• Journal of Korean Neurosurgical Society
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• 제57권2호
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• pp.88-93
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• 2015

Objective : Elevated cellular retinoic acid binding protein-I (CRABP-I) is thought to be related to the abnormal proliferation and migration of smooth muscle cells (SMCs). Accordingly, a higher CRABP-I level could cause disorganized vessel walls by causing immature SMC phenotypes and altering extracellular matrix proteins which could result in vulnerable arterial walls with inadequate responses to hemodynamic stress. We hypothesized that elevated CRABP-I level in the cerebrospinal fluid (CSF) could be related to subarachnoid hemorrhage (SAH). Moreover, we also extended this hypothesis in patients with vascular malformation according to the presence of hemorrhage. Methods : We investigated the CSF of 26 patients : SAH, n=7; unruptured intracranial aneurysm (UIA), n=7; arteriovenous malformation (AVM), n=4; cavernous malformation (CM), n=3; control group, n=5. The optical density of CRABP-I was confirmed by Western blotting and presented as mean${\pm}$standard error of the measurement. Results : CRABP-I in SAH ($0.33{\pm}0.09$) was significantly higher than that in the UIA ($0.12{\pm}0.01$, p=0.033) or control group ($0.10{\pm}0.01$, p=0.012). Hemorrhage presenting AVM (mean 0.45, ranged 0.30-0.59) had a higher CRABP-I level than that in AVM without hemorrhage presentation (mean 0.16, ranged 0.14-0.17). The CRABP-I intensity in CM with hemorrhage was 0.21 and 0.31, and for CM without hemorrhage 0.14. Overall, the hemorrhage presenting group (n=11, $0.34{\pm}0.06$) showed a significantly higher CRABP-I intensity than that of the non-hemorrhage presenting group (n= 10, $0.13{\pm}0.01$, p=0.001). Conclusion : The results suggest that elevated CRABP-I in the CSF could be related with aneurysm rupture. Additionally, a higher CRABP-I level seems to be associated with hemorrhage development in vascular malformation.

• Journal of Korean Neurosurgical Society
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• 제45권4호
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• pp.224-230
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• 2009

Objective : We aimed to analyze clinical and radiological outcomes retrospectively in patients with basilar apex aneurysms treated by coiling or clipping. Methods : Outcomes of basilar bifurcation aneurysms were assessed retrospectively in 77 consecutive patients (61 women, 16 men), ranging in age from 25 to 79 years (mean, 53.7 years) from 1999 to 2007. Results : Forty-nine patients out of 77 patients (63.6%) presented with subarachnoid hemorrhages of the 49 patients treated with coiling, 27 (55.1 %) showed complete occlusion of the aneurysm sac. Of these, 13 patients (26.5%) developed coil compaction on angiographic or MRI follow-up, with recoiling required in 9 patients (18.4%). Procedural complications of coiling were acute infarction in nine patients and the bleeding of the aneurysms in six patients. The remaining 28 patients underwent microsurgery : twenty-six of these (92.9%) with microsurgery followed up with conventional angiography. Complete occlusion of the aneurysm sac was achieved in 19 patients (73.1%). Operation-related complications of microsurgery were thalamoperforating artery injuries in three patients, retraction venous injury in two, postoperative epidural hemorrhage (EDH) in one, and transient partial or complete occulomotor palsy in 14 patients. Glasgow Outcome Scores (GOS) were 4 or 5 in 21 of 28 (75%) patients treated with microsurgery at discharge, and at 6 month follow-up, 20 of 28 (70.9%) maintained the same GOS. In comparison, GOS of four or 5 was observed in 36 of 49 (73.5%) patients treated with coiling at discharge and at 6 month follow-up, 33 of 49 patients (67.3%) maintained the GOS from discharge. Conclusion : Basilar top aneurysms were still challenging lesions based on our series. Endovascular or microsurgery endowed with its inborn risks and procedural complications for the treatment of basilar apex aneurysms individually. Microsurgery provided better outcome in some specific basilar apex aneurysms. For reaching the most favorable outcome, endovascular modality as well as microsurgery was inevitably considered for each specific basilar apex aneurysm.

• Journal of Preventive Medicine and Public Health
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• 제29권3호
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• pp.639-655
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• 1996

Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of these diseases are mostly alike. But some risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group (RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of monarch, and prothrombin time. The factor whose level was higher in AMI than ill RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAM than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAM and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age, uric acid, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.

• Radiation Oncology Journal
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• 제6권2호
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• pp.177-182
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• 1988

1979년부터 1985년까지 서울대학교병원 치료방사선과에서 치료를 받은 송과선종 환자 23명에 대한 후향적 분석을 시행하였다. 종양에 대한 조직학적 진단은 1명에서만 이루어졌고, 나머지 22명의 환자에 있어서의 진단은 임상적 소견 및 방사선학적 경사결과에 의거하였다. 방사선조사는 1명에 있어서는 종양부위에 국한하였고, 14명에 있어서는 전 뇌부위, 8명에 있어서는 전뇌-척수부위에 대하여 시행하였다. 전 환자의 5년 생존율은 $71.5\%$이었고, 전 뇌부위 치료 환자의 5년 생존율은$69.3\%$, 전뇌-척수부 위 치료 환자의 5년 생존율은 $73.3\%$이었다. 원발 부위 및 원격부위에서의 재발이 각각 한명씩 확인되었으며 척수부위에서의 치료실패는 확인된 경우가 없었다. 이상의 분석결과 및 기왕의 여러 보고를 바탕으로 하여 송과선종의 방사선치료에 있어서 모든 환자에서 전척수 조사를 시행하는 것은 타당치 않으며 전척수 조사는 뇌척수액내에서 종양세포가 발견된 경우나 또는 종양의 제거나 생검을 위하여 외과적 시술이 시행되었던 경우 등에 국한되어야 할 것으로 결론지었다

• The Korean Journal of Physiology and Pharmacology
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• 제3권4호
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• pp.415-425
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• 1999

$[K^+]_o$ can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of $[K^+]_o$ in the range of $5{\sim}15$ mM may affect tensions of blood vessels and cause relaxation of agonist-induced precontracted vascular smooth muscle $(K^+-induced$ relaxation). In this study, effect of the increase in extracellular $K^+$ concentration on the agonist-induced contractions of various arteries including resistant arteries of rabbit was examined, using home-made Mulvany-type myograph. Extracellular $K^+$ was increased in three different ways; from initial 1 to 3 mM, from initial 3 to 6 mM, or from initial 6 to 12 mM. In superior mesenteric arteries, the relaxation induced by extracellular $K^+$ elevation from initial 6 to 12 mM was the most prominent among the relaxations induced by the elevations in three different ways. In cerebral arteries, the most prominent relaxation was produced by the elevation of extracellular $K^+$ from initial 1 to 3 mM and a slight relaxation was provoked by the elevation from initial 6 to 12 mM. In superior mesenteric arteries, $K^+-induced$ relaxation by the elevation from initial 6 to 12 mM was blocked by $Ba^{2+}\;(30\;{\mu}M)$ and the relaxation by the elevation from 1 to 3 mM or from 3 to 6 mM was not blocked by $Ba^{2+}.$ In cerebral arteries, however, $K^+-induced$ relaxation by the elevation from initial 3 to 6 mM was blocked by $Ba^{2+},$ whereas the relaxation by the elevation from 1 to 3 mM was not blocked by $Ba^{2+}.$ Ouabain inhibited all of the relaxations induced by the extracellular $K^+$ elevations in three different ways. In cerebral arteries, when extracellular $K^+$ was increased to 14 mM with 2 or 3 mM increments, almost complete relaxation was induced at 1 or 3 mM of initial $K^+$ concentration and slight relaxation occurred at 6 mM. TEA did not inhibit $Ba^{2+}-sensitive$ relaxation at all and NMMA or endothelial removal did not inhibit $K^+-induced$ relaxation. Most conduit arteries such as aorta, carotid artery, and renal artery were not relaxed by the elevation of extracellular $K^+.$ Among conduit arteries, trunk of superior mesenteric artery and basilar artery were relaxed by the elevations of $[K^+]_o.$ These data suggest that $K^+-induced$ relaxation has two independent components, $Ba^{2+}-sensitive$ and $Ba^{2+}-insensitive$ one and there are different mechanisms for $K^+-induced$ relaxation in various arteries.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.84-87
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• 2017

뇌과관류증후군은 경동맥 스텐트 삽입술 또는 내막 절제술 시행 시 발생할 수 있는 드문 합병증으로 대사 요구량보다 관류가 더 많은 상태를 유발하는 다양한 기전에 의해 발생한다. 주 임상 증상은 편측성 두통, 고혈압, 발작 및 국소 신경계 결손이 있으며, 심한 경우 지주막하 출혈 및 뇌실질 출혈로 영구적 장애 또는 사망까지 유발할 수 있다. 일반적으로 뇌과관류증후군은 두개경유도플러, 관류 뇌자기공명영상 및 단일광자방출컴퓨터단층촬영으로 진단할 수 있다. 저자들의 연구에서는 내경동맥 스텐트 이후 확인한 혈관조영술에서 의미있는 정맥울혈 증상을 보여 뇌과관류증후군을 진단할 수 있었다. 환자는 증상성 양쪽 내경동맥 협착을 보이고 있었고, 협착으로 인해 곁순환 동맥들이 잘 발달하게 되었다. 이렇게 곁순환 동맥이 잘 발달된 상태에서 환자에게 내경동맥 스텐트를 삽입한 이후 대뇌 혈류량이 증가되며 혈류의 방향이 바뀌어 정맥 울혈이 생길 수 있으며, 경동맥 스텐트 삽입술 또는 내막 절제술 시행 이후 정맥울혈이 보일 시 뇌과관류증후군을 예측할 수 있다. 이 연구는 내경동맥 스텐트 삽입 후 바로 시행하는 혈관 조영술을 통해서 뇌과관류증후군을 확진할 수 있음을 보여준 1례의 보고이다.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.644-649
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• 2000

저자들의 방법으로 급성 수두증이 지속되는 환자를 치료한다면 첫째, 뇌압이 상승된 환자에서 요추지주막하 배액의 가장 우려되는 합병증인 탈뇌의 가능성을 미리 예측 할 수 있고 둘째, 뇌실외배액을 뇌실염 발생 이전에 요추지주막하배액으로 대치하여 뇌실염을 예방할 수 있으며 셋째, 뇌실외배액으로 인하여 뇌실염이 이미 발생한 경우에는 요추지주막하 배액으로 치환하여, 이물질(foreign body)로 작용하여 감염치료를 저해하는 뇌실내 카테터를 제거할 수 있고 동시에 경막내 항생제 투여로 뇌실염의 치료를 기대할 수 있으며 넷째, 요추지주막하 배액은 뇌실외배액에 비해 반복적 시술에 따른 두개강내 출혈, 경련 등의 위험으로부터 안전하며 천자가 가능한 부위가 많아 기간이 오래되거나 혹은 천자가 실패하여 다른 부위로 옮겨야할 때 위치 변경이 용이하다는 등의 장점이 기대된다. 본 교실에서는 여러 가지 원인으로 인하여 발생한 급성 수두증이 조기에 해결되지 않고 잔존혈괴나 감염 등의 이유로 단락술을 바로 시행할 수도 없는 경우에 간단한 시험을 통하여 탈뇌의 가능성을 배제한 다음 뇌실외배액을 요추지주막하 배액으로 치환하여 치료함으로써 좋은 결과를 얻었기에 이러한 곤란한 경우의 치료법의 한가지 대안으로 제안하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제51권6호
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• pp.328-333
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• 2012

Objective : The aim of this study is to determine the association between the cerebrospinal fluid (CSF) biomarkers and inflammation, and the predictive value of these CSF biomarkers for subsequent shunt associated infection. Methods : We obtained CSF samples from the patients with hydrocephalus during ventriculoperitoneal (VP) shunt operations. Twenty-two patients were enrolled for this study and divided into 3 groups: subarachnoid hemorrhage (SAH)-induced hydrocephalus, idiopathic normal pressure hydrocephalus (INPH) and hydrocephalus with a subsequent shunt infection. We analyzed the transforming growth factor-${\beta}1$, tumor necrosis factor-${\alpha}$, vascular endothelial growth factor (VEGF) and total tau in the CSF by performing enzyme-linked immunosorbent assay. The subsequent development of shunt infection was confirmed by the clinical presentations, the CSF parameters and CSF culture from the shunt devices. Results : The mean VEGF concentration (${\pm}$standard deviation) in the CSF of the SAH-induced hydrocephalus, INPH and shunt infection groups was $236{\pm}138$, $237{\pm}80$ and $627{\pm}391$ pg/mL, respectively. There was a significant difference among the three groups (p=0.01). Between the SAH-induced hydrocephalus and infection groups and between the INPH and infection groups, there was a significant difference of the VEGF levels (p<0.01). However, the other marker levels did not differ among them. Conclusion : The present study showed that only the CSF VEGF levels are associated with the subsequent development of shunt infection. Our results suggest that increased CSF VEGF could provide a good condition for bacteria that are introduced at the time of surgery to grow in the brain, rather than reflecting a sequel of bacterial infection before VP shunt.

• 정신신체의학
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• 제7권2호
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• pp.263-273
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• 1999

두통은 인류의 가장 흔한 호소 중의 하나로 임상에서 흔히 보는 장애이다. 두통은 뇌막염, 뇌출혈, 또는 뇌종양과 같은 다른 질환의 증상일수 있으나, 또한 편두통이나 군발두통 등과 같은 질병 자체로 표현된다. 일차적으로 두통 장애의 역학이나 국제 두통학회의 진단기준을 이해하고 흔치 않으나 심각한 이차적인 두통장애와 감별에 관심을 둬야 한다. 환자가 일차 두통장애의 기준에 맞으면 신경학적 진단검사의 보충이 없어도 치료를 시작한다. 두통 유형, 표현 양상, 동통기간과 강도 등에 따라 진통소염제나 혼합진통제, 혈관작용의 항편두통 약물 또는 신경이완제나 corticosteroid등을 선택한다. 편두통의 빈도와 강도에 따라 예방치료가 보통 4~6개월간 조절한다. 긴장형 두통은 발작성과 만성두통으로 구분되나 치료적으로는 급성완화와 예방치료로 시도된다. 많은 만성매일두통 환자들이 진통제나 ergotamine을 과용하고 있으며 그들의 의존성과 내재된 갈등조절, 수면장애, 우울등으로 과용된 약물의 제한이 쉽지 않다. 치료의 첫단계는 약물을 끊고 조심스럽게 대치요법을 시행한다.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1188-1194
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• 2000

Objective : Internal carotid-posterior communicating artery(IC-PC) aneurysms can be clipped easily without any special preparations. Occasionally, however, it is difficult to clip the low-lying IC-PC aneurysms without some kinds of additional procedures. Clinical Material and Methods : We experienced four cases of low-lying IC-PC aneurysms, which the intradural anterior clinoidectomy and/or anterior petroclinoid fold(APF) resection was essential to expose the proximal side of the aneurysmal neck and/or proximal control. One patient harbored two low-lying IC-PC aneurysms bilaterally. The patients were divided into two groups according to the necessity of anterior clinoidectomy : Group I(n=4) that needed an intradural clinoidectomy and/or APF resection and Group II(n=29) that had IC-PC aneurysms, easily clipped without any special preparation. Also, various radiometric parameters were measured through the preoperative angiograms. Results : The incidence of such aneurysms was 12% among a total of thirty-three surgically treated IC-PC aneurysms during lasr 3 years. Among four cases, three cases presented with subarachnoid hemorrhage and all aneurysmal sac projected to postero-inferior direction. In our study, We initially considered the necessity of intraoperative anterior clinoid process(ACP) removal and/or resection of APF in cases of shorter distance less than 5.6mm between the proximal aneurysmal sac and tip of the ACP(p<0.001), and the proximal portion of aneurysmal neck has located below the interclinoid line(p=0.001). Conclusion : Through a careful preoperative evaluation, some radiometric parameters can be used to determine whether the ACP should be removed in clipping of the low-lying IC-PC aneurysms. Unlike to total removal of the ACP, the intradural partial anterior clinolidectomy and/or APF resection, which are more familiar to surgeons, reduce the risks of the premature rupture, operative time, and also contribute a more precise clip placement with proximal control than the extradural clinoidectomy.