• Journal of Korean Neurosurgical Society
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• 제53권5호
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• pp.312-315
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• 2013

Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.505-511
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• 2016

Objective : Microvascular decompression (MVD) for hemifacial spasm (HFS) involving the vertebral artery (VA) can be technically challenging. We investigated the therapeutic effects of a bioglue-coated Teflon sling technique on the VA during MVD in 42 cases. Methods : A bioglue-coated Teflon sling was crafted by the surgeon and applied to patients in whom neurovascular compression was caused by the VA. The radiologic data, intra-operative findings with detailed introduction of the procedure, and the clinical outcomes of each patient were reviewed and analyzed. Results : The 42 patients included in the analysis consisted of 22 females and 20 males, with an average follow-up duration of 76 months (range 24-132 months). Intraoperative investigation revealed that an artery other than the VA was responsible for the neurovascular compression in all cases : posterior inferior cerebellar artery (PICA) in 23 patients (54.7%) and anterior inferior cerebellar artery (AICA) in 11 patients (26.2%). All patients became symptom-free after MVD. Neither recurrence nor postoperative neurological deficit was noted during the 2-year follow-up, except in one patient who developed permanent deafness. Cerebrospinal fluid (CSF) leak occurred in three patients, and one required dural repair. Conclusion : Transposition of the VA using a bioglue-coated Teflon sling is a safe and effective surgical technique for HFS involving the VA. A future prospective study to compare clinical outcomes between groups with and without use of this novel technique is required.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.512-517
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• 2016

Objective : The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. Methods : Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (${\geq}50%$ decrease in the diameter of the syrinx) were investigated. The follow-up period was $72.7{\pm}55.6$ months. Results : Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. Conclusion : Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.

• Journal of Korean Neurosurgical Society
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• 제52권5호
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• pp.441-446
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• 2012

Objective : Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH. Methods : Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and ${\geq}70$ years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and ${\geq}70$ years of age). Results : Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (${\geq}70$ years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus. Conclusion : In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.340-345
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• 2009

Objective : We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. Methods : A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. Results : Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. Conclusion : The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.

• 정보처리학회논문지:소프트웨어 및 데이터공학
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• 제3권10호
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• pp.421-428
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• 2014

파킨슨병은 뇌의 흑질 영역에서 도파민계 신경이 파괴되는 질병으로 알츠하이머병과 함께 대표적인 퇴행성 뇌 질환이다. 현재까지 병을 완치시킬 수 있는 치료법은 없지만 병의 진행을 완화시킬 수 있는 치료법이 존재하기 때문에 병의 진단이 굉장히 중요하다. 파킨슨병을 진단하기 위한 과거의 연구는 대부분 단일 바이오마커를 이용한 것으로 이러한 방법은 파킨슨병 환자를 높은 정확도로 진단할 수 있지만 정상인에 대한 진단은 상대적으로 낮은 성능의 한계성이 존재한다. 따라서 본 연구에서는 생화학적 바이오마커인 뇌척수액 내의 ${\alpha}$-synuclein 단백질 수치와 영상학적 바이오마커인 확산 텐서 영상의 여러 모수들을 결합하여 특징으로 사용하는 파킨슨병 진단 모델을 개발하고 성능을 평가하였다. 진단을 위해 개발된 모든 모델은 10-fold cross validation 성능평가에서 정확도가 최고 91.3%의 높은 성능을 보였으며, test 성능평가에서는 확산 텐서 영상의 모수들 중 FA와 ${\alpha}$-synuclein 단백질 수치가 결합된 모델, MO와 ${\alpha}$-synuclein 단백질 수치가 결합된 두 모델에서 최고 72%의 정확도 성능을 보여 파킨슨병의 진단에 유용하게 사용될 수 있는 가능성을 제시하였다. 파킨슨병의 진단을 위해 개발된 모델의 영상학적 특징 벡터를 통하여 파킨슨병 환자와 정상인의 신경섬유 경로의 특징을 분석하였다.

• 한국산학기술학회논문지
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• 제14권4호
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• pp.1765-1773
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• 2013

본 연구에서는 단순천공배액술을 시행하고 호전된 환자들과 이차 수술로 단순천공배액술을 실시하거나 경막하복강단락술을 실시한 환자들의 임상적 경과 분석을 통해 뇌경막하수종 치료에 도움이 되고자 한다. 2006년 7월부터 2012년 6월까지 본원에서 뇌경막하수종으로 입원하여 단순천공배액술을 시행받은 16례 전체 환자를 대상으로 분석하였다. 연구결과 아스피린을 복용하고 있는 환자는 모두 이차 수술을 시행하였다(p<0.001). 경막하복강단락술을 시행한 환자 4명 중 2명이 아스피린을 복용하여 통계적으로 유의하였다(p=0.014). 경막하복강단락술을 시행한 그룹과 시행하지 않은 그룹 간의 비교 결과, 4명의 환자는 일차수술 후 GCS의 변화는 없었으나 추적 전산화단층촬영 상 정중선 편위가 심하였고 경막하수종은 증가하거나 변화가 없었으며 두통, 구토, 발열, 호흡곤란 등의 뇌압상승 증상을 보여 단락술을 결정하게 되었다(p=0.006). 아스피린을 복용했던 환자들의 수술적 치료는 주의를 요하며 개두술 과정에서 뇌척수액의 급격한 소실과 뇌압의 지나친 변화를 예방하는 것이 중요하다고 사료된다.

• Clinical and Experimental Pediatrics
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• 제53권4호
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• pp.603-606
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• 2010

부신생물 변연계뇌염(paraneoplastic limbic encephalitis)은 신경계의 전이가 없이 종양의 원격 작용에 의해 발생하는 질환으로 소아에서는 드물게 보고되고 있다. 저자들은 사춘기 여아에서 발생한 성숙 난소기형종에 동반된 부신생물 변연뇌염을 경험하고 보고하고자 한다. 15세 여자 환자가 신경정신증상, 기억력 저하, 경련, 의식 저하를 주소로 내원하였다. 뇌척수액 검사, 뇌 MRI는 정상이었으나, 뇌 SPECT 검사에서 양측 측두엽의 저관류가 관찰되었다. 복부 초음파와 MRI에서 좌측 난소의 낭성 종양이 발견되었다. 종양의 수술적 제거 후 성숙 난소기형종으로 확인되었으며, 종양 제거 및 면역글로불린 정맥 투여로 완전한 인지 기능의 회복을 보였다.

• Clinical and Experimental Pediatrics
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• 제53권4호
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• pp.607-611
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• 2010

Bickerstaff 뇌간 뇌염은(BBE) 4주 이내의 진행성이며, 비교적 대칭성으로 오는 안근 마비와 실조증, 의식 장애 또는 심부건 반사 항진 등의 임상적 특징을 가지며, 뇌간을 침범하는 타 질환을 배제하였을 때 진단할 수 있는 드문 질환이다. 혈청 또는 뇌척수액의 항 Ganglioside 항체(GM, GD and GQ) 는 때로 BBE의 진단에 도움이 되기도 하며, 뇌 자기 공명 영상, 뇌 척수액 검사, 신경 전도 검사 및 근 전도 검사 등은 진단에 크게 도움이 되지 않는다. 저자들은 안근 마비, 실조증, 언어 운동 장애, 연하 장애, 점진적 사지 마비, 의식 저하 등의 증상을 보이며 혈청과 뇌척수액에서 anti-GM1 항체의 증가를 보여 BBE로 진단하고 면역 글로불린과 스테로이드 치료 후 완치되었던 9세의 여아의 증례를 경험하였기에 문헌 고찰과 함께 이를 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제58권9호
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• pp.358-361
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• 2015

Hemophagocytic lymphohistiocytosis (HLH) is characterized by fever, splenomegaly, jaundice, and pathologic findings of hemophagocytosis in bone marrow or other tissues such as the lymph nodes and liver. Pleocytosis, or the presence of elevated protein levels in cerebrospinal fluid, could be helpful in diagnosing HLH. However, the pathologic diagnosis of the brain is not included in the diagnostic criteria for this condition. In the present report, we describe the case of a patient diagnosed with HLH, in whom the brain pathology, but not the bone marrow pathology, showed hemophagocytosis. As the diagnosis of HLH is difficult in many cases, a high level of suspicion is required. Moreover, the pathologic diagnosis of organs other than the bone marrow, liver, and lymph nodes may be a useful alternative.