전방상소뇌 종양에 대한 후두경천막접근법

윤완수(Wan-Soo Yoon),이근수(Kun-Soo Lee),전신수(Sin-Soo Jeun) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.2

Objectives : To minimize the retraction of the cerebellum and access the feeding artery directly, we used the occipital transtentorial approach for the anterosuperior cerebellar tumors. Here, we describe the surgical technique and the advantage of occipital transtentorial approach for anterosuperior cerebellar tumors. Methods : From January 1999 to December 2007, we performed the occipital transtentorial approach for 3 patients with infratentorial tumors: one cerebellar hemangioblastoma, one metastatic cerebellar tumor, and one transtentorial meningioma. All tumors were located at anterosuperior cerebellum. Digital subtraction angiography was performed to hemangioblastoma patient. We routinely checked visual acuity and visual field postoperatively. Results : All tumors were removed totally. One patient had transtentoiral meningioma showed transient hemianopsia postoperatively but improved spontaneously. There was no severe morbidity and mortality. Conclusions : Despite of the limited experience, occipital transtentorial approach is a useful surgical strategy for the removal of tumors located at the anterosuperior cerebellar tumors. To prevent the neurologic complication, excessive occipital lobe retraction should be avoided.

추체경사대 수막종의 치료 전략

박재성(Jae-Sung Park),전신수(Sin-Soo Jeun) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.1

후각 이상을 동반하지 않은 후구신경초종 증례보고

우종윤 ( Jong Yun Woo ),이근수 ( Kun Soo Lee ),이태규 ( Tae Kyu Lee ),이관성 ( Kwan Sung Lee ),전신수 ( Sin Soo Jeun ),김문찬 ( Moon Chan Kim ),박춘근 ( Chun Kun Park ),홍용길 ( Yong Kil Hong ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.2

A 38-year old male patient visited our hospital because of decreased visual acuity. Brain magnetic resonance(MR) images revealed a 4.7×4.9×3.7 cm sized lobulated cystic mass which was well enhanced in olfactory groove. The patient underwent left subfrontal approach and total tumor removal was done. Pathology revealed neurilemmoma and postoperative magnetic resonance images showed no residual mass.

임상 : 쥐 골수 기질 세포의 면역 효과 세포로의 활성화

김효창 ( Hyo Chang Kim ),강석구 ( Seok Gu Kang ),전신수 ( Sin Soo Jeun ),유도성 ( Do Sung Yoo ),허필우 ( Pil Woo Huh ),조경석 ( Kyung Souk Cho ),김달수 ( Dal Soo Kim ),박춘근 ( Chun Kun Park ) 대한뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.1

Object:Marrow stromal cells(MSCs) have been shown to have the capacity of orthodox and unorthodox plasticity. In this study, the authors tried to differentiate MSCs into immune effector cell and also to access in vitro cytotoxicity of MSCs from rat. Methods:Rat MSCs(rMSCs) were isolated by standard methodology and were activated by interleukin-2(IL-2), interleukin- 15(IL-15), colony stimulating factor GM-CSF, and combinations. Phenotypes of these various activated cells were determined using flow cytometry. The secreted protein from effector cells was estimated by enzyme-linked immunosorbent assay. Cytotoxicity of rMSCs and activated rMSCs against the target cells(9L rat glioma cell line) were estimated using visual survival cell assay. The expression of immune response related genes in activated cells was measured. Results:After various cytokines activation of rMSCs, the population of immune effector cells(CD8, CD161a) and immune reaction related proteins(IL-4, γ-INF) were increased. There was a significant cytotoxicity of rMSCs activated with various cytokine combinations. Apoptosis may be one of the lysis mechanism of target cells by activated rMSCs. The contributing genes could be γ-INF, FasL and perforin. Conclusion:This study suggests that rMSC may differentiate into immune effector cells and have cytotoxic capability against malignant glioma cells. However, we have to investigate orthotopic animal study for the proper translation.

임상 : 내시경을 사용한 경비적 경접형동 수술에서의 뇌척수액 유출 예방에 대한 고찰

박준상 ( Jun Sang Park ),강석구 ( Seok Gu Kang ),홍용길 ( Yong Gil Hong ),전신수 ( Sin Soo Jeun ) 대한뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.2

Objectives:The endoscopic endonasal transsphenoidal approach (EETSA) is increasingly being used to treat pituitary adenomas and other sellar/suprasellar pathologies. One important complication of the transsphenoidal approach is cerebrospinal fluid (CSF) leakage, which occurs in 0.4 to 9% of cases. We report our experience with EETSA and describe the me-thods that we use to prevent CSF leakage. Methods:A single surgeon performed EETSA on 170 consecutive patients between Feb 2004 and Apr 2011. Patients were divided into three groups based on their CSF leakage status as follows: no CSF leakage, minor CSF leakage, and major CSF leakage. Sellar floor reconstruction was performed according to this classification. In the no-CSF leakage group, sellar floor reconstruction was performed with oxidative cellulose (Surgicel®) only. In the second group (minor CSF leakage), sellar floor reconstruction was performed using autologous fat and bone grafts. Patients in the third group (major CSF leakage) underwent an additional reconstructive procedure of the skull base using the pedicled septal mucosal flap. Results:Of 170 patients, 30 (17.6%) showed CSF leakage in the operation field ; 24 (14.1%) were classified as having minor CSF leakage and 6 (3.5%) patients were classified as having major CSF leakage. Post-operative CSF leakage occurred in only two cases. Conclusion:CSF leakage, though relatively common in the operation field, can be prevented effectively with adequate reconstruction techniques. Assignment of patients to one of three groups based on their CSF leakage in the operation field and sellar floor reconstruction based on this classification resulted in favorable postoperative outcomes.

내시경을 사용한 경비적 경접형동 수술에서의 뇌척수액 유출 예방에 대한 고찰

박준상 ( Jun Sang Park ),강석구 ( Seok Gu Kang ),홍용길 ( Yong Gil Hong ),전신수 ( Sin Soo Jeun ) 대한뇌종양학회 대한신경종양학회 2014 Brain Tumor Research and Treatment Vol.2 No.1

Objectives:The endoscopic endonasal transsphenoidal approach (EETSA) is increasingly being used to treat pituitary ad-enomas and other sellar/suprasellar pathologies. One important complication of the transsphenoidal approach is cerebro-spinal fluid (CSF) leakage, which occurs in 0.4 to 9% of cases. We report our experience with EETSA and describe the methods that we use to prevent CSF leakage. Methods:A single surgeon performed EETSA on 170 consecutive patients between Feb 2004 and Apr 2011. Patients were divided into three groups based on their CSF leakage status as follows: no CSF leakage, minor CSF leakage, and major CSF leakage. Sellar floor reconstruction was performed according to this classification. In the no-CSF leakage group, sel-lar floor reconstruction was performed with oxidative cellulose (Surgicel®) only. In the second group (minor CSF leakage), sellar floor reconstruction was performed using autologous fat and bone grafts. Patients in the third group (major CSF leakage) underwent an additional reconstructive procedure of the skull base using the pedicled septal mucosal flap. Results:Of 170 patients, 30 (17.6%) showed CSF leakage in the operation field ; 24 (14.1%) were classified as having minor CSF leakage and 6 (3.5%) patients were classified as having major CSF leakage. Post-operative CSF leakage occurred in only two cases. Conclusion:CSF leakage, though relatively common in the operation field, can be prevented effectively with adequate reconstruction techniques. Assignment of patients to one of three groups based on their CSF leakage in the operation field and sellar floor reconstruction based on this classification resulted in favorable postoperative outcomes.

척삭수막종:증례보고

배정식(Jung Sik Bae),김동철(Dong Chul Kim),전신수(Sin Soo Jeun) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.1

Chordoid meningioma is a rare variant of meningioma. That is classified as a grade Ⅱ tumors by world health organization classification due to a high rate of recurrence. We present a 61 year-old male patient harboring a chordoid meningioma without systemic hematologic disease. The tumor was located at the left infra and supra-tentorium. Histological examination of supratentorial mass demonstrated a finding compatible with a chordoid meningioma. We present this rare chordoid meningioma in the conception of it’s rarity and particular clinical manifestations associated with hematologic disease.

뇌경색에 대한 골수유래 중간엽줄기세포치료

이관성 ( Kwan Sung Lee ),양승호 ( Seung Ho Yang ),전신수 ( Sin Soo Jeun ),박춘근 ( Chun Kun Park ) 한국조직공학과 재생의학회 2008 조직공학과 재생의학 Vol.5 No.4

Although there has been vast advances in the prevention and treatment of cerebrovascular diseases, ischemic stroke remains the main cause of serious adult disability and mortality in the world. Stem cells have shown notable functional restoration by cellular transplantation in experimental models of stroke. Furthermore, stimulation of endogenous adult stem cell-mediated repair mechanisms in the brain might offer new avenues for stroke therapy. However, important scientific issues need to be addressed to advance our understanding of underlying mechanisms in the critical steps of stroke. In this review, we summarize preclinical experimental studies using bone-marrow derived stem cells for the treatment of stroke, and discuss the parameters to be determined for transplantation success.

임상 : 상모양세포성별세포종; 20명 환자들의 임상적 특징과 결과

허정우 ( Jung Woo Hur ),배정식 ( Jung Sik Bae ),양승호 ( Seung Ho Yang ),전신수 ( Sin Soo Jeun ),박춘근 ( Chun Kun Park ),김문찬 ( Moon Chan Kim ) 대한뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2

Objective: Most pilocytic astrocytomas (PA) are benign tumors. However, there can be a bad outcome according to the patient`s age, the degree of tumor resection and the location in which the established outcomes have not yet been reported. We therefore analyzed and evaluated the outcome and features of PAs in a retrospective study. Methods: We retrospectively analyzed 20 patients who were treated at our hospital between 1995 and 2009. Age, Karnofsky Performance Scale (KPS) score, tumor location, the degree of tumor resection, tumor recurrence or malignant transformation, the disease progression-free survival (PFS) rate and the overall survival (OS) rate were examined. Results: The mean age of the patients was 18.0±13.6 years. The mean PFS and OS rates were 53.3±49.2 months and 62.7±52.1 months. Twelve patients were less than 16 years of age and 8 patients were 16 years of age or older with the mean PFS rates 72.4±52.7 months and 24.6±25.5 months, respectively. Nine patients (45%) had tumor recurrence or progression and the mean PFS rate was 41.3±37.2 months. Among the recurrence group, the patients younger than 16 (5 cases) had a longer mean PFS (65.8±34.3 months) than the patients who was 16 or older (4 cases ; 11.8±12.2 months). Other factors did not show statistically significant differences in the PFS and OS rates. Conclusion: Generally, PA patients have a good prognosis. However, a bad prognosis can occur in adult patients, particularly with incomplete resection. Therefore, aggressive operations should be performed to prevent recurrence in older patients. Additionally, even though radical tumor resections are done, we should be aware of tumor recurrences, especially within the first 4 years after the operation.

Crouzon 증후군 환아에서 시신경 감압

손병철(Byung Chul Son),양승호(Seung-Ho Yang),전신수(Sin Soo Jeun),이상원(Sang Won Lee) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.1

Six-year old boy with Crouzon’s syndrome underwent reconstruction and frontoorbital advancement for brachycephaly 3 years ago. The vision of the left eye had been gradually decreased for 3 months recently. Finger count apart from 30cm was failed. Visual acuity of the right eye was 0.4. The optic disc of the left eye was pale. Visual evoked potentials (VEP) of the left side showed the delayed latency compared with that of the right side. There was no symptom of increased intracranial pressure. Extradural anterior clinoidectomy and optic canal decompression was performed via small temporal craniotomy. The vision of the left eye was improved to 0.05. We report a case of Crouzon’s syndrome underwent optic canal decompression for the treatment of visual deterioration. Optic canal decompression could be effective for vision recovery in patients with Crouzon’s syndrome initially underwent craniofacial surgery.