경동맥 내막 절제술 : 19례의 임상 경험

김재용,오창완,정영섭,권오기,한대희,Kim, Chae-Yong,Oh, Chang-Wan,Chung, Young Seob,Kwon, O-Ki,Han, Dae Hee 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objective : Stroke is leading cause of death and more importantly it is cause of serious disability. The effective treatment of acute ischemic stroke still remains a challenge to modern medicine. Recent clinical trials have shown that carotid endareterctomy(CEA) provide overwhelming benefits compared with medical therapy in preventing subsequent stroke for symptomatic carotid stenosis. For the asymptomatic ones, the data are less compelling, but highly suggestive that CEA do have benefits in properly selected patients. Materials and Methods : To investigate the clinical manifestations of carotid stenosis and results of CEAs, authors analyzed retrospectively 19 CEAs in 16 patients from June 1986 to June 1999. Age of patients ranged from 55 to 76 years(median, 66) and male to female ratio was 14 to 2. The duration of follow-up was 1 to 144 months (median, 26). All of CEAs were done on the side of stenosis more than 80% and bilateral CEAs were done in three. Six CEAs were performed in asymptomatic patients. Results : Seventeen of 19 CEAs showed excellent results and complication rate was low although ipsilateral ischemic stroke occurred in two. Conclusion : CEA may be a valuable surgical treatment for ischemic stroke caused by carotid stenosis and also for prevention of stroke of asymptomatic patients with carotid stenosis.

뇌하수체선종에 대한 미세현미경 경접형동 수술과 내시경 경접형동 수술의 비교

김영훈(Young-Hoon Kim),김용휘(Yong Hwy Kim),주진덕(Jin-Deok Joo),한정호(Jung Ho Han),김재용(Chae-Yong Kim) 대한두개저학회 2015 대한두개저학회지 Vol.10 No.1

The recent advancement in the endoscopic skullbase surgery has made a paradigm shift on the surgical treatment for pituitary tumors. The endoscopic endonasal transsphenoidal approach (EETSA) has rapidly replaced the microscope-based transsphenoidal approach (MTSA). However, there is a still a debate on whether the EETSA is superior to the MTSA for pituitary adenomas or not. The use of the endoscope to visualize the sella via a direct endonasal approach offers the surgeons dramatically better visualization as well as improved range of motion compared to the operating microscope. On the other hand, the endonasal and bleeding complications are significantly higher in the EETSA compared with the MTSA. In Particular, patient discomfort, smell, and taste impairment are higher with the endoscopic method compared with microscopic ones. This paper will review on the basis of the data available in literature the pros and cons of the two methods, EETSA and MTSA.

청신경초종에 대해 의도적 아전절제술 후 감마나이프 수술의 장기 종양조절율과 안면 신경 보존율

김영훈(Young-Hoon Kim),김진욱(Jin Wook Kim),김용휘(Yong Hwy Kim),한정호(Jung Ho Han),박철기(Chul-Kee Park),김재용(Chae-Yong Kim),백선하(Sun Ha Paek),김동규(Dong Gyu Kim),정희원(Hee-Won Jung) 대한두개저학회 2012 대한두개저학회지 Vol.7 No.1

Objective : Gross total removal(GTR) without neurological impairments for large vestibular schwannoma(VS) has been challenging to neurosurgeons. The purpose of this study was to evaluate long-term surgical and neurological outcome of attempted subtotal removal(STR) followed by Gamma Knife radiosurgery(GKRS) for VS. Methods : A total of 279 patients, who underwent surgical resection with or without GKRS for VS, were enrolled in this study. The median age and follow-up duration were 45 years(range, 19-73) and 5.5 years(2-15), respectively. Two hundred-forty six cases(88.2%) were in Koos grade 3 or 4. GTR or near total removal(NTR), STR, and partial removal(PR) were achieved in 75(26.9%), 160(57.3%), and 44 patients(15.8%), respectively. Adjuvant GKRS were performed in 124 patients(44.4%). Results : The long-term overall tumor control rate was 91.8%(256/279). Of the 160 patients with STR, the tumor control rate was significantly higher in 86 patients who received GKRS(97.7%) than that in 74 patients who did not undergo GKRS(82.4%; p=0.004). However, the adjuvant GKRS did not significantly influence the tumor control rate in GTR, NTR, and PR groups. The functional preservation rate of facial nerve was significantly higher in the STR or PR groups(188/204; 92.2%) than that in the GTR or NTR groups(56/75; 74.7%; p<0.001). Conclusion : Attempted STR with adjuvant GKRS could acquire excellent tumor control and facial never functional outcome of the patients, who underwent surgery for unilateral sporadic VS.

낭종제거술로 회복된 제3뇌신경 부분마비를 보인 안장위 유구낭미충증

양희경,김재용,황정민.Hee Kyung Yang. MD. Chae-Yong Kim. MD. Jeong-Min Hwang. MD 대한안과학회 2009 대한안과학회지 Vol.50 No.4

Purpose: To report a case of partial third cranial nerve palsy in a patient with suprasellar cysticercosis. Surgical removal of the cyst was followed by symptom improvement. Case summary: A 36-year-old man presented with binocular diplopia for 3 months. His best corrected visual acuities were 20/20 in both eyes, and both slit lamp and fundus examinations were unremarkable. The alternate prism cover test revealed four prism diopters (Δ) of exotropia and 4Δ of left hypotropia. Supraduction and adduction was mildly limited in the left eye. Pupil size was larger in the left eye and anisocoria was greater under bright light. Color test and visual field examination were normal. Neurologic examination showed a weakness of grade IV in the upper and lower extremities. Brain magnetic resonance imaging revealed a well-encapsulated cystic mass of homogeneous low intensity signal in the suprasellar area extending into the midbrain. Craniotomy and cyst removal were performed, and histologic findings were compatible with neurocysticercosis. Two weeks postoperatively the patient was free of diplopia and limb weakness. Conclusions: Neurocysticercosis of a suprasellar origin may produce mass effects on the midbrain, inducing focal neurologic deficits of partial third cranial nerve palsy along with limb weakness. Masses of suprasellar origin can be successfully treated by surgical removal of the cyst. J Korean Ophthalmol Soc 2009;50(4):640-644

임상 : 상전두개저 종양 절제술; 전통적인 두개안면절제술과 내시경적 두개안면절제술의 비교

최호용 ( Ho Yong Choi ),김재용 ( Chae Yong Kim ),이철희 ( Chul Hee Lee ),조성윤 ( Sung Yun Cho ),오창완 ( Chang Wan Oh ) 대한뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2

Tumors of the anterior skull base are rare. Most neurosurgeons and ENT surgeons use traditional craniofacial resection (TCFR) to remove anterior skull base tumors. Recently, endoscopic craniofacial resection (ECFR) also has been used for resection of the tumors of the nasal side; this strategy facilitates superior visualization, avoids facial incisions, and preserves local structures. The purpose of this study was to compare the outcome of these two approaches. A retrospective analysis was conducted to identify patients undergoing resection of anterior skull base tumors between September 1996 and May 2010. Demographic data, pathology, surgical approach, operative time, estimated blood loss, hospital stay, and complications were analyzed. Recurrence and mortality rates were also investigated. Eight patients were managed with ECFR, and 24 patients were treated with TCFR. Differences were observed between the two groups with respect to the operation time, estimated blood loss, and hospital stay. Complications were encountered in 1/8 (12.5%) and 4/24 (16.7%) patients in the ECFR and TCFR groups, respectively. Recurrence was observed in 4/8 (50%) and 10/24 (41.7%) patients in the ECFR and TCFR groups, respectively. Mortality rates were 2/8 (25.0%) and 13/24 (54.2%), in the ECFR and TCFR groups, respectively. Consequently, ECFR was significantly better than TCFR with respect to the operation time, estimated blood loss, and hospital stay. The rate of complications, recurrence, and mortality were not statistically different between the two groups. This comparison suggests that the ECFR approach might be an alternative surgical treatment option for the removal of anterior skull base tumors.

역형성 희돌기교종의 장기추적 결과

이준호 ( June Ho Lee ),김재용 ( Chae Yong Kim ),황성곤 ( Sung Kyun Hwang ),백선하 ( Sun Ha Pa다 ),김동규 ( Dong Gyu Kim ),정희원 ( Hee Won Jung ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Objective:Aggressive oligodendroglioma(ODG) is reported to be more sensitive to chemotherapy than other glial tumors. Authors retrospectively analyzed the clinical outcome of anaplastic ODG after treatment with cytoreductive surgery and then adjuvant chemotherapy following radiotherapy. Methods:The clinical records of 25 anaplastic ODG patients, registered between 1991 and 1998 and then followed-up more than two years after completion of each treatment, were reviewed. These patients were subdivided by the degree of resection and the treatment modality;operation+radiotherapy group versus operation+radiotherapy+adjuvant chemotherapy( PCV regimen) group. Treatment outcomes were evaluated by the presence of recurrence in follow-up magnetic resonance image(MRI) and the recurrence-free survival curves were obtained for each group by using Kaplan-Meier method. The mean follow-up period for anaplastic ODG was 57.7 months. Results:There were only five cases of recurrence among the 14 patients(36%) with anaplastic ODG treated with operation+ radiotherapy alone compared to two of 10 patients treated with adjuvant chemotherapy after operation+radiotherapy. The recurrence-free survival period for operation+radiotherapy groups was 82.8 months compared to 82.5 months for adjuvant chemotherapy groups. The recurrence-free survival for the patients with more than near totally resected anaplastic ODG showed twice as long as those less than subtotally resected group Conclusion:Contrary to previous reports on anaplastic ODG as a chemosensitive tumor, recurrence rate and recurrencefree survival period for the anaplastic ODG patients treated with adjuvant chemotherapy was not significantly different from those treated with operation+radiotherapy alone. However, the degree of resection affected the recurrence-free survival in anaplastic ODG irrelevant to the treatment modality.

뇌하수체선종으로 오인된 터키안 내 연골양 척삭종

김창욱(Chang-Wook Kim),김영훈(Young-Hoon Kim),한정호(Jung Ho Han),김재용(Chae-Yong Kim) 대한두개저학회 2014 대한두개저학회지 Vol.9 No.1

Chordomas are rare, slow-growing malignant tumors of the midline, representing approximately 0.1 to 0.2% of intracranial neoplasms. We describe the case of intrasellar chondroid chordoma, hardly distinguished from pituitary adenoma. Initially, the lesion was considered to be a nonfunctioning pituitary adenoma. After endoscopic endonasal approach, the tumor was subtotally removed, and the histopathological diagnosis was a chondroid chordoma. The patient underwent Gamma Knife radiosurgery. Although this tumor is easily misdiagnosed, initial aggressive surgical resection and gamma knife radiosurgery can yield a favorable prognosis.

Tamoxifen 복용중인 유방암환자에서 발생한 출혈성 뇌전이를 닮은 정맥 색전증

이승준 ( Seung Joon Lee ),허원 ( Won Huh ),김재용 ( Chae Yong Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

We report a rare clinical case of cortical vein thrombosis diagnosed in a patient with breast cancer treated with tamoxifen. A 70-year-old woman presented with sudden right hemiparesis and motor aphasia. She had been diagnosed with breast cancer four years earlier, and had undergone a modified radical mastectomy. She was taking tamoxifen as an adjuvant hormonal therapy, afterwards. Serial brain computed tomography(CT) revealed growing size of multiple hemorrhage in the left high frontoparietal area and contrast-enhanced brain magnetic resonance image(MRI) revealed a small enhanced lesion around the hematoma. We performed craniotomy and the removal of the lesion to allow a pathological diagnosis of possible brain metastasis and cerebral decompression. During surgery, a bluish area was observed in the left postcentral area and there was a thrombosed cortical vein in the center of this area, previously emptying into the superior sagittal sinus. The pathologic finding demonstrated that the surrounding brain tissue and the hematoma showed no evidence of cancer cells. We concluded that the occlusion of the cortical vein by a thrombosis caused the hemorrhagic infarction. Given the popular use of tamoxifen therapy in breast cancer patients, we should consider a possible cerebral venous thromboses mimicking brain metastasis, especially cortical vein thromboses, in patients presenting with rapid neurological deterioration.

광범위한 뇌연수막 파종으로 나타난 역형성 성상세포종의 특이 발현 Temozolomide를 기초로 치료한 두 증례 보고

최정원 ( Jung Won Choi ),김인아 ( In A Kim ),최기영 ( Ghee Young Choe ),김재용 ( Chae Yong Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

We describe two unusual cases of diffuse leptomeningeal seeding as the initial manifestation of a subtle brain mass lesion. At first, they were misdiagnosed as tuberculous encephalitis because there was no obvious mass lesion in magnetic resonance(MR) images of the brain and the cerebrospinal fluid profile was highly suggestive of an infective process. The MR images showed only ill-defined lesions in the basal ganglia. Anaplastic astrocytomas were finally diagnosed following stereotactic brain biopsies. Whole-spine MR images from these two patients revealed diffuse leptomeningeal enhancing lesions that affected the whole spine. We planned aggressive multimodal treatment including concurrent chemoradiation therapy using temozolomide. One patient died from disease progression eight months after the initial diagnosis. The second patient was treated more aggressively. She survived for more than thirteen months after diagnosis. Biopsy and aggressive treatment must be considered in cases of ill-defined lesions with clinical manifestation indicating unusual encephalitis.

임상 : 연구에비소세포폐암의 뇌전이암에 대한 정위적 방사선 수술의 치료 효과

이원석 ( Won Seok Lee ),김영훈 ( Young Hoon Kim ),한정호 ( Jung Ho Han ),김재용 ( Chae Yong Kim ) 대한뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.1

Objectives: This study was performed to evaluate the therapeutic efficacy of stereotactic radiosurgery (SRS) for non-small cell lung cancer (NSCLC) brain metastases and to assess the associative factors for patients` survival. Methods: Seventy-three consecutive patients with 387 brain metastases from NSCLC were treated with SRS. The mean age of patients was 61.9±11.7 years (range, 34-84), and 44 (60.3%) patients were male. The mean number of tumors was 5.3±6.6 (range, 1-33). The mean tumor volume was 1.38±3.60 cm3 (range, 0.01-25.40), and the mean marginal radiation dose was 19.37 Gy±2.98 Gy (range, 7.00-25.00) at 53.91±8.32 % isodose line. Results: The median overall survival (OS) after SRS was 17.2 months (95% CI, 7.3-27.1), and the actuarial OS rate 54.4 and 40.3% at the first and second year, respectively. In the multivariate analysis, the Karnofsky`s Performance Score was the only independent prognostic factor (HR=2.942 ; 95% CI, 1.337-6.476 ; p=0.007) for OS. Local control failure occurred in 17 patients (23.3%), and distant disease progression developed in 19 patients (26.0%) at a mean follow-up duration of 11.3±8.6 months. Neurological deficits and early tumor response (≤1 month) were significant prognostic factors for disease progression. Conclusion: SRS was an effective treatment option for patients with brain metastases from NSCLC. Initial status of pa-tients was the most important indicators for survival and disease progression after SRS for NSCLC brain metastases.