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.

외식업 종사자의 감정부조화가 잔류의도에 미치는 영향

장진우(Chang, Jin-Woo),박진영(Park, Jin-Yung),김명희(Kim, Myung-Hee) 한국호텔외식관광경영학회 2015 호텔경영학연구 Vol.24 No.7

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.

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.

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.

뇌실질 전이가 있는 비소세포성 폐암 환자에서의 연수막 전이 빈도 및 예후 인자

나영철 ( Young Cheol Na ),김지희 ( Ji Hee Kim ),김창환 ( Chang Hwan Kim ),장원석 ( Won Seok Chang ),장진우 ( Jin Woo Chang ),박용구 ( Yong Gou Park ) 대한뇌종양학회 대한신경종양학회 2014 Brain Tumor Research and Treatment Vol.2 No.1

Objectives:The object of this study is to evaluate the incidence, survival and the prognostic factors in patients with leptomeningeal metastasis from non-small cell lung cancer. Methods:The study included fifty-five consecutive patients diagnosed with brain parenchymal metastasis on magnetic resonance image (MRI) clinically from non-small cell lung cancer between July 2010 and February 2011. All the patients underwent lumbar puncture for cerebrospinal fluid examination including cytology examination with cytokeratine immunostain. If the patients showed positive in cerebrospinal cytology or leptomeningeal enhancement on T1 weighted gadolinium enhanced MRI, whole spine MRI with gadolinium enhancement was also taken for evaluation of spinal disease. For evaluation of prognostic factors, we investigated the patient`s age, interval from the time of diagnosis of systemic disease to the time of diagnosis of leptomeningeal metastasis, interval from the time of diagnosis of parenchymal metastasis to the time of diagnosis of leptomeningeal metastasis, performance status of the patients, and following treatment modality after diagnosis of leptomeningeal metastasis. Result:In eleven (20%) of the fifty-five patients, the diagnosis of leptomeningeal metastasis was made on the basis of MRI findings and the results from cerebrospinal fluid cytology. Among those eleven patients, eight (72.7%) had positive cerebrospinal fluid cytology at the time of initial examination. Eight of the eleven patients underwent an operation for intraventricular catheter and reservoir placement in order to receive intraventricular chemotherapy. In six (75%) of the eight intraventricular chemotherapy patients, the negative conversion of cerebrospinal fluid cytology was achieved during induction chemotherapy of four weeks. The overall median survival for the eleven patients after the diagnosis of leptomeningeal metastasis and the eight subsequent intraventricular chemotherapy patients was 62 days (95% confidence interval 27.4-96.6). The most possible prognostic factor was the intervals from primary disease to leptomeningeal metastasis (p=0.071). Conclusion:In this study, we found that relatively high proportion of the patients of non-small cell lung cancer with parenchymal metastases were co-morbided by leptomeningeal metastases, and revealed that the interval from primary disease to leptomeningeal metastasis could be an important factor for survival. However, further well-designed investigations, with larger sample sizes, must be conducted to evaluate other prognostic factors as well as new drugs, and to define the optimal treatment combinations and route.

임상 : 뇌실질 전이가 있는 비소세포성 폐암 환자에서의 연수막 전이 빈도 및 예후 인자

나영철 ( Young Cheol Na ),김지희 ( Ji Hee Kim ),김창환 ( Chang Hwan Kim ),장원석 ( Won Seok Chang ),장진우 ( Jin Woo Chang ),박용구 ( Yong Gou Park ) 대한뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.2

Objectives:The object of this study is to evaluate the incidence, survival and the prognostic factors in patients with leptomeningeal metastasis from non-small cell lung cancer. Methods:The study included fifty-five consecutive patients diagnosed with brain parenchymal metastasis on magnetic resonance image (MRI) clinically from non-small cell lung cancer between July 2010 and February 2011. All the patients underwent lumbar puncture for cerebrospinal fluid examination including cytology examination with cytokeratine immunostain. If the patients showed positive in cerebrospinal cytology or leptomeningeal enhancement on T1 weighted gadolinium enhanced MRI, whole spine MRI with gadolinium enhancement was also taken for evaluation of spinal disease. For evaluation of prognostic factors, we investigated the patient’s age, interval from the time of diagnosis of systemic disease to the time of diagnosis of leptomeningeal metastasis, interval from the time of diagnosis of parenchymal metastasis to the time of diagnosis of leptomeningeal metastasis, performance status of the patients, and following treatment modality after diagnosis of leptomeningeal metastasis. Result:In eleven (20%) of the fifty-five patients, the diagnosis of leptomeningeal metastasis was made on the basis of MRI findings and the results from cerebrospinal fluid cytology. Among those eleven patients, eight (72.7%) had positive cerebrospinal fluid cytology at the time of initial examination. Eight of the eleven patients underwent an operation for intraventricular catheter and reservoir placement in order to receive intraventricular chemotherapy. In six (75%) of the eight intraventricular chemotherapy patients, the negative conversion of cerebrospinal fluid cytology was achieved during induction chemotherapy of four weeks. The overall median survival for the eleven patients after the diagnosis of leptomeningeal metastasis and the eight subsequent intraventricular chemotherapy patients was 62 days (95% confidence interval 27.4 96.6). The most possible prognostic factor was the intervals from primary disease to leptomeningeal metastasis (p=0.071). Conclusion:In this study, we found that relatively high proportion of the patients of non-small cell lung cancer with parenchymal metastases were co-morbided by leptomeningeal metastases, and revealed that the interval from primary disease to leptomeningeal metastasis could be an important factor for survival. However, further well-designed investigations, with larger sample sizes, must be conducted to evaluate other prognostic factors as well as new drugs, and to define the optimal treatment combinations and route.

Long-Term Results of Gamma Knife Radiosurgery for Intracranial Meningioma

Chang Ki Jang,정현호,장종희,장진우,박용구,장원석 대한뇌종양학회 2015 Brain Tumor Research and Treatment Vol.3 No.2

Background The predominant treatment modality for meningioma is surgical resection. However, gamma knife radiosurgery is also an important treatment modality for meningioma that is small or cannot be completely removed because of its location. In this study, we evaluated the effectiveness and long-term results of radiosurgical treatment for meningioma in our institution. Methods We studied 628 patients (130 men and 498 women) who underwent gamma knife radiosurgery for intracranial meningioma, which is radiologically diagnosed, from Jan 2008 to Nov 2012. We included patients with single lesion meningioma, and followed up after 6 months with imaging, and then at 24 months with a clinical examination. Patients with high-grade meningioma or multiple meningiomas were excluded. We analyzed each of the factors associated with progression free survival. The median patient’s age was 56.8 years. Maximal dosage was 27.8 Gy and marginal dosage was 13.9 Gy. Results The overall tumor control rate was 95%. Twenty-eight patients (4.4%) showed evidence of tumor recurrence. Ninety-eight patients (15%) developed peritumoral edema (PTE) after gamma-knife surgery; two of them (2%) underwent surgical resections due to PTE. Nine patients had craniotomy and tumor removal after gamma knife surgery. Conclusion Gamma knife surgery for intracranial meningioma has proven to be a safe and effective treatment tool with successful long-term outcomes. Gamma knife radiosurgery can be especially effective in cases of remnant meningioma after surgical resection or where PTE is not present.

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.

2.4/5.8GHz 이중 대역 코프래너 급전 평면형 모노폴 능동 안테나 설계

김준일,장진우,이원택,지용,Kim, Joon-Il,Chang, Jin-Woo,Lee, Won-Taek,Jee, Yong 대한전자공학회 2007 電子工學會論文誌-TC (Telecommunications) Vol.44 No.8

본 논문은 2.4/5.8GHz 이중 대역 수신용 능동 안테나 설계 구조를 제시하였다. 제시된 능동 안테나는 한 개의 초광대역(Ultra Wideband, UWB) 안테나를 이용하여 2.4GHz 영역과 5.2GHz 영역에서 수신 및 증폭이 동시에 이루어지게 하는 구조이다. 각 동작 영역에서 초광대역 안테나의 출력단과 능동 소자 입력단 사이의 상호 임피던스 정합은 직접 연결법에 의해 이루어지게 하였으며 직접 연결법에 의한 동작 주파수에서의 임피던스 정합은 평면형 초광대역 안테나의 급전선로 길이를 변화시켜 구현하였으며 안테나의 코프래너 급전선로 길이는 $1/20{\lambda}0$(@5.8GHz) 이내로 설정하였다. 구현된 수신용 능동 안테나의 주파수 대역폭$(VSWR{\leq}2)$은 2.4GHz 동작 주파수에서 $2.0\sim3.1GHz$, 5.8GHz 대역에서 $5.25\sim5.9GHz$로 이루어졌다. 실험 결과 2.4GHz에서 17.0dB 및 5.2GHz에서 15.0dB의 이득(gain)이 측정되었고 1.5dB의 잡음지수(noise figure, NF)가 측정되었다. This paper presents design methods for dual-frequency(2.4/5.8GHz) active receiving antennas. The proposed active receiving antennas are designed to interconnect the output port of a wideband antenna to the input port of an active device of High Electron Mobility Transistor directly and to receive RF signals of 2.4GHz and 5.2GHz simultaneously where the impedance matching conditions are optimized by adjusting the length of $1/20{\lambda}_0$(@5.8GHz) CPW transmission line in the planar antenna The bandwidth of implemented dual-frequency active receiving antennas is measured in the range of 2.0GHz to 3.1GHz and 5.25GHz to 5.9GHz. Gains are measured of 17.0dB at 2.4GHz and 15.0dB at 5.2GHz. The measured noise figure is 1.5dB at operating frequencies.