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뇌량 주위 동맥 근위부에 발생한 외상성 뇌동맥류 - 증례보고 1예 -
우원철,송시헌,고현송,염진영,김성호,김윤,Woo, Won Cheol,Song, Shi Hun,Koh, Hyeon Song,Yeom, Jin Young,Kim, Seng Ho,Kim, Youn 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2
Traumatic aneurysm is a rare complication of head trauma. Unfortunately, it is rarely recognized until their presence is heralded by delayed deterioration or intracranial hematoma, etc,. Early diagnosis and surgical treatment are most important for good outcome. We recently encountered a patient who developed a pericallosal aneurysm after major trauma. With a high index of suspicion about traumatic aneurysm, brain MRI and MRA were performed. Definitive diagnosis was made by transfemoral carotid angiography, revealing a aneurysm of the right proximal pericallosal artery. The aneurysm was explored through right interhemispheric approch. A $15{\times}15mm$ sized traumatic aneurysmal sac, located in proximal portion of right pericallosal artery was noted. It was dissected from the falx of cerebri and its neck was clipped. The postoperative course was uneventful. Traumatic intracranial aneurysm should be suspected in any patient who deteriorates after the trauma. Early recognition and prompt treatment are warranted in this setting. Definitive surgical treatment of all traumatic intracranial aneurysm is recommended.
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우원철,송시헌,고현송,염진영,김성호,김윤,Woo, Won Cheol,Song, Shi Hun,Koh, Hyeon Song,Yeom, Jin Young,Kim, Seong Ho,Kim, Youn 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11
Objectives : The Objective of this study was to analyze the prognostic factors affecting survival in the patients with glioblastomas. Methods : We retrospectively studied 55 consecutive patients with glioblastomas who were admitted to neurosurgery department from January 1988 to March 1998. Fifteen pateients were excluded from the analysis because of follow-up loss and surgical motality. There were 24 male and 16 female patients, with a mean age of 51 years. Surgery consisted of biopsy in 4(10.0%) patients, subtotal resection in 9(22.5%) patients and gross total resection in 27(67.5%) patients. Nine(22.5%) patients received second operation. Twenty-eight(70%) received postoperative radiation therapy. Various levels of radiation dose were used, 6,000 rad over 7 weeks in most cases. The variable factors were examined for their relationship with survival ; age at the time of diagnosis, gender, duration of neurological symptoms, preoperative neurological state(Karnofsky performance score), extent of surgical resection, location of tumor, reoperation, and postoperative radiotherapy and chemotherapy. Result : The mean survival time was 55 weeks, three(7.5%) of the 40 patients survived more than two years. Survival time with biopsy only cases was 24 weeks, for those with subtotal resection 43 weeks, and for those with gross total resection 67 weeks. A mean survival time from the time of reoperation was 42 weeks. Statistically significant survival factors in glioblastoma were extent of surgical resection, postoperative radiotherapy and reoperation. Summary : Results of our series support the views that the extent of surgery, reoperation and postoperative radiation are important prognostic factors. We also recommend radical tumor removal, postoperative radiotherapy and reoperation, if possible.
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김윤,우원철 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2
The authors analyzed 74 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1985 to October 1998. Clinical features and radiological findings were reviewed and analyzed. The results of the analysis are summarized as follow: 1. The basal skull fracture were more common in man than woman. 2. 61% of the injured were by traffic accident and 35% were by fall down 3. The outcome of treatment were related to initial GCS(Glasgow coma scale) of the patients. 4. Clinical features were otorrhea(64%), rhinorrhea(49%), and raccoon eye(34%) etc in decreasing order. 5. Combined pathologies were pneumocephalus(58%), skull fracture(53%), epidural hematoma (24%), contusion(18%) etc in decreasing order. 6. CSF leakage were noted in 53 cases and immediate type of CSF leakage was more than delayed type 7. The facial nerve and optic nerve were the most commonly injured cranial nerve 8. The time of onset and the degree of facial palsy had a influence on recovery of facial nerve function. 9. Meningitis occured in 3 cases (4%) of basal skull fracture associated with CSF leakage
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김성호,우원철,이용묵 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2
Fifteen cases with symptomatic hemorrhages caused by brain tumors were analyzed. The neoplasm which showed the highest incidence of tumor hemorrhage was the primitive neuroectodermal tumor. The location of the hemorrhages was intratumoral in all but two cases which were intracerebral. Eight patients showed sudden neurologic symptoms without previous chronic symptoms. The diagnosis was delayed in two cases which were initially regarded as hemorrhages from a vascular origin. There was no significant predisposing factor which was responsible to inducing brain tumor hemorrhages.
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