수두증을 동반한 송과체 부위 종양에 대한 내시경적 치료

김정훈,나영신,김준수,안재성,김창진,권병덕,Kim, Jeong Hoon,Ra, Young Shin,Kim, Joon Soo,Ahn, Jae Sung,Kim, Chang Jin,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.

척수 수질내에 재발한 신경장관성 낭종 - 증례보고 -

이종주,나영신,강신광,노성우,임승철,Rhee, Jong Joo,Ra, Young Shin,Khang, Shin Kwang,Roh, Sung Woo,Rhim, Seung Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Neurenteric cysts are developmental cysts derived from embryonic endodermal layers. Fewer than 100 have been reported in which there were no associated bone or soft-tissue malformations and only six among those cases showed intramedullary location in the literatures. The authors report a 16-year-old young man with a thoracic intramedullary neurenteric cyst which presented with symptoms of axillary pain and paraparesis. The magnetic resonance imaging showed intramedullary mass extended from level of T3 to T7. There was no associated bone or soft-tissue anomaly. This cyst was partially excised and marupialized into subarachnoid space. The pathological findings were compatible with neurenteric cyst. Nine months later, the cyst recurred and at second operation, cyst wall was removed completely.

맥락총 종양에 대한 임상적 분석

김재명 ( Jae Myung Kim ),나영신 ( Young Shin Ra ),안영상 ( Young Sang Ahn ),김태형 ( Thad T Ghim ),권병덕 ( Byung Duk Kwun ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Clinical features, surgical management and prognosis of choroid plexus neoplasms depend on various factors including age of onset, location of tumor, histologic findings and presence of hydrocephalus. Nine patients with choroid plexus papilloma(CPP) and 2 with choroid plexus carcinoma(CPC) were analyzed regarding clinical features, radiologic findings, surgical methods, postoperative complications and outcomes retrospectively. Tumor locations were lateral ventricle (6 patients), 4th ventricle(3) and multiple(2). The most frequent symptoms and signs were macrocephaly, ataxic gait, and hemiparesis. Surgical approaches were transcortical posterior parietal approach(7 patients) transcallosal approach (1), suboccipital midline craniotomy(3), and orbitofrontal approach(1). Among 9 CPPs, total resection of tumor was performed in 7 patients who have been in complete remission. Two patients with subtotal resection of CPP underwent radiosurgery for residual tumors subsequently. One was stable but the other was dead 11 months later because of brain stem edema. Two patients with CPC underwent subtotal tumor resection, adjuvant chemotherapy and/or radiosurgery. One has been in complete remission and the other was dead because of hypernatremia during chemotherapy. Among 9 patients with preoperative hydrocephalus, 7 patients improved without shunting procedure but 2 needed shunt surgery eventually. Conclusively, Complete resection of tumor is the important prognostic factor in choroid plexus tumors and postoperative adjuvant therapy is helpful to manage CPCs. Also hydrocephalus of most patients can be managed by successful removal of tumors without shunt.

모비키즈: 통신전자파 노출과 어린이청소년의 뇌종양에 관한 환자 -대조군 연구 프로토콜

최경화,김동석,이정일,나영신,피지훈,안영환,권종화,이애경,최형도,하미나,Choi, Kyung-Hwa,Kim, Dong-Seok,Lee, Jung-il,Ra, Young-Shin,Phi, Ji Hoon,Ahn, Young Hwan,Kwon, Jong Hwa,Lee, Ae-Kyoung,Choi, Hyung-Do,Ha, Mina 한국환경보건학회 2015 한국환경보건학회지 Vol.41 No.3

Objectives: To introduce a protocol of Mobi-kids study which was aimed to examine an association between radiofrequency (RF) radiation exposure by mobile phone use and brain tumor risk in children and adolescents. Methods: The Mobi-kids study was a multinational matched case control study using a standardized protocol with the number of subjects targeted about 1,000 cases and 2,000 controls aged 10 to 24. In Mobi-Kids Korea, the source population was restricted to Seoul, Incheon, and Gyeonggi-do province. Eligible cases of primary brain tumor (glioma, meningioma, and others) were diagnosed from January 2012 to June 2015. Eligible controls were appendicitis patients operated during the study period. Two controls were matched on age, gender, and study region for 1 case. Information about pattern and history of mobile phone use and other covariates were obtained by face to face interview by trained interviewer. The Mobi-kids study has been involved in Mobi-expo as a validation study about mobile phone use, XGridmaster to localize tumor in the brain for RF energy calculation, and histological review for validation of diagnosis. Results: The Mobi-kids was the first and largest study in children and adolescents to estimate risk of brain tumor in association with the RF energy absorption in the brain estimated by mobile phone use. Forty-six-cases and 54 controls were collected as of September 2014 in Korea. Conclusions: The meaningful results of the study were expected because of the largest sample size, high validity of EMF exposure assessment as well as the susceptible study populationof children and adolescents.

성인에서 천막상부, 두개엽에 위치한 원발성 교모세포종의 치료에서 종양 절제의 역할

이종주,안재성,전상룡,김정훈,나영신,김창진,이정교,권병덕,Rhee, Jong Joo,Ahn, Jae Sung,Jeon, Sang Ryong,Kim, Jeong Hoon,Ra, Young Shin,Kim, Chang Jin,Lee, Jung Kyo,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : The therapeutic impact of tumor resection in glioblastomas is poorly defined and still questionable. Therefore, we conducted the current study to verify the role of tumor resection in the treatment of these highly malignant tumors. Methods : A retrospective study was performed(1990-1999) to compare the treatment results of surgical resection plus radiotherapy(130 patients) with those of stereotactic biopsy plus radiotherapy(19 patients) in glioblastomas. Only adult patients with supratentorial, de novo glioblastoma located in one lobe were included. Survival time/rate was analysed with Kaplan-Meier method, and prognostic variables were obtained from the univariate log-rank test and the multivariate Cox's proportional hazards model. Results : The resection group and the biopsy group did not differ in terms of age, gender, duration of symptoms, presenting symptoms, tumor location, tumor side, tumor size, and the frequency of midline shift. Patients in the biopsy group more often were found to have worse preoperative Karnofsky performance status(KPS)(p=0.001). On univariate analysis, age, KPS, and tumor side were associated with survival(p=0.0053, 0.0001, and 0.0331 respectively). Median survival time and 1-year survival rate were also statistically improved by tumor resection ; resection group - 13 months and 61.2%, and biopsy group - 8 months and 19.7%, respectively(p=0.0001). In patients with midline shift of the tumor, resection was highly effective comparing to biopsy(p=0.0001), but in patients without midline shift, external beam radiation alone was as effective as tumor resection(p=0.0605). Other prognostic variables did not affect survival. On multivariate analysis after variable selection, survival was independently associated with KPS(p=0.001), but not the surgical resection(p=0.2837). Even in biopsy group with midline shift of the tumor, survival rate was not different from that seen after tumor resection(p=0.3505). Conclusions : Radiotherapy alone was as effective as tumor resection plus radiotherapy in patients without midline shift of the tumor. Although there was not statistically significant, tumor resection looked like effective in patients with midline shift. For supratentorial, lobar glioblastoma patients without mass effect of the tumor, biopsy with radiotherapy is one of rational treatment strategies. We consider that tumor resection should be performed in patients with pretreatment midline shift.

내시경적 경접형동 접근술에 의한 뇌하수체 종양의 수술

안영상,전영일,안재성,전상룡,김정훈,나영신,노성우,김창진,권양,임승철,이정교,권병덕,Ahn, Young Sang,Chun, Young Il,Ahn, Jae Sung,Jeon, Sang Ryong,Kim, Jeong Hoon,Ra, Young Shin,Roh, Sung Woo,Kim, Chang Jin,Kwon, Yang,Rhim, Seung Chul,Lee 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. Methods : This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. Results : There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. Conclusion : The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.

측두엽내 공간 점유 병소와 동반된 난치성 간질의 수술적 치료 성적

박준범,이완수,이정교,전상룡,김정훈,노성우,나영신,김창진,권양,임승철,권병덕,강중구,이상암,고태성,Park, Jun Bum,Lee, Wan Su,Lee, Jung Kyo,Jeon, Sang Ryong,Kim, Jeong Hoon,Roh, Sung Woo,Ra, Young Shin,Kim, Chang Jin,Kwon, Yang,Rhim, Seung Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : The increasing use of sensitive neuroimaging techniques has demonstrated that significant percentage of patients with intractable complex partial seizures have brain masses, especially in temporal lobe. The optimal surgical solution for these patients is still open to debate. The purpose of our investigation is to evaluate the surgical outcome of patient with lesion-related temporal lobe epilepsy with respect to the types of surgery and the location of lesion. Patients and Methods : From DEC. 1993 to Dec. 1997, 35 patients with intractable epilepsy and space occupying temporal lobe lesion identified in preoperative MRI were included in this study. The types of surgery were lesionectomy, anterior temporal lobectomy with or without hippocampectomy. The location of lesion was divided as anteromedial group and lateral cortical group. The postoperative seizure outcomes according to the type of surgery and location of the lesion were compared. Results : Twenty-six of 34 patients(76.5%) were seizure-free after surgery. The Engel's class was favorable after anterior temporal lobectomy with or without hippocampectomy(p=.044) Conclusion : It is favorable to perform anterior temporal lobectomy for the treatment of intractable epilepsy with space-occipying lesion in temporal lobe. The resection of the hippocampus can be individualized.

두개인두종의 감마나이프 치료 후 장기 추적 결과

김윤석,이도희,라동숙,전영일,안재성,전상룡,김정훈,노성우,나영신,김창진,권양,임승철,이정교,권병덕,Kim, Yun Sok,Lee, Do Heui,Ra, Dong Suk,Chun, Young Il,Ahn, Jae Sung,Jeon, Sang Ryong,Kim, Jeong Hoon,Roh, Sung Woo,Ra, Young Shin,Kim, Chang Jin 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

두개저와 상부 경추를 침범한 고어햄씨병의 보존적 치료 및 방사선 치료에 대한 경험 -증례보고-

장인석 ( In Seok Jang ),박준범 ( Jun Bum Park ),나영신 ( Young Shin Ra ),김정훈 ( Jeong Hoon Kim ),구현령 ( Hyun Lyoung Koo ),강신광 ( Shin Kwang Khang ) 대한뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

A 10-year-old boy was admitted at our institute with neck pain, limiting the neck movement and chin point deviation to the right. Which confirmed the suspected diagnosis of Gorham`s disease, the patient underwent biopsy on the 3rd cervical spine. Gorham`s disease was confidently diagnosed with the support of present clinical and radiographic findgings by a regional histopathologist. In order to diminish neck pain and ensure radiation field uniformity, a halo-vest was recommended. The patient received 4,000 cGy of radiation to the upper cervical osteolytic lesion. There has been no radiographic evidence of progression of the disease at the MR follow-up of post-radiotherapy 23 months. At present, the patient is remarkably doing well with no evidence of disease progression. The authors suggest that application of a halo-vest and early radiation therapy can be a good choice to management of Gorham`s disease involving skull base and upper cervical spine. However, long term follow-up will be essential to confirm the remission of disease.

라스케씨 열낭종과 동시에 발생한 뇌하수체 선종

김정훈 ( Jeong Hoon Kim ),권순찬 ( Soon Chan Kwon ),안재성 ( Jae Sung Ahn ),전상룡 ( Sang Ryong Jeon ),나영신 ( Young Shin Ra ),김창진 ( Chang Jin Kim ),이정교 ( Jung Kyo Lee ) 대한뇌종양학회 2003 대한뇌종양학회지 Vol.2 No.2

Objective:The goal of this study was to characterize the clinical, radiological, surgical, and pathological findings in patients with both pituitary adenoma and Rathke`s cleft cyst. Methods:We conducted a retrospective study of patients with concomitant pituitary adenoma and Rathke`s cleft cyst operated on from 1991 through 2001 at our institution. Three patients were identified with this diagnosis. The medical records, neuroradiologic studies, and histologies were reviewed. Results:There were 771 patients with pituitary adenoma and 46 with Rathke`s cleft cyst in the same period. The frequency of the combination was 0.39 % of pituitary adenoma and 6.5% of Rathke`s cleft cyst. One case was associated with hyperprolactinemia. Preoperative diagnosis on the basis of CT/MRI was pituitary adenoma in all three cases. Transsphenoidal approaches were done for these three patients, and postoperative courses were uneventful. Hormonal and visual symptoms were improved. Histologically, the tumor was composed of typical pituitary adenoma and component compatible with Rathke`s cleft cyst. Conclusion:When a non-enhancing cyst-like structure is demonstrated in a patient with pituitary adenoma, the possibility of a coexisting Rathke`s cleft cyst should be considered. Patients with this kind of pituitary tumor can be managed in the same fashion as patients with other types of pituitary adenoma.