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이채혁(Chae Heuck Lee) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.2
Schwannomas arising from the geniculate ganglion are very rare. The author report the clinical feature, image and surgical findings of facial nerve schwannoma originated from the geniculate ganglion. The clinical feature was right facial paralysis for five years. Imaging study revealed a mass on the cerebellopontine angle, meatal, labyrinthine, geniculate, and greater petrosal portion of the petrous bone. Subtotal tumor removal with intraoperative facial nerve monitoring was done through a subtemporal extra- and intradural approach. Anatomical relationship of the facial nerve at the petrous temporal bone, clinical presentation, differential diagnosis, and management are discussed.
임상 : 역형성 핍지교종 환자의 치료 결과에 관한 연구
이성호 ( Sung Ho Lee ),고영초 ( Young Cho Koh ),최우진 ( Jin Woo Choe ),조요한 ( Yo Han Cho ),노홍기 ( Hong Gee Roh ),홍세미 ( Se Mi Hong ),임소덕 ( So Duck Lim ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2
Objects:To evaluate prognostic impacts of surgical extent, postoperative Karnofsky performance status(KPS), and chemotherapy( CTx) in patients with anaplastic oligodendroglioma(AO), the authors analyzed the overall survival(OS) and progression free survival(PFS) in these patients according to those factors. Methods:Twenty nine patients with AO, who had undergone surgery by a single surgeon at the three university hospitals where the senior author had been active staff during the last 20 years, were enrolled in this retrospective analysis. Maximal safe resection was tried in all cases with or without neuronavigation techniue. The extent of removal was evaluated by immediate postoperative MRI. Impact of surgical extent, CTx, and postoperative KPS were evaluated on the OS and PFS in these patients. Results:Thirteen men and 16 women patients with the mean age at the diagnosis of 42.9 years(7-71 yrs) were included in this study. The mean follow-up duration was 61.8 months(3-237 months) and 12 patients died of tumor progression during the follow-up. There was no operative mortality. Gross total resection(GTR) was done in 15 patients, and either subtotal resection(STR) or partial resection(PR) was done in 14 patients. Of the 29 patients 26 were subjected to conventional radiotherapy(RT). The three remaining patients in poor KPS, less than 60, didn`t undergo RT. Twenty patients were subjected to CTx either with PCV(procarbazine, CCNU, vincristine) or Temozolomide(TMZ). Nineteen patients tolerated well the CTx with mild to moderate hematological or other toxicities and could finish the 6 or 7 cycles of PCV or TMZ. During the follow-up, tumor recurrences had been observed in 13 patients, for whom additional operations and /or salvage CTx were tried. GTR affects significantly on OS and PFS(p<0.01). Good postoperative KPS was also favorable for OS and PFS(p<0.05). Adjuvant CTx either with PCV or TMZ in addition to RT in patients with AO was not statistically significant prognostic impact for OS and PFS in this study(p>0.05). Conclusion:From this single-surgeon-operated series, the authors could confirm significant prognostic impacts of radical surgery, and good postoperative KPS in patients with AO on PFS and OS.
다발성 원발 악성종양 및 다형성 교모세포증을 동반한 환자에서 발생한 원격 부상 신경교종 증후군 -증 례 보 고-
최현준 ( Hyun Jun Choi ),최찬영 ( Chan Young Choi ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회 대한신경종양학회 2014 Brain Tumor Research and Treatment Vol.2 No.1
It has been well known that postoperative hemorrhage can occur in the surgical bed, especially after incomplete resection of highly vascularized tumor, such as glioblastoma. A 55-year old female patient who has breast cancer and multifocal glioblastoma mimicking brain metastasis together showed postoperative hemorrhage in the surgical bed and spontaneous postoperative bleeding of remote tumor site, which was called distant wounded glioma syndrome. In multifocal glioblastoma, histological confirmation may be necessary to differentiate from brain metastasis, even in the presence of a known primary malignancy of other organ. Perioperative careful examination for patient`s coagulation system may also be necessary to prevent or treat distant wounded glioma syndrome.
전두부 두개골을 침범한 염증성 근섬유모세포종 -증례보고-
김태호 ( Tae Ho Kim ),최우진 ( Woo Jin Choe ),이승준 ( Seung Jun Lee ),이종주 ( Jong Joo Rhee ),이혜경 ( Hye Kyung Lee ),이채혁 ( Chae Heuck Lee ),김명수 ( Myoung Soo Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.1
Inflammatory myofibroblastic tumor(IMT) includes a diverse group of lesions characterized by inflammatory cell infiltration and variable fibrotic responses, which mimic neoplastic lesions. IMTs of the head and neck occur most commonly in the orbits, and their occurrence in the skull is rare. To our knowledge, only eight cases of IMTs of the skull(excluding cases in the eye and maxillary sinus) have been reported in Korea. We report a case of IMT involving the frontal bone. A 43-year-old man presented with right frontal pain. A right frontal scalp mass had been removed at another hospital one month ago, but the pain persisted. Brain computed tomography showed a suspected sclerotic lesion near the right coronal suture, with an enhancing epidural mass. A lesion of the frontal bone was removed by craniectomy. The cortical bone appeared pinkish-brown color. Dura mater adherent to the bone showed an inflammatory reaction and thickening and it was removed. Duroplasty and cranioplasty were performed. The pathology test indicated IMT. IMT must be distinguished from other infectious, granulomatous, and neoplastic lesions. It requires an aggressive approach including surgical intervention, with resection of all the bone and dura mater involved. We describe the diagnosis and treatment of skull IMT.
안상현 ( Sang Hyun Ahn ),최찬영 ( Chan Young Choi ),한성록 ( Seong Rok Han ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2
Intra-axial tumors of the brain stem that growing into the cerebellopotine angle exophytically have been rarely reported in adult. Differentiation of the intra-axial tumors from the extra-axial tumors occurring in the cerebellopontine angle can be difficult due to the similarity of the clinical and radiological features. We describe a rare case of pontine anaplastic astrocytoma in adult with ventrolateral exophytic growth from the pons that presented as a cerebellopontine angle mass. Clinico-radiological features that distinguish this rare lesion of the exophytic pontine glioma from cerebellopontine angle mass were discussed also.
다발성 원발 악성종양 및 다형성 교모세포증을 동반한 환자에서 발생한 원격 부상 신경교종 증후군 - 증례보고 -
최현준 ( Hyun Jun Choi ),최찬영 ( Chan Young Choi ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.2
It has been well known that postoperative hemorrhage can occur in the surgical bed, especially after incomplete resection of highly vascularized tumor, such as glioblastoma. A 55-year old female patient who has breast cancer and multifocal glioblastoma mimicking brain metastasis together showed postoperative hemorrhage in the surgical bed and spontaneous postoperative bleeding of remote tumor site, which was called distant wounded glioma syndrome. In multifocal glioblastoma, histological confirmation may be necessary to differentiate from brain metastasis, even in the presence of a known primary malignancy of other organ. Perioperative careful examination for patient’s coagulation system may also be necessary to prevent or treat distant wounded glioma syndrome
장회영 ( Hoe Young Chang ),김명수 ( Myoung Soo Kim ),이채혁 ( Chae Heuck Lee ),강윤경 ( Yun Kyung Kang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1
A 24-year-old woman presented with headache and subjective gait disturbance. Neurological examination was unremarkable. Brain magnetic resonance imaging demonstrated a posterior fossa cyst and hydrocephalus. Surgical removal of the cyst was done. The cyst had the unique histological feature of a single-layered cuboidal epithelial lining. Detailed immunohistochemical study supported a neuroectodermal origin. The differential diagnosis and the histogenesis of epithelial cysts in the central nervous system are discussed.
구해원(Hae-Won Gu),최찬영(Chan Young Choi),한성록(Sung Rok Han),이기택(Gi Taek Yee),이채혁(Chae Heuck Lee) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.2
We report a rare case of intracranial cystic esthesioneuroblastoma that was originated from the cribriform plate. A 65-year-old female presented with intermittent memory loss and headache a few months ago. On MRI, the tumor looked like meningioma that is located in anterior cranial fossa. So, she underwent an craniotomy and gross total removal was performed. The histopathology of tumor was confirmed as esthesioneuroblastoma. We reviewed intracranial esthesioneuroblastoma with a relevant literatures.
임상 : 비비 양성 수막종의 노발리스 방사선 수술 및 정위적 분할 방사선 치료 -임상분석-
김현두 ( Hyun Doo Kim ),최찬영 ( Chan Young Choi ),한성록 ( Seong Rok Han ),이기택 ( Gi Taek Yee ),이동준 ( Dong Joon Lee ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2
Objective: Atypical and malignant meningiomas (AM, MM) are known to be rare and show aggressive behavior. Limit-ed data are available concerning the clinical features, and role of radiosurgery with non-benign meningiomas. The objec-tive of this study is to assess the local control rate, the risk of complications, and the variables that predict outcome in non-benign meningioma patients treated with radiosurgery with Novalis system. Methods: Between 2000 and 2009, 20 lesions of 10 patients were treated with radiosurgery using Novalis system for non-benign meningiomas (9cases AM, 1case MM) at our institution. FSRT were used in eloquent area and large size, pa-ranasal sinus, in close proximity to the optic nerve, prior irradiated sites. The changes of tumor size, volume , and KPS after RS were examined retrospectively during mean follow up period of 5 years. Mean target volume was 30,280.37 mm3. Mean total dose was 21.72 Gy in SRS and 39.88 Gy with 2.27 Gy per fraction in FSRS. Results: During follow-up period, all patients were survived and complications associated with RS were not observed. Mean target volume was 30,280.37 mm3. Mean total dose was 21.72 Gy in SRS and 39.88 Gy with 2.27 Gy per fraction in FSRS. Overall local tumor control rate was 95%. 11 lesions were decresed in size. 8 lesions were no change, 1 lesion was increased. Conclusions: These data demonstrate that radiosurgery using Novlais system is an effective and safe treatment modality for non-benign meningiomas with a minimal risk. We think that follow-up for longer periods is needed to assess exact ef-fectiveness of RS for non-benign meningiomas.
임상 : 두개저 수막종에 대한 노발리스 방사선수술의 임상 결과 분석
안상현 ( Sang Hyun Ahn ),손문준 ( Moon Jun Sohn ),윤상원 ( Sang Won Yoon ),한성록 ( Seong Rok Han ),최찬영 ( Chan Young Choi ),이동준 ( Dong Joon Lee ),이채혁 ( Chae Heuck Lee ),황충진 ( C Jin Whang ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2
Objective:Stereotactic radiosurgery is becoming an important surgical treatment option in neurosurgical field. Optimal treatment protocol and proper clinical applications could minimize early and late toxicity associated with the radiosurgical treatment. This study is to analyze the clinical results of Novalis radiosurgery for skull base meningioma. Methods:Between Nov. 2001 and Jan. 2006, 43 patients underwent radiosurgery using Novalis shaped beam surgery unit. Male to female ratio was 13:30(1:2.3) with the mean age of 54.2 year-old(range 28-73 year-old). Total of 36 lesions were included to analyze dosimetric data and volume changes during the follow-up period. Median of follow up period was 26.8 months(range 2-60 months). The dosage prescriptions were determined on the basis of tumor volume, location, and proximity to optic nerve and brainstem. Results:13 lesions were treated in a single session but 23 lesions were irradiated in fractionation. The mean initial tumor volume of a single session and fractionated radiosurgery was 4.4±4.0 cm3 and 22.4±18.4 cm3, respectively, while follow- up tumor volume following radiosurgery was significantly decreased to 3.1±4.5 cm3 and 13.4±12.3 cm3, respectively( p<0.05). Overall local tumor control rate was 97.2%(35 lesions);however, there was no radiation related toxicity during the follow up periods. Conclusion:Novalis radiosurgery for skull base meningiomas offers an effective local tumor control in using either single session or fractionated irradiation. With advent of modern radiosurgical treatment and developed optimal clinical protocol, we could successfully treat this surgically difficult tumor to control including larger tumors and tumors adjacent to sellar & parasellar regions.