• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.939-942
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• 2001

Thirty nine-year-old man who required urgent shunt operation due to rapidly deteriorating visual acuity suffered from ventriculitis after aneurysmal operation. Daily dose of 20mg of vancomycin and amikyn were given intraventricularly via external ventricular catheter after failure of various kinds of systemic antibiotics. The exit of the catheter was made on the upper chest wall to prevent superinfection. External ventricular drainage could finally be switched to ventriculo-peritoneal shunt and he was discharged with clinical improvement.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.609-614
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• 2000

Objective : A retrograde clinical study was undertaken to determine the effect of opening lamina terminalis on the development of hydrocephalus after aneurysmal subarachnoid hemorrhage(SAH). We compared the incidence ratios of the development of hydrocephalus with and without opening lamina terminalis during operation after aneurysmal SAH. Patients and Methods : From Oct. 1996 to Sep. 1998, we performed 138 aneurysm surgery for 122 patients. In 98 cases, the lamina terminalis was opened to make direct cerebrospinal fluid flow from the third ventricle to subarachnoid space for prevention of delayed hydrocephalus. We compared the incidence of hydrocephalus after opening lamina terminalis to those without opened lamina terminalis. Results : In 95 cases, the hydrocephalus was noticed in 2 cases(2.2%). It is significantly lower in the group with opening lamina terminalis than the group without opening lamina terminalis(about 10%). Conclusion : It is simple and easy procedure to open the lamina terminalis during aneurysm surgery. With this maneuver, we could reduce the incidence of hydrocephalus after aneurysmal spontaneous SAH. Thus, it is considered that the opening lamina terminalis is one of the effective methods for preventing the development of hydrocephalus after aneurysmal spontaneous SAH.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1375-1380
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• 2001

Objective : The authors analyzed the incidence, the cause and the prognosis of hydrocephalus following aneurysmal subarachnoid hemorrhage to evaluate the risk factors of hydrocephalus and to provide the proper treatment method for hydrocephalus following aneurysmal subarachnoid hemorrhage. Methods : The 505 cases of subarachnoid hemorrhage followed by aneurysmal surgery from January 1990 to May 1999, were divided into shunt group and shunt-free group and we were reviewed for the clinical status, Fisher's grade, brain CT findings and prognosis. Results : The incidence of acute hydrocephalus was 37.2% of patients and 18.9% to developed chronic hydrocephalus. Shunt surgery due to chronic hydrocephalus was required in 6.5% of patients. We found following variables were significantly related to shunt-dependent hydrocephalus : high Hunt-Hess and Fisher grade, initial CT findings of intraventricular hemorrahge, posterior circulation aneurysm, preoperative rebleeding, delayed ischemic deficits, and initial high ventricular size index. There were no statistically significant relationships between shunt-dependent hydrocephalus and patient age or sex, timing of operation. The previous hypertension was not related to shunt dependent hydrocephalus. Prognosis in shunt group showed poor result. Conclusion : The risk factors of hydrocephalus following aneurysmal subarachnoid hemorrhage are high Hunt-Hess grade, high Fisher's grade, aneurysms of posterior circulations, preoperative aneurysmal rebleeding, delayed ischemic deficits, initial CT findings of intraventricular hemorrahge and initially increased ventricular size. The patients with these factors should the carefully observed and managed accordingly due to poor prognosis related to hydrocephalus requiring shunt operation.

• 대한한방내과학회지
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• 제41권1호
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• pp.97-110
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• 2020

The purpose of this case study was to report the effectiveness of aphasia in patients with cerebral infarction with hydrocephalus. A patient diagnosed with a middle cerebral artery infarction and hydrocephalus was treated with Gami-cheongeumjowi-tang, acupuncture, and moxibustion. The degree of improvement of symptoms was evaluated using the Korean version of the Frenchay Aphasia Screening Test (K-FAST) and the Mini-Mental State Examination-Korea (MMSE-K). At the time of admission, the K-FAST score was 7 points and the MMSE-K score was 4 points because no words other than 'Yes' could be spoken. At discharge, the K-FAST score was 22 points and the MMSE-K score was 19 points. A particularly noticeable improvement was found in spoken and written comprehension, reading, and repetition. The study findings indicate that Korean medicine treatment can be used to treat the symptoms of patients with aphasia. The periventricular region may be distorted by hydrocephalus, resulting in Broca's aphasia in a cerebral infarction of the middle cerebral artery inferior division.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.68-72
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• 2001

Objective : The goal of this study was to document the influence of the treatment modality(surgery versus endovascular treatment) on the development of chronic shunt-dependent hydrocephalus in a series of 296 patients treated after aneurysmal subarachnoid hemorrhage(SAH). Methods : The following parameters were retrospectively analyzed for association with chronic shunt-dependent hydrocephalus : 1) Age and Sex, 2) Hunt and Hess grade, 3) Fisher computed tomographic grade, 4) aneurysm location, and 5) treatment modality(surgery versus endovascular treatment). Results : Thirty-six of 251 patients(14.3%) who survived the SAH and its neurological and/or medical sequelae underwent definitive shunting for treatment of chronic hydrocephalus. The rate of shunt dependency was positively correlated with a higher age, a higher Hunt and Hess grade, a higher Fisher computed tomographic grade, and aneurysms arising at the anterior communicating artery(p<0.05). Conclusion : The results of the present study indicate that the treatment modality used does not affect the risk of the later development of chronic shunt-dependent hydrocephalus(surgery, 16.2% [25 of 154] ; endovascular treatment, 11.3% [11 of 97] ; p=0.45).

• 대한한방내과학회지
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• 제44권1호
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• pp.77-85
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• 2023

Objective: This clinical study describes the effect of Korean medicine on a post-traumatic hydrocephalus patient complaining of gait disturbance and dementia. Case presentation: A post-traumatic hydrocephalus patient complaining of gait disturbance and dementia was treated with herbal medicine, acupuncture, moxibustion, and cupping. Clinical symptoms were measured with the Korean Mini Mental Status Exam (K-MMSE), Functional Independence Measure (FIM), and Modified Barthel Index (MBI). After treatment, the patient showed improved K-MMSE, FIM, and MBI scores. Conclusion: This clinical case study provides evidence of the effect of Korean medicine on a post-traumatic hydrocephalus patient complaining of gait disturbance and dementia.

• Pediatric Infection and Vaccine
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• 제19권3호
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• pp.141-148
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• 2012

목 적 : 뇌실-복강 단락 수술은 수두증이 있는 소아 환자에서 중요한 치료 방법 중 하나이다. 뇌실-복강 단락에서 단락 감염은 중요한 합병증이며 수술의 예후를 결정하는 중요한 요인이다. 이 연구는 소아 환자에서의 뇌실-복강 단락 감염의 역학적 특성과 임상 증상, 치료와 예후를 파악하고 진단 및 치료에 도움이 되고자 하였다. 방 법 : 1995년 4월부터 2010년 6월까지 뇌실-복강 단락 수술을 시행 받은 18세 이하의 환자를 대상으로 하였으며 후향적으로 의무 기록을 분석하였다. 결 과 : 총 190명(여자 82명, 남자 107명)의 환자에서 327건의 뇌실-복강 단락 수술을 시행하였다. 중위 연령은 2.4세이며(0.02-17.9세) 뇌실-복강 단락 수술의 가장 흔한 원인은 악성 뇌종양이었다. 수술 1건 당 감염률은 6.7% (22/327건), 환자 1명 당 감염률은 9.5% (18/190명)이며 100건의 수술-년 당 감염은 0.45건 이었다. 가장 흔한 원인 균은 coagulase-negative staphylococcus (7건) 이며 methicillin resistant Staphylococcus aureus에 의한 감염은 1건 이었다. 10건의 감염에서 vancomycin과 beta-lactam antibiotics (cephalosporin or carbapenem)의 복합 정주 치료를 시행하였으며 7건의 감염에서 vancomycin 단독 정주 치료를 시행하였다. 치료 기간의 중앙값은 26일(7-58일)이었으며 수술적 치료는 18건에서 시행하였다(18/22건, 81.8%). 결 론 : 본 연구는 단일 기관에서 15년 동안의 뇌실-복강 단락 감염의 역학을 요약한 연구로 소아 환자에서의 뇌실-복강 단락 감염의 역학적 정보는 적절한 치료를 시행하는데 큰 도움이 될 것이다. 향후 단락 감염의 발생과 관련한 위험 인자에 대한 추가적인 연구가 필요할 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.575-580
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• 2001

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.

• 대한핵의학회지
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• 제27권2호
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• pp.175-182
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• 1993

지주막하출혈은 혈관경련, 재출혈, 수두증의 합병증이 빈번히 동반되며, 이 합병증 유무에 따라 예후에 큰 영향을 받는다. 뇌동맥파열에 의한 지주막하출혈 환자 21명과 지주막하출혈 환자 중 10명(48%)의 환자에서 SPECT 검사상 양측성 관류저하가 관찰되었으며, 일측성 관류저하가 7명(33%), 관류저하가 없는 예가 4명 (19%)이었다. 반면에 CT/MRI에서 양측성 병소가 관찰된 예는 3예(14%)이었다. 발견된 병소의 수도 SPECT의 경우는 56개었으나 CT/MRI에서는 25개만이 관찰되었다. 언어장애 또는 편측 운동장애가 발생한 환자에서 SPECT로 관련영역의 관류전하를 확인할 수 있었으며 Matastest를 시행하여 뇌동맥폐쇄시술 시 위험유무를 판정할 수 있었다. 이상의 결과로 $^{99m}Tc$-HMPAO SPECT 검사는 지주 막하출혈 환자에서 CT/MRI에 비하여 기능변화를 정확히 반영하여, 환자의 정확한 임상상을 비관혈적으로 객관적으로 평가할 수 있는 유용한 검사법으로 생각되었다.

• Pediatric Infection and Vaccine
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• 제29권3호
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• pp.147-154
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• 2022

코로나바이러스-19 (COVID-19)는 일반적으로 성인에 비해 소아에서 임상적으로 경한 양상을 보이며, 대부분의 소아에서 약 7일간의 격리가 끝나면 증상이 호전되어 특별한 이벤트 없이 퇴원하게 된다. 우리는 통상적인 임상경과와는 다르게, 격리 해제시점 또는 퇴원을 고려하고 있는 시점에 갑자기 악화된 임상증상을 보이는 3명의 청소년 환아들을 경험하였다. 세 명의 아이들은 공통적으로 신경학적 질환을 기저질환으로 가지고 있었다. Case 1은 울리히 선천성 근디스트로피로 진단받고 밤에만 이중양압기로 호흡보조를 받던 17세 남환의 경우로, 첫 COVID-19 증상 이후 9일이 지나고 증상 호전되어 퇴원을 준비하던 중 심폐정지가 발생하였다. Case 2는 뇌출혈 및 뇌경색 이후 병상에 누워 지내며 기관절개관 삽입 후 가정용 인공호흡기로 호흡보조를 받던 12세 여자 환아로, 증상이 호전되어 퇴원하였으나 첫 COVID-19 증상 이후 11일이 지난 후 심폐정지가 발생하였다. Case 3의 경우 조산아로 출생하여 뇌실출혈 및 수두증 진단받고 병상에 누워 지내나 호흡보조는 받지 않았던 12세 남자 환아로, 첫 증상 이후 호전추세였으나 10일 후 다기관 기능부전 확인되어 입원 진행하였다. 항바이러스제, 스테로이드제, 경험적 항생제가 투여되었고 중환자실 치료를 시행하였다. 세 환아들 중 2명 (case 1, 3)은 치료를 통해 호전되었으나, 1명 (case 2)는 심부전 진행하여 사망하였다. 이러한 경험에 비추어 볼 때, COVID-19 격리 기간이 끝나고 퇴원 가능한 시점이라도 갑작스러운 증상 악화를 보일 가능성이 있기에, 긴장을 놓지 않고 임상 증상의 변화를 확인하고 필요시 빠른 조치를 취해야 할 것으로 생각된다. 특히 신경학적 또는 호흡기적 만성 질환을 갖는 아이들에게 주의가 더 필요할 것으로 생각된다.