척수 손상 백서에서 MK801 투여가 체성감각 유발전위 및 척수 조직에 미치는 효과

노성우,김영수,윤도흠,임승철,공경엽,박성혜,이경희,Roh, Sung Woo,Kim, Young Soo,Yoon, Do Heum,Rhim, Seung Chul,Kong, Kyung Yup,Park, Sung Hye,Lee, Kyung Hee 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objectives : This study was undertaken to investigate the effect of noncompetitive NMDA receptor blocker, MK801 on motor recovery, SSEP and pathology in spinal cord injured rat. Methods : The effects of MK801 on neuronal function protection, SSEP, and pathology were measured on spinal cord injury rats which were divided into 6 groups according to dose, time of drug delivery and magnitude of injury. Spinal cord injury was made with the magnitude of 25gm-cm and 50gm-cm on 42 rats. BBB locomotor function test was performed to evaluate the motor power recovery in hindlimb for 2 weeks after injury. After motor function test was completed, SSEP was measured. Amplitude and latency of the P1, N1 peak was measured and compared between groups. Finally rats were sacrificed, and pathologic findings including measurement of area of necrotic cord were studied and compared between groups. Results : Motor recovery at 2 weeks was better in MK801 group comparing to saline control group. SSEP at 2 weeks showed no difference in N1, P1 latencies, but significantly greater amplitude in MK801 group, compared to saline control group. On light microscope, there was no specific histologic differences between experimental groups. The cystic necrotic area in coronal plane was measured and compared in each group. The necrotic area was significantly smaller in MK801 1mg/kg group(delivered after injury) than vehicle group. The necrotic area in MK801 5mg/kg group and MK801 1mg/kg group(delivered before injury) was smaller than vehicle group even though it was not statistically significant. Conclusion : From the above result, it is speculated that NMDA blocker, MK801 can improve impaired neuronal function in spinal cord injury.

Spinal Ganglion Cyst of Lumbar Posterior Longitudinal Ligament

노성우,임승철,이호규,강신광,Roh, Sung Woo,Rhim, Seung Chul,Lee, Ho Kyu,Kang, Sin Kwang The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.4

결절종은 말초 관절이나 인대에서 비교적 흔히 발견되나 척추 내 결절종은 드물게 보고되고 있다. 저자들은 5예의 요추후종인대에서 발생한 결절종을 경험하고 이들의 임상적, 방사선학적 특징, 수술소견 등에 대하여 고찰하였다. 저자들의 예에서 요추 내 결절종은 요통 및 하지통증을 유발하여 임상적으로 요추간반탈출증과 유사한 소견을 보였다. 요추 MRI상 진단이 가능하였고 5예 모두에서 특징적으로 요추디스크의 퇴행성 변화와 연관되어 있었으며 결절종이 요추디스크와 바로 인접된 부위에 위치하였다. 본 소견으로 저자들은 요추후종인대에서 발생한 결절종은 디스크의 퇴행성 변화와 밀접한 관계가 있다고 추론하였다. 수술은 5예 모두에서 완전절제가 가능하였고 전 예에서 수술 후 증상호전을 보였다. Objective : In contrary to ganglion cyst that commonly develops in connective tissue of peripheral joint or tendon, spinal ganglion cysts have been rarely reported. The authors report five cases of spinal ganglion cysts which originated from posterior longitudinal ligament of the lumbar spine. Methods : The authors retrospectively analyzed clinical, radiological, and surgical findings of five cases of spinal ganglion cysts and speculated the pathogenesis of spinal ganglion cyst. Result : Cysts were excised totally and symptoms improved without complications in all cases. Intraoperative findings revealed cysts that were tightly adherent to posterior longitudinal ligament. Conclusion : Five cases of ganglion cyst which caused similar symptoms and signs those of lumbar disc herniations were excised successfully. MRI and operative findings suggested spinal ganglion cyst of posterior longitudinal ligament were closely associated with disc degeneration which imply disc degeneration or herniation may play an important role in the pathogenesis of ganglion cyst.

흉추에 발생한 유골 골종 - 증례보고 -

윤병민,임승철,노성우,Yun, Byung Min,Rhim, Seung Chul,Roh, Sung Woo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

A 22-year-old man is presented with 3 months' history of dull pain on the lower thoracic area. Imaging studies suggested osteoid osteoma of 11th thoracic spine, which was verified pathologically after en bloc resection through transfacetal approach. The patient's preoperative pain was resolved immediately. We emphasize the importance of early diagnosis and complete surgical excision of tumor nidus.

전방경추수술중 추골동맥 손상 : 2예 보고

이동걸,임승철,노성우,임수빈,권양,권병덕,Lee, Dong Girl,Rhim, Seung Chul,Roh, Sung Woo,Im, Su Bin,Kwon, Yang,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Vertebral artery injury is a rare complication of anterior cervical approach. We report two patients who suffered injury to vertebral artery during anterior cervical spine surgery. The mechanism of injury, their operative management, and the subsequent outcome were assessed and relevant literatures reviewed. The awareness of the possibility of vertebral artery injury is most important to prevent and it's occurrence is best avoided by a thorough understanding of the anatomical relationships of the artery, the spinal canal, and the vertebral body and careful use of surgical instruments.

Atlantoaxial Rotatory Fixation - 3 례 보 고 -

손문준,임승철,노성우,박형천,Sohn, Moon Jun,Rhim, Seung Chul,Roh, Sung Woo,Park, Hyung Chun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

The atlantoaxial rotatory fixation is a uncommon disease of deformity, occuring much more frequently in children than in adults. Despite of its benign clinical course, delayed recognition or improper management may cause persistent deformity or recurrence. We report three cases of typical atlantoaxial rotatory fixation. Successful reduction was achieved with posterior atlantoaxial fusion in one case and nonoperative treatment in others. We emphasize that it is necessary to perform dynamic CT scan to obtain correct diagnosis and to plan proper treatment for this disease entity.

경척수증 환자에 대한 보행분석의 적용

윤상원,임승철,노성우,유종윤,하상배,Yoon, Sang Won,Rhim, Seung Chul,Roh, Sung Woo,Yu, Jong Youn,Ha, Sang Bae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : To investigate objectively the postoperative improvement of gait disturbance in patients with cervical myelopathy through a gait analysis. Patients and Methods : Ten patients who underwent cervical decompression and fusion for cervical myelopathy caused by spondylosis, OPLL, or concomitant hypertrophy of ligamentum flavum were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated by gait analysis using three dimensional motion analyzer to collect data of linear and kinematic parameters before surgery, 1 week and 3 months after surgery. Statistical analysis of the related pre-and post-operative data were performed. Results : In the linear parameters, average value of cadence, walking speed, stride length, step time, width and double support were increased postoperatively compare to preoperative value. In the kinematic parameters, average value of knee flexion during initial swing phase, plantar flexion of ankle and range of motion of hip joint were increased as well. These differences were statistically significant(p<0.05). Conclusion : This study suggests that gait analysis can be used as a method of quantitative analysis of postoperative gait improvement in patients with cervical myelopathy.

척수 수질내에 재발한 신경장관성 낭종 - 증례보고 -

이종주,나영신,강신광,노성우,임승철,Rhee, Jong Joo,Ra, Young Shin,Khang, Shin Kwang,Roh, Sung Woo,Rhim, Seung Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Neurenteric cysts are developmental cysts derived from embryonic endodermal layers. Fewer than 100 have been reported in which there were no associated bone or soft-tissue malformations and only six among those cases showed intramedullary location in the literatures. The authors report a 16-year-old young man with a thoracic intramedullary neurenteric cyst which presented with symptoms of axillary pain and paraparesis. The magnetic resonance imaging showed intramedullary mass extended from level of T3 to T7. There was no associated bone or soft-tissue anomaly. This cyst was partially excised and marupialized into subarachnoid space. The pathological findings were compatible with neurenteric cyst. Nine months later, the cyst recurred and at second operation, cyst wall was removed completely.

내시경적 경접형동 접근술에 의한 뇌하수체 종양의 수술

안영상,전영일,안재성,전상룡,김정훈,나영신,노성우,김창진,권양,임승철,이정교,권병덕,Ahn, Young Sang,Chun, Young Il,Ahn, Jae Sung,Jeon, Sang Ryong,Kim, Jeong Hoon,Ra, Young Shin,Roh, Sung Woo,Kim, Chang Jin,Kwon, Yang,Rhim, Seung Chul,Lee 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. Methods : This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. Results : There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. Conclusion : The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.

두개인두종의 감마나이프 치료 후 장기 추적 결과

김윤석,이도희,라동숙,전영일,안재성,전상룡,김정훈,노성우,나영신,김창진,권양,임승철,이정교,권병덕,Kim, Yun Sok,Lee, Do Heui,Ra, Dong Suk,Chun, Young Il,Ahn, Jae Sung,Jeon, Sang Ryong,Kim, Jeong Hoon,Roh, Sung Woo,Ra, Young Shin,Kim, Chang Jin 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

측두엽내 공간 점유 병소와 동반된 난치성 간질의 수술적 치료 성적

박준범,이완수,이정교,전상룡,김정훈,노성우,나영신,김창진,권양,임승철,권병덕,강중구,이상암,고태성,Park, Jun Bum,Lee, Wan Su,Lee, Jung Kyo,Jeon, Sang Ryong,Kim, Jeong Hoon,Roh, Sung Woo,Ra, Young Shin,Kim, Chang Jin,Kwon, Yang,Rhim, Seung Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : The increasing use of sensitive neuroimaging techniques has demonstrated that significant percentage of patients with intractable complex partial seizures have brain masses, especially in temporal lobe. The optimal surgical solution for these patients is still open to debate. The purpose of our investigation is to evaluate the surgical outcome of patient with lesion-related temporal lobe epilepsy with respect to the types of surgery and the location of lesion. Patients and Methods : From DEC. 1993 to Dec. 1997, 35 patients with intractable epilepsy and space occupying temporal lobe lesion identified in preoperative MRI were included in this study. The types of surgery were lesionectomy, anterior temporal lobectomy with or without hippocampectomy. The location of lesion was divided as anteromedial group and lateral cortical group. The postoperative seizure outcomes according to the type of surgery and location of the lesion were compared. Results : Twenty-six of 34 patients(76.5%) were seizure-free after surgery. The Engel's class was favorable after anterior temporal lobectomy with or without hippocampectomy(p=.044) Conclusion : It is favorable to perform anterior temporal lobectomy for the treatment of intractable epilepsy with space-occipying lesion in temporal lobe. The resection of the hippocampus can be individualized.