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이홍재(Hong Jae Lee),이태규(Tae Gyu Lee),이관성(Kwan sung Lee),전신수(Sin soo Jeun),이상원(Sang Won Lee),홍용길(Yong Gil Hong),박춘근(Chun kun Park),김문찬(Moon Chan Kim),선동일(Dong Il Sun),김민식(Min Sik Kim) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.1
Surgical treatment of neoplasms involving the anterior skull base is a relatively recent developing procedure and is on the border of the domains of neurosurgery as well as head and neck surgery. This report presents the result of 13 patients with primary tumors of the anterior skull base treated by craniofacial resection during a 5-year period. Their ages ranged from 5 to 69 years, with a mean age of 48 years. The most common type of tumor was squamous cell carcinoma (4 patients), followed by malignant meningioma (2), squamous cell papilloma (2), olfactory neuroblastoma (1), neurofibroma (1), malignant fibrohistiocytosis (1), ossifying fibroma (1), and chondrosarcoma (1). Postoperative complications were noted in five cases after surgery. The complications were a cerebrospinal fluid leak in 3 patients, and infection in 2 patients; none resulted in any neurological deficit. Malignancies involving the skull base can be successfully resected with surgical margin using a craniofacial approach, with minimum operative mortality and morbidity.
이홍재(Hong Jae Lee),강석구(Seok Gu Kang),이태규(Tae Gyu Lee),이관성(Kwan sung Lee),전신수(Sin soo Jeun),이상원(Sang Won Lee),홍용길(Yong Gil Hong),박춘근(Chun kun Park),김문찬(Moon Chan Kim) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.1
During recent years it has been demonstrated that subgroups of brain stem glioma may be associated with a better prognosis than others. We investigated some correlations between the pathological findings and radiologic (magnetic resonance imaging, computed tomography) imaging appearance of 13 brain stem gliomas, which were able to follow up over 1 year. The growth patterns of brain stem glioma was observed retrospectively. 8 cases were low grade gliomas and 5 cases were high grade gliomas that included three definite diffuse brain stem gliomas in magnetic resonance imagings even though these tumors were not confirmed by pathologist. Superior and dorsal exophytic growth patterns was observed in low grade brain stem glioma and multidirectional growth patterns in high grade brain stem glioma. According to this observation, growth of low grade brain stem glioma has stereotypical growth pattern by barrier and high grade glioma was unhindered by barrier. Growth patterns of brain stem glioma will help to assess the histological grade and establish the therapeutic plan.
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.
양성자 화학적 이동영상기법(<sup>1</sup>H-CSI)을 이용한 정위적 뇌생검
장경술,손병철,김문찬,최병길,김의녕,김범수,최보영,백현만,홍용길,강준기,Chang, Kyung-Sool,Son, Byung-Chul,Kim, Moon-Chan,Choi, Byung-Gil,Kim, Euy-Neying,Kim, Bum-Soo,Choe, Bo-Young,Baik, Hyun-Man,Hong, Yong-Kil,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12
Objective : To obtain more reliable sample in stereotactic biopsy, authors adopted proton chemical shift imaging ($^1H$-CSI)-directed biopsy. Until now, proton single voxel spectroscopy($^1H$-SVS) technique has been reported as a technique using metabolic information in stereotactic biopsy. The authors performed $^1H$-CSI with a stereotactic headframe in place and evaluated the pathologic results obtained from local metabolic information through $^1H$-CSI. Methods : $^1H$ CSI-directed stereotactic biopsy was performed in four patients. $^1H$-CSI and conventional Gd-enhancement stereotactic MRI was done simultaneously after application of the stereotatic frame. After reconstruction of metabolic maps of NAA/Cr, Cho/Cr, and Lactate/Cr ratios, the focal areas of increased Cho/Cr ratios and decreased NAA/Cr ratios were selected for target sites in the MR images Results : There was no difficulty in performing $^1H$-CSI with the stereotactic headframe in place. In pathologic examinations, the samples taken in area of increased Cho/Cr ratios and decreased NAA/Cr ratios showed the features of increased cellularity, mitoses and cellular atypism, thus facilitated the diagnosis. The pathologic samples taken from the area of increased Lactate/Cr ratios showed prominent feature of necrosis. Conclusion : $^1H$-CSI was feasible with stereotactic head frame in place. The final pathologic results obtained in our samples were concordant with the local metabolic informations from $^1H$-CSI. Authors believe that $^1H$ CSI-directed stereotactic biopsy may provide us advantages in obtaining more reliable tissue specimen in stereotactic biopsy.
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.
이연수,김성훈,정용안,최보영,손형선,김의녕,홍용길,유이령,정수교 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.6
Purpose: Thallim-201 (201Tl) brain SPECT and proton (1H) magnetic resonance spectroscopy (MRS) have been used to evaluate tumor grade and viability of glioma. We assessed the correlations between 201Tl brain index or spectrum of metabolites of 1H MRS and grade of glioma or histopathologic findings. Materials and Methods: We studied 17 patients (4 astrocytoma, 7 anaplastic astrocytoma and 6 glioblastoma). On 201Tl Brain SPECT, 201Tl index was measured as the ratio of average counts for region of interest to those for the contralateral normal brain. On 1H MRS, we calculated choline (Cho) /creatine (Cr) ratio and N-acetylaspartate (NAA)/Cr ratio in ROI defined as tumor center. Histopathologic findings were graded by Ki-67 index, cellularity, mitosis, pleomorphism, necrosis and endothelial proliferation. An unpaired t test and statistical correlations were performed to evaluate these data. Results: Tl-index showed the best correlation with Ki-67 index (p<0.01), less correlations with cellularity, mitosis, and endothelial proliferation, but no correlation with results of MRS, pleomorphism, or necrosis. The findings of MRS did not correlate with all of the above. The cases of glioblastoma demonstrated a higher Tl-index, Cho/Cr ratio, Ki-67 index and lower NAA/Cr ratio, albeit without statistical significance. Conclusion: Even though 201Tl brain SPECT did not correlate directly with grade of malignancy, it may still be useful in determining biological aggressiveness of tumor and prognosis of patients because it correlated well with Ki-67 index, a growth fraction of glioma, cellularity, mitosis and endothelial proliferation.
김성훈,이연수,손형선,김의녕,정용안,정수교,홍용길 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.5
Purpose: Thallim-201 (201Tl) brain SPECT, which can represent cellular activity of brain lesions, may provide more useful information in differentiating between benign and malignant brain lesions more so than CT or MRI, that merely represents anatomic changes or breakdown of blood brain barrier. We used 201Tl brain SPECT prospectively to evaluate the utility of 201Tl-indices as an indicator of benign or malignant lesions. Materials and Methods: We studied 28 patients. There were 13 cases of benign lesions (3: nonspecific benign lesion, 3: meningioma, 2: low grade glioma, 1: tuberculoma, central neurocytoma, hemangioblastoma, radiation necrosis, and choroid plexus papilloma) and 15 cases of malignant lesions (6: glioblastoma multiforme, 5: anaplastic glioma, 2: medulloblastoma, 1: metastasis and lymphoma). In all patients, CT and/or MRI were obtained and then 201Tl brain SPECT was obtained with measuring mean 201Tl index and peak 201Tl index. An unpaired t-test was performed to compare the 201Tl-indices and pathologic diagnoses to evaluate the utility of 201Tl-indices as an indicator of benign or malignant lesions. Results: There were no statistically significant difference in 201Tl-indices between benign and malignant brain lesions (P>0.05). Conclusion: These results demonstrated that we could not use 201Tl indices on brain SPECT alone as an indicator of benign or malignant brain lesions.