Huge Choroid Plexus Carcinoma in an Infant

김해유,황용순,신형식,박상근 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.34 No.5

Choroid plexus carcinoma is a rare malignant brain tumor that occurs predominantly in childhood. A 203-day-old infant was admitted to our hospital with macrocephaly and right hemiparesis. The skull protruded diffusely in the left parietal area. Brain magnetic resonance imaging) revealed a huge mass in the left ventricle. We performed an open biopsy and discovered a choroid plexus carcinoma. The tumor bled very easily and hemostasis was difficult. After three cycles of chemotherapy, we resected the entire mass in a staged operation. Chemotherapy enabled us to resect the entire tumor by reducing its size. We report this case to stress the benefits of preoperative chemo-therapy and review the relevant literature. Key words:Choroid plexus carcinoma;Perioperative chemotherapy;Brain tumor.

알츠하이머 치매에 대한 뇌자극 치료

김해유(Hae Yu Kim),박진세(Jinse Park),이해구(Haegoo Lee) 대한인간공학회 2018 대한인간공학회 학술대회논문집 Vol.2018 No.11

Disappearance of a Distal Shunt Catheter: A Case Report of an Unusual Cause of Shunt Malfunction

김도엽,김해유,진성철,이성준 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.1

Shunt malfunction is a common complication in patients who undergo ventriculoperitonealshunt (VPS) placement for the treatment of hydrocephalus. A plethora of reports regardingshunt malfunctions due to distal catheter migration have been demonstrated in the literature. However, to our knowledge, there have been no reports thus far of shunt malfunctionscaused by the complete disappearance of a distal catheter. A 70-year-old man was admittedto our hospital for progressive gait disturbance beginning approximately 5 months ago. He received a VPS for posthemorrhagic hydrocephalus and was doing well over the courseof 18 months of follow-up. Since no increase in the size of the ventricle was observed onbrain computed tomography taken at the outpatient clinic, we tried to readjust the pressuresetting of his programmable shunt valve to relieve his symptoms. Without any progression,we discovered later by chance that the distal shunt catheter was missing. Shunt revisionsurgery was performed. At the 2-year follow-up, a slight improvement in gait was observed. Although it is very rare, the distal catheter can disappear without any noticeable symptoms. If shunt malfunction is suspected, it is important to check whether the entire shunt system isstructurally intact

Radiation-induced change after Gamma Knife radiosurgery for cerebral arteriovenous malformations

이학수,김해유,이선일,우준범,진성철,김무성 대한정위기능신경외과학회 2023 대한정위기능신경외과학회지 Vol.19 No.1

ObjectiveRadiation-induced change (RIC) on magnetic resonance imaging after Gamma Knife radiosurgery (GKRS) for cerebral arteriovenous malformations (AVMs) is not rare. We reviewed patients who underwent GKRS for AVMs and analyzed the results and factors associated with RIC. MethodsWe reviewed 189 patients who underwent GKRS for AVMs between October 2002 and August 2017. All patients were followed up for at least 3 years. This study included 111 males and 78 females (mean age, 39.63 years; range, 3-79 years). Nineteen patients underwent pre-GKRS embolization. Seventy-six patients had ruptured AVMs and 113 had unruptured AVMs. We analyzed obliteration and RIC occurrence rates. Several demographic and clinical factors were analyzed to determine the influence of AVM obliteration on RIC occurrence. ResultsThe overall obliteration rate (OR) was 72.49% (137/189) at the final follow-up. The actuarial OR was 55.5% 36 months after GKRS. The overall RIC occurrence rate was 28.04% (53/189), and the actuarial RIC occurrence rate was 26.8% 24 months after GKRS. The OR showed a statistically significant difference according to AVM rupture (p<0.01) and sex (p<0.01). The RIC occurrence rate was significantly associated with AVM rupture (p<0.01), lesion volume (p=0.04), and treatment volume (p=0.03). Other factors showed statistically non-significant relationships. ConclusionThe overall OR after GKRS for AVMs was comparable to the results of other previous reports. RIC is a common postoperative outcome following GKRS for AVMs. In this study, the OR was higher in ruptured AVMs and male patients, whereas RIC occurred more frequently in larger and unruptured AVMs. KEY WORDS: Radiation, Radiosurgery, Arteriovenous malformations

Cervical Spinal Fracture Caused by Untreated Tourette Syndrome: A Case Report

김창곤,최병삼,김해유,이성준 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

Cervical myelopathy can occur in Tourette syndrome patients with severe motor ticsshowing repetitive and violent neck movements. However, motor tics causing spinalfractures have been rarely reported. A 15-year-old girl presented at our clinic, complainingof recent development of motor weakness of all 4 extremities. She had untreated motortics involving the neck. Computed tomography and magnetic resonance imaging fndingssuggested cervical spinal fractures and myelopathy. Afer diagnosing of Tourette syndrome,medical and psychologic therapies were started. Her motor tics were well controlled, andno complications in the patient's daily life were observed later. Cervical radiography takenat a 9-month follow-up showed bony healings of the fractured cervical spines. Uncontrolledsevere motor tics may cause spinal fractures. Conservative treatments would sufce forproper control of these tics and stabilize the spine, and considered as initial treatment inpatients with Tourette syndrome

전상돌기에 발생한 점액낭종 1예

박병후,이근익,김해유,김용완 대한이비인후과학회 부산,울산,경남 지부회 2020 임상이비인후과 Vol.31 No.2

Sinus mucocele is epithelial lined benign cystic lesion usually due to obstruction of the sinus ostia. It is commonly seen in frontal and ethmoidal sinus, although rarely, in sphenoid sinus. Anterior clinoid process is bony process on the superolateral aspect of the sphenoid sinus and its pneumatization is observed approximately 9.5% in sphenoid sinus. An anterior clinoid process mucoceles account for merely 1% of paranasal sinus mucoceles and can lead to optic neuropathy, or even dysfunction of third, fourth, sixth cranial nerves due to its proximity to optic canal. There have only been 19 cases of anterior clinoid mucocele causing visual disturbance. We report a case of mucocele in anterior clinoid process in a 53-year-old man who presented with visual disturbance and ocular pain 1week ago.

Anterior Spinal Artery Syndrome Occurring after One Level Segmental Artery Ligation during Spinal Surgery

John Kwon,최병삼,김해유,이성준 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

In treating the ventral pathology of spine, ligating the segmental vessels is sometimesnecessary. This may cause spinal cord ischemia, and concerns of neurologic injury have beenpresented. However, spinal cord ischemic injury afer sacrifcing segmental vessels duringspine surgery is very rare. Reports of this have been scarce in the literature and most of thesecomplications occur afer multi-level segmental vessel ligation. Here we report a case of apatient with postoperative anterior spinal artery syndrome, which occurred afer ligating onelevel segmental vessels during spinal surgery for a T8 vertebral pathologic fracture. Despiteits rarity, the risk of spinal cord ischemic injury afer segmental vessel ligation is certainlypresent. Surgeons must keep in mind such risk, and surgery should be planned under acareful risk-beneft consideration

Optimal Treatment Decision for Brain Metastases of Unknown Primary Origin: The Role and Timing of Radiosurgery

한현진,장원석,정현호,박용구,김해유,장종희 대한뇌종양학회 2016 Brain Tumor Research and Treatment Vol. No.

Background Up to 15% of all patients with brain metastases have no clearly detected primary site despite intensive evaluation, and this incidence has decreased with the use of improved imaging technology. Radiosurgery has been evaluated as one of the treatment modality for patients with limited brain metastases. In this study, we evaluated the effectiveness of radiosurgery for brain metastases from unknown primary tumors. Methods We retrospectively evaluated 540 patients who underwent gamma knife radiosurgery (GKRS) for brain metastases radiologically diagnosed between August 1992 and September 2007 in our institution. First, the brain metastases were grouped into metachronous, synchronous, and precocious presentations according to the timing of diagnosis of the brain metastases. Then, synchronous and precocious brain metastases were further grouped into 1) unknown primary; 2) delayed known primary; and 3) synchronous metastases according to the timing of diagnosis of the primary origin. We analyzed the survival time and time to new brain metastasis in each group. Results Of the 540 patients, 29 (5.4%) presented precocious or synchronous metastases (34 GKRS procedures for 174 lesions). The primary tumor was not found even after intensive and repeated systemic evaluation in 10 patients (unknown primary, 34.5%); found after 8 months in 3 patients (delayed known primary, 1.2%); and diagnosed at the same time as the brain metastases in 16 patients (synchronous metastasis, 55.2%). No statistically significant differences in survival time and time to new brain metastasis were found among the three groups. Conclusion Identification of a primary tumor before GKRS did not affect the patient outcomes. If other possible differential diagnoses were completely excluded, early GKRS can be an effective treatment option for brain metastases from unknown primary tumor.

Considerations in Treating Neonatal and Infantile Patients with a Retrocerebellar Arachnoid Cyst: in the Perspective of Different CSF Dynamics

이승준,진성철,허윤정,김해유 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.4

Arachnoid cysts found under the age of 1 year are more likely to grow in size, relatively short term follow-up is required. Retrocerebellar location predicts a high risk of hydrocephalus, and the time window until irreversible neuronal damage is often narrow if the arachnoid cyst increases in size and becomes symptomatic. However, when and how to treat a neonatal or infantile patient with a retrocerebellar arachnoid cyst is still a controversial subject. We recently experienced 3 differently treated very young pediatric patients with retrocerebellar arachnoid cysts. One patient was treated two weeks after birth by a cystoperitoneal shunt. This patient showed normal development after the surgery. The other patient was treated by a ventriculoperitoneal shunt and subsequent cystoventriculostomy at the age of 4 months because of his mother’s refusal on 14th day after birth. This one showed developmental delay despite of decreasing size of ventricles after the surgery. The last patient was treated with microscopic fenestration, which failed in its initial attempt. A revision operation by cyst excision succeeded and had no problem after the surgery. Therefore, we suggest that early surgical intervention for retrocerebellar arachnoid cyst can be considered. Although there are concerns of long term complications related to shunts, a cystoperitoneal shunt would be a feasible treatment if we consider the minor cerebrospinal fluid pathway which is the dominant cerebrospinal fluid dynamic at this age.

A Network Analysis of 15O-H2O PET Reveals Deep Brain Stimulation Effects on Brain Network of Parkinson’s Disease

박해정,장진우,박범희,김해유,오맹근,김중일,윤미선,이종두 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.3

Purpose: As Parkinson’s disease (PD) can be considered a network abnormality, the effects of deep brain stimulation (DBS) need to be investigated in the aspect of networks. This study aimed to examine how DBS of the bilateral subthalamic nucleus(STN) affects the motor networks of patients with idiopathic PD during motorperformance and to show the feasibility of the network analysis using cross-sectional positron emission tomography (PET) images in DBS studies. Materials and Methods: We obtained [15O]H2O PET images from ten patients with PD duringa sequential finger-to-thumb opposition task and during the resting state, with DBS-On and DBS-Off at STN. To identify the alteration of motor networks in PD and their changes due to STN-DBS, we applied independent component analysis (ICA) to all the cross-sectional PET images. We analysed the strength of each component according to DBS effects, task effects and interaction effects. Results: ICA blindly decomposed components of functionally associated distributed clusters,which were comparable to the results of univariate statistical parametric mapping. ICA further revealed that STN-DBS modifies usage-strengths of components corresponding to the basal ganglia-thalamo-cortical circuits in PD patients by increasingthe hypoactive basal ganglia and by suppressing the hyperactive cortical motor areas, ventrolateral thalamus and cerebellum. Conclusion: Our results suggestthat STN-DBS may affect not only the abnormal local activity, but also alter brain networks in patients with PD. This study also demonstrated the usefulness of ICA for cross-sectional PET data to reveal network modifications due to DBS, which was not observable using the subtraction method.