신경외과에서의 수술전후 항경련제의 사용

피지훈,정천기 대한간질학회 2003 대한간질학회지 Vol.7 No.1

소아 뇌혈관질환

피지훈,김승기,왕규창,조병규 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.12

Recently, accumulated clinical experience and advanced neuroradiological techniques have led to a better understanding of pediatric cerebrovascular disease (CVD), which was once considered rare. Approximately 10% of pediatric neurosurgical patients have CVD; therefore, it is no longer uncommon to pediatricians and pediatric neurosurgeons. Furthermore, children with CVD tend to recover better than adults after stroke because the immature brain is more plastic than the mature one. Therefore, active treatment often proves more rewarding in pediatric medicine than in adult medicine.

Dysembryoplastic Neuroepithelial Tumor: A Benign but Complex Tumor of the Cerebral Cortex

피지훈,김세훈 대한뇌종양학회 2022 Brain Tumor Research and Treatment Vol.10 No.3

Dysembryoplastic neuroepithelial tumor (DNET) is a distinct type of low-grade glioneuronal tumor. Clini- cally, DNET is highly associated with intractable epilepsy in young children and adolescents. Therefore, the burden of the tumor comprises oncological concerns (recurrence), seizure control, and quality of life. The pathology of DNET is characterized by glioneuronal elements and floating neurons. Grossly, many DNETs harbor separate nodules on the medial side of the mass. Some of the satellite lesions are bone fide tumor nodules that grow during the follow-up. Therefore, removing all satellite lesions may be im- portant to prevent tumor progression. Seizure control is highly dependent on the complete removal of tumors, and the presence of satellite lesions also exerts a negative impact on seizure outcomes

소아뇌종양의 수술적 치료

피지훈,왕규창,김승기,강석주 대한의사협회 2012 대한의사협회지 Vol.55 No.5

Brain tumors are the second most common form of cancer in the pediatric age group. Surgical treatment is the mainstay of therapy for many brain tumors and is usually the first treatment given to children with brain tumors. Pediatric brain tumors differ from those of adults in many aspects: histological diagnosis, immaturity of the pediatric central nervous system, and the vulnerability of children to blood loss during the operation. The completeness of surgery is strongly associated with the prognosis of afflicted children, whereas surgical morbidities can be life-time deficits and handicaps for the children. Therefore, practicing pediatric neurosurgeons should combine a thorough knowledge on neuroanatomy and pathophysiology with state-of-theart surgical skills and experience to obtain the best results. They should also take time for reflecting on the difficulties encountered and complications arising during operations.

Tethered Cord Syndrome in Adulthood : Reconsidering the Prognosis

피지훈,정천기,이동엽,장태안,김현집 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.36 No.2

Objective : The surgical outcome of tethered cord syndrome(TCS) in adulthood has been known to be excellent. However, some patient seems to take worse clinical course despite the surgical intervention. The purpose of this study is to present the clinical characteristics of adulthood TCS and to analyze the surgical outcomes. Methods : We retrospectively reviewed the medial records and radiological data of the 16 adult patients who was diagnosed as TCS and received detethering operation. After mean follow-up period of 43 months, neurological symptom and signs as well as the functional scores were taken for comparison with the preoperative status. Results : Voiding difficulty was the most common symptoms. Delay of the proper diagnosis was notable with a mean interval of 14.4 years. Lipomyelomeningocele, especially of complex type was the most common etiologic lesion. After operation, only three patients got improvement of their preexisting symptoms. Two patients underwent progressive neurological dysfunction despite detethering. Only one patient showed improvement in functional scores. Three patients even received multiple operations. But the results were poor with no symptomatic improvement. Conclusion : Detethering halted the progression of neurological deficit in the majority of cases, but both symptomatic and functional improvement was disappointing. Long symptomatic period with delayed diagnosis, dominant bladder dysfunction and complex lipomyelomeningocele may influence negatively on the surgical outcome. This finding should be kept in mind for patient counseling and proper selection of surgical candidate.

Postoperative Transient Neurologic Dysfunction: A Proposal for Pathophysiology

피지훈,이승진,강현승,김정은,김승기,조원상,이서영 대한신경과학회 2018 Journal of Clinical Neurology Vol.14 No.3

Background and Purpose Sudden neurological deterioration which cannot be explained by structural change, ischemia or seizure is often observed among neurosurgical patients. We aimed to provide new insight into the pathophysiology of postoperative transient neurologic dysfunction. Methods We describe prolonged but fully reversible focal neurologic dysfunction of unknown origin based on the initial evaluation in 8 patients who had received encephalo-duro-arteriosynangiosis for moyamoya disease. We performed brain imaging, including diffusion weighted imaging and perfusion magnetic resonance imaging or single photon emission computed tomography, and electroencephalography (EEG) during the episodes and after resolution of the symptoms. Results The symptoms consisted of dysarthria, hemiparesis, or hemiparesthesia of limbs contralateral to the operated side. These symptoms developed between 12 hours and 8 days after surgery and lasted between 12 hours and 17 days. Structural imaging did not show any significant interval change compared with the immediate postoperative images. Perfusion imaging showed increased cerebral blood flow in the symptomatic hemisphere. EEG revealed low amplitude arrhythmic slowing in the corresponding hemisphere. Follow-up imaging and EEG after recovery did not show any abnormalities. Conclusions Transient neurologic dysfunction can occur during the postoperative period of brain surgery. Although this may last more than usual transient ischemic attack or seizure, it eventually resolves regardless of treatment. Based on our observation, we propose that this is the manifestation of the transient cortical depression triggered by mechanical stimulation, analogous to migraine aura associated with cortical spreading depression.

뇌종양과 연관된 간질의 치료

피지훈,정천기 대한의사협회 2010 대한의사협회지 Vol.53 No.7

Epilepsy associated with brain tumors (EABT) is a multi-faceted disease that both oncological and epileptological concerns should be taken into consideration. Usually, it is characterized by chronic drug-resistant epilepsy with a low-grade brain tumor in the cerebrum. However, the distinction of typical EABT and simple brain tumors with short-term epilepsy is obscure. We need a working formulation based on the patient’s burden in both oncological and epileptological aspects. The diagnosis of EABT is straightforward, but the treatment should be more complex. Medical treatment with anticonvulsants aloneseems tobe anoutdated remedy for EABT because of the risk of tumor growth and malignant progression in some patients as well as the expected favorable seizure control after surgery. Surgical treatment of EABT has resulted in seizure-free state in about 80% of patients. Complete resection of the tumor is an important prognostic factor in seizure control and probably also in tumor control. Recently, many authors emphasized a lesion-directed surgery aimed at a complete tumor removal in EABT. However, in some patients,especially in patients with dual pathology, electrophysiological studies have to be thoroughly applied. For the treatment of EABT in the temporal lobe, more sophisticated surgical strategy is required. A lesionectomy saving the uninterrupted hippocampus could be applied for selected patients. Further research is strongly needed for better understanding and treatment of EABT and low-grade glioma.

비내 내시경적 접근으로 재건한 선천성 기저형 뇌류 3예

전영진,피지훈,왕규창,원태빈 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.5

Encephalocele is a malformation characterized by protrusions of the brain and meninges through openings in the cranial bones. They are managed surgically and approached in various ways, mainly on the basis of its location. Basal encephaloceles have been traditionally approached intracranially via bicoronal approach in the pediatric population. We report three cases of congenital basal encephaloceles treated by endoscopic endonasal approach in our institution. In 2 patients, the skull base defect was successfully corrected whereas in one case, recurrence was observed. No major complications were encountered. Although the endoscopic endonasal repair approach of basal encephaloceles in the pediatric population is associated with potential technical difficulties, it is a viable and minimally invasive alternative to the traditional craniotomy. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(5):406-13

Long-Term Outcomes and Sequelae Analysis of Intracranial Germinoma: Need to Reduce the Extended-Field Radiotherapy Volume and Dose to Minimize Late Sequelae

이주호,엄근용,피지훈,박철기,김승기,조병규,김태민,허대석,홍경택,최정윤,강형진,신희영,최승홍,이순태,박성혜,왕규창,김일한 대한암학회 2021 Cancer Research and Treatment Vol.53 No.4

Purpose We aimed to refine the radiotherapy (RT) volume and dose for intracranial germinoma considering recurrences and long-term toxicities. Materials and Methods Total 189 patients with intracranial germinoma were treated with RT alone (n=50) and RT with upfront chemotherapy (CRT) (n=139). All cases were confirmed histologically. RT fields comprised the extended-field and involved-field only for primary site. The extended-field, including craniospinal, whole brain (WB), and whole ventricle (WV) for cranial field, is followed by involved-field boost. The median follow-up duration was 115 months. Results The relapses developed in 13 patients (6.9%). For the extended-field, cranial RT dose down to 18 Gy exhibited no cranial recurrence in 34 patients. In CRT, 74 patients (56.5%) showed complete response to chemotherapy and no involved-field recurrence with low-dose RT of 30 Gy. WV RT with chemotherapy for the basal ganglia or thalamus germinoma showed no recurrence. Secondary malignancy developed in 10 patients (5.3%) with a latency of 20 years (range, 4 to 26 years) and caused mortalities in six. WB or craniospinal field rather than WV or involved-field significantly increased the rate of hormone deficiencies, and secondary malignancy. RT dose for extended-field correlated significantly with the rate of hormone deficiencies, secondary malignancy, and neurocognitive dysfunction. Conclusion De-intensifying extended-field rather than involved-field or total scheme of RT will be critical to decrease the late toxicities. Upfront chemotherapy could be beneficial for the patients with complete response to minimize the RT dose down to 30 Gy. Prospective trials focused on de-intensification of the extended-field RT are warranted.

Pathological Classification of the Intramedullary Spinal Cord Tumors According to 2021 World Health Organization Classification of Central Nervous System Tumors, a Single-Institute Experience

박성혜,원재경,김치헌,피지훈,김승기,최승홍,정춘기 대한척추신경외과학회 2022 Neurospine Vol.19 No.3

According to the new 2021 World Health Organization (WHO) classification of tumors of the central nervous system (CNS) the classification of the primary intramedullary spinal cord tumors (IM-SCT) follows that of CNS tumors. However, since the genetics and methylation profile of ependymal tumors depend on the location of the tumor, the ‘spinal (SP)’ should be added for the ependymoma (EPN) and subependymoma (SubEPN). For an evidence-based review, the authors reviewed SCTs in the archives of the Seoul National University Hospital over the past decade. The frequent pathologies of primary IM-SCT were SP-EPN (45.1%), hemangioblastoma (20.0%), astrocytic tumors (17.4%, including pilocytic astrocytoma [4.6%] and diffuse midline glioma, H3 K27-altered [4.0%]), myxopapillary EPN (11.0%), and SP-subEPN (3.0%) in decreasing order. IDH-mutant astrocytomas, oligodendrogliomas, glioneuronal tumors, embryonal tumors, and germ cell tumors can occur but are extremely rare in the spinal cord. Genetic studies should support for the primary IM-SCT classification. In the 2021 WHO classifications, extramedullary SCT did not change significantly but contained several new genetically defined types of mesenchymal tumors. This article focused on primary IM-SCT for tumor frequency, age, sex difference, pathological features, and genetic abnormalities, based on a single-institute experience.