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Novalis system을 이용한 정위적 방사선 수술
최찬영,이동준,이기택,손문준,황금철,황충진 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1
■ Objective Stereotactic radiosurgery premises excellent tumor control and minimal risk in the treatment of various intracranial tumors or vascular malformations in risky surgical locations such as cavernous sinus Moreover. it offers superior local control rates of many metastatic tumors and has promise as an adjuvant boost in certain malignant gliomas. The purpose of this study is to evaluate the efficacy of LINAC based Novalis shaped beam radiosurgery. ■ Methods and materials Between Dec. 2000 and Mar. 2002. 56 patients (86 lesions) with various intracranial tumors and vascular malformations were treated with stereotactic radiosurgery(SRS) using Novalis. 46 patients were diagnosed by prior surgical resection, biopsy or cerebral angiographic finding. 1 patient of lymphoma and 5 patients of malignant glioma, 4 patients of metastatic brain tumor had also received conventional external radiotherapy previously. The patients who underwent SRS were acoustic schwannoma(12), AVM(9), recurrent meningioma(11), cerebral metastases(12), spinal neurofibroma(1), residual spinal schwannoma(1), recurrent or residual malignant glioma(5), lymphoma(3) and others(5). The mean volume(cc) and marginal dose(Gy) were 5.7 /12 in acoustic schwannoma, 5.1/ 16 in meningioma, 8/12 in malignant glioma, 3/24 in AVM. 4/14 in lymphoma, 5/l8 in metastatic tumor. The radiographic follow up period ranged from 1 month to 17 months. ■ Results Of 56 patients treated with SRS, 9, 27, 20 patients were vascular malformation, benign tumor, malignant tumor respectively. Of 27 patients with benign tumor, 26 patients(96%) showed slight regression or no change In its size. Although only one patient of 12 acoustic schwannomas showed progression of tumor size, we considered that it was cystic degeneration with reactive swelling in 17 months post SRS radiosurgery because there was loss of central enhancement in tumor. The others did not show tumor progression. One of 9 AVMs showed nearly total obliteration of nidus in post SRS 15 months. The other AVMs were still observed. We have treated one spinal neurofibroma through extracranial stereotactic system(Exactrac) and the follow up study showed decrease in the degree of enhancement and slight decrease in its site. ■ Conclusions Although the follow up period of this study is rather short, stereotactic radiosurgery using Novalis is comparable to other radiosurgery modalities such as gamma knife and also may promise the efficacy of treatment about certain specific extracranial tumors.
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GPS 구간검지 기반의 교통정보 수집을 위한 Network 체계의 구축
최찬영,김재민,김도성 대한교통학회 2003 대한교통학회 학술대회지 Vol.44 No.-
ITS(지능형 교통 체계)에서 요구되는 교통정보 제공 서비스의 기본적인 형태는 통행속도, 통행시간, 혼잡도 등으로 설명할 수 있다. 그러므로, 신뢰성 있는 교통정보 제공을 위해서는 실시간 교통정보 수집 방법들에 대한 고찰과 검토가 필요하다.
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Novalis system을 이용한 분할 정위적 방사선 수술
최찬영,이동준,이기택,손문준,황금철,황충진 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S
■ Objective Stereotactic radiosurgery is increasingly popular method for various brain tumors because of its minimal invasiveness and excellent tumor control. However, a single high dose treatment becomes a concern because of its potential morbidity when treatment volume becomes a larger or the tumor is at or vicinity of eloquent areas. For this reasons, fractionated stereotactic radiosurgery(FSRS) was developed. The purpose of this study is to evaluate the efficacy of FSRS for various tumors. ■ Methods and materials Between Dec. 2000 and Mar. 2002, 64 patients (77 lesions) with various intracranial tumors were treated with fractionated stereotactic radiosurgery(FSRS) using Novalis. 60 patients were diagnosed by prior surgical resection or biopsy. 1 patient in recurrent pituitary adenoma, 6 patients in malignant glioma, 2 patients in low grade glioma, 2 patients in metastatic tumor had received conventional external radiotherapy previously. The patients who underwent FSRS were large acoustic schwannoma(2), recurrent meningioma(7), residual or recurrent pituitary adenoma(8), recurrent or residual malignant glioma(24), residual craniopharyngioma(2) and others(8). The mean volume(cc), fractionation numbers and marginal dose(Gy) were 21 /20/ 36 in large acoustic schwannoma, 17.5/ 18/35 in meningioma, 8.8/21/46 in pituitary adenoma, 37/14/37 in malignant glioma, and 30/16/39 in brain stem glioma respectively. The radiographic follow up period ranged from 2 months to 19months. ■ Results Of 64 patients treated with FSRS, 34 patients were benign tumor, 2 patients were metastatic tumor, 24 patients were malignant glioma and others were adenocarcinoma, chordoma, germ cell tumor. 29 of 34(85%) benign tumor patients showed slight regression or no change in tumor size on radiographic image. But 5 patients with brain tumors showed slight progression in its size : 1 oligodendroglioma, 1 brain stem glioma, 1 optic glioma, 1 craniopharyngioma, 1 acoustic schwannoma. Of 24 malignant glioma patients, 3 patients have died of tumor progression in post-FSRS 5,7,13 months respectively. The others were still observed and among them, one glioblastoma patient with 16 months - follow up showed tumor regression in post FSRS 9 months. She has received tumor resection, FSRS and chemotherapy. Thus, overall median survival of malignant gliomas was 8.5 months and 1-year survival rates were 33.3%. ■ Conclusions Since the period of follow up of this study is rather short and an insufficient number of patients have been enrolled, it is premature to make any definite conclusions as to the efficacy of FSRS. However FSRS may offer alternative treatment chances for malignant tumors and benign tumors of relatively large size or tumors in eloquent areas. Therefore, this study requires further investigation to confirm and to determine as optimal dose/fractionation scheme.
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최찬영,민병국,석종식 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10
The intradural cavernous hemangioma of the spinal cord is a rara vasular malformation. We report a case of cavernous hemangioma of the cauda equina in a 46-year-old female who presented with intermittent low-back pain and radiating pain to both lower extremities. A intradural mass was detected by spinal MRI. She underwent complete removal of the mass through L1 total laminectomy. Her symptoms were improved. The clinical radiological. histopathological feature of this leion are discussed together a review of the literature.
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