성인 쿠싱병의 치료성적과 예후인자

박철기,황승균,곽호신,유헌,정영섭,백선하,김동규,정희원,김성연,홍승관,Park, Chul-Kee,Hwang, Sung Kyun,Gwak, Ho-Shin,Yoo, Heon,Chung, Young Seob,Paek, Sun Ha,Kim, Dong Gyu,Jung, Hee-Won,Kim, Seong Yeon,Hong, Seung Kuan 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Objectives : The authors analyzed the surgical series of Cushing's disease to evaluate the proper treatment policy and to verify the possible prognostic factors. Material and Methods : Of 50 patients diagnosed as Cushing's disease and operated at Department of Neurosurgery of our institute between 1988 and 1999, 48 patients with available medical records were analyzed retrospectively. Mean follow-up period was 48 months(3 to 109 months). Preoperative diagnosis was made after evaluating the patients with multiple-stage endocrinological studies and 31 selective patients were evaluated with inferior petrosal sinus sampling(IPSS). Magnetic resonance imaging(MRI) and/or high resolution computerized tomography(CT) was done in all patients. A total of 51 transsphenoidal adenomectomy(TSA) were performed including 3 revision for initial surgical failure cases. Remission was decided on the basis of both endocrinological criteria and clinical status. Radiation and/or ketoconazole therapy were applied to failed cases. For the verification of prognostic factors, the authors evaluated the statistical significance of multiple variables over remission rate by chi-square test. Result : Sensitivity of IPSS for central localization was 93.5% which was better than that of MRI(87.5%). But for lateralization, it was 72.4% for IPSS versus MRI 90.5%. Success rate of TSA was 82%(42/51) and recurrence rate was 9%(4/48). When including adjuvant treatments for surgically failed cases, overall success rate was 89.6% and all of 3 reoperated cases(TSA) due to recurrence were successful. Significant complication occurred in 7.8%(4/51) after TSA including hypopituitarism, diabetes insipidus, and visual loss. Non-existence of tumor in MRI and prolonged symptom duration(>3 years) were significant prognostic factors. Conclusion : TSA can be considered as initial treatment for Cushing's disease. In surgically failed cases, multiple treatment modality may improve the overall outcome and repeated TSA for recurrent cases seem to provide similar success.

기저핵 수막종 1례

김진욱(Jin Wook Kim),박철기(Chul-Kee Park),한정호(Jung Ho Han),정희원(Hee-Won Jung) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.1

We report a rare case of the subcortical meningioma located in basal ganglia without dural attachment which was successfully removed by surgery. A 15-year-old girl with two months history of slowly progressing right sided weakness and motor dysphasia had the well-circumscribed, homogeneously enhancing solid mass with peritumoral edema in the left basal ganglia without any attachment to the sylvian fissure in magnetic resonance imaging. Total resection was done without complications and the histological diagnosis of the mass was a meningothelial meningioma. The possibility of the meningioma should be considered when the well-circumscribed insular mass has characteristic peritumoral edema and surgical removal should be the treatment of choice.

내시경적 경비강 경사골 접근술을 통한 후각고랑 수막종의 제거

김용휘(Yong Hwy Kim),한두희(Doo Hee Han),원태빈(Tae Bin Won),박철기(Chul-Kee Park),이철희(Chul Hee Lee),김동규(Dong Gyu Kim),정희원(Hee-Won Jung) 대한두개저학회 2012 대한두개저학회지 Vol.7 No.1

Introduction : Olfactory groove meningiomas are usually resected via various skullbase approaches. In this report, a direct approach to the tumor via the endonasal route is described. Material and Method : Four patients presented with headache or seizure. Radiological images revealed olfactory groove meningioma associated with surrounding edema. The olfactory function examination revealed the hyposmia in all patients. All tumors were resected via endoscopic endonasal trans-ethmoidal approach. Results : The tumors were completely resected, including the dura of origin and bone. The skullbase reconstruction was performed with multi-layers fashion. There was no postoperative neurologic deficit except anosmia and morbidity including the leakage of cerebrospinal fluid. Conclusion : The endoscopic endonasal transethmoidal approach could be a safe and curative surgical approach to treating for olfactory groove meningiomas.

해면정맥동을 침범하는 뇌수막종의 치료

이승준(Seung-Joon Lee),한정호(Jung Ho Han),박철기(Chul-Kee Park),김재용(Chae-Yong Kim),백선하(Sun-Ha Paek),김동규(Dong Gyu Kim),정희원(Hee-Won Jung) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.1

OBJECTIVE : We retrospectively analyzed the long-term outcomes in patients with cavernous sinus meningiomas (CSMNGs) treated with the various treatment modalities including surgical resection, radiotherapy, radiosurgery, and clinical observation to find out an optimal strategy in selecting a treatment option. PATIENTS AND METHOD : Of the 77 consecutive patients with CSMNGs treated between 1986 and 2004, 60 were followed up for more than 36 months. Thirty-six (60.0%) patients were female. The mean age of the patients was 52±12 years, and the mean follow-up duration was 83±46 months. The population was divided into four groups including the microsurgery group (n=26, 43.3%), the observation group (n=11, 18.3%), the conventional radiotherapy (CRT) group (n=10, 16.7%), and the radiosurgery group (n=13, 21.7%) according to the initial treatment modality. RESULTS : The actuarial tumor control rates were 84.9%, 78.3%, and 41.8% at 5, 10, and 15 years, respectively. Adjuvant radiation therapy using (CRT) after surgery seemed to be positively associated with tumor control, however it did not reach the statistical significance (p=0.277). The patients treated with CRT or radiosurgery as an initial management also showed better outcome in terms of tumor control, however which was not statistically significant (p=0.138). Tumor progression was observed in 12 patients; 7 (26.9%) of the surgery group, 3 (27.3%) of the observation group, 1 (11.1%) of the CRT group, and 1 (7.7%) of the radiosurgery group. Unfavorable KPS was identified in a total of 13 patients; 7 (26.9%) of the surgery group, 1 (9.1%) of the observation group, 4 (44.4%) of the CRT group, and 1 (7.7%) of the radiosurgery group. Finally, aggravation of the cranial neuropathy mostly developed in 8 (30.8%) patients of the surgery group. Failure of tumor control was negatively related with the outcome of the functional status and the cranial neuropathy after long-term follow-up period. Conclusion : Considering a high rate of tumor progression after long-term follow-up period, CRT and radiosurgery seem to be optimal. However, in terms of the functional status and cranial neuropathy, observation also seems to be an effective modality. Based on our experience, selection of a treatment among various modalities for patients with CSMNGs should be done considering the age of patient, the presence of cranial neuropathy, and the tumor size.

청신경초종에 대해 의도적 아전절제술 후 감마나이프 수술의 장기 종양조절율과 안면 신경 보존율

김영훈(Young-Hoon Kim),김진욱(Jin Wook Kim),김용휘(Yong Hwy Kim),한정호(Jung Ho Han),박철기(Chul-Kee Park),김재용(Chae-Yong Kim),백선하(Sun Ha Paek),김동규(Dong Gyu Kim),정희원(Hee-Won Jung) 대한두개저학회 2012 대한두개저학회지 Vol.7 No.1

Objective : Gross total removal(GTR) without neurological impairments for large vestibular schwannoma(VS) has been challenging to neurosurgeons. The purpose of this study was to evaluate long-term surgical and neurological outcome of attempted subtotal removal(STR) followed by Gamma Knife radiosurgery(GKRS) for VS. Methods : A total of 279 patients, who underwent surgical resection with or without GKRS for VS, were enrolled in this study. The median age and follow-up duration were 45 years(range, 19-73) and 5.5 years(2-15), respectively. Two hundred-forty six cases(88.2%) were in Koos grade 3 or 4. GTR or near total removal(NTR), STR, and partial removal(PR) were achieved in 75(26.9%), 160(57.3%), and 44 patients(15.8%), respectively. Adjuvant GKRS were performed in 124 patients(44.4%). Results : The long-term overall tumor control rate was 91.8%(256/279). Of the 160 patients with STR, the tumor control rate was significantly higher in 86 patients who received GKRS(97.7%) than that in 74 patients who did not undergo GKRS(82.4%; p=0.004). However, the adjuvant GKRS did not significantly influence the tumor control rate in GTR, NTR, and PR groups. The functional preservation rate of facial nerve was significantly higher in the STR or PR groups(188/204; 92.2%) than that in the GTR or NTR groups(56/75; 74.7%; p<0.001). Conclusion : Attempted STR with adjuvant GKRS could acquire excellent tumor control and facial never functional outcome of the patients, who underwent surgery for unilateral sporadic VS.

징병 신체검사에서 나타난 청소년기 추간반탈출증의 유병률과 임상적 특징 : A Study Based on Examinations for Conscription

홍창기,박철기,박형천,윤승환 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

Objective: The authors analyzed the large series of intervertebral disc herniation in adolescence to evaluate the prevalence, clinical characteristics, and possible risk factors on the basis of the data from the examinations for conscription. Material and Methods: Of 77685 nineteen-old-males who were given an examination for conscription at Regional Military Manpower Administration of Seoul in 2002, 382 patients exempted from conscription due to intervertebral disc herniation were analyzed. The diagnosis were made from the medical certificate, medical record, magnetic resonance imaging(MRI)(or computed tomography(CT)) which examinee presented and confirmed with the aid of reexamination of CT. Radiological char cteristics and severity of intervertebral disc herniation as well as structural abnormalities of vertebral columns were carefully evaluated with CT scan and MRI scan. Possible risk factors like overweight, structural abnormality of vertebral column, trauma were analyzed statistically using one-sample T-test and chi - square test on the assumption that P value less than 0.05 was considered statistically significant. Result: Prevalence of intervertebral disc herniation in adolescence aged nineteen years and younger were 0.5%. L4-5 level was the most frequently affected site followed by L5-S1. Of all 382 patients of intervertebral disc herniation, 29% were considered serious with reference to radiological evidence of root compression or siginificant discogenic spinal stenosis. Limbus fracture was found in 6.8% of patients. Overweight was the significant risk factor of the disease(p=0.0). However, neither structural abnormality of vertebral column nor trauma showed any relation to pathogenesis of intervertebral disc herniation. Conclusion: In adolescence aged nineteen years and younger, the prevalence of intervertebral disc herniation was 0.5% and accompanying limbus fracture was more frequent when compared with adult. Overweight was the only significant risk factor of the disease.