신경외과학

집필진 iv
머릿글 vi
Chapter 01 총론 ....................................................................1
1. 신경외과학의 역사.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
1.1 고대 신경외과학.....................................................................2
1.2 그리스 로마시대 신경외과학.................................................2
1.3 중세시대 신경외과학..............................................................2
1.4 근대 신경외과학.....................................................................3
1.5 신경외과학의 전망.................................................................5
1.6 우리나라 신경외과학의 역사.................................................5
2. 임상해부학.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
2.1 두피.......................................................................................10
2.2 두개골...................................................................................11
2.3 뇌...........................................................................................12
2.4 척수.......................................................................................19
3. 신경학적 검사.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
3.1 신경학적 병력......................................................................25
3.2 신체검사...............................................................................26
3.3 정신상태 검사......................................................................26
3.4 뇌신경 검사.......................................................................... 28
3.5 운동계...................................................................................36
3.6 지각계...................................................................................38
3.7 반사.......................................................................................40
3.8 소뇌기능 검사......................................................................42
3.9 자율신경계...........................................................................43
3.10 신경근, 말초신경 및 척수 병변 시 신경학적 검사.........45
3.11 대뇌의 국재 진단...............................................................50
4. 보조진단법.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
4.1 단순 X-선 촬영....................................................................54
4.2 전산화단층촬영....................................................................64
4.3 자기공명영상.......................................................................69
4.4 혈관조영술...........................................................................77
4.5 신경핵의학...........................................................................79
4.6 신경초음파...........................................................................84
4.7 전기생리학적 검사..............................................................85
4.8 뇌척수액 검사......................................................................89
4.9 신경심리검사.......................................................................91
5. 두개강내압 항진.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
5.1 병태생리...............................................................................93
5.2 두개강내압 항진의 원인과 임상적 의의............................95
5.3 두개강내압 항진의 증상 및 징후.......................................96
5.4 두개강내압의 치료..............................................................97
6. 신경외과 환자관리.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98
6.1 응급 및 중환자 관리............................................................98
6.2 수술 환자 관리...................................................................103
6.3 신경외과 환자의 모니터링................................................117
7. 뇌사와 연명의료중단.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
7.1 뇌사의 정의........................................................................118
7.2 뇌사판정의 역사................................................................118
7.3 뇌사추정자 신고 및 뇌사판정 신청.................................119
7.4 뇌사판정 절차....................................................................119
7.5 뇌사 환자의 관리...............................................................120
7.6 연명의료결정제도..............................................................121

Chapter 02 뇌종양 ...........................................................125
1. 뇌종양의 생물학.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
1.1 뇌종양의 정의....................................................................126
1.2 뇌종양의 발생 원인...........................................................127
1.3 중추신경계 종양의 분류...................................................130
1.4 뇌종양의 생물학과 면역학................................................135
2. 뇌종양 진단.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
2.1 뇌종양의 증상과 징후.......................................................138
2.2 뇌종양의 영상학적 소견...................................................141
3. 뇌종양 치료.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
3.1 수술적 치료........................................................................145
3.2 방사선치료.........................................................................153
3.3 화학요법.............................................................................155
3.4 면역요법 및 유전자 치료..................................................158
4. 신경교종.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
4.1 성인형 미만성 신경교종...................................................159
4.2 소아형 미만성 저등급 신경교종.......................................167
4.3 소아형 미만성 고등급 신경교..........................................167
4.4 경계좋은 성상세포 교종...................................................169
4.5 신경교 및 신경 종양..........................................................172
4.6 뇌실막 종양........................................................................173
5. 뇌수막종.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
5.1 원인 및 분류.......................................................................175
5.2 진단 및 치료.......................................................................178
5.3 부위별 수막종의 특징.......................................................180
6. 뇌하수체 샘종.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185
6.1 역학.....................................................................................185
6.2 발생 부위 및 관련 해부학.................................................185
6.3 병리소견 및 분류...............................................................185
6.4 진단.....................................................................................186
6.5 임상증상.............................................................................188
6.6 치료.....................................................................................190
6.7 예후.....................................................................................191
6.8 뇌하수체졸중.....................................................................191
6.9 뇌하수체 암종....................................................................192
7. 신경초종.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192
7.1 청신경초종.........................................................................192
7.2 기타 신경초종....................................................................198
8. 전이성 뇌종양.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200
8.1 발생 비율 및 분류..............................................................200
8.2 해부학적 전이 부위...........................................................201
8.3 임상소견.............................................................................201
8.4 영상의학적 소견................................................................201
8.5 감별진단.............................................................................202
8.6 치료 방향 설정...................................................................202
8.7 치료 방법............................................................................202
9. 기타 뇌종양.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204
9.1 혈관모세포종.....................................................................204
9.2 단일섬유종양.....................................................................207
9.3 후각신경아세포종 ............................................................208
9.4 원발성 중추신경계림프종.................................................209
9.5 표피모양종과 유피종.........................................................211
9.6 제3뇌실의 콜로이드 낭종.................................................213
10. 두개골 종양 및 두피 종양.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
10.1 골종..................................................................................214
10.2 섬유형성이상...................................................................214
10.3 두개골 표피모양종과 유피종.........................................214
10.4 다발골수종......................................................................215
10.5 골육종..............................................................................215
10.6 연골육종과 척삭종..........................................................216
10.7 파제트병..........................................................................216
10.8 세포조직구증...................................................................216
10.9 전이성 두개골 종양........................................................216
10.10 두피 종양.......................................................................217

Chapter 03 뇌혈관 질환 ................................................221
1. 뇌혈관질환의 개요.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222
1.1 뇌혈관계 해부학................................................................222
1.2 뇌혈관조영술.....................................................................223
1.3 뇌혈관질환의 분류............................................................225
1.4 뇌혈관질환의 빈도 ...........................................................225
1.5 뇌졸중의 위험인자 ...........................................................225
2. 자발성 뇌출혈.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
2.1 자발성 뇌출혈의 원인.......................................................226
2.2 자발성 뇌출혈의 병태생리................................................226
2.3 임상 증상 및 징후..............................................................227
2.4 자발성 뇌출혈의 진단.......................................................227
2.5 자발성 뇌출혈의 치료.......................................................229
3. 뇌동맥류와 뇌지주막하출혈.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230
3.1 뇌동맥류의 개요................................................................230
3.2 뇌지주막하출혈..................................................................232
3.3 뇌동맥류의 진단................................................................235
3.4 뇌동맥류의 치료................................................................238
3.5 비파열 뇌동맥류................................................................240
3.6 박리성뇌동맥류..................................................................241
4. 뇌혈관기형.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
4.1 동정맥기형.........................................................................244
4.2 해면상혈관종.....................................................................248
4.3 정맥기형.............................................................................249
5. 경막동정맥루.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
5.1 개요.....................................................................................250
5.2 해면정맥동 경막동정맥루.................................................251
5.3 횡 및 S상 정맥동 경막동정맥루.......................................252
6. 모야모야병.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253
6.1 임상증상.............................................................................254
6.2 진단.....................................................................................255
6.3 치료.....................................................................................256
6.4 치료성적.............................................................................258
7. 폐쇄성뇌혈관질환.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259
7.1 뇌경색.................................................................................259
7.2 두개강외 경동맥 협착증의 치료.......................................271
7.3 두개강내 혈관폐색 또는 협착증의 치료 ........................272
7.4 뇌정맥 및 정맥동 혈전증의 치료.....................................273

Chapter 04 척추 및 척수 질환 ....................................279
1. 퇴행성 척추질환.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280
1.1 척추 전방 전위증...............................................................280
1.2 요추 척추관 협착증...........................................................282
1.3 후종인대 골화증................................................................284
1.4 경추 척추증........................................................................287
1.5 황색인대 골화증................................................................292
2. 추간판 탈출증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293
2.1 추간판 퇴행성 변화...........................................................293
2.2 경추간판탈출증..................................................................294
2.3 흉추간판 탈출증................................................................298
2.4 요추간판 탈출증................................................................299
3. 전신성 및 염증성 질환.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302
3.1 골감소증과 골다공증.........................................................302
3.2 류마티스 관절염................................................................305
3.3 강직성 척추염....................................................................307
4. 척수 및 척추 종양.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310
4.1 경막내 척수내 종양...........................................................310
4.2 경막내 수외종양................................................................312
4.3 원발성 척추 종양...............................................................315
4.4 전이성 척추 종양...............................................................322
5. 외상성 질환.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .331
5.1 총론·개요 .......................................................................331
5.2 척수 손상............................................................................333
5.3 경추부 골절........................................................................341
5.4 흉요추부 골절....................................................................347
5.5 소아 척추 및 척수 외상.....................................................353
5.6 골다공증성 척추 골절의 치료..........................................358
6. 척수 혈관 질환. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .360
6.1 척수 혈관 질환...................................................................360
6.2 척수 혈관기형....................................................................363
7. 척추와 척수 감염.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366
7.1 추간판염과 경막외 농양...................................................366
7.2 화농성 척추 골수염...........................................................367
7.3 결핵성 척추염....................................................................369
7.4 수술후 척추 감염...............................................................371
8. 척추 변형.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373
8.1 총론(척추변형의 평가 및 분류)........................................373
8.2 경추의 변형........................................................................377
8.3 흉요추 변형........................................................................380
8.4 청소년기 특발성 측만증...................................................382
9. 척추 수술.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .390
9.1 상부 경추 수술(전후방)....................................................390
9.1 상부 경추 후방 접근법......................................................394
9.2 하부 경추 수술 .................................................................398
9.3 흉추 수술(측방, 후방).......................................................403
9.4 요추 수술(전방, 측방, 후방).............................................407
9.5 수술중신경감시..................................................................412

Chapter 05 말초신경 손상 및 치료 ...........................417
1. 총론.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .418
1.1 말초신경의 해부 ...............................................................418
1.2 말초신경의 신호 전달 기전 .............................................419
1.3 말초신경 손상의 병태 생리..............................................419
1.4 말초신경 손상의 분류.......................................................420
1.5 말초신경 손상의 종류와 기전..........................................421
1.6 말초신경 손상의 임상 소견..............................................422
1.7 말초신경 손상의 보조 진단..............................................423
1.8 말초신경 손상의 치료.......................................................424
2. 말초신경 손상.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .425
2.1 상완신경총 손상...............................................................425
2.2 정중신경 손상 ...................................................................427
2.3 요골신경 손상 ...................................................................427
2.4 척골신경 손상....................................................................428
2.5 액와신경 손상 ...................................................................428
2.6 근피신경 손상 ...................................................................429
2.7 하지 말초신경 손상 ..........................................................429
3. 포착성 신경병증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .429
3.1 상지의 포착성 신경병증...................................................429
3.2 하지의 포착성 신경병증...................................................435
4. 말초신경종양.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .438
4.1 신경초종 ............................................................................438
4.2 신경섬유종.........................................................................439
4.3 악성 말초신경종양............................................................440
5. 말초신경 수술의 술기.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .441
5.1 신경박리술 혹은 신경감압술............................................441
5.2 신경봉합술.........................................................................441
5.3 신경치환술.........................................................................443
6. 말초신경 동통.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .444
6.1 분류.....................................................................................444

Chapter 06 두부 외상 .....................................................447
1. 기전.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .448
1.1 생체역학.............................................................................448
1.2 외상의 기전........................................................................448
2. 분류.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .451
2.1 두부 손상의 정도에 따른 분류.........................................452
2.2 두부 손상의 형태에 따른 분류.........................................452
2.3 뇌 CT에 따른 일차 뇌손상 분류......................................453
2.4 병태생리에 근거한 일차 뇌손상과 이차 뇌손상.............453
3. 두부 외상의 진단.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .456
3.1 신경검사.............................................................................456
3.2 신체검사.............................................................................459
3.3 방사선 검사........................................................................459
3.4 기타 검사............................................................................460
4. 경증 두부 외상. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .462
4.1 정의.....................................................................................462
4.2 발생빈도.............................................................................463
4.3 원인 및 위험인자...............................................................463
4.4 진단.....................................................................................464
4.5 치료.....................................................................................466
4.6 예후.....................................................................................466
5. 두부 외상의 내과적 치료.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .466
5.1 이차적 뇌손상.....................................................................466
5.2 두개강내압 상승의 내과적 치료.......................................466
5.3 심부정맥혈전증과 폐색전증.............................................469
5.4 외상 후 응고장애...............................................................469
6. 두피 손상.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .469
6.1 두피손상의 분류 및 치료..................................................469
7. 두개골 골절.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .470
7.1 두개골 골절의 의미...........................................................470
7.2 두개골 골절의 분류...........................................................471
7.3 선상 골절............................................................................471
7.4 분쇄 골절............................................................................472
7.5 함몰 골절............................................................................472
7.6 두개저 골절........................................................................473
8. 외상성 두개강내 혈종.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .474
8.1 경막외혈종.........................................................................474
8.2 경막하혈종.........................................................................475
8.3 뇌내혈종.............................................................................479
8.4 기타.....................................................................................480
9. 두부 외상의 합병증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .483
9.1 외상성 기뇌증....................................................................483
9.2 외상성 뇌척수액루.............................................................484
9.3 감염.....................................................................................485
9.4 혈관 합병증........................................................................486
10. 두개골 성형술.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .488
10.1 두개골 결손.....................................................................488
10.2 두개골 성형술.................................................................489
10.3 소아에서의 두개골 성형술.............................................490
11. 두부 외상의 후유증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .490
11.1 신경정신과적 후유증......................................................490
11.2 외상후 경련과 외상후 뇌전증........................................495

Chapter 07 신경계 감염 ................................................503
1. 세균성 감염.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .504
1.1 두개골 골수염....................................................................504
1.2 세균성 뇌막염....................................................................505
1.3 경막외 농양........................................................................507
1.4 경막하 축농........................................................................507
1.5 뇌농양.................................................................................508
1.6 뇌실염.................................................................................509
2. 바이러스 감염.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .510
2.1 감염 경로............................................................................510
2.2 후천성 면역결핍증.............................................................511
2.3 단순 포진 뇌염...................................................................512
3. 기생충 감염.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .512
3.1 뇌 낭미충증........................................................................512
3.2 뇌 폐흡충증........................................................................514
3.3 뇌 스파르가눔증................................................................514
4. 육아종증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .515
4.1 결핵.....................................................................................515
4.2 사르코이드증.....................................................................516

Chapter 08 소아..................................................................519
1. 소아뇌종양.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .520
1.1 중추신경계종양의 WHO 분류에 대한 소개.......................520
1.2 안장위 종양: 두개인두종과 시신경 교종.........................527
1.3 송과체 부위 종양: 종자세포종양을 중심으로.....................534
1.4 후두와 종양........................................................................537
2. 선천성 기형.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .547
2.1 발생학적 원인 및 분류......................................................547
2.2 신경계 정중선 유합부전....................................................549
2.3 지주막낭종.........................................................................552
2.4 두개유합증.........................................................................555
2.5 후두개와 기형.....................................................................559
2.5 댄디-워커 기형.................................................................560
3. 소아두부외상.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .561
3.1 아동학대.............................................................................561
3.2 두부외상.............................................................................563

Chapter 09 정위신경외과..............................................569
1. 총론.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .570
1.1 목적과 대상........................................................................570
1.2 개념과 원리........................................................................570
1.3 정위 장치의 발전...............................................................571
2. 수술방법.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .571
2.1 정위기구 부착....................................................................571
2.2 영상 촬영............................................................................572
2.3 진입점 및 진입경로 결정..................................................572
2.4 표적 결정............................................................................573
3. 수술의 종류.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .574
3.1 기능적 정위수술................................................................574
3.2 비기능적 정위수술............................................................575
4. 기능수술의 발전.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .578
4.1 N avigation-Guided stereotactic
neurosurgery (뇌항법수술)........................................... 578
4.2 R obotic arm based stereotactic
neurosurgery............................................. 580
5. 정위적방사선수술.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .584
5.1 총론.....................................................................................584
5.2 방사선수술의 개념과 원리................................................587
5.3 정위적방사선수술 장비.....................................................587
5.4 정위적방사선수술 적응증.................................................587
5.5 정위적방사선수술 치료과정.............................................590
5.6 정위적방사선수술 합병증.................................................590
6. M R-guided transcranial focused
ultrasound surgery..................................................................590
6.1 총론.....................................................................................590
6.2 개념과 원리........................................................................590
6.3 FUS 수술장비....................................................................591
6.4 MRgFUS thermal lesioning 적응증.........................592
6.5 MRgFUS thermal lesioning 치료과정......................592
6.6 MRgFUS thermal lesioning 치료효과.....................592
6.7 MRgFUS thermal lesioning 합병증.........................593

Chapter 10 기능신경외과..............................................597
1. 통증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .598
1.1 통증의 개요........................................................................598
1.2 통증의 정의........................................................................598
1.3 통증의 생리학....................................................................598
1.4 통증의 분류, 유형과 증상.................................................606
1.5 통증 진단 및 임상 평가.....................................................608
1.6 급성 통증 및 만성 통증의 치료 ......................................610
2. 이상운동질환.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .613
2.1 총론.....................................................................................613
2.2 운동질환의 종류와 병태생리............................................614
2.3 운동질환의 약물적 치료...................................................615
2.4 운동질환의 수술적 치료...................................................615
2.5 운동질환의 보존적 치료...................................................617
3. 뇌전증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .618
3.1 총론.....................................................................................618
3.2 발작과 뇌전증의 분류.......................................................618
3.3 뇌전증의 진단방법............................................................622
3.4 뇌전증의 약물적 치료.......................................................623
3.5 뇌전증의 수술적 치료.......................................................626
3.6 뇌전증 수술의 종류...........................................................628
4. 경직.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .631
4.1 정의.....................................................................................631
4.2 경직의 병태 생리...............................................................632
4.3 경직의 평가........................................................................632
4.4 경직의 치료........................................................................633
5. 정신수술.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .637
5.1 정신수술의 역사적 배경...................................................637
5.2 정신질환에서 관찰되는 뇌신경망의 이상.......................638
5.3 우울증에 대한 정신수술...................................................639
5.4 강박증에 대한 정신수술...................................................640
5.5 기타 정신질환의 수술적 치료..........................................640
6. 뇌신경근병증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .641
6.1 총론.....................................................................................641
6.2 뇌신경근병증의 병태생리.................................................641
6.3 반측성 안면연축................................................................642
6.4 삼차신경통.........................................................................644
6.5 기타 뇌신경근병증............................................................646
7. 도수의학.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .647
7.1 정골의학.............................................................................647
7.2 카이로프랙틱.....................................................................647
7.3 기능신경학.........................................................................648
7.4 도수치료의 정의와 분절 및 신체의 기능 장애.......................648
7.5 한국에서의 도수치료.........................................................649

Chapter 11 수두증 및 인지장애...................................657
1. 수두증.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .658
1.1 병태생리 ............................................................................658
1.2 임상 증상과 징후 ..............................................................660
1.3 수두증의 진단....................................................................661
1.4 치료.....................................................................................662
1.5 특발성 정상압 수두증.......................................................665
2. 인지장애, 치매.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .668
2.1 치매의 정의........................................................................668
2.2 치매의 분류........................................................................668
2.3 알츠하이머의 병태생리.....................................................669
2.4 치매의 임상양상................................................................670
2.5 치매신경심리검사..............................................................672
2.6 정신행동장애.....................................................................676
2.7 치매 약물 및 치료..............................................................677
2.8 치매관리국가시스템..........................................................680

Chapter 12 신경질환의 장애평가..............................685
1. 장애평가의 목적과 원칙.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .686
1.1 장애평가의 목적................................................................686
1.2 장애의 개념........................................................................686
1.3 우리나라 장애평가의 특징................................................686
1.4 장애평가보고서의 역할 ...................................................687
1.5 장애평가의 원칙 ...............................................................687
1.6 의료감정서(장애진단서) 기재내용...................................688
1.7 장애평가시기.....................................................................688
1.8 중복장애의 평가(두 가지 장애율 병산법).......................689
2. 중추신경(뇌병변, 척수병변) 장애평가.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .689
2.1 맥브라이드(뇌, 척수병변) 장애 판정...............................689
2.2 AMA 중추신경계(뇌, 척수병변) 장애 판정.....................691
2.3 대한의학회 중추신경계(뇌, 척수병변) 장애 판정..........691
2.4 장애인복지법 중추신경계(뇌, 척수병변) 장애 판정 .....695
2.5 산 업재해보상법 중추신경계(뇌, 척수병변)
장애 판정 기준................................................................. 696
2.6 생명보험 중추신경계(뇌, 척수병변) 장애 판정 .............697
3. 척추장애평가.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .698
3.1 맥브라이드 척추장애판정.................................................699
3.2 AMA 척추장애 판정........................................................701
3.3 대한의학회 척추장애판정.................................................703
3.4 장애인 복지법 척추장애 판정..........................................707
3.5 산업재해 보상법 척추장애 판정.......................................707
3.6 생명 보험 척추장애 판정..................................................708
4. 신체장애평가 시 알아야 할 사항들.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .709
4.1 직업계수 ............................................................................709
4.2 한시적(일시적) 장애와 영구적 장애 ..............................710
4.3 관여도(기여도)..................................................................710
4.4 개호.....................................................................................711
4.5 여명.....................................................................................711
4.6 향후 치료 내역 및 예상 비용산출....................................712
5. 맺음말.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .712