저의 신경외과 전공의 시절을 되돌아 볼 때, 1년 차 첫 날, 기본적인 서류 처리부터(입원 환자 및 수술 환자에게 필요한 처방과 진단명, 수술코드 등) 쉽지 않았습니다. 과도한 업무량과 공부를 동시에 해내야 하는 전공의의 현실에서, 도움을 받을 수 있는 책이 딱히 없다는 사실이 가장 큰 문제점이었습니다. 기존 신경외과 교재들은 이해하기 쉽지 않거나 너무 분량이 많거나 혹은 너무 기본적인 내용만 다룬 경우가 많아, 현실적인 임상 적용에는 한계가 많았습니다. 보다 알차고 체계화 된 신경외과 메뉴얼의 절실한 필요성을 절감하여, 현실에 맞는 진료지침을 제시하고자 이 책을 씁니다.
이 책은 환자를 치료하면서 필요한 현실적인 지침들(입원 환자 및 수술 환자에게 필요한 처방과 진단명, 수술코드)이 잘 정리되어 있습니다. 진단과 치료를 중심으로 현장에서 적용되는 각종 지식 및 술기 등을 가능한 생생하게 그림으로 잘 설명하고 있습니다.
임상 적용 이론과 실제를 쉽게 조화시켰기에 신경외과학적 진찰에 익숙하지 않은 신입 신경외과 전공의뿐만 아니라 타과의사와 의과대학 학생들도 빠른 시간 내에 쉽게 신경외과적 지식을 이해하고 습득할 수 있게 구성되어 있습니다.
이 작은 책자가 신경외과 전공의 및 관계 의료진 뿐 아니라 의과대 학생들에게도 유용한 길잡이가 될 것을 소망하며, 저의 시간과 노력을 아낌없이 보냅니다.
마지막으로 본 책자를 위해 도움을 주신 출판사 관계자분들과 사랑하는 가족에게도 깊은 감사를 드립니다.
Contents
머리말 · ···························································································· iii
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PART 1 신경외과학에 대한 이해
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Chapter 01 신경외과 영역에서 필요한 기본 Anatomy • 3
1. Skull surface anatomical point· ························································· 4
2. Skull base foramen & Cranial nerve·················································· 5
3. Brain surface·················································································· 6
4. Vascular anatomy········································································· 11
5. CSF pathway· ·············································································· 24
6. Chiasmatic cistern········································································· 25
7. Cranial nerve(12신경)····································································· 26
쉬어가는 코너: 상처 치료에 있어 파상풍 예방 지침의 요약················ 32
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Chapter 02 신경외과 영역에서 자주 쓰이는 Scale • 33
1. 의식의 단계 및 종류······································································· 34
2. Glasgow coma scale· ··································································· 35
3. SAH(Subarachnoid hemorrhage) 관련 grade· ·································· 37
4. AVM(Avascular malformation) 관련 scale(The Spetzler-Martin scale)·· 38
5. Suzuki classification of Moyamoya disease······································ 39
6. TLICS(Thoracolumbar injury classification & severity scale)················ 40
7. Asia scale···················································································· 41
8. Hoehn & Yhar grade····································································· 42
9. UPDRS motor scale······································································· 43
10. NIHSS(National institutes of health stroke scale)· ····························· 47
11. Visual analog scale· ···································································· 49
12. 오스웨스트리 요통장애 지수(Oswestry disability index)····················· 50
쉬어가는 코너: 포클랄 시럽에 대해서 알아보자.· ···························· 53
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Chapter 03 Spine 신경학적 검사 • 55
1. Dermatome· ················································································· 56
2. 추간판 탈출증··············································································· 57
3. Cord inury type· ··········································································· 60
쉬어가는 코너: 매독... 어떤검사? 처방은 어떻게?··························· 63
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Chapter 04 외과 영역에서 필요한 치료 처방 가이드 라인 • 65
1. 고혈압·························································································· 66
2. 이상지혈증· ·················································································· 72
3. 당뇨병·························································································· 75
4. 부신기능 부전증(Addison병) 또는 다른 원인으로 스테로이드를 복용하고 있는 경우·······································································82
5. Timeline for Warfarin and LMWH bridging at surgery························ 83
6. 약제별 상품명 정리········································································ 86
쉬어가는 코너: 뱀에게 물렸을 경우 치료법···································· 89
Chapter 05 약물을 이용한 통증관리 • 91
1. 비마약성 진통제············································································ 92
2. 마약성 진통제··············································································· 94
3. 진통보조제··················································································· 95
쉬어가는 코너: 설사 비켜... Loperamide 투여방법· ························ 98
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Chapter 06 신경외과에서 기본이 되는 감염 치료 • 99
1. 항생제 사용의 일반원칙································································ 100
2. 항생제의 실제적 사용·································································· 103
3. 폐렴의 항생제 사용법··································································· 110
4. 패혈증의 실제적인 치료································································ 116
5. 항결핵제···················································································· 121
6. 기타 항균제· ··············································································· 125
7. 항 바이러스제· ············································································ 126
8. 항진균제 · ·················································································· 129
쉬어가는 코너: 신경외과에 관련된 알짜 지식, 혹시 알고 계셨나요?··· 131
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Chapter 07 신경외과 영역에서 수술 후 Management • 133
1. 기본 Pre-Op., Post.-Op. order····················································· 134
2. NS ICU 기본 order form······························································· 136
3. TFCA order················································································ 138
4. DBS, thalamotomy, palidotomy order············································· 139
5. Balloon test occlusion 방법· ························································· 140
6. CAS(carotid artery stent) periprocedural management· ··················· 141
7. CEA(carotid endarterectomy)의 postoperative care and management of complication······················································ 142
8. Tumor embolization technique······················································ 143
9. Balloon remodeling technique· ····················································· 144
쉬어가는 코너: Swllowing test 진행방법 및 PEG 이후관리··········· 145
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Chapter 08 신경외과에서 필요한 처방 및 기타 Management • 147
1. AED principle· ············································································ 148
2. Status epilepticus management···················································· 150
3. 소아경련 Management································································· 152
4. Mannitol effect· ··········································································· 153
5. SIADH 진단과 치료······································································ 155
6. 임신관련 Medication···································································· 156
7. t-PA(tissue plasminogen activator) 사용법······································ 159
8. Extracranial vertebral artery disease management· ························ 160
9. Intracranial artherosclerosis management· ·······································161
10. ICH BP control·········································································· 162
11. SAH general care· ···································································· 163
12. Dural AVF 치료········································································· 164
13. Carvernous malformation management········································ 165
14. 뇌종양 환자의 수술 전 스테로이드 투여 및 AED(antiepileptic drug)··· 166
15. 뇌종양 Regimen········································································ 166
16. Acute SCI(spinal cord injury)시 steroid megadose therapy의 indication 및 dosage································································· 167
17. Skull tong traction(경추 견인술)···················································· 172
18. Osteoporosis medication···························································· 174
19. Barbiturate coma therapy dosing regimen(Thiopental)··················· 174
20. Wernicke’s Encephalopathy 치료· ················································175
21. 뇌수막염 포인트 치료· ································································ 176
22. 치매 치료의 보험기준································································· 179
23. 신경외과 무의식환자 간호 요약···················································· 184
24. Parkinson’s disease medical therapy··········································· 187
쉬어가는 코너: 딸꾹... 딸꾹... Hiccup medication························ 189
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Chapter 09 의사라면 알아야 하는 필수 처방 및 Management • 191
1. Anaphylaxis management···························································· 192
2. 순환기 관련 management· ··························································· 193
3. Pulmonary thromboembolism ······················································ 196
4. Deep vein thrombosis 치료·························································· 196
5. 수액 요법 실제············································································ 197
6. 투여금기···················································································· 203
7. 신경외과 Pediatric 처방모음 ························································· 205
8. 저체온증의 실질적인 치료····························································· 206
9. 천식의 평가 및 기본 치료······························································ 209
10. 편두통의 치료· ·········································································· 212
11. 약물중독 환자에서 실질적인 대처법·············································· 214
12. 실신의 평가·············································································· 217
13. 소아 기본 처방예· ······································································ 219
14. 수혈 가이드라인· ······································································· 221
15. ABGA 분석법············································································ 234
16. 대사성 산증 치료······································································· 237
쉬어가는 코너: 불면증 치료····················································· 240
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Chapter 10 신경외과 영역에서 기본 술기 • 241
1. Endotracheal intubation· ······························································ 242
2. Tracheostomy············································································· 243
3. Cricothyroidotomy· ······································································ 245
4. C-line······················································································· 246
5. 흉관삽입···················································································· 249
6. 요추천자· ··················································································· 253
7. 척수마취(Spinal block), 경막외마취(Epidural block)· ························· 255
8. EVD management······································································ 257
쉬어가는 코너: 위세척 및 활성탄 투여 방법································· 259
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PART 2 신경외과학 중요 내용 정리
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Chapter 01 총론 • 263
1. Braodmann area········································································· 264
2. Lundberg 의 ICP classification······················································ 266
3. Abnormal respiratory patterns· ····················································· 267
4. Brain herniation··········································································· 267
5. 뇌사판정기준···············································································268
6. Brain MRI에서 primary motor cortex를 찾는 방법···························· 269
7. Cytoxic edema VS Vasogenic edema ·········································· 270
8. Indication for intracranial pressure monitoring································· 270
9. ICH volume measurment······························································ 271
10. Upper motor neuron vs lower motor neuron · ······························ 271
11. CBF 공식·················································································· 272
12. Cellular consequences of impaired CBF······································ 272
13. Cerebral physiology· ································································· 273
14. Brain energy metabolism parameter············································ 273
15. Internal capsule········································································· 274
16. Physiologic calcification······························································ 275
17. Thalamus················································································· 276
18. Monro-Kellie doctrine································································ 279
쉬어가는 코너: 조영제... 부작용 가능성은 희박하지만 그래도 조심하자!!!································································· 280
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Chapter 02 혈관 • 281
1. TCD(Transcranial doppler)···························································· 282
2. TCD(Transcranial doppler) 활용···················································· 283
3. Recommendation CEA(carotid endarterectomy) for the following patients······················································································ 284
4. Key point of ruptured aneurysm on multiple aneurysms·················· 285
5. Limited successful EVT(endovascular treatment) for aneurysm· ······· 285
6. Factors associated with Rupture of Unruptured aneurysm··············· 286
7. CCF(carotid-cavernous fistula)· ···················································· 287
8. ICA와 dangerous anastomosis 할 수 있는 ECA······························ 289
9. Cranial nerver common arterial supply·········································· 289
10. A shift of the anterior cerebral vessel··········································· 290
쉬어가는 코너: 인공호흡기(Ventilator) 간단 정리· ························ 292
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Chapter 03 종양 • 293
1. Pituitary adenoma······································································· 294
2. CPA tumor 수술 후 facial palsy····················································· 295
3. Metastatic brain tumor· ································································ 296
4. Meningioma Simpson grade· ······················································· 297
5. Meningioma 수술 후 RT 하는 경우················································ 297
6. Germ cell turmor(germinoma, chorioca, endodermalsinus tumor, teratoma)· ············· 298
쉬어가는 코너: COPD(Chronic obstructive disease)관련 management··········································································· 300
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Chapter 04 척추 • 301
1. 화농성 척추염과 결핵성 척추염 감별·············································· 302
2. 화농성 척추염 특징· ···································································· 302
3. Spinal Shock, Neurogenic Shock, hypovolemic shock의 차이점······ 303
4. 척추골절 종류············································································· 304
5. Transverse myelitis······································································ 308
6. 신경인성 파행과 혈관인성 파행· ···················································· 310
7. Cervical myelopathy···································································· 311
8. Osteoporotic compression fracture················································ 312
9. 척수종양의 분류·········································································· 313
10. Spondylolisthesis······································································· 314
11. Modic 's classification································································· 314
12. Pure lig. injury and AOD(atlanto-occipital dislocation)의 radiographic diagnosis·················································································· 315
13. Recurred disc와 epidural scar DDx.················································ 318
14. Pseudoarthrosis VS nonunion························································ 318
15. Anterior cervical instrumentation 시 이용할 수 있는 external anatomical landmark······················································································ 318
16. Spinal column을 침범한 전이성 종양의 일반적 치료원칙······················ 319
17. 척추 방사선 치료시에 radiation myelopathy······································· 320
18. OPLL(ossification of posterior longitudinal ligament)··························· 321
쉬어가는 코너: PT(물리 치료) 처방은 무엇이 있을까?···················· 322
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Chapter 05 소아 • 323
1. Arachnoid cyst··········································································· 324
2. 소아 척수종양 성인과 비교· ·························································· 325
3. 소아 scoliosis·············································································· 326
4. Encephalocele· ·········································································· 327
5. Dandy-Walker synd.··································································· 328
6. Chiari malformation······································································ 329
7. Myelomeningocele······································································ 331
8. Myelocystocele··········································································· 332
9. Lipomyelomeningocele ······························································· 333
10. Split spinal cord· ······································································· 335
11. Tetherd spinal cord···································································· 335
12. Dermal sinus tracts···································································· 335
13. Pattern of craniosynostosis························································· 336
14. 출생시 외상성 뇌손상································································· 337
15. Grisel's syndrome······································································ 338
쉬어가는 코너: 테이핑 요법을 아시나요?····································· 339
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Chapter 06 외상 • 341
1. 뇌혈종의 자기공명영상에 있어 시기별 신호강도의 소견 및 heme iron의 대사상태··················································································· 342
2. `Traumatic brain injury 환자에 있어 Indication for evacuation of intracranial hematoma· ······························································· 343
3. Indication for surgery(brain hemorrhage)· ······································ 344
4. 수술도중 뇌가 심하게 부어 오를 때의 management························· 346
5. Ventriculostomy landmark···························································· 347
6. Temporal bone fracture· ······························································ 348
7. Chronic SDH· ············································································· 349
쉬어가는 코너: 소아의 해열제 부르펜 용량·································· 350
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Chapter 07 말초 • 351
1. Nerve inury grading(Sunderland grading system)··························· 352
2. Brachial plexus··········································································· 352
3. EMG 설명··················································································· 353
4. Carpal tunnel syndrome(CTS)······················································· 354
5. Cubital tunnel syndrome······························································ 357
6. Pelvic nerve entrapment······························································ 358
7. Common peroneal nerve entrapment············································ 359
8. Tarsal tunnel synd.······································································ 359
쉬어가는 코너: 삼차신경통의 치료법? 개두술이 꼭 필요한가?·········· 360
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Chapter 08 정위 • 361
1. Tremor······················································································· 362
2. Tremor 양상에 따른 구분····························································· 362
3. BG(basal ganglia) 구성································································ 363
4. Parkinson disease mechanism····················································· 364
5. Parkinson disease DBS inclusion criteria······································· 365
6. Spasmodic torticollis 치료 ··························································· 366
7. Pain 기전··················································································· 367
8. DDX. TN vs atypical facial pain vs RSD(reflex sympathetic dystrophy of the face)················································································ 368
9. NPH, alzheimer's disease, Binswanger's disease 감별····················· 368
10. Optic neuritis············································································· 369
11. Neuroulogy··············································································· 370
12. Headache················································································ 371
쉬어가는 코너: 이상운동증의 약물치료······································ 372
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PART 3 부록
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의사라면 꼭 숙지해야 할 기본 서류 • 376
1. 진단서 작성················································································ 376
2. 사망진단서 작성· ········································································· 379
신경외과 영역에서 필요한 수술 동의서 • 385
1. 개두술 및 종양 제거술 수술 동의서················································ 385
2. 개두술 및 혈종제거술 수술 동의서················································· 387
3. 개두술, 동맥류 결찰술 및 혈종 제거술 수술 동의서··························· 389
4. 경접형동 접근법 및 종양 제거술 수술 동의서··································· 391
5. 두개 천두술 및 혈종 배액술 수술 동의서········································· 393
6. 뇌정위수술 및 혈종 제거술 수술 동의서·········································· 395
7. 개두술 및 농양 제거술 수술 동의서· ··············································· 397
8. 현미경 미세술을 통한 추간판 제거술 수술 동의서····························· 399
9. 신경관 감압 후궁 절제술 수술 동의서············································· 401
10. 현미경 미세술을 통한 추간판 제거술 및 후궁 절제술, 나사못 고정술 수술 동의서··············································································· 403
11. 뇌심부 자극술에 대한 수술 동의서· ·············································· 405
12. 삼차신경통 시술(풍선압박술)에 대한 동의서··································· 407
13. 연축성 사경의 말초신경차단술 수술 동의서· ·································· 410
14. 정위수술(수전증) 수술 동의서······················································ 412
15. 두개골성형술 수술 동의서··························································· 414
16. 대퇴동맥 뇌혈관 촬영술 동의서···················································· 414
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신경과 및 신경외과에서 필요한 혈액검사 • 415
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MRI 의료 보험 혜택 • 424
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희귀난치성 질환목록(107개) • 425
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신경외과 영역에서 자주 쓰는 상병명 • 433
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신경외과 영역에서 자주 쓰는 수술코드 • 474
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신경외과 영역에서 민감한 차트정리 • 488
1. Brain관련 admission note····························································· 488
2. Cervical lesion admission note····················································· 490
3. Lumbar lesion admission note······················································ 491
4. 삼차신경통 차트·········································································· 492
5. STN DBS 차트정리 예시······························································· 493
6. Dystonia DBS 차트정리································································ 499
7. Meige Synd. DBS 차트 정리························································· 506
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찾아보기······················································································· 511
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