Survival, Prognostic Factors, and Volumetric Analysis of Extent of Resection for Anaplastic Gliomas

홍제범,노태훈,강석구,김세훈,문주형,김의현,안성수,최혜진,조재호,서창옥,장종희 대한암학회 2020 Cancer Research and Treatment Vol.52 No.4

Purpose The aim of this study is to evaluate the survival rate and prognostic factors of anaplastic gliomas according to the 2016 World Health Organization classification, including extent of resection (EOR) as measured by contrast-enhanced T1-weighted magnetic resonance imaging (MRI) and the T2-weighted MRI. Materials and Methods The records of 113 patients with anaplastic glioma who were newly diagnosed at our institute between 2000 and 2013 were retrospectively reviewed. There were 62 cases (54.9%) of anaplastic astrocytoma, isocitrate dehydrogenase (IDH) wild-type (AAw), 18 cases (16.0%) of anaplastic astrocytoma, IDH-mutant, and 33 cases (29.2%) of anaplastic oligodendroglioma, IDH-mutant and 1p/19q-codeleted. Results The median overall survival (OS) was 48.4 months in the whole anaplastic glioma group and 21.5 months in AAw group. In multivariate analysis, age, preoperative Karnofsky Performance Scale score, O6-methylguanine-DNA methyltransferase (MGMT) methylation status, postoperative tumor volume, and EOR measured from the T2 MRI sequence were significant prognostic factors. The EOR cut-off point for OS measured in contrast-enhanced T1-weighted MRI and T2-weighted MRI were 99.96% and 85.64%, respectively. Conclusion We found that complete resection of the contrast-enhanced portion (99.96%) and more than 85.64% resection of the non-enhanced portion of the tumor have prognostic impacts on patient survival from anaplastic glioma.

The Clinical and Radiological Characteristics of Male Patients who Underwent Vertebroplasty Due to Osteoporotic Compression Fracture

홍제범,김경현,박정윤,진동규,구성욱,조용은 대한척추신경외과학회 2011 Neurospine Vol.8 No.3

Objective: To investigate the clinical characteristics of male population who underwent vertebroplasty for osteoporotic compression fracture and evaluate the clinical, radiological outcomes compared to female group. Methods: The medical records and radiological data were reviewed in total 155 patients who underwent vertebroplasty for osteoporotic vertebral compression fracture from February 2006 to November 2009. We compared 32 male patients with 123 female patients in terms of preoperative factors, intraoperative factors, and clinical and radiologic outcomes. Results: The mean age of male group was 67.8±8.6 years and their mean T-score on bone mineral density (BMD) was -3.2±0.8. The mean age of female group was 71.8±8.9 years and their mean T-score was -3.7±0.7 (p=0.025 for age, p=0.002 for BMD). Male patients (21 out of 32, 65.6%) had more frequent traumatic event than female patients (51 out of 123, 41.5%)(p=0.012). The secondary osteoporosis was more frequently seen in male group than female group (53.1% vs 26.8%, p=0.005). The lump cement distribution pattern was found more frequently in male group than female group (46.9% vs 28.5 %, p=0.040). There was no statistically significant difference between the two groups in clinical outcomes. Conclusion: Male patients had significantly more risk factors for secondary osteoporosis and obvious traumatic event than female group. Clinicians should always be aware of secondary causes of osteoporosis and history of traumatic events in male patients with osteoporotic compression fracture and also pay attention to correct the cause of secondary osteoporosis and recommend anti-osteoporosis management.

저척수 부신경 해면상 혈관종 -증례보고-

홍제범 ( Je Beom Hong ),홍창기 ( Chang Ki Hong ),이규성 ( Kyu Sung Lee ),윤선옥 ( Sun Och Yoon ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2

We present a case of spinal accessory nerve cavernous hemangioma. A 44-year-old male patient visited our hospital because a mass at his foramen magnum had been found during a medical checkup. A magnetic resonance (MR) image revealed a well-enhanced mass in the foramen magnum, with displacement of the medulla oblongata to the left side by this mass. The lesion was resected using a far-lateral approach, and the pathological diagnosis was a cavernous hemangioma. Although cranial nerve cavernous hemangioma is a rare condition, it should be considered when making differential diagnoses of foramen magnum masses.

경정맥공 종양의 수술적 접근법

홍제범(Je Beom Hong),김한규(Han Kyu Kim),김주평(Joo Pyung Kim),장종희(Jong Hee Chang),문인석(In Seok Moon) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Background: The infratemporal fossa approach type A (ITFA-A) is a good approach for small jugular foramen tumors with a small extraforaminal cervical extension. On the other hand, the posterolateral approach to jugular foramen has been adopted to see the posterior aspect of the jugular foramen. For large tumors, we combined posterolateral approach with various otologic operations including ITFA-A, transcochlear approach and fallopian bridge technique. The purpose of this study is to evaluate the surgical adequacy of our approaches including postoperative complications and outcomes. Methods: From January 2014 to January 2017, we operated total 14 cases of jugular foramen tumors. We chose the surgical approach to these tumors based on their location and extent. And the facial nerve manipulation was added in combined approach in which facial nerve was dissected and transpositioned (3 cases) or remained in fallopian canal (fallopian bridge technique, 3 cases). Results: Grossly total resection was achieved in 12 patients (85.7%). Immediate postoperative lower cranial nerve deficit occurred in 10 patients (71.4%). Postoperative facial nerve paralysis and hearing impairment occurred in 4 patients (28.6%) and 6 patients (42.9%) respectively. Two-thirds of the jugular foramen could be exposed in the combined approach which enabled the complete removal of tumors regardless of the size at this area. Conclusion: Using skull base technique with thorough understanding of surrounding anatomic structures followed in wider exposure, gross total removal can be achieved by multidirectional approach under relative safety.

Surgical Treatment for Falcotentorial Meningiomas

박승우,홍창기,홍제범,박헌호,문주형,장종희,이규성 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.4

Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomasand provide a review of our experience.

거대 상상돌기 수막종에서의 미세수술 전략

송정원(Jung-Won Song),홍제범(Je-Beom Hong),오성한(Sung-Han Oh),김한규(Han-Kyu Kim) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Background : The giant clinoidal meningiomas (CLMs) inevitably engulf the neurovascular structures around the anterior clinoid process (ACP), which make the surgery in great danger of internal carotid artery (ICA) compromise, neuroendocrine disturbance, blindness and oculomotor nerve palsy. The aim of this study was to suggest the safe surgical strategy for these dreadful tumors. Materials and Methods : From March 2008 to April 2016, 12 patients underwent surgical removal for their giant CLMs. The clinical profile, radiological imaging, surgical records including surgical videos and postoperative neurologic outcomes were reviewed. Results : The mean age of patients was 51.9 years. Average size of the tumors was 6.3 cm ranging from 5.0 cm to 8.3 cm. Surgery was performed in supine position and head was rotated about 45°to the contralateral side. The extradural anterior clinoidectomy was applied with extended pterional craniotomy including zygomatic osteotomy or orbitozygomatic osteotomy. We removed the tumor with the concept of compartment dissection in which we divided the tumor into medial and lateral compartment with the reference of ICA-M1 (sphenoidal segment of middle cerebral artery) line. Total tumor removal was achieved in 8 patients (67%) and subtotal in 4 patients (33%). Postoperative complications were transient oculomotor nerve palsy in 3 patients and decreased visual acuity in one patient. The mean preoperative Karnofsky Performance Scale (KPS) score was 82.5 (range 60-90) and improved to 95.8 (range 80-100) in the last follow up period. Conclusion : The surgery of giant clinoidal meningiomas is difficult because of their giant size and multiple neurovascular and cisternal involvement. The most important factor for successful surgery is a three dimensional orientation of tumor with its surroundings. The concept of compartment dissection would help surgeons to be oriented in perception of neurovascular structure surrounding the tumor. The extended pterional craniotomy, extradural anterior clinoidectomy, extended durotomy, and compartmental dissection are recommended for the efficient removal of these dreadful tumors.

Solitary Osteochondroma Presenting as a Dumbbell Tumor Compressing the Cervical Spinal Cord

이주형,오성한,조평구,한은미,홍제범 대한척추신경외과학회 2017 Neurospine Vol.14 No.3

We report a case of a solitary osteochondroma as a dumbbell tumor compressing the spinal cord and its surgical strategy. The patient is a 16-year-old female with longstanding posterior neck pain and left arm abduction weakness. She was examined by plain X-ray, three-dimensionalcomputed tomography, magnetic resonance imaging, and vertebral angiography. The analyses indicated a calcified extradural mass compressing the cord in the C3-4 portion extending into the neural and vertebral foramen with eroded vertebral body. The tumor was successfully excised using a modified combined anterior and posterior approach. Histopathologic study of the resected material confirmed the diagnosis. The postoperative assessment was followed by clinical and radiologically therapy for 5 years after surgery. Osteochondroma arises from enchondral bone but it rarely involves the spine, especially not as s dumbbell type. In this patient, the tumor may have arisen from the neural arch and extended into the extradural and extraforaminal space over a long period. We successfully removed the dumbbell tumor with a combined anterior oblique and posterior approach. However, further observation is essential because of the possibility of recurrence and sarcomatous change.

Efficacy of Surgical Treatment for Brain Metastasis in Patients with Non-Small Cell Lung Cancer

변민광,김상영,홍창기,김태훈,홍제범,박철환,장윤수,김형중,안철민 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1

Purpose: Patients with non-small cell lung cancer (NSCLC) and simultaneously having brain metastases at the initial diagnosis, presenting symptoms related brain metastasis, survived shorter duration and showed poor quality of life. We analyzed our experiences on surgical treatment of brain metastasis in patients with NSCLC. Materials and Methods: We performed a single-center, retrospective review of 36 patients with NSCLC and synchronous brain metastases between April 2006 and December 2011. Patients were categorized according to the presence of neurologicalsymptoms and having a brain surgery. As a result, 14 patients did not show neurological symptoms and 22 patients presented neurological symptoms. Symptomatic22 patients were divided into two groups according to undergoing brain surgery (neurosurgery group; n=11, non-neurosurgery group; n=11). We analyzed overall surgery (OS), intracranial progression-free survival (PFS), and quality of life. Results: Survival analysis showed there was no difference between patients with neurosurgery (OS, 12.1 months) and non-neurosurgery (OS, 10.2 months; p=0.550). Likewise for intracranial PFS, there was no significant difference betweenpatients with neurosurgery (PFS, 6.3 months) and non-neurosurgery (PFS, 5.3 months; p=0.666). Reliable neurological one month follow up by the Medical Research Council neurological function evaluation scale were performed in symptomatic22 patients. The scale improved in eight (73%) patients in the neurosurgerygroup, but only in three (27%) patients in the non-neurosurgery group (p=0.0495). Conclusion: Patients with NSCLC and synchronous brain metastases,presenting neurological symptoms showed no survival benefit from neurosurgicalresection, although quality of life was improved due to early control of neurologicalsymptoms.

두개저 병변 수술에서 Transcrusal 및 개두술 접근법을 통한 청력 보존: 연속된 5예들의 청력 결과

이상민,고범준,성한경,김한규,홍제범,안윤숙 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.11

Background and Objectives This study reviewed our experience and outcomes of surgery via transcrusal approach to the skull base lesions. Subjects and Method We performed transcrusal approach technique on five patients with skull base lesions (Cavernous malformation, Petroclival meningioma, Craniopharyngioma, Anaplastic astrocytoma, and Trigerminal epidermoid cyst) aiming at preserving hearing. Pre- and post-operative pure tone audiometry (PTA) and caloric test were performed in all patients. The transcrusal approach technique was performed as reported in the previous references. The approach included trephination of the superior and posterior semicircular canals from the ampullae to the common crus. The main outcome of this study was preserving hearing and the vestibular function after surgery, which was determined by PTA and caloric test. Results The average diameter of skull base lesion of the five patients was 3.68 cm. The mean follow up period was 114.2 days. The pre-operative mean PTA of five patients was 11 dB. The mean PTA of five patients within seven days after surgery was 28 dB. The last measured mean PTA was 29.8 dB. The pre and post-operative caloric results measured revealed vestibular function deficit in all of the patients after surgery (mean decreased value: 64%). All patients were stable during the surgery. Complications included two cerebrospinal fluid leak (40%) and one cranial VI nerve deficit (20%). Conclusion Transcrusal approach is a method that can simultaneously preserve hearing and afford enough exposure of the skull base lesion if appropriately combined with other transcranial approach. We performed transcrusal approach targeting skull base lesion with hearing preservation, and we found excellent hearing result with this technique. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(11):548-53

감마나이프 방사선 수술로 조절되지 않은 두개저 수막종의 수술적 제거 : 증례보고

이재철(Jae Cheol Lee),정연구(Yeongu Chung),홍제범(Je Beom Hong),김한규(Han Kyu Kim) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.2

Because of their deep location, surrounded by many vital neurovascular structures, skull base meningiomas have been regarded as challenging lesions for surgical treatment. Stereotactic radiosurgery has been reported to be safe and effective to control skull base meningiomas. However, the use of radiosurgery must be considered very cautiously in treating skull base meningiomas, especially younger patients. In this study, we report a case with a huge skull base meningioma who had received radiosurgery prior to surgical removal.