뇌로 전이된 포상 연부 육종 - 증례보고 -

정진환,김충현,백광흠,김재민,오석전,Cheong, Jin Hwan,Kim, Choong Hyun,Bak, Koang Hum,Kim, Jae Min,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Alveolar Soft Part Sarcoma(ASPS) is a rare entity that invariably ends in death from the disseminated disease. Although the most common site of metastasis is the lung, the central nervous system is also the third common site. Its histogenesis remains to be unknown and the gold standard treatment is radically surgical removal of the mass. However, adjuvant chemotherapy and radiotherapy are known to be less effective. The authors present a 24-year-old man who was admitted with headache and neck discomfort. Magnetic resonance( MR) imaging scans demonstrated multiple masses in the left frontal lobe, parietal lobe, and right cerebellum. The patient underwent surgery to remove multiple masses in the staged fashion. The postoperative course was uneventful, but the patient committed suicide 5 months later. The authors reviewed the pertinent literature and discussed this clinical entity with references.

자연 소실된 송과체 배아종 - 증례보고 -

정진환,김재민,백광흠,김충현,오석전,Cheong, Jin Hwan,Kim, Jae Min,Bak, Koang Hum,Kim, Choong Hyun,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.10

Germinoma is a rare central nervous system neoplasm in children and young adults. It is well known that a malignant primary neoplasm can be cured by conventional radiation therapy alone or reduced-volume and field irradiation in combination with chemotherapy. The authors report a very rare case of a pineal germinoma, which was completely disappeared after repeated diagnostic brain computed tomography(CT) with review of pertinent literature. There has been neither tumor recurrence nor metastasis during follow-up period.

기저핵부 뇌실질내 출혈에 대한 수술후 뇌농양으로 오인한 다형성 교아세포종

정진환,김재민,백광흠,박용욱,김충현,오석전,Cheong, Jin Hwan,Kim, Jae Min,Bak, Koang Hum,Park, Yong Wook,Kim, Choong Hyun,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

A 51-year-old woman presented with sudden severe headache, vomiting, and right hemiparesis at first admission. Computed tomography(CT) scans revealed an hemorrhagic density at left basal ganglia. Preoperative cerebral angiography showed no vascular lesion. Under the diagnosis of hypertensive intracerebral hemorrhage(ICH), total extirpation of hematoma was done. The postoperative neurological condition improved gradually and discharged without any neurological sequelae. Two months later, she revisited with headache, vomiting and progressive right hemiparesis. CT scans at second admission showed an irregular rim enhanced mass with central low density with surrounding edema at the initial bleeding area. Repeated craniotomy was performed and the mass was partially removed. The histopathological diagnosis of the specimen was confirmed as glioblastoma. The authors report a glioblastoma, which occurred at initial ICH site and regarded as a brain abscess with literature review.

인체 뇌종양조직에서 텔로머레이즈의 발현과 세포사멸

김충현,정진환,백광흠,김재민,고용,오석전,Kim, Choong Hyun,Cheong, Jin Hwan,Bak, Koang Hum,Kim, Jae Min,Ko, Yong,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : Telomerase, a ribonucleoprotein adds telomere repeats to the ends of telomeres to compensate for the progressive loss. A favorable prognosis associated with low or no telomerase activity in some tumors, and cells transfected with antisense human telomerase lost telomeric repeats and die. We studied about the relationship between telomerase activity and apoptosis in the human brain tumors. Material and Methods : Between July 1998 and December 1999, 62 patients with brain tumors underwent surgery and their surgical specimens were obtained. Telomerase activity was investigated by telomeric repeats amplification protocol(TRAP) assay. Apoptosis was also evaluated by DNA fragmentation analysis. Differences and correlation in data were analyzed using Mann-Whitney test and Wilcoxon-signed rank test. Results : Expression rate of telomerase activity and apoptosis were 80% and 30% in malignant gliomas, 33% and 0% in low grade gliomas, 63% and 38% in meningiomas, 67% and 33% in pituitary adenomas, 33% and 33% in metastatic tumors, 67% and 17% in acoustic neurinomas, 100% and 100% in pineoblastomas, 100% and 0% in the hemangioblastoma, respectively. There was no significant difference of telomerase activity and apoptosis between histological types. But a significant difference was noted in the expression of telomerase activity between malignant gliomas and low grade gliomas(p = 0.022). Brain tumors with telomerase activity expressed the lower rate of apoptosis. A significant correlation was also found between telomerase activity and absence of apoptosis in the human brain tumors(p = 0.005). Conclusions : Our data suggests that telomerase may protect from apoptosis of the human brain tumors and also may play an important role in the biological malignancy of the gliomas.

요추부 후측방 유합술에서 골편대체물로서 황산칼슘의 효과에 대한 연구

이승구,김충현,정진환,백광흠,김재민,오석전,Lee, Seung Ku,Kim, Choong Hyun,Cheong, Jin Hwan,Bak, Koang Hum,Kim, Jae Min,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : The authors investigated the efficacy of the calcium sulfate(OsteoSet$^{(R)}$ pellets) as an autograft extender when used to perform posterolateral lumbar fusions. Patients and Methods : Twenty patients who underwent lumbar posterolateral arthrodesis for various spinal diseases between October 1999 and March 2000 were evaluated. Arthrodesis was performed by transpedicular screw fixation and bone grafting with a mixture of autograft + calcium sulfate in a 1 : 1 ratio. At time intervals of 1, 2, 3, and 6 months, postoperative radiographs were obtained to review the resorption of calcium sulfate and the evidence of fusion. A modified Lenke scale was used to assess the status of the fusion. Results : At 2 months after operation, the average modified Lenke scale score for the OsteoSet$^{(R)}$ pellets group was 3.8. However at 6 months after operation, the average modified Lenke scale score for the OsteoSet$^{(R)}$ pellets group was 1.8. Resorption of calcium sulfate pellets was revealed in all cases at 6 months after surgery. Conclusion : It is presumed that a combination of calcium sulfate and autograft can play a role as an effective autograft extender in the posterolateral spinal fusion.

요통과 하지방사통에 대한 경막외 스테로이드 주입후 발생한 치명적 합병증 - 증례보고 -

김태준,김충현,정진환,백광흠,김재민,오석전,Kim, Tae Joon,Kim, Choong Hyun,Cheong, Jin Hwan,Bak, Koang Hum,Kim, Jae Min,Oh, Suck Jun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Epidural steroid injection(ESI) has been a commonly applied conservative therapy for the management of chronic low back pain and sciatica. However, there are many reports concerning various local, systemic and neurological complications related to ESI. We report two cases with fatal complications after ESI for low back pain and sciatica. In both patients, ventriculitis and meningitis were causative factors to be fatal. Aseptic procedures and careful post-procedure assessment are essential to avoid serious complications following ESI.

뇌하수체 선종의 크기와 위치에 따른 시야변화

강성민,김준현,정진환,Sung-Min Kang,Joon-Hyun Kim,Jin-Hwan Cheong 대한안과학회 2005 대한안과학회지 Vol.46 No.10

Purpose: To evaluate the relationship between the location and size of pituitary adenoma and visual field change. Methods: Fifty-two patients were diagnosed with pituitary adenoma and underwent tumor resection at the Department of Neurosurgery in our hospital between July 1999 and July 2004. Among them, we retrospectively studied that location and size of pituitary adenoma as related to visual field changes in 29 patients who had credible perimetry results and no other ophthalmologic problems that caused visual field changes. We obtained the information about the size and location of pituitary adenoma using MRI, and performed ophthalmologic examination such as perimetry and fundus examination. Results: There were no visual field changes in 18 patients. The visual field changes observed were as follows; bitemporal hemianopsia in 4 patients who had inferior involvement of optic chiasm; scotoma in one eye and temporal hemianopsia in the other eye in 2 patients who had lateral and inferior involvement; bitemporal superior quadranopsia in 2 patients who had anterior and inferior involvement; and 3 patients showed visual field changes, but they had no optic nerve involvement of pituitary adenoma. The size of adenoma was not exactly related to visual field changes. Conclusions: These results indicate that visual field changes can be influenced by the location and size of pituitary adenoma.

뇌 동맥류 수술 후 혈관조영술의 적응증에 대한 분석

이우택,김재민,정진환,백광흠,김충현,김광명,오석전,Rhee, Woo Tack,Kim, Jae Min,Cheong, Jin Hwan,Bak, Koang Hum,Kim, Choong Hyun,Kim, Kwang Myung,Oh, Suck Jun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objective : Subarachnoid hemorrhage(SAH) is still one of the most serious disease with high morbidity and mortality in the neurosurgical field. Clipping of the aneurysmal neck is the gold standard of the surgical treatment of aneurysmal SAH. The purpose of this study was to investigate the role of the postoperative angiography and to assess the risk factors related to the incomplete clipping. Materials and Methods : From July 1995 to June 1998, the pre- and postoperative angiography were performed in 50 patients among total 81 patients who have underwent the aneurysmal surgery. We reviewed the various contributing factors including age, sex, Hunt-Hess grade, Fisher grade and the premature rupture of aneurysm during operation retrospectively. Careful evaluation of pre- and postoperative angiography focusing on the size, shape, and remnant neck of the aneurysms and vasospasm was performed. According to the angiographic findings, the patients were divided into two groups ; a complete clipping group and an incomplete clipping group. The data were analyzed by using unpaired independent sample t test after F-test to compare the significance between two groups. Results : Incomplete clipping of aneurysms was found in 6(12%) patients through the evaluation of postoperative angiography. Among them, three cases were located on the middle cerebral artery territory. Whereas the patient age, sex, Hunt-Hess grade, and Fisher grade were not significant(p>0.05), an intraoperative premature rupture had a statistical significance(p<0.05). A severe vasospasm occurred in 24(48%) cases and one patient with anterior communicating aneurysm was reoperated due to residual sac. Conclusion : According to our experience, the surgeons' judgement is the most reliable factor in deciding the postoperative angiography. During the aneurysmal surgery, the premature rupture always disturbs a complete clipping of aneurysms. Therefore, the temporary clipping of parent arteries is considered essential for a successful clipping. We believe that the postoperative angiography has a role in decreasing the re-bleeding risk due to clip migration and an inaccurate clipping only in the selected cases.

면역학과 뇌조양의 면역요법

김충현 ( Cjppmh-hyun Kim ),정진환 ( Jin Hwan Cheong ),백광흠 ( Koang Hum Bak ),김재민 ( Jae Min Kim ) 대한뇌종양학회 2004 대한뇌종양학회지 Vol.3 No.1

Although intensive strategies to treat brain tumors have been applied, the prognosis for patient malignant brain tumors, such as anaplastic astrocytomas and glioblastomas is dismal. Recent advances in basic immunology and molecular biology of the central nervous system(CNS) has prompted an intensive search for immunotherapy of brain tumors. The immune system is mostly controlled by antigen-presenting cells like dendritic cells(DC), lumphocytes, and cytokines. This article reviews the basic immune systems, neuroimmunolohy, and immunotherapy including DC vaccine therapy of the brain tumors with the goal to provide a comprehensive information of ongoing cancer vaccine and cellular vaccine and cellular immunotherapy clinical trals. Modern neuroimmunolohy and recent experimental studies exist whereby potent antitumor cellular immune responses can be generated. However, the immunotherapeutic efficacy of clinical trials for brain tumor has not been successful. Several strategies to improve its efficacy, such as detection of tumor-specific antigens, modulation of immune response, and development of potent antitumor DC vaccine are required. Newly advanced immunotherapeutic manipulations may provide a hope for neuroncologist treating brain tumors refractory to conventional managements.

추골동맥 몸통부 및 후·하소뇌동맥 근위부 동맥류에 대한 원위측후두하접근법을 통한 수술 결과

조현(Hyun Cho),김재민(Jae Min Kim),정진환(Jin Hwan Cheong),김성수(Sung Soo Kim),백광흠(Koang Hum Bak),김충현(Choong Hyun Kim) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2

Vertebral artery (VA) trunk and proximal posteroinferior cerebellar artery (PICA) aneurysms are challenging problem to treat surgically, with high reported perioperative complication rates. We describe the postoperative complications and clinical outcomes obtained via a far lateral suboccipital approach in 3 ruptured VA trunk and 6 ruptured proximal PICA aneurysms. Datas were collected retrospectively about the 3 VA trunk and 6 proximal PICA aneurysms treated surgically by a single surgeon between January 2001 and December 2004. Direct aneurysm clippings were achieved in 7 cases. In 2 cases, trappings without a revascularization procedure were used for dissecting VA aneurysms. Three patients(33.3%) who had the postoperative mild to moderate low cranial nerve palsy (LCNP) completely recovered within 3 months. Although the surgical clipping of VA trunk and proximal PICA aneurysms is very difficult, a far lateral suboccipital approach can provide the adequate space to clip without undue manupulation of the low cranial nerves and with minimal cerebellar retraction. The authors recommend that surgical obliteration of the aneurysm via the far lateral suboccipital approach be considered a first-line therapeutic option for the favorable outcomes and low postoperative morbidity in this subset of patients.