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문경섭,정신,강삼석,김인영,김현우,이정길,김태선,김재휴,김수한,이제혁,Moon, Kyung Sub,Jung, Shin,Kang, Sam Suk,Kim, In Young,Kim, Hyun Woo,Lee, Jung Kil,Kim, Tae Sun,Kim, Jae Hyoo,Kim, Soo Han,Lee, Je Hyuk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1
Germinoma associated with chronic granulomatous inflammation of pineal gland has been rarely reported in the literature. The mechanism of chronic granulomatous inflammation is not understood well. We report a case of chronic granulomatous inflammation in pineal germinoma. In a 17 year-old male who suffered from headache and diplopia for six months, the mass of pineal gland was detected by brain MRI and removed through occipital transtentorial approach. The pathological specimen revealed the mass was predominantly composed of chronic granulomatous inflammation associated with small portion of germ cell tumor nests In the pathological interpretation of chronic granulomatous inflammation of pineal mass, it would be obliged to search for the presence of germ cell component.
배양된 대뇌피질세포에서 산화성 손상에 대한 6R-Tetrahydrobiopterin의 억제작용
문경섭,이제혁,강삼석,김수한,김재휴,정신,김태선,이정길,Moon, Kyung Sub,Lee, Je Hyuk,Kang, Sam Suk,Kim, Soo Han,Kim, Jae Hyoo,Jung, Shin,Kim, Tae Sun,Lee, Jung Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9
Objective : 6R-Tetrahydrobiopterin(BH4) is a cofactor for the aromatic amino acid hydroxylases which is essential for the biosynthesis of catecholamines and serotonin. It also acts as a cofactor for nitric oxide synthase, and stimulates the release of some neurotransmitters such as dopamine, serotonin, acetylcholine and glutamate. Recently, it has been reported that BH4 could induce cellular proliferation and enhance neuronal survival. This study was performed to investigate the antioxidative effect of BH4 on the various oxidative insults in mouse cerebral cortical cell cultures. Methods : Iron ion(FeCl2), zinc ion(ZnCl2), sodium nitroprusside(SNP) and buthionine sulfoximine(BSO, a glutathione depletor) were used as oxidants. Cell death was assessed by measurement of lactate dehydrogenase efflux to bathing media at the end of exposure. Result : All 4 oxidants induced neuronal cell death associated with cell body swelling, which was markedly inhibited by trolox($100{\mu}M$), a vitamin E analog. BH4($10-100{\mu}M$) markedly inhibited the neuronal cell death induced by all 4 oxidants($20{\mu}M\;Cu^{2+}$, $20{\mu}M\;Zn^{2+}$, $1{\mu}M$ SNP or 1mM BSO). However, BH4 failed to inhibit the neuronal cell death induced by 24hr exposure to $20{\mu}M$ NMDA. Conculsion : These results suggest that BH4 has antioxidative action independently of any actions of enzyme cofactor.
두개강외의 두피 종괴로 발현된 두개강내 골용해성 비정형 수막종
문경섭 ( Kyung Sub Moon ),정신 ( Shin Jung ),전효철 ( Hyo Cheol Cheon ),김인영 ( In Young Kim ),이정길 ( Jung Kil Lee ),김태선 ( Tae Sun Kim ),김재휴 ( Jae Hyoo Kim ),강삼석 ( Sam Suk Kang ),이제혁 ( Je Hyuk Lee ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1
A rare case of intracranial osteolytic atypical meningioma appearing as extracranial soft tissue mass is presented. The patient was a 14-year-old girl with a forehead mass, and over several months this mass continued to grow, with progressive softness and tenderness. Computed tomographic scanning and magnetic resonance imaging findings showed the mass was enhanced heterogeneously and multilobulated in the right frontal area, and associated with overlying bony destruction. The tumor was removed gross totally without complication and diagnosed as atypical meningioma histopathologically.
정신 ( Shin Jung ),문경섭 ( Kyung Sub Moon ),강삼석 ( Sam Suk Kang ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1
Until the introduction of microsurgery, the surgical result of pineal region tumors was very poor with high mortality and morbidity. However, there have been remarkable improvements with advanced imaging, surgical approaches, and microsurgery. Now the main surgical approaches to pineal region tumors are the occipital transtentorial approach and the infratentorial supracerebellar approach. Surgical techniques of the occipital transtentorial approach are described here. The occipital transtentorial approach is showed to be effective not only for pineal body tumors, but also for superomedial cerebellar tumors. Current operative techniques allow safe, effective removal of pineal region tumors. To date, published results of this operative approach have been excellent with little risk of specific complications including hemianopsia, parenchymal venous infarction, and air embolus. Our surgical results are presented.
피질과 피질하 뇌종양 수술 후 지연 발생한 경막하 수종2례 보고
문형식 ( Hyung Sik Moon ),정태영 ( Tae Young Jung ),최정욱 ( Jeong Wook Choi ),정신 ( Shin Jung ),문경섭 ( Kyung Sub Moon ),김인영 ( In Young Kim ),강삼석 ( Sam Suk Kang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2
Subdural hygroma is a common complication of craniotomy. We introduce two cases of delayed-onset subdural hygroma, which developed after cortical or subcortical tumor surgery, and reviewed recent related literature to discuss the possible pathogenesis and clinical course of these hygromas, and to provide appropriate guidelines for the optimal management of this clinical condition. The possible pathogenesis of delayed postoperative subdural hygroma may be associated with CSF retention due to the tearing of the arachnoid membrane during surgery.
임상 : 방사선에 예민한 구조물 인근에 위치한 뇌종양에 대한 분할 조사 감마나이프 시술의 임상적 경험
조원진 ( Won Jin Cho ),정신 ( Shin Jung ),문경섭 ( Kyung Sub Moon ),김인영 ( In Young Kim ),정태영 ( Tae Young Jung ),박승진 ( Seung Jin Park ) 대한뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1
Objective:This study was performed to investigate the radiological and functional outcomes after fractionated gamma knife radiosurgery in the patients with intracranial tumors located near radiosensitive structures. Material & Methods:A total of 19 patients performed fractionated GKRS from 2006 to 2008. Among these patients, 12 patients followed at least 6 month were retrospectively reviewed. Fractionated GKS was performed because of old age, higher surgical risk, large size and adjacent to critical structures. There were 4 male & 8 female patients(mean age 59.3, range 37-80). GKRS performed as a primary technique in 8 patients and adjuvant treatment following open surgery and chemotherapy in 4 patients. The mean tumor volume was 12.4(range 1.2-30.9). The dose delivered at the tumor margin ranged 5 to 12 Gy(mean dose 6.9 Gy) and fraction time was 2.5(range 2-3). Results:The locations were maxilla in one case, suprasellar in one case, hypothalamus & suprasella in one case, clinoid in two cases, frontal lobe in one case, tuberculum sellae in one case, sphenopetoclival in one case, multiple in two cases and petroclivocavernous in two cases. The presumptive diagnosis of the lesion were maxillary cancer in one case, craniopharyngioma in two cases, multiple metastatic cancer in two cases, meningioma in seven cases. The critical structures, should be spared from high dose radiation were optic apparatus and brain stem in our patients. Among the 12 cases, 2 (16.7%) cases showed a tumor response as shrunken, static in 8(66.7%) of the cases and none of the case showed enlarged. Pre-operative neurological deficits were found in 6 cases, 4 cases(66.7%) showed a clinical improvement and 2 cases showed no changes. There were no specific complications & no delayed worsening or new cranial nerve deficits after fractionated GKRS. Conclusion:The fractionated GKRS were usefully used in near critical structure, large volume, surgically high risk patients and provided good tumor controls in some cases without any adverse effects.
기초 :In Situ Film Zymography를 이용한 신경교종의 기질 금속단백분해효소 활성도 관찰
김서광 ( Shu Guang Jin ),정신 ( Shin Jung ),문경섭 ( Kyung Sub Moon ),김인영 ( In Young Kim ),배검 ( Jian Pei ),정태영 ( Tae Young Jung ) 대한뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1
Introduction:Glioma is a common brain tumor, during the initial stage of oncogenesis, there are both invasions of normal tissues nearby and metastasis to contralateral cerebral hemisphere. Among the tumor invasion factors, matrix metalloproteinases( MMPs) facilitates the invasiveness of tumor cells and is highly expressed in malignant brain tumors. This study is to investigate the level of MMP expression, its location in glioma, using in situ film zymography. Materials and Methods:Thirteen glioblastoma samples and 5 oligodendroglioma samples were studied. Using in situ film zymography method, we classified the MMP expression into 4 patterns, such as tumor center, margin, both(center & margin), and negative. Results:In glioblastoma samples, 10 samples(76.9%) were positive. Among them, 7 expressed the pattern of margin. In 5 oligodendroglioma samples, only one anaplastic oligodendroglioma which was transformed from oligodendroglioma, expressed as marginal pattern. There was no MMPs expression in normal brain tissues. Conclusion:The conclusion of this study is that MMPs highly expressed in glioblastoma, and mostly in the pattern of margin. MMPs is thought to be secreted by tumor cells and it may be practical of using MMP inhibitor during the treatment of glioma patients.
고병수(Byung-Soo Ko),정신(Shin Jung),문경섭(Kyung-Sub Moon),조성범(Sung-Bum Cho) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.1
We experienced the patient of HCC metastasizing to the skull base involving multiple cranial nerves. A 67-year-old man presented with symptoms of diplopia, hoarseness and dysphagia which had been developed two weeks ago. On neurologic examination, he showed the disturbances of the right abducens nerve and the low cranial nerves from ninth to twelfth. Neuroimaging studies revealed the destructive mass in skull base, including clivus, petrosal bone and occipital condyle on the right side, with involvement of hypopharyngeal canal and cavernous sinus. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological finding and imaging studies without histological examination. Although metastatic HCC to the skull base involving multiple cranial nerves is very rare, we need to be vigilant and investigate the exact neurologic examination and the imaging studies for HCC patients with disturbance of cranial nerve.
내측 접형능선수막종의 수술적 치료 : 수술 전 얕은중간대뇌정맥의 혈류개통 상태에 대한 평가 및 수술 결과
장우열(Woo-Youl Jang),정신(Shin Jung),문경섭(Kyung-Sub Moon),정태영(Tae-young Jung),김인영(In-Young Kim) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.2
Objectives Surgical management of medial sphenoid ridge meningioma is challenging due to their intimate relationship with anterior visual pathway, cavernous sinus, and arteries of anterior circulation. We analyzed extent of resection and recurrence rate of medial sphenoid ridge meningiomas and discuss the usefulness of preoperative cerebral angiogram in determining preservation of large drainage vein. Methods Between 1995 and 2010, 38 cases of medial sphenoid ridge meningioma underwent surgical resection. Preoperative cerebral angiogram was performed in 29 patients (76.3%) and evaluated the patency of superficial middle cerebral vein and collateral circulation. Results Total resection was achieved in 27 patients (71.1%). Recurrence was observed in 3 patients (11.1%). Regrowth was observed in 4 (36.4%) of the 11 patients with subtotal resection. Two patients of sphenoid ridge meningioma with interdural cavernous sinus extension were successfully removed. Superficial middle cerebral vein was sacrificed in 1 patient. There was no surgical mortality and symptomatic cerebral infarction. Conclusions Sphenoid ridge meningioma with interdural cavernous sinus extension can be removed safely without cranial nerve deficit compared to the meningioma with intracavernous sinus extension. The patency of superficial middle cerebral vein and development of collateral vessel were helpful to determine intraoperative preservation of large drainage vein.
임상 : 두개저 뇌수막종에 대한 저선량 감마나이프 방사선수술 치료 결과
박현웅 ( Hyun Woong Park ),정신 ( Shin Jung ),문경섭 ( Kyung Sub Moon ),임동호 ( Dong Ho Lim ),김인영 ( In Young Kim ),박승진 ( Seung Jin Park ) 대한뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1
Objective:Recently, gamma knife radiosurgery has been applied to skull base meningiomas as a primary or postoperative adjuvant treatment, due to the high morbidity and mortality of conventional surgery. We analyzed the results of gamma knife radiosurgery for selective cases of skull base meningiomas using low radiation doses for the tumor control. Patients & Methods:Between June 2004 and January 2007, We reviewed 40 of 48 patients treated with gamma knife radiosurgery for skull base meningiomas. The mean patient age at the time of gamma knife radiosurgery was 60.1 years (range, 28-86 yr). There were 28 female and 12 male patients. Ten patients(25.0%) had radiosurgery as an adjuvant treatment after microsurgery, and 30 patients(75.0%) underwent radiosurgery as the primary treatment. The mean radiological follow-up period was 39.3 months(range, 24.5-56.8 months). The tumor control, neuroradiological and neurological outcomes, and adverse effects were analyzed during the follow-up period. Results:The mean tumor volume was 11.4 cc(range 0.5-48.3 cc). The main symptoms before radiosurgery were cranial nerve palsies. The dose delivered at the tumor margin ranged from 8 to 14 Gy(mean dose 11.9 Gy). Tumor control was achieved in 37 of the 40 patients(92.5%). All 40 patients were survived. During the follow-up period, the neurological symptoms and signs improved in 25 of the 40 patients who underwent gamma knife radiosurgery, remained stable in 15 including 5 incidental patients, and no delayed worsening or new cranial nerve deficits were observed after radiosurgery. Conclusion:Gamma knife radiosurgery, using a relatively low radiation dose(less than 15 Gy) can provide good tumor control rate without any morbidity in skull base meningiomas.