Pituitary Neuroendocrine Tumor: Is It Benign or Malignant?

( Chae Heuck Lee ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2023 Brain Tumor Research and Treatment Vol.11 No.3

The World Health Organization (WHO) updated the classification of pituitary tumors in 2022. The new classification presents detailed histological subtyping of a pituitary neuroendocrine tumor (PitNET) based on the tumor cell lineage, cell type, and related characteristics. The immunohistochemistry for pituitary transcription factors (PIT1, TPIT, SF1, GATA3, and ERα) is routinely needed in this classification. The controversy regarding the change of behavior code of all PitNET/pituitary adenoma from “0” for benign tumors to “3” for primary malignant tumors is a topic of debate among experts, nowadays. Some authors represent that pituitary adenoma has a tendency for hemorrhage and necrosis and frequent invasion of the cavernous sinus. However, most small PitNET/pituitary adenoma do not need any treatment because of benign biologic behavior or less than 5% recurrence after gross total removal. Pituitary apoplexy is also benign nature but has a tendency of cranial nerve compression or panhypopituitarism. Most of cavernous invasion is compression of the cavernous sinus. Aggressive PitNET/ pituitary adenoma with malignant biological behavior is less than 1%.

Spontaneous Regression of the Pseudoaneurysm Developed after Balloon Occlusion of the Direct Carotid-cavernous Fistula

Lee, Chae-Heuck,Kim, Myoung-Soo,Lee, Ghi-Jai The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.41 No.5

Direct carotid-cavernous fistula [CCF] is a common post-traumatic disease. However, pseudoaneurysm formation after balloon occlusion is a rare complication. The author present such a case with review of the literature. A 26-year-old man involved in a motor vehicle accident as a driver. Only mild conjunctival injection and minimal exophthalmos on the right eye were noted after trauma. However, angiography revealed a direct CCF and dissection of the proximal intracranial internal carotid artery [ICA]. After first balloon occlusion of the CCF, the patient redeveloped fistula due to early deflation of the balloon. After the second balloon occlusion, pseudoaneurysm and diplopia were developed with the change of balloon position and shape. However, visual symptom spontaneously resolved and pseudoaneurysm was also decreased within 6 months after balloon occlusion.

슬신경절에서 발생한 안면신경초종 : 증례보고

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.

Vasospasm as Severe Complication Following Transcranial Removal of Large Pituitary Adenoma : Clinical Review and Analysis

Lee, Chae Heuck,Whang, Choong Jin 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

최근까지 뇌하수체종양 수술 후 혈관연축의 합병증을 보고한 예는 드문 편이며 또한 그 기전에 대해서도 여러 가지 이론이 많다. 저자들은 뇌하수체 종양으로 진단받고 transcranial subfrontal approach로 수술 후 혈관연축을 Transcranial doppler 및 혈관조영술로 진단받은 4례를 분석하였다. 이와 함께 문헌 고찰하여 개두술로 뇌하수체종양 수술 후 혈관연축의 합병증이 있었다고 보고 된 4례와 비교분석 하였다. 저자들이 경험한 4례 중에서, 환자의 나이는 23세에서 59세까지 다양하였고 남녀 각각 2명이었다. 1례를 제외한 모두에서 의식저하 또는 신경학적 결손이 어느 정도의 기간이 지난 후에 나타났고, 2례는 완전히 회복되었으나 2례는 bedridden 상태가 되었다. 혈관연축은 혈관조영술 및 Transcranial Doppler Ultrasonogram(TCI)로 확진했으며, 가능성 있는 기전에 대하여 문헌고찰 및 논의하였다. 혈관이 수술 시 물리적자극이나 뇌저조(basal cystern)으로 흘러 들어간 피는 노출되었다가 혈관수축물질이 놔하수체간 또는 수술 시 손상받은 시상하부에서 유리되어 뇌기저부 수조(cysternal space)로 확산되어 이미 어느 정도 노출된 혈관과 반응하여 혈관연축을 일으키는 것으로 생각된다. Very few cases of arterial spasm after pituitary surgery have been reported to date. The author analysed 4 patients with vasospasm following transcranial subfrontal removal of pituitary adenoma. which were adimitted to our department and 4 cases were reviewed in the literature^(6)7)). In our 4 cases, the age of the patients varied between 23 to 59 years. There were 2 men and 2 women. Delayed deterioration of consciousness or neurologic deficit was observed in all cases. Two patients recovered completely and two were bed-ridden. Vasospasm was documented by angiogram or transcranial doppler ultrasonography(TCD. EME Co.). Possible mechanisms underlying this unusual complication are reviewed and discussed. Vessels were primed to spasm during operation due to blood in the cistern or mechanical injury. Vasoactive materials are liberated from the pituitary stalk or injured hypothalamus, either at the time of surgery, or later, after portions of tumor have undergone necrosis. These agents might then diffuse into the basal cisternal space and interact with blood vessel walls in such a way as to produce vascular spasm.

Delayed Burr Hole Surgery in Patients with Acute Subdural Hematoma : Clinical Analysis

Choi, Yoon Heuck,Han, Seong Rok,Lee, Chang Hyun,Choi, Chan Young,Sohn, Moon Jun,Lee, Chae Heuck The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.6

Objective : To evaluate the effectiveness and efficacy of delayed burr hole surgery in relation to the reduction of postoperative subdural hematoma (SDH) volume in patients with acute SDH. Methods : We retrospectively analyzed patients with acute SDH who received delayed burr hole surgery at our institute. Age, sex, Glasgow coma scale, maximal SDH thickness, volume of SDH, midline shifts, hounsfield unit (HU), and medical history of anticoagulant agent usage were recorded. Outcome measures were delayed operation day, reduction of SDH volume after operation, and the Glasgow outcome scale (GOS) score at discharge. The patients were divided two groups according to the postoperative reduction of volume of SDH (${\geq}50%$, group A; <50%, group B). We also analyzed variables and differences between two groups. Results : Eighteen patients were available for this analysis. The mean delayed of surgery was $13.9{\pm}7.5$ days. Maximal thickness of SDH was changed from $10.0{\pm}3.5mm$ to $12.2{\pm}3.7mm$. Volume of SDH was changed from $38.7{\pm}28.0mL$ to $42.6{\pm}29.6mL$. Midline shifts were changed from $5.8{\pm}3.3mm$ to $6.6{\pm}3.3mm$. HU were changed from $66.4{\pm}11.2$ to $53.2{\pm}20.6$. Post-operative reduction of SDH volume was $52.1{\pm}21.1%$. Eleven patients (61%) had a discharge GOS score of 1 (good recovery). Ten patients (56%) were enrolled in group A. Midline shifting was greater in group A than in group B ($7.4{\pm}3.3$ vs. $3.0{\pm}2.4mm$; p<0.02). The delay of surgery was shorter for group A than group B ($9.2{\pm}2.3$ vs. $19.8{\pm}7.7$ days; p<0.0008). Conclusion : Among well selected patients, delayed burr hole surgery in patients with acute SDH may be effective for reduction of SDH volume. Further studies will be necessary to establish the effectiveness and safety of delayed burr hole surgery in patients with acute SDH.

두개내 설하 신경초종

이채혁,이호연,황충진 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

뇌실질내 악성 뇌수막종 : 증례보고 Case Report

이채혁,이정교 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.6

Middle Cerebral Artery Aneurysm in a Premature Neonate

Choi, Chan-Young,Lee, Chae-Heuck The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.6

Intracranial aneurysms in the neonate are very rare and their clinicopathological findings remain unclear. We report a 26-day-old premature neonate who underwent microsurgical clipping on the ruptured middle cerebral artery bifurcation aneurysm successfully with a review of relevant literature.

Lymphomatosis Cerebri

Choi, Chan-Young,Lee, Chae-Heuck,Joo, Mee The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.5

Lymphomatosis cerebri is considered a diffuse form of primary central nervous system lymphoma and very rare. It is not well recognized and may be misdiagnosed with infiltrating tumors, degenerative disorders, ischemic diseases, and infectious diseases developed in the brain. Awareness of the possibility of this rare disease and early biopsy are required for differential diagnosis and preventing poor clinical outcomes. We report a case with lymphomatosis cerebri who presented with rapid neurological deteriorations and review the relevant literatures.

Spontaneous Dissecting Aneurysm of the Anterior Cerebral Artery

Kim, Myoung-Soo,Lee, Chae-Heuck,Lee, Seung-Joon,Rhee, Jong-Joo The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.40 No.3

Spontaneous dissection of the anterior cerebral artery is an unusual cause of subarachnoid hemorrhage. We present a case of a dissecting aneurysm of the anterior cerebral artery presenting with subarachnoid hemorrhage. A 51-year-old woman presented to our hospital with severe headache. Neurological examination demonstrated neck stiffness, decreased visual acuity of the left eye, and left ankle weakness. Computed tomographic scans showed subarachnoid hemorrhage. The initial cerebral angiogram demonstrated a slightly narrowed caliber and mild poststenotic dilation of the right A1 segment. A second cerebral angiogram 14 days later revealed no change in the focal narrowing of the proximal A1 segment but marked progression of the dilatation of the distal A1 segment. Right pterional craniotomy was performed. A sausage-like dilation of the right A1 segment was found with no definite mural hematoma. This abnormal right A1 segment was wrapped with a Sundt clip. A postoperative computed tomographic scan revealed Infarction of the right head of the caudate nucleus and the anterior limb of the right internal capsule. If a dissecting aneurysm is suspected, serial angiographic studies should be performed because of the possibility of dynamic changes over a short period.