• Journal of Korean Neurosurgical Society
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• 제39권2호
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• pp.96-101
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• 2006

Objective : The authors assess the long term effectiveness of gamma knife radiosurgery[GKS] for remnant or recurred craniopharyngiomas on tumor control and possibly set proper radiation dose for tumor control with utmost preservation of the adjacent structures. Methods : Sixteen GKS were done in 14 patients with recurred or remnant craniopharyngiomas after surgery. Mean follow up duration was 44.2 months [range $11.3{\sim}123.6\;months$]. Follow up MR imagings were analyzed. Results : Mean tumor volume was $3.6cm^3$ [range $0.6{\sim}18cm^3$] and mean margin dose was 12.2Gy [range $8{\sim}22.4Gy$]. Tumor control was achieved in 87.5% [14 of 16 tumors] which were either solid or cystic in nature. Dose to optic apparatus was mean 7.9Gy and no radiation related complications were observed. Conclusion : GKS seems to be effective treatment modality for craniopharyngiomas regardless of nature of tumor whether it is cystic or solid. Dose of 8 to 8.5Gy may be sufficient to achieve long term tumor control for remnant or recurred craniopharyngiomas.

• 대한두경부종양학회지
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• 제30권2호
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• pp.119-122
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• 2014

Rhabdomyosarcoma is the most common sarcoma in children less than 15 years of age. Two major histological subtypes are embryonal and alveolar. Embryonal rhabdomyosarcoma is diagnosed by immunopathology and treatments require coordinated management plans that include surgery, chemotherapy, and usually radiotherapy. 8-month-old male infant visited with swelling in left parotid area. Computed tomography scan showed a heterogeneous mass in the left parotid area and the result of fine-needle aspiration cytology was suspicious malignancy. Left total parotidectomy was performed and CSF leakage was noted and repaired. Confirmed by positive reactions to desmin and myogenin, the diagnosis was embryonal rhabdomyosarcoma. On postoperative brain MRI, extension along the meninges was noted and for treatment, chemotherapy and gamma knife radiosurgery were done. Five years after initial surgical resection(3 years and 10 months after completion of chemotherapy and gamma knife radiosurgery), the child did not show any evidence of local recurrence or distant metastasis.

• Journal of Korean Neurosurgical Society
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• 제58권1호
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• pp.83-88
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• 2015

Organized hematoma is a rare complication that can develop following gamma knife radiosurgery (GKS) for cerebral arteriovenous malformation (AVM). Here, we describe 5 patients with growing organized hematomas that developed from completely obliterated AVMs several years after GKS. The patients were 15, 16, 30, 36, and 38 years old at the time of GKS, respectively, and 3 patients were female. Four AVMs were located in the lobe of the brain, and the remaining AVM were in the thalamus. Between 2-12 years after GKS, patients developed progressive symptoms such intractable headache or hemiparesis and enhancing mass lesions were identified. Follow-up visits revealed the slow expansion of the hematomas and surrounding edema. Steroids were ineffective, and thus surgery was performed. Histology revealed organized hematomas with a capsule, but there was no evidence of residual AVMs or vascular malformation. After surgery, the neurological symptoms of all patients improved and the surrounding edema resolved. However, the hematoma continued to expand and intraventricular hemorrhage developed in 1 patient whose hematoma was only partially removed. GKS for cerebral AVM can be complicated by growing, organized hematomas that develop after complete obliteration. Growing hematomas should be surgically evacuated if they are symptomatic. Radical resection of the hematoma capsule is also strongly recommended.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1001-1007
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• 2000

Objective : We analysed diverse clinical features of the cavernous angioma. Also, we report the experience in differ-ent methods of the management and their results. Method : Data from 80 patients who were confirmed pathologically or diagnosed radiologically between Jan. 1990 and Sept. 1998 at our hospital were analysed. Variable factors that were examined were : clinical features, effects of treatment, and complications. Results : There were 47 male and 33 female patients. The age at the first presentation was from 3 to 57(mean 34.1) years old. Clinical features were seizure in 28 cases(38%), bleeding in 24 cases(32%), neurologic deficits in 12 cases(16%), headache in 10 cases(14%), and six incidental cases. The locations of lesion were cerebral and cerebellar hemisphere in 45 cases(56.2%), brainstem, basal ganglia, and thalamus in 32 cases(40%), multiple in 3 cases (3.8%). Seizure was common at the third decade and occurred frequently with the cavernous angioma in temporal (43%) or frontal lobe(39%). Bleeding was frequent after the third decade with peak at the fourth decade and had high incidence in brainstem or thalamus. The gamma-knife radiosurgery was done in 47 cases. Rebleeding occurred in 3 cases, but it was within postradiosurgery 1 year. Symptomatic radiation change occurred in 2 cases of 8 radiation change on MRI. On follow-up MRI, no evidence of rebleeding was found in 30 cases. Also, The lesion size was decreased in 3 cases. Resection was performed in 23 cases ; total 20, subtotal 2, partial 1. Postoperative complication occurred in 6 cases(26.1%). After surgery, 7(63.6%) of 11 seizure patients had outcome of seizure-free. Subclinical rebleeding occurred in one of two subtotal resected cases. In 11 patients, conservative management was done. There was neither rebleeding nor symptom aggravation during follow-up period of mean 17.2 months. Conclusion : The solution for prevention of rebleeding is complete removal of the lesion located at noneloquent area or accessible region, especially for the patients who presented symptoms or intractable seizure. However, the Gamma knife radiosurgery is considered when the lesions are located at eloquent area or when severe postoperative morbidity is expected.

• Molecules and Cells
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• 제27권2호
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• pp.263-268
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• 2009

Gamma knife surgery (GKS) is used for the treatment of various human brain disorders. However, the biological effects of gamma ray irradiation on both the target area, and the surrounding tissues are not well studied. The effects of gamma ray exposure to both targeted and untargeted regions were therefore evaluated by monitoring gene expression changes in the unilateral irradiated (60 Gy) and contralateral un-irradiated striata in the rat. Striata of irradiated and control brains were dissected 16 hours post-irradiation for analysis using a whole genome 44K DNA oligo microarray approach. The results revealed 230 induced and 144 repressed genes in the irradiated striatum and 432 induced and 239 repressed genes in the unirradiated striatum. Out of these altered genes 39 of the induced and 16 of the reduced genes were common to both irradiated and un-irradiated tissue. Results of semiquantitative, confirmatory RT-PCR and western blot analyses suggested that ${\gamma}$-irradiation caused cellular damage, including oxidative stress, in the striata of both hemispheres of the brains of treated animals.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1228-1232
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• 2000

목 적 : 본 연구는 삼차신경통에 대한 감마나이프 방사선 수술을 한 경우에 있어서 그 장기추적 결과를 분석하고자 하였다. 방 법 : 총 증례수는 11례였고 신경근 입구부(nerve root entry zone)에 수술의 목표점으로 최대량 67~85Gy를 조사하였다. 4mm collimator를 사용하였고 목표점은 뇌교의 표면으로부터 1~6mm 원위부 신경근에 위치하였다. 초기 3례에 있어서는 신경근과 뇌교가 만나는 접합부를 방사선수술의 목표점으로 삼았다. 이들 증례에서는 뇌교에 56 혹은 60Gy가 조사되었다. 후반 8례에서는 목표점을 다소 신경근의 원위부로 이동하여 뇌교의 가장자리가 최대량의 20% 이하로 조사되도록 계획하였다. 결 과 : 평균추적 기간은 25개월(13~50개월)이었다. 통증감소의 시작시점은 수술후 일주일내에서부터 길게는 5개월째였다. 통증의 치료결과는 삼례에서 완전소실, 3례에서 현격히 감소(80~90%)하였고 4례에서는 의미있게 감소하였다. 단 한례에서 최종추적결과 수술전과 같은 정도의 통증재발이 있었다. 전례에서 감마나이프 방사선수술과 관련된 의미있는 정도의 부작용은 관찰되지않았다. 결 론 : 장기추적 결과 감마나이프 방사선 수술이 삼차신경통의 치료에 효과적임이 관찰되었고 향후 이 질환에 대한 일차적 치료법으로 정하기 위하여 좀더 많은 치료경험이 필요할 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.122-129
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• 2024

Paragangliomas are rare neuroendocrine tumors that are usually benign in nature. They may be either familial or sporadic in their occurrence. Numerous neuroendocrine tumors are collectively included under the umbrella of paragangliomas. Among them, carotid body tumors and glomus jugulare tumors are extremely rare. Thus, we present a rare case of 29-year-old male who was admitted with hearing difficulties and tinnitus in the left ear, with swelling on the left side of the neck. Based on clinical and radiological findings, a diagnosis of left-sided glomus jugulare with carotid body tumor was made. The patient underwent a two-stage surgery with an interval of approximately 2 months. Histopathology revealed a paraganglioma. Herein, we present the clinical features, imaging findings, management, and a brief review of literature on the classification, evaluation, and management of carotid body and glomus jugulare tumors. Paraganglioma is a slow-growing tumor. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Microsurgical resection remains the primary treatment modality. Therefore, our patient underwent two-stage surgery. The rarity of occurrence and the proximity and adherence to vital neurovascular structures have resulted in the treatment of paragangliomas remaining a challenge.

• 대한두경부종양학회지
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• 제20권1호
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• pp.7-12
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• 2004

Background and Objectives: Brain metastasis from well-differentiated thyroid carcinoma is uncommon, and the treatment remains controversial. In this study, we analyzed cases of brain metastasis from well differentiated thyroid carcinoma to determine optimal treatment. Material and Methods: From March 1986 to May 2003, we experienced 13 cases of brain metastases from well-differentiated thyroid carcinomas. There were 6 men and 7 women with a mean age of 62.3 years. The time interval detecting the brain metastasis, treatment methods, outcomes, and the prognostic factors were analyzed. Results: In 11 patients, brain metastasis was found at a mean of 96 months after thyroid surgery (range, 1-204months). In 1 patient, brain metastasis was found simultaneously with the thyroid cancer. In the remaining one, brain metastasis was presented as the first sign. Treatment included gamma knife therapy in 2, external radiation therapy (ExRT) in 2, resection and ExRT in 2, gamma knife therapy and ExRT in 2 and intracranial holmium injection in 1. Three patients received no treatment. The mean survival was 20.5months (1-119 months). Only 2 patients with early detection remained alive after treatment (23months and 119months). The age, sex, primary tumor size, combined organs of distant metastasis and treatment methods did not affect the prognosis. There were noticeable symptomatic improvements in patients who received any kind of treatment for brain metastasis. Conclusion: Early detection and treatment of brain metastasis appears to bring symptomatic relief and improve survival. Therefore, early screening for brain metastasis is recommended for patients with symptoms. However, further study is needed to determine the optimal method of treatment.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.199-204
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• 2008

Objective : This study was designed to compare the efficacy of micro-vascular decompression (MVD) and Gamma knife radiosurgery (GKRS) for elderly idiopathic trigeminal neuralgia patients by analyzing the clinical outcome. Methods : In the past 10 years, 27 elderly patients were treated with MVD while 18 patients were treated with GKRS (>65-years-old). We reviewed their clinical characteristics and clinical courses after treatment as well as the treatment outcomes. For patients who were treated with MVD, additional treatment methods such as rhizotomy were combined in some areas. In GKRS, we radiated the root entry zone (REZ) with the mean maximum dose of 77.8 (70-84.3) Gy and one 4 mm collimator. Results : The mean age was 68.1 years for MVD, and 71.1 years for GKS group. The average time interval between first presenting symptom and surgery was 84.1 (1-361) months, and 51.4 (1-120) months, respectively. The mean follow-up period after the surgery was 35.9 months for MVD, and 33.1 months for GKRS. According to Pain Intensity Scale, MVD group showed better prognosis with 17 (63%) cases in grade I-II versus 10 (55.6%) cases in GKRS group after the treatment. The pain recurrence rate during follow up did not show much difference with 3 (11.1%) in MVD, and 2 (11.1%) in GKRS. After the treatment, 2 cases of facial numbness, and 1 case each of herpes zoster, cerebrospinal fluid (CSF) leakage, hearing disturbance, and subdural hematoma occurred in MVD Group. In GKRS, there was 1 (5.6%) case of dysesthesia but was not permanent. Three cases were retreated by GKRS but the prognosis was not as good as when the surgery was used as primary treatment, with 1 case of grade I-II, and 1 case of recurrence. The maximal relieve of pain was seen just after surgery in MVD group, and 1 year after treatment in GKRS group. Conclusion : For trigeminal neuralgia patients with advanced age, MVD showed advantages in immediately relieving the pain. However, in overall, GKRS was preferable, despite the delayed pain relief, due to the lower rate of surgical complications that arise owing to the old age.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.192-196
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• 2015

Objective : Tremor is a common movement disorder that interferes with daily living. Since the medication for tremor has some limitations, surgical intervention is needed in many patients. In certain patients who cannot undergo aggressive surgical intervention, Gamma Knife thalamotomy (GKT) is a safe and effective alternative. Methods : From June 2012 to August 2013, 7 patients with an intractable tremor underwent GKT. Four of these 7 patients had medical comorbidities, and 3 patients refused to undergo traditional surgery. Each patient was evaluated with the modified Fahn-Tolosa-Marin tremor rating scale (TRS) along with analysis of handwriting samples. All of the patients underwent GKT with a maximal dose of 130 Gy to the left ventralis intermedius (VIM) nucleus of the thalamus. Follow-up brain MRI was performed after 3 to 8 months of GKT, and evaluation with the TRS was also performed. Results : Six patients showed objective improvement in the TRS score. Excluding one patient who demonstrated tremor progression, there was 28.9% improvement in the TRS score. However, five patients showed subjective improvement in their symptoms. On comparing the TRS scores between follow-up periods of more and less than 4 months, the follow-up TRS score at more than 4 months of GKT was significantly improved compared to that at less than 4 months of GKT. Follow-up MRI showed radiosurgical changes in 5 patients. Conclusion : GKT with a maximal dose of 130 Gy to the VIM is a safe procedure that can replace other surgical procedures.