Gliomatosis Cerebri : Clinical Features and Prognostic Factors of Long-term Survival

설호준,정희원,김동규,황성균,양희진,김민경 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.2

원발성 뇌실내 임파종 -증례보고-

설호준 ( Ho Jun Seol ),박승우 ( Seoung Woo Park ),김광기 ( Kwang Ki Kim ),박성혜 ( Sung Hye Park ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.1

The incidence of primary central nervous system lymphoma(PCNSL) is increasing, however, primary ventricular involvement is very rare. We report a rare case of intraventricular PCNSL in a 76 year-old male who presented with cognitive dysfunction. Brain magnetic resonance imaging showed enhancing nodular lesions in both frontal horns and right temporal horn of lateral ventricle. Diffuse large B-cell lymphoma was confirmed by endoscopic biopsy. No evidence of parenchymal central nervous system or systemic lymphoma was identified throughout the course of disease.

상의하 파종을 보인 재발성 상의하세포종의 증례 보고

설호준 ( Ho Jun Seol ),황승균 ( Sung Kyun Hwang ),최윤라 ( Yoon La Choi ),지제근 ( Je G Chi ),정희원 ( Hee Won Jung ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Subependymoma is a rare, slow growing, rarely recurrent tumor. We report a case of recurrent subependymoma with subependymal seeding. An intraventricular tumor in the left temporal horn was detected in a 48-year-old female who presented with a 4-year history of dizziness and memory disturbance. Following near total surgical resection, a tumor diagnosis of subependymoma was confirmed by scattered clusters of isomorphic nuclei embedded in a dense fibrillary matrix of glial cell processes. Twenty six months after surgery, follow-up(F/U) magnetic resonance(MR) imaging revealed tumor recurrence in the previous site which necessitated linear accelerator radiosurgery(LINAC). A further 21 months later, F/U MR imaging showed recurrent, multiple, enhanced, nodular lesions in the enlarged left lateral ventricle for which the patient underwent reoperation. Radiological and operative findings revealed local relapse with subependymal seeding. The pathological finding was similar to that of the previous tumor and compatible with subependymoma. Immunohistochemical studies revealed that glial fibrillary acidic protein(GFAP) was positive and CD-99 was negative. The patient underwent radiation therapy for the residual tumor. This case history suggests that symptomatic residual tumors require close observation even though the clinical course of subependymoma is usually benign.

중간 크기 이상의 전정신경초종에서의 적절한 수술적 접근법

설호준(Ho Jun Seol) 대한두개저학회 2019 대한두개저학회지 Vol.14 No.1

Traditional surgical approaches to larger than medium-sized vestibular schwannomas (VSs) were retrosigmoid suboccipital craniotomy in neurosurgical area. The approach has plenty of advantages for these tumors, however, several disadvantages such as cerebellar retraction injury, postoperative headache, hydrocephalus, etc. Therefore, most of otolaryngologists and some neurosurgeons have used posterior transpetrosal approaches like translabyrinthine one to diminish the above complications. The selection of the surgical approaches is not the issue of the department, but the experience as well as rational basis. Thus, I reviewed these approaches for the medium- or larger VSs to understand how to choose the appropriate approaches.

Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp Grading System

황주영,설호준,남도현,이정일,이민호,공두식 대한뇌종양학회 2016 Brain Tumor Research and Treatment Vol. No.

Background Non-functioning pituitary adenomas (NFPA) invading into the cavernous sinus are surgically challenging. To decrease recurrence rate, surgeon makes a strong endeavor to resect tumor gross totally. However, gross total resection (GTR) is difficult to achieve with cavernous sinus invasion. Recently, a new classification system for cavernous invasion of pituitary adenomas was suggested. The aim of this study is to validate this new classification system and to identify limitations and considerations in designing treatment strategies for patients with NFPA involving the cavernous sinus. Methods Between January 2000 and January 2012, 275 patients who underwent operation for NFPA were enrolled in the study. Median age was 50 years (15–79 years). There were 145 males and 130 females. The median follow-up duration was 4 years (range 1–12.5 years). Results Related to extent of tumor removal, GTR was obtained in 184 patients (66.9%), near total resection (NTR) was obtained in 45 patients (16.3%), and sub-total resection (STR) was obtained in 46 patients (16.7%) of a total 275 patients. There were statistically significant differences between the extent of resection and the new Knosp classification (p<0.001). In the high-grade group of the new Knosp classification, there was no difference in recurrence between patients who underwent GTR or NTR only and those who underwent STR with adjuvant radiation therapy (p=0.515). Conclusion In case of high risk of surgical complications, STR with adjuvant radiation therapy can be considered as an alternative strategy for safe treatment of cavernous-invading adenomas.

Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea

김병섭,설호준,남도현,박철기,김일한,김태민,김정훈,조영현,윤상민,장종희,강석구,김의현,서창옥,정태영,이경화,김재용,김인아,홍창기,유헌,김진희,강신혁,강민규,김은영,김선환,정동섭,황선철,송준호,조성진,이선일,이연수,안국진,김세훈,임도훈,곽호신,이세훈,홍용길 대한암학회 2017 Cancer Research and Treatment Vol.49 No.1

Purpose The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. Materials and Methods A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. Results After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. Conclusion Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.

의료과오 사례를 이용한 환자안전 교육

노혜린,설호준,강성식,서인범,류세민 한국의학교육학회 2008 Korean journal of medical education Vol.20 No.3

Purpose: To draw attention to patient safety and increase its awareness among medical students, we developed a program that teaches patient safety based on common medical error cases. The aim of this study is to introduce this program and improve student receptivity to it. Methods: As part of the “Patient, Doctor, and Society” course, third-year medical students participated in 8 hours of a medical error education program. Students discussed recent, typical medical lawsuits that were generated from internal medicine, surgery, pediatrics, obstetrics and gynecology, neurosurgery, medication, anesthesia, and blood transfusion cases. Students weighed these issues in small groups, using various discussion methods. After finishing the program, students completed a course evaluation questionnaire. Results: The students rated this program as satisfactory, highly motivating, and helpful in preparing their future practices. They responded that although the cases were interesting, some were difficult. They stated that the small group discussion techniques encouraged them to take active part in the discussion and to consider the cases more deeply. Conclusion: Small group discussion of medical error cases is an effective method for students to study patient safety.

Genetically engineered human neural stem cells with rabbit carboxyl esterase can target brain metastasis from breast cancer

강원영,설호준,진주연,양희경,남도현 한국실험동물학회 2012 한국실험동물학회 학술발표대회 논문집 Vol.2012 No.8

Recurrence and Facial Nerve Function in Relation to the Extent of Resection of Vestibular Schwannoma Surgery

김충효,정희원,설호준,김치헌,김동규 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.3

Objective : The aims of the surgical treatment of vestibular schwannoma are complete removal with preserving facial nerve function. Complete removal, however, carries significant risk of facial nerve palsy. Alternatively with subtotal removal of tumor, recurrence rate was known to be high. The objective of this study was to assess the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection. Methods : From 1990 to 1999, 125 cases of vestibular schwannoma were retrospectively reviewed. The degree of resection was classified as gross total resection (GTR), near total resection (NTR), Subtotal resection (STR). The tumor recurrence or re-growth was determined by the increase in its greatest dimension on follow-up imaging studies. Facial nerve function was graded with the modified House-Brackmann Grade postoperatively. For clinical comparison, these were grouped into the categories : good ; grade 1-2, intermediate or poor; 3-6. Results : Of the 125 patients, 28(22%) underwent GTR, 37(30%) had NTR, and 60(48%) had STR. The recurrence rate were 3.5% (1 of 28), 7.8% (3 of 37) and 28% (16 of 60) for GTR, NTR and STR. GTR and NTR showed no statistical difference in recurrence rate (P=0.628). However NTR had less recurrence rate than STR (P=0.034). The postoperative good facial nerve function achieved in 22% of GTR, 53% of NTR and 53% of STR. NTR had lower risk of facial nerve palsy than GTR(P=0.028). Conclusion : In treating vestibular schwannoma, NTR had higher facial nerve sparing rate than GTR without significantly increasing the recurrence rate. NTR is a good surgical strategy.

Clinical and Radiological Characteristics of Angiomatous Meningiomas

황주영,공두식,설호준,남도현,이정일,최정원 대한뇌종양학회 2016 Brain Tumor Research and Treatment Vol. No.

Background Angiomatous meningioma is a rare histological subtype of meningioma. Therefore, this specific medical condition is rarely reviewed in the literature. In the present work, we report the clinical and radiological features with postoperative outcomes of angiomatous meningioma. Methods This retrospective study included the patients who were pathologically diagnosed with angiomatous meningioma after surgical resection between February 2010 and September 2015 in our institute. We analyzed the clinical data, radiological manifestation, treatment and prognosis of all patients. Results The 15 patients (5 males and 10 females) were diagnosed with angiomatous meningioma during the study period. The median age of patients at the time of surgery was 63 years (range: 40 to 80 years). According to Simpson classification, 7, 5, and 3 patients achieved Simpson grade I, II, and IV resection, respectively. In the follow-up period, recurrence was noted in one patient. Ten out of the 15 patients showed homogeneous enhancement. Two patients demonstrated cystic changes. There was no occurrence of calcification or hemorrhage in our patients. Characteristically, 14 out of 15 patients showed signal voids of vessels. Significant peritumoral edema was observed in the majority of tumors (67%). Conclusion Angiomatous meningiomas are rare benign meningioma. Brain images of angiomatous meningioma usually demonstrate signal void signs and peritumoral edema. In the present study, angiomatous meningiomas showed good prognosis after surgical resection.