• Journal of Yeungnam Medical Science
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• 제1권1호
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• pp.25-34
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• 1984

저자들이 지난 10년간 치험했던 25예의 중추신경계 낭미충증 환자를 임상분석한 결과 다음과 같은 결론을 얻었다. 1. 연령분포는 20-50세 사이가 약 70%로 대부분이었고 남여별 빈도는 거의 비슷했다. 2. 임상증상의 기간은 대부분이 6개월 미만이었고 뇌실질형에서는 주로 간질발작, 국소신경이상소견, 뇌압항진소견등을 보인 반면 뇌실형에서는 뇌압항진소견과 소뇌이상소견을 주로 보였다. 3. Nieto 분류방법에 따라서 보면 뇌실형이 44%, 뇌실질형이 36%로 대부분을 차지했다. 4. 뇌신경마비는 제6 뇌신경마비, 제7 뇌신경마비의 순으로 그 빈도가 나타났다. 5. 피하결절은 32%에서 촉지할 수 있었다. 6. 변검사상 충란은 20%에서 검출됐고, 호산구의 증가는 12%, 뇌척수액 담백질 증가는 80%, 혈침의 증가는 20%에서 볼 수 있었다. 7. 방사선학적 검사에서 이상소견은 단순촬영상 17%, 뇌동맥조영술상 84%, 뇌실조영술상 94%에서 나타났고 콤퓨터 단층촬영상 이상소견은 시행했던 10예 모두 이상소견을 보였으며 이 방법이 뇌낭충증 진단에 가장 정확한 진단방법이라고 판단된다. 8. 수술은 24예에서 25회 실시됐고 그 결과 약 72%에서는 호전이 됐고 24%는 변화가 없었으며 4%에서는 입원중 사망했다. 제4뇌실 낭미충증의 경우가 수술후 가장 좋은 예후를 보였고 후두와 개두술과 낭종의 흡인방법으로 비교적 쉽게 낭종의 제거가 가능했다.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.85-90
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• 2001

Objective : DREZotomy is effective for the treatment of deafferentation pain as a consequence of root avulsion, postparaplegic pain, posttraumatic syrinx, postherpetic neuralgia, spinal cord injury, and peripheral nerve injury. We performed microsurgical DREZotomy to the patients with deafferentation pain and relieved pain without any serious complication. The purpose of this study is to evaluate the usefulness of the microsurgical DREZotomy for deafferentation pain. Methods : We evaluated 4 patients with deafferntation pain who were intractable to medical therapy. Two of them were brachial plexus injury with root avulsion owing to trauma, one was axillary metastasis of the squamous cell carcinoma of the left forearm, and the last was anesthesia dolorosa after surgical treatment(MVD and rhizotomy) of trigeminal neuralgia. Preoperative evaluation was based on the neurologic examination, radiologic imaging, and electrophysiological study. In the case of anesthesia dolorosa, we produced two parallel lesions in cephalocaudal direction, 2mm in distance, from the C2 dorsal rootlet to the 5mm superior to the obex including nucleus caudalis, after suboccipital craniectomy and C1-2 laminectomy, with use of microelectrode. In the others, we confirmed lesion site with identification of the nerve root after hemilaminectomy. We performed arachnoid dissection along the posterolateral sulcus and made lesion with microsurgical knife and microelectrocoagulation, 2mm in depth, 2mm in distance, to the direction of 30-45 degrees in the medial portion of the Lissauer's tract and the most dorsal layers of the posterior horn at the one root level above and below the lesion. Results : Compared with preoperative state, microsurgical DREZotomy significantly diminished dosage of the drugs and relieved pain meaningfully. One patient showed tansient ipsilateral ataxia, but recovered soon. There was not any serious complication. Conclusion : It may be concluded that microsurgical DREZotomy is very useful and safe therapeutic modality for deafferentation pain, especially segmentally distributed intermittent or evoke pain. Complete preoperative evaluation and proper selection of the patients and lesion making device are needed to improve the result.