두개인두종에 대한 감마나이프 방사선수술

장종희,장진우,박용구,정상섭,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : The purpose of this study are to evaluate the effectiveness of Gamma Knife radiosurgery(GKS) as a treatment of craniopharyngioma and to investigate the proper dose planning technique in GKS for craniopharyngioma. Method : Between May 1992 and March 1999, seven Gamma Knife radiosurgical procedures were done for residual tumor mass of 6 patients with craniopharyngioma after microsurgical resection. Conventional radiation therapy was not performed. In this study, their clinical, radiological and radiosurgical data were analyzed and the radiation dosage to the optic pathway, hypothalamus, pituitary stalk, and cavernous sinus were calculated and correlation with clinical outcome was evaluated. The mean follow-up period was 33.5 months(12.3-55.2 months). Result : The mean tumor volume was 4.4cc(0.4-18.0cc) and the maximum radiation dose ranged from 14 to 32 Gy(mean 20.9Gy). The radiation was given with isodose curve, 50-90% and the marginal dose varied within 8-22.4Gy(mean 12.7Gy). The mean number of isocenter was 4.3(1-12). The tumor was well controlled in all cases. In 5 of 7 cases, the size of tumor decreased to 10-50% of pre-GKS volume and remaining two showed no volume change. The mean dose to optic pathway was 5.7Gy(5.1-11.2Gy) and there were no complications. Conclusion : GKS seems to be effective for control of craniopharyngioma as an adjuvant treatment after microsurgical resection and even suboptimal dose for tumor margin is considered to be enough for tumor control. It is safe with careful dose planning to protect surrounding important structures, especially optic pathway. We believe conventional radiation therapy should be avoided because it has limitation for dose planning of additional treatments such as radiosurgery or intracystic instillation of radioisotope in case of recurrence.

뇌동정맥기형에 대한 감마나이프 방사선수술시 치료성적에 영향을 주는 인자들

장종희,박용구,최재영,장진우,정상섭,Chang, Jong Hee,Park, Yong Gou,Choi, Jae Young,Chang, Jin Woo,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Objective : The goal of this study was to evaluate the effect of Gamma Knife radiosurgery(GKS) on cerebral arteriovenous malformation(AVM) and the factors associated with complete occlusion. Patients and Methods : A total of 369 radiosurgical procedures for 336 patients with cerebral AVMs were performed between December 1988 and June 2001. Three hundreds and twenty-four cases of 293 patients who were treated with GKS procedures from May 1992 to December 2000 were analyzed. Various clinical and radiologic parameters were evaluated. Results : The total obliteration rate for the cases with satisfactory radiological follow-up(more than 2 years) after GKS was 79.3%. In multivariate analysis, maximal diameter, angiographic form of AVM nidus, and number of draining veins significantly influenced the result of radiosurgery. In addition, marginal radiation dose, Spetzler-Martin grade, and flow pattern of AVM nidi also partly influenced the radiosurgical outcome. Conclusion : GKS on cerebral AVM is considered as an effective treatment modality. The risk of hemorrhage seems to decrease within the latency interval between GKS and complete occlusion of nidus. Along with the size, topography, or radiosurgical parameters of AVMs, it is necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

터어키안 주변종양에 대한 감마나이프 방사선 수술

장종희,장진우,박용구,정상섭,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Objective : Around the sellar area, there are many important structures. But, the optimal radiation dosage for minimal toxicity to surrounding neural tissue has not been firmly established. The purpose of this study is to evaluate the radiosurgical outcome of juxtasellar tumors and to investigate the relationship between radiation dosage and toxicity to neural tissue. Method : Between May 1992 and June 2000, we treated 65 juxtasellar tumors by using the Leksell Gamma Knife. Among them, 52 patients who could be followed more than 1 year were included in this study. The radiosurgical dosage to the optic pathway, cavernous sinus, Meckel's cave, hypothalamus, pituitary gland and stalk, and brain stem was analyzed and correlated with clinical outcome. The mean follow-up period was 33.5 months(range 12.2- 99.0 months). Result : The clinical response rate was 69.2%. The volume response rate was 61.0% and the radiologic control rate was 92.7%. There were 4 complications(7.7%) of 2 trigeminal neuropathy, 1 abducens nerve palsy, and 1 trigeminal and transient abducens nerve palsy. The optic apparatus appeared to tolerate doses greater than 10Gy. The risk of cranial nerve complications in cavernous sinus seemed to be related to doses of more than 16Gy. In 3 of 4 patients who received more than 16Gy to cavernous sinus, the abducens or trigeminal neuropathy occurred. Also, one patient who received more than 15Gy to the Meckel's cave, trigeminal neuropathy developed. The hypothalamus, pituitary gland and stalk, and brain stem were relatively tolerable to radiation. Conclusion : Gamma Knife radiosurgery seems to be an effective method to control the growth of juxtasellar tumors. To avoid injury to surrounding important neural tissue, careful dose planning and further study for radiation toxicity to neural tissue were needed.

두경부 T 세포 림프종 환자에서 발생한 진행성 다초점성 백질뇌병증 - 증 례 보 고 -

신동아,장종희,장진우,박용구,김태승,정상섭,Shin, Dong Ah,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Kim, Tai Seung,Chung, Sang Sup 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12

Progressive multifocal leukoencephalopathy(PML) is a fatal demyelinating disease that occurs in immunocompromised hosts. We report a case of PML that developed in patient with T cell lymphoma of head and neck. During chemotherapy for lymphoma, she was confused and had memory impairment. A magnetic resonance imaging of the brain revealed confluent signal change at white matter of the frontal lobe, insula, and anterior limb and genu of internal capsule. The lesion was confirmed with brain biopsy and the histopathological finding was compatible with PML.

두개강내 수막종에 대한 감마나이프 방사선수술

심규원,장종희,최재영,장진우,박용구,정상섭,Shim, Kyu Won,Chang, Jong Hee,Choi, Jae Young,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11

Objective : To analyze the radiosurgical results of intracranial meningiomas after Gamma Knife radiosurgery (GKS) and to assess the possible factors related to the outcome and complications in treating meningiomas. Patients and Methods : We retrospectively reviewed the clinical and radiological data in 179 patients(194 lesions) treated with GKS for intracranial meningiomas between May 1992 and October 2000. Radiosurgical responses were categorized as shrinkage, stasis and enlargement, and we defined the shrunken and static group as a radio-logical control. A Cox proportional hazards model was used to evaluate the correlation between the radiosurgical outcomes and various factors such as location and size of tumor, age and gender of patients, relation to venous sinus, pre-GKS degree of edema, treatment modality, radiosurgical parameters, and pathologic findings. Results : Patients were grouped into skull base meningiomas(57.7%), non-skull base tumor including convexity, parasagittal, and falx meningiomas(37.1%), and others(5.2%) according to the location of tumors. The mean maximum dose and the margin dose of tumor was 30.0Gy(19-45Gy) and 15.1Gy(9.5-24.5Gy), respectively. The mean volume of the tumors was 9.4cc(0.003-45.0cc). The radiologic control rate was 97.1%. The radiation induced imaging change with or without neurologic deficit was the most common complication(23.6%). There were seen mostly in convexity, parasagittal, and falx meningiomas which were deeply embedded in cortex. Conclusion : GKS for intracranial meningioma seems to be safe and effective treatments. However, GKS should be considered very cautiously in non-skull base tumor such as convexity, parasagittal, or falx meningiomas with regards to patient's age and general condition, size and location of tumor, pattern of embedding into cortex, presenting symptoms and patient's preference.

난치성 암성 통증 제어를 위한 뇌정위적 대상회 절개술

정진영,장종희,장진우,박용구,정상섭,Jung, Jin Young,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

반측성 안면경련증 환자에서 안면신경의 미세혈관감압술 후에 시행한 자기공명영상의 역할

한인보,장종희,장진우,박용구,김동익,정상섭,Han, In Bo,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Kim, Dong Ik,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objectives : The objective of this study was to investigate the role of postoperative three dimensional short-range magnetic resonance angiography(3D-TOF MRA) in predicting the clinical outcomes following microvascular decompression(MVD) for the treatment of a hemifacial spasm(HFS). Material and Method : Postoperative magnetic resonance(MR) imaging was performed on 123 patients with a HFS between March 1999 and May 2000. All patients who had postoperative MR imaging were undertaken preoperative MR imaging. Of the 123 patients, 122 patients were included in this retrospective study. The degree of the detachment of vascular contact, and change of the position of offender were determined by pre- and postoperative 3D-TOF MRA. These findings were compared with the surgical findings and clinical outcomes. Results : Of 122 patients who had successful MVD, clear decompression of offenders of the root entry zone(REZ) of facial nerve was found in 106 patients(86.9%), partial decompression in 10 patients(8.2%) and contact of offenders to the REZ of facial nerve in 6 patients(4.9%) by the postoperative 3D-TOF MRA. Our patients demonstrated that the types of offender did not influence with the degree of decompression of REZ of facial nerve and with surgical outcomes(p>0.05). Also, there was no significant relationship between the degree of decompression of the REZ of facial nerve from offenders and an improvement of symptoms(p>0.05). Futhermore, there was no significant relationship between the degree of decompression of the REZ of facial nerve from offenders and an improvement time (p>0.05). Conclusion : Our data suggests that MVD of facial nerve alone may not be sufficient to resolve the symptoms in all patients with hemifacial spasm. Therefore, another unknown factors besides vascular compression may be involved to cause symptoms in certain patients and it may be necessary to remove these factors with MVD simultaneously to obtain the resolution of symptom.

골화를 동반한 만성 경막외혈종 - 증례보고 -

심규원,장종희,장진우,박용구,김태승,정상섭,Shim, Kyu Won,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Kim, Tai Seung,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

We report a case of 15 year-old female patient with a ossified chronic epidural hematoma. She had had head trauma 10 weeks previously and conservative care for delayed onset epidural hematoma at other hospital. Ossification was identified about 4 weeks after head injury and then progressed rapidly. We removed the chronic epidural hematoma with thick capsule and newly formed bone. The mechanism of the ossification associated with cephalhematoma and chronic subdural hematoma is reviewed and discussed.

본태성 진전에 대한 시상파괴술과 뇌심부 자극술의 비교

이윤호,박용숙,장종희,장진우,박용구,정상섭,Lee, Yoon-Ho,Park, Yong-Sook,Chang, Jong-Hee,Chang, Jin-Woo,Park, Yong-Gou,Chung, Sang-Sup 대한신경외과학회 2005 Journal of Korean neurosurgical society Vol.37 No.2

Objective: Thalamic lesioning and deep brain stimulation(DBS) have proved to be beneficial to the treatment of essential tremor(ET). The authors compared the effects and complications of two modalities. Methods: A total of 34 patients with ET were treated with ventral intermediate(Vim) nucleus thalamotomy or Vim DBS from May 1999 to May 2003. The procedure of lesioning or stimulation were performed as usual manner with or without microelectrode recording. Postoperatively, utilizing the various combinations of frequency, voltage and pulse width optimized the stimulation. The degree of improvements of tremor and the occurrence of the complications were evaluated postoperatively and at follow-up. Results: There were 38 procedures, including 27 with Vim thalamotomy and 11 with DBS, in 34 patients. Of the thalamotomy group, left Vim lesioning is 25 and right one is 2. Follow-up duration ranged from 12 to 57 months. In the thalamotomy group, the rate of overall good outcome was 88.9% but 12 patients (44.4%) showed permanent adverse effects. In the cases of stimulation, the rate of overall good outcome was 90.9% and two patients had acceptable dysarthria. Conclusion: Both Vim thalamotomy and Vim DBS were effective for the treatment of ET, although perioperative adverse effects tended to be higher in patients who had thalamotomy. In cases of DBS, adjustments of stimulation parameters enabled an acceptable position to be achieved with tremor control and unwanted effects.

뇌교종 수술에서 뇌지도화

조진모 ( Jin Mo Cho ),장종희 ( Jong Hee Chang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

The aims of brain glioma surgery are to potentiate adjuvant therapies and to extend survival with maximizing the quality of resection, while minimizing the risk of postoperative neurologic deficits. However, it is often limited by the location and spatial extent of the tumor and its relationship to the eloquent tissue. Moreover, there is interindividual anatomofunctional variability and so, each patient should be evaluated for cortical functional organization, effective connectivity and potential for plasticity. Recently, “maximum safe resection” has been made possible by preoperative functional neuroimaging, intraoperative imaging and image-guided surgery, and intraoperative functional mapping. In each patient, preoperative evaluation of cortical functional organization and relationship between tumor and surrounding brain tissue, and intraoperative evaluation of anatomo-functional connectivity and short-term plasticity using repeated cortical and subcortical stimulation during resection made tailored resection of glioma in eloquent area possible. With continuous accumulation of neuroanatomical & neurophysiological knowledge and experience of preoperative and intraoperative mapping, we could understand more and better about dynamic functional anatomy of brain.