained were as follows : 1) In the control group, severe contralateral hemiplegia was developed in the early stage following the MCA occlusion, however the neurological deficits were progressively improved to the state of abnormal walking in 24 hours to 2 weeks. The hemorrhagic infarct was involving the basal ganglia, internal capsule and extending to the cortex with mild brain edema in the early stage and the area of the infarct was gradually enlarged from 6 hours to 24 hours following the MCA occlusion. Although the brain edema of surrounding area of the lesion was remained unchanged, the size and distribution of the infarct were decreased in one week to 2 weeks. Extensive ischemic neuronal damage was observed in the control group. 2) In the Rheomacrodex-treated group, mild to moderate neurological deficit was developed in the early stage after MCA occlusion and the deficit was less severe than control group. The clinical deficit was improving in the time course and one case had shown completely normal activity in 2 weeks. The distribution of the infarct was well defined and it was smaller than control group. The infarct mainly involved the basal ganglia and internal capsule. The area of the infarct was gradually enlarged from 6 hours to one week after MCA occlusion, then the extent of the infart was decresed in 2 weeks. The ischemic neuronal change in this group was less severe than control group. 3) In the induced hypotension group, the early neurological deficit was worse than that of the control group and severe hemiplegia was developed in one week. There was minimal improvement of the neurological deficit in 2 weeks. The area of the infarct was ill-defined and hemorrhagic extending a large portion of the brain with severe brain edema. The infart was involving the basal ganglia, internal capsule, claustrum and the cortex from 3 hours to 24 hours after the occlusion and the area of the infarct was not changed during the observation. Severe ischemic nerve cell change or resolution of the cells was observed in this group. 4) In the induced hypertension group, the neurological deficit was mild and it was better than that of the control group. The distribution of the infarct was well localized and minimum in extent. The extent of the infarct was not changed during the observation. There was no observable gross brain edema and the ischemic nerve cell changes were not severe.

두개안면골 형성부전증(頭蓋顔面骨 形成不全症) 수술에 대한 임상경험 : 수술 치험 9예 보고 Reports of Nine Operative Cases

강준기,송진언 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.1

The craniofacial dysostoses are due to synostosis of the basal skull sutures in the anterior cranial fossa. Patients with these abnormalities potentially have normal brains that are distorted by the misshapen skull; shallow anterior fossa and reduction of the orbital volume, exophthalmos, and hypoplasia of the maxilla. The authors describe the operative repair and results of 9 cases of craniosynostosis. The craniofacial dysmorphic states are presumably caused by premature closure of basal skull sutures in combination with the coronary suture. In an effort to arrest and correct both the cranial and facial deformities as well as obviate the need for further radical surgery, the authors have treated 9 children with Crouzon's disease with linear suture craniectomy along the base of the skull, forehead advancement and unilateral canthal advancement techniques. A linear craniectomy along the synostotic sutures does not affect the synostotic process at the base of the skull. The advance of supraorbital margin and creating an artificial suture at the base of skull allowed for proper correction those craniofacial deformities. Following those procedure, deformity has regressed and ultimate cosmatic improvement has been obtained in 4 cases of grade Ⅲ and 3 cases of the grade Ⅱ and 2 cases of grade Ⅰ among the 9 patients. Early neurosurgical intervention using the procedure of the forehead advancement and lateral supraorbital ridge advancement combined with linear craniectomy along the skull base suture, yields excellent results in the majority of these children.

국소적 뇌병소에 대한 체성감각유발전위 반응

강준기,김문찬,조태훈,백민우,강세기,윤석훈,허춘웅,송진언 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.3

Cerebral somatosensory evoked potentials(SEPs) produced by stimulation of peripheral nerves provide a useful diagnostic index of conduction in somatosensory pathways to the cortex. Thus the integrity of both dorsal column-medial lemniscus pathway and primary sensorimotor area has been considered an essential requirement to record a nomal SEP. There are suggestions that SEPs contain several components arising from different neuronal sources, the early short latency potentials corresponding to the lemniscus-mediated responses and the late waves to the diffuse spino-thalamic projections. The present work analyses the influence on SEPs of focal brain lesions, using the computerized tomography in detecting and localizing brain lesion. Somatosensroy evoked potentials were recorded in 20 patients with focal brain lesions recognized by computerized tomography. 1) Patients with primary sensorimotor area (PSMA) damages (group Ⅰ) had a very abnormal of the early component (No, Po, N1, Pl) in 100% on the lesion side. 2) Patients presented supratentorial lesions, sparing PSMA (group Ⅱ), 87.5% showing abnormal SEPs in early components and characterized by increment of amplitude in late components. 3) Brainstem damage (group Ⅲ) produced a distortion of the early components especially N11, N20 msec latency. 4) In incomplete spinal cord injuries, the SEPs is indeed signal of functional recovery, of posterior column and incorrespondance with clinical improvement.

선천성 및 후천성 중추신경계기형 치료의 합병증

강준기 대한신경외과학회 1981 대한신경외과학회 학술대회 Vol.- No.2

소아기 간질 발작의 치료

강준기 한국의학사 1989 診斷과治療 Vol.9 No.3

선천성 중추신경계기형 치료

강준기 최신의학사 1984 最新醫學 Vol.27 No.1

국소적 뇌손상에 따른 국소 뇌혈류 변화와 뇌부종 형성에 대한 실험적 연구 : An Experimental Gerbil Model

강준기,송진언,Crockard, Alan,Symon, Lindsay 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.1

An experimental trauma model in gerbils is described in which we have attempted to produce a focal laceration and contusion. This experimental main objective was to replicate some of the mechanisms involving in human brain injuries, and observe the effect of focal brain injury on regional cerebral blood flow and oedema formation. 80 adult gerbils weighing 40 to 60 gm, were used in this study. The components of the pathophysiological responses, systemic changes, and regional cerebral blood flow (rCBF) associated with the focal brain laceration injury were studied in groups pf animals. Three groups were studied. A mild injury (20 animals) was produced by moving the drill along a predetermined pathway through the right orbit at 50 revs per minute over 2 seconds and a severe injury (20 animals) produced in a similar fashion at 200 revs per minute for 8 seconds. An indomethacin preatreated group (20 animals) was produced in a same method of severe injury. The rCBF measurements were performed immediately after injury in each animal, at 30 minutes and the final few at 60 animal by Pasztor hydrogen clearance technique. Brain specific gravity measurements as an index of brain water was determined in each animal at 1 hour after injury by using Nelson's column gradient method. There are systemic changes associated with this injury which are neurogenically mediated and results in an immediate reduction to 50 mmHg in blood pressure, a bradycardia and a generalized reduction to 50% -60% in cerebral blood flow during the immediate post-traumatic period. During 30-60 minutes following trauma, a tendency towards slight increasing of blood flow was found in each group, however marked increasing tendency of flow except focal injury site was found in severe injury animal group. The affects of rCBF are independent of the severity of the local brain injury. These vasomotor effects may induce. Cortical cerebral ischemia and this profoundly influence post-traumatic cerebral function and cause irreversible damage. There is generalized edema as judged by a decreased brain specific gravity probably related to hypoperfusion secondary to a fall in cardiac output. But there is also superimprosed on this an oedema gradient which is maximal also to the injury. This is turn affects the local capillary flow and further decreases rCBF. In the first hoar after this injury prostaglandins do not appear to be involved in the oedema formation.