Paraclinoid Aneurysm의 분류 및 수술적 치료

손문준,이채혁,나영신,김창진,권양,임승철,이정교,권병덕,황충진 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.9

Paraclinoid aneurysms arose from the proximal internal carotid artery between the site of emergence of carotid artery from the roof of the cavernous sinus and posterior communication artery. Surgery of these aneurysms presents special difficulties because of its complicated osseous, dura, and neurovascular structures ; sella trucica,cavernous sinus, optic nerve. The clinical and radiological characteristics in twenty-seven patients with the paraclinoid aneurysms were reviewed and classified into four subgroups according to their branch of origin in this segment ; 1) carotid cave aneurysm(2 cases), 2) ophthalmic artery aneurysm(11 cases), 3) superior hypophyseal artery aneurysm(11 cases), 4) proximal posterior carotid artery wall aneurysm or global type aneurysm(3 cases). Surgery required orbital unroofing and removal of anterior clinoid process with releases of dural ring. To provide easy proximal control, exposure of cervical carotid artery was helpful in some cases. Preoperative balloon occlusion testing was mandatory. Outcomes were considered as good to fair in 19 patients, poor in five, and three patients died. The patients who had poor results were poor preoperative status-four were grade Ⅳ, one was grade Ⅱ(Hunt-Hess grade). The causes of death were premature rupture(2 cases) and extensive vasospasm(1 case). Preoperative classification of these lesions provides excellent correlation of operative findings and surgical preparation to expose the proximal part of internal carotid artery.

전이성 뇌종양에 있어서 감마나이프 방사선 수술에 대한 임상적 분석

손문준,권양,김정훈,전상룡,이동준,김창진,권병덕 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.5

Commentary on “Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients”

손문준 대한척추신경외과학회 2022 Neurospine Vol.19 No.1

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경막내 연수 주위 동정맥루(제Ⅳ형 척수 동정맥 기형)의 수술적 치료

손문준,박형천,박현선,김재중,김은영 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.31 No.4

불안정성을 동반한 흉요추부 척추질환의 TSRH기구를 이용한 수술치료

손문준,이호연,김정훈,나영신,권양,임승철,이정교,권병덕,황충진 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.8

The authors present surgical experience with 33 patients who had incurred unstable thoracic or lumbar spine pathology(22 degenerative lumbar spine disease, 6 trauma. 3 tumor, 2 vertebral tuberculosis) and who were intraoperatively stabilized with the Texas Scottish Rite Hospital(TSRH) universal instrumentation system over 20 months period. The 11 men and 22 women(mean age 45 years, range 23 to 71 years) presenting with signs or symptoms of neural compression underwent surgery consisting of neural decompression. internal fixation, and bone grafting. Spondylolistnesis were fused in situ without reduction. For thoracic and thoracolumbar junction pathology, multisegment fixations were performed. A 95% fusion rate was obtained with a mean follow-up period of 15 months. There were no cases of instrumentation failure. Major postoperative complications included 2 isolated nerve root deficits(one transient, one permanent) and 3 pulmonary embolism(one fatal). The construct design of the TSRH system offers some advantages compared to other forms of internal fixation : simple assembly, rigid stability, safety, and ability to remove easily. This system provides a highly successful method to obtain arthrodesis for unstable thoracic or lumbar spine.

수모세포종과 원시 신경외배엽 종양 : 임상 및 분자생물학적 분석과 예후에 관한 연구

손문준,전상룡,김저훈,나영신,이정교,권병덕,서재희,이인철 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.2

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.

정위 마스크 시스템을 사용한 방사선수술시 회전중심점의 재현성

이동준,손문준,이기택,최찬영,황금철,황충진 한국의학물리학회 2002 의학물리 Vol.13 No.3

치료대상 병소에 분할 방사선수술을 시술할 경우 회전중심(isocenter)은 정확하고 재현성 이 있어야 한다. 본 연구는 노발리스 방사선 수술장비와 정위 마스크 시스템을 사용한 분할방사선 수술에서 회전중심의 재현성을 측정하고 평가 하였다. 마스크는 열가소성 재질의 상용을 사용하였고 회전중심의 재현성을 측정하기 위해 고안된 머리 모양의 아크릴 팬텀에 맞도록 제작하였다. 팬텀의 내부에는 직경 5 mm의 아크릴봉을 수직으로 세우고 그 끝단을 회전중심으로 선택하였으며 예상되는 회전중심점에 pin hole을 낸 monochromic 필름을 설치하여 방사선 조사 후 회전중심의 재현성을 측정할 수 있도록 하였다. 측정 결과 회전중심은 공간오차가 평균 1 mm 이내이고 표준편차 또한 2 mm 이내여서 이미 보고된 타 문헌에서의 측정값과 비교해 볼 때 모든 측정값이 제시된 오차범위 내에 있었다. 결론적으로 분할방사선수술에 사용하는 정위 마스크 시스템은 매우 정확하고 재현성이 우수하였으며, 실제로 방사선 수술대상의 병소의 직경이 10 mm 정도 이상이라면 일반적인 한번의 고선량 방사선 수술에 정위 마스크 시스템의 사용이 가능할 것으로 사료된다. Fractionated stereotactic radiosurguy (FSRS) requires precise and reproducible patient set up. For these reasons non-invasive mask fixation methods have been used in Linac based FSRS. In this study, we measured and assessed the isocenter reproducibility using a commercial head mask fixation system based on thermoplastic materials. For the verification and the measurement of isocenter deviation a special acrylic brain phantom was designed. The designed phantom has 22 vertical rods and each rod has different lengths. At the end of the 8 rods, the monochromic film is attached and irradiated due to planned target position. Deviations of isocenter were measured separately for each direction. The mean deviation showed 0.4 mm in longitudinal direction, 0.1 mm in the lateral direction, 0.1 mm in the anterior-posterior direction of the treatment couch. The data demonstrates the high accuracy and reproducibility. This study reinforces previous literature published.

척추의 전이암: 노발리스 방사선 수술 후의 자기공명영상소견

황윤준,손문준,황충진,이동준,허감,차순주,김용훈,김수영,서정욱,한윤희,김미영 대한영상의학회 2006 대한영상의학회지 Vol.55 No.5

Purpose: To assess the therapeutic effect of Novalis radiosurgery for metastatic spinal tumors and evaluate the changes after treatment using MR imaging. Materials and Methods: Between November 2003 and June 2005, 21 patients with metastatic spinal tumors underwent Novalis radiosurgery. Of these patients, the 7 with 13 metastatic spinal tumors who had undergone follow-up MR imaging were included in this study. The tumor locations were cervical spine in three, thoracic spine in four, lumbar spine in five and sacrum in one. During the first three months after Novalis radiosurgery, follow-up MRI was performed monthly and subsequently at 3-6-month intervals. On MR imaging, the volume of the tumors, the changes of their signal intensities and any changes in adjacent spinal cord were evaluated. Results: Among the 13 lesions, 9 were decreased in volume (69.2%), 2 were stable (15.4%) and 2 were slightly increased. Seven of 9 lesions showed decreased signal intensity on T2 weighted images and 4 had compressive deformity. Two of 9 lesions had increased T2 signal intensity and tumor necrosis were detected on contrast-enhanced MR imaging. No changes in spinal cord were noted in any of the lesions. Those changes were detected on MRI obtained 1 month after Novalis surgery and the lesion sizes were gradually changed up to 3 months. Conclusion: Novalis radiosurgery was effective for the treatment of metastatic spinal tumor and the suppression of tumor growth. The estimation of therapeutic effect and detecting complication were precisely evaluated on MR imaging. 목적: 척추의 전이암 환자에 있어서 노발리스 방사선 수술을 시행한 후 자기공명영상을 통하여 전이암의 변화를 알아보고자 한다. 대상과 방법: 노발리스 방사선 수술을 시행한 척추의 전이암 환자 21명 중 자기공명영상으로 추적 관찰이 가능하였던 7명의 환자에서 총 13개의 병변을 대상으로 하였다. 병변의 위치는 경추 3개, 흉추 4개, 요추 5개, 천추 1개였다. 노발리스 방사선 수술 후 첫 3개월간은 매달 자기공명영상으로 추적 관찰하였고 그 이후에는 3개월-6개월 마다 관찰하였다. 자기공명영상을 통하여 병변의 체적 및 신호강도의 변화를 관찰하였고 인접한 척수의 변화 유무도 관찰하였다. 결과: 총 13개의 병변 중 체적이 감소한 예가 9병소(69.2%), 변화가 없었던 예가 2병소(15.4%)였고, 2병소(15.4%)에서는 약간 증가하였다. 병변의 체적이 감소한 9병소 중 7병소에서 T2신호강도가 감소하였고 그 중 4병소에서는 압박 변형을 동반하고 있었다. 나머지 2병소에서는 T2 신호강도 증가 소견을 보였고 조영증강영상에서 병변의 괴사가 관찰되었다. 척수는 전 예에서 변화를 보이지 않았다. 이러한 변화들은 노발리스 방사선수술 후 1개월 후에 시행한 자기공명영상에서 관찰할 수 있었고 병변의 체적은 추적관찰 영상에서 더욱 감소하였다. 결론: 노발리스 방사선 수술은 척추 전이암의 치료 및 성장 억제에 유용하였고 자기공명영상을 통하여 치료 효과 판정 및 합병증 발병 유무를 정확히 관찰할 수 있었다.

Analysis of Treatment Result for Pineal Region Tumors

Kim, Jung Hoon,Son, Mun Joon,Kwon, Yang,Lee, Jung Kyo,Kwun, Byung Duk,Whang, Jin 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.5

송과체부위종양의 가장 바람직한 치료방법은 수술적 요법이며, 과거의 shunting, 방사선 치료와 같은 보존적 요법은 이제 적당히 않다고 생각한다. 저자들은 1989년 6월부터 1994년 6월까지 본 병원에 입원하여 치료를 받았던 17예의 송과체부위종양 환자들을 대상으로 임상증상, 진단, 치료방법 및 그 결과를 보고하고자 한다. 남성에게 약간 많이 발생하였고, 평균연령은 다른 저자들의 보고마다 높은 약 32세 정도이었으며, 13세에서 51세까지의 연령분포도를 보였다. 14예에서 조직학적 확진이 가능하였으며(6예 ; occipital transtentorial approach, 5예 : infratentoria supracerebellar approach, 2예 : stereotaxic biopsy, 1예 : frontotemporal craniotomy for ectopic germinoma), 배세포종이 가장 많았다. 종양의 진행으로 인하여 3예에서 사망하였다. 송과체부위에서 발견되는 종양이 조직학적으로 다양하여 이에 따른 각기 다른 치료방법을 요하고, 또한 미세현미경적수술 및 뇌정위적수술 수기가 향상되어 사망률 및 이환율이 낮아졌으므로 생검진단은 반드시 시행되어야한다. TThe authors think that the more desirable treatment for pineal region tumors is definitive surgery with a histological diagnosis and that a conservative approach consisting of shunting and radiation therapy no longer seems to be appropriate. We report the result of a retrospective review of the presentation. treatment, and outcome of the seventeen patients treated between June. 1989 and June, 1994. Nine patients were males and eight patients were females. and the age ranged from 13 to 51 years (mean age about 32 years old). Histological verification was available in fourteen tumors ; six by an occipital transtentorial and five by an infratentonal supracerebellar approach and two by a stereotaxic biopsy and one by a frontotemporal crniotomy for ectopic germinoma. Germinomas were the most common type. Three of the seventeen patients died of tumor progression. Because the treat variety of tumor found in the pineal region must be treated in different way and because improved microsurgical and stereotaxic surgical techniques have made mortality and morbidity rates acceptably low, a biopsy diagnosis should be obtained.