임상 : 뇌종양에 대한 보조적 항암치료 동안 발생하는 뇌종양 연관성 간질에 대한 연구

박성훈 ( Sung Hoon Park ),김영준 ( Young Zoon Kim ),조용운 ( Yong Woon Cho ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

Objective:Topiramate is a new anti-epileptic drug with few drug interactions and side effects, which are important obstacles to chemotherapy. The purpose of this prospective observational study was to determine the efficacy of topiramate for the treatment of brain tumor associated epilepsy(BTAE) during adjuvant chemotherapy, and to examine the risk factors for development of BATE. Methods:From March 2006 to February 2009, 81 patients who underwent adjuvant chemotherapy with concomitant topiramate administration after surgery for a brain tumor were enrolled. The authors determined the number of patients that experienced BTAE and the number of BTAE attacks during chemotherapy according to the following comparative groups:presence versus absence of previous history of BTAE;high risk group versus low risk group;progressive disease versus stable disease. Results:Overall 73 of the 81 patients(90.1%) remained seizure-free during chemotherapy. Seizure-free rates were 89.3% and 90.6% among patients with or without a previous history of BTAE, respectively(p=0.527), 88.1% and 94.9% among high and low risk patients(p=0.083), and 58.8% and 98.4% among patients with a progressive or a responsive brain tumor(p=0.000). Total 18 seizure attacks occurred. Although the side effects of topiramate were found in 16 patients, they were well tolerable to patients. Conclusion:Topiramate was found to achieve adequate seizure-control with tolerable side effects during adjuvant chemotherapy in brain tumor patients after surgery. However, responsiveness of brain tumor to chemotherapy importantly modulated the effects of BTAE.

후두골 형성 부전을 동반한 총상 신경섬유종

김성수 ( Sung Soo Kim ),김충현 ( Choong Hyun Kim ),정진환 ( Jin Hwan Cheong ),김재민 ( Jae Min Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.2

Plexiform neurofibroma(PNF) occurring at the occipital scalp is rare. It occasionally accompanies occipital bony defect and dysplasia, especially near the lambdoid suture. But the etiology is not known. We report a case of 17-year-old male presented with large mass on the left parietooccipital scalp. As reported cases, our case was also associated with occipital bony defect. In experience of our case and review of literatures, we think that PNF should be considered as a differential diagnosis in the scalp masses which accompany bony defect and dysplasia.

뇌하수체 거대선종의 피막외 접근법 -2례의 증례보고-

박열범 ( Yeul Bum Park ),김민수 ( Min Su Kim ),김성호 ( Seong Ho Kim ),김오룡 ( Oh Lyong Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.2

Pituitary adenoma is one of the most common benign intracranial neoplasms. As the tumor enlarges, it compresses the surrounding pituitary gland, ultimately producing a pseudocapsule. We reviewed the clinical advantage and side effect of the extracapsular approach. A 66-year-old female was brought to the hospital due to bitemporal hemianopsia and headache. A brain magnetic resonance image showed a 16×32mm macroadenoma. The second case was a 57-year-old male who was brought to the hospital due to progressive visual loss. Radiologic evaluation showed a 20×32mm macroadenoma. By trans-sphenoidal microsurgery, we approached the outer part of the pseudocapsule between the normal pituitary gland along the tumor and surgically removed the adenoma. Histology showed tumor cell invasion in pseudocapsule. A follow up brain MRI showed total removal of the pituitary macroadenoma. A complication was cerebrospinal fluid leakage. The extracapsular approach for pituitary macroadenoma may be useful for one stage removal as it does not require additional maneuvers to push the tumor downward. However, careful dissection is necessary to avoid cerebrospinal fluid leakage.

장기 생존한 교모세포종 -증례보고 2례-

김성진 ( Sung Jin Kim ),한성록 ( Seong Rok Han ),윤상원 ( Sang Won Yoon ),이기택 ( Gi Taek Yee ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Sohn ),이동준 ( Dong Joon Lee ),김한성 ( Han Seong Kim ),황충진 ( Choong Jin Whang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.2

Despite multimodal therapy, glioblastoma multiforme(GBM) is associated with a poor prognosis with a median survival of less than 1 year. GBM with long-term survival over 5 years is rare, and no definite markers of better prognosis have been identified till date. We present two patients who were diagnosed a frontal GBM and a cerebellar GBM respectively. Both patients were survived for more than 5 years, who had been treated with surgery, Novalis radiosurgery and chemotherapy. We also discussed prognostic factors who were long term survival with GBM.

만성 경막하 혈종으로 증세 발현된 수막종 -증례보고-

한인보 ( In Bo Han ),정영선 ( Young Sun Chung ),허륭 ( Ryoong Huh ),김태헌 ( Tae Heon Kim ),정상섭 ( Sang Sup Chung ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.2

A meningioma manifesting chronic subdural hematoma(SDH) is very rare. Although several reports have been presented, the mechanisms of chronic SDH formation in the presence of meningioma are not yet understood. A 71-year-old woman presented with 5-day history of headache and vomiting. There was no history of trauma and the patient was not on any anticoagulant therapy. On admission, the patient was alert and oriented. However, the patient became drowsy suddenly, with left hemiparesis(grade III). A noncontrast computed tomographic(CT) scan of the head revealed a right chronic SDH and subsequent magnetic resonance image(MRI) showed a right chronic SDH associated with an extraaxial and well enhancing mass in the right frontal convexity. Complete resection of the tumor as well as the removal of the chronic SDH was performed. Histological examination revealed an atypical meningioma with intratumoral hemorrhage. We describe a case of meningioma associated with chronic SDH and review the previous reports.

복합 화학-면역치료

정동섭 ( Dong Sup Chung ),홍용길 ( Yong Kil Hong ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

Cytotoxic chemotherapy has been an important treatment modality in human malignancy as well as surgery and radiotherapy. Chemotherapeutic agents have continued to improve in efficacy, but there are few cases in which a single drug or treatment modality has sufficien+t activity to cure the malignancy by itself. The active immunotherapeutic strategy to induce an immune response against tumors is quite attractive because it offers the potential for high tumor-specific toxicity, minimal side effects, and a durable antitumor effect. However, its clinical effects on patients with malignancy have not been up to the expectation because of immune tolerance, sheer physical burden of tumor antigens, tumor escape mechanisms from the immune surveillance system and so on. Although the combined chemotherapy and immunotherapy would seem to be contradictory, preclinical and clinical data have shown that many chemotherapeutic agents such as cyclophosphamide, gemcitabine and temozolomide enhance the efficacy of immunotherapy when used prior to immunotherapy. Explainable mechanisms of action are lessening of inhibitory immune effect by tumors, improvement of the effector T cell:tumor ratio, inhibition of regulatory T cells, enhancement of antigen presentation by tumors, alteration of tumor microenvironment, or some yet unknown method. Recent developed targeted therapies such as the monoclonal antibodies cetuximab, bevacizumab and trastuzumab, seem to be more effective when given with chemotherapy or other targeted therapies. More experimental and clinical trials are needed to evoke the full potential of the synergistic antitumor effects of chemotherapy combined with immunotherapy.

기초 : 핍지교세종의 염색체 연구에 의한 예후 판단

권윤광 ( Yoon Kwang Kwon ),박성호 ( Seong Ho Park ),손은익 ( Eun Ik Son ),김일만 ( Eal Maan Kim ),김상표 ( Sang Pyo Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

Objective:This study focused on the clinical outcomes and the potential impact of genetic analysis to predict the clinical outcomes following treatment options including surgery, adjuvant radiotherapy and chemotherapy in patients with oligodendroglial tumors. Methods:We conducted a retrospective analysis of the medical records of 13 patients who were newly diagnosed with oligodendroglioma and anaplastic oligodendroglioma between 1995 and 2006. Results:The 13 patients included ten men(77%) and three women(23%). Seven tumors were histologically classified as low-grade oligodendrogliomas(WHO grade II), and the remaining six tumors were classified as anaplastic oligodendrogliomas( grade III). Seizure was the most frequent presenting symptom. All patients were treated surgically. Molecular genetic studies were performed on tumor and blood samples from all patients. LOH for loci on chromosome 1p was detected in all oligodendrogliomas(100%) and four of six anaplastic oligodendrogliomas(67%). LOH in loci from chromosome 19 was found in all oligodendrogliomas(100%) and in five of six anaplastic oligodendrogliomas(83%). One patient with anaplastic oligodendroglioma revealed no loss of 19q. Two patients with anaplastic oligodendroglioma died, one in whom the anaplastic oligodendroglioma retained 19q and the other in whom the anaplastic oligodendroglioma had lost 19q. Those two patients showed a rapid spread of the tumor and no responsiveness to chemotherapy. Conclusion:Molecular genetic study is a potentially useful way of characterizing the biological features of patients and identifying patients with a high risk of developing oligodendroglial tumors. Oligodendroglial tumors correlate with a high occurrence of loss of heterozygosity(LOH) on chromosomes 1p and 19q. It can be a specific predictor of prognosis of oligodendroglial tumors.

임상 : 비정형성 수막종의 임상 경험

한성록 ( Seong Rok Han ),윤상원 ( Sang Won Yoon ),이기택 ( Gi Taek Yee ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Sohn ),이동준 ( Dong Joon Lee ),황충진 ( Choong Jin Whang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

Objective:Atypical meningiomas(AMs) are difficult tumors to manage. The authors evaluate local control and survival after primary surgery for patients with AMs. Methods:Of the 108 meningioma patients surgically treated between 2000 and 2005, pathologically proven 10 AMs were reviewed. Mean follow-up periods were 35.9(range, 7-68) months. Results:Four(40%) had local recurrences during the follow-up, of which 1(14%) of 7 gross total removal and 3(100%) of 3 subtotal removal. The mean time to recurrence was 33.8 months. The overall 3-year local control rates were 70%. All patients were survived during follow-up period. Seven(70%) patients were treated Novalis radiosurgery. 3 patients had residual tumors and 4 patients had recurrent tumor. Conclusion:The aim of treatment for AMs is to resect totally as possible. Radiosurgery for remnant or recurrent AMs could be considered as adjuvant therapy, although further study is mandatory.

뇌수막종의 종양주위부종에 대한 임상적 고찰

최정훈 ( Jeong Hoon Choi ),김창현 ( Chang Hyun Kim ),문재곤 ( Jae Gon Moon ),이호국 ( Ho Kook Lee ),이민진 ( Min Jin Lee ),최종훈 ( Jong Hun Choi ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

Objective:The extent of peritumoral brain edema(PTBE) in meningioma is very variable and PTBE can adversely affect the clinical course. Many influenceable factors have been investigated, but the mechanism of that is not fully understood. Recent reports have focused on the arterial blood supply pattern and immunohistopathological aspect. The authors investigated several clinical and immunohistopathological factors that may influence the development of PTBE and postoperative edema patterns in meningioma. Methods:We studied 30 cases of intracranial meningioma which were histologically proven. We focused on identifying the interaction of the location, the tumor and edema volume, the histological subtype, the preoperative edema index(EI), the biological activity indicated by the VEGF and the MIB-1 labeling index(LI), the postoperative EI. Results:There was no statistically significant correlation between the location and the PTBE. There was statistically significant correlation between the histology and the PTBE. But there was no significant correlation between the histology and the decrease in postoperative remaining PTBE. The MIB-1 LI was positively related to the PTBE formation in meningiomas. Also MIB-1 LI was related to the decrease in postoperative remaining PTBE. The VEGF was positively correlated with the PTBE formation in meningiomas but there was no statistically correlation with the decrease in postoperative remaining PTBE. Conclusion:The greater MIB-1 LI results in greater PTBE formation and more decreased in postoperative PTBE. The greater VEGF expression results in greater PTBE formation.

접형골연 수막종의 수술 후 발생한 치명적 뇌실질내 혈종 -증례보고-

허윤희 ( Yun Hee Hue ),김충현 ( Choong Hyun Kim ),정진환 ( Jin Hwan Cheong ),김재민 ( Jae Min Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

Intracranial meningiomas are mainly benign lesions amenable for surgical resection. However, removal of an intracranial meningioma carries a higher risk of postoperative hemorrhage compared to surgery for other intracranial neoplasms. The sphenoid ridge meningioma especially has difficult surgical problems because it can involve arteries of the anterior circulation, anterior visual pathways, and oculomotor nerve. The authors report a 50-year-old patient who had resection of sphenoid ridge meningioma and postoperative intracerebral hemorrhage occurred at postoperative 1 day. Despite of emergency hematoma removal, patient expired at postoperative 4 day. We review pertinent literatures, and discuss risk factors and prevention of postoperative hematoma.