• Journal of Korean Neurosurgical Society
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• v.30 no.12
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• pp.1381-1387
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• 2001

Objective : Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. Material and Methods : Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin($20mg/m^2$), etoposide($100mg/m^2$) and bleomycin($15mg/m^2$) as well as external beam radiation therapy. We compared the management problems for these tumors. Result : In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. Conclusion : Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.666-669
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• 2001

We report a case of meningeal hemangiopericytoma presenting as metastasis in the vertebral body and pedicle of the thoracic spine. Hemangiopericytoma is a rare vascular neoplasm. Although the tumor has a strong propensity for both local recurrence and extracranial metastasis, metastasis to thoracic spine is very rare and only two cases were found in the literature. A 44-year-old woman with paraparesis and pain in the thoracic and lower legs was examined by plain radiographs and magnetic resonance imaging. The intracranial hemangiopericytoma was operated 3 years ago. Magnetic resonance imaging demonstrated a tumor invading the left vertebral body and pedicle of the 11th thoracic spine, and compressing the dural sac. The patient was gradually improved after surgical removal of the lesions and the histologic findings were characteristics of hemangiopericytoma.

• Journal of Korean Neurosurgical Society
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• v.61 no.3
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• pp.333-342
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• 2018

Intracranial germ cell tumors (iGCTs) are a heterogeneous group of tumors with peculiar characteristics clearly distinguished from other brain tumors of neuroepithelial origin. Diverse histology, similarity to gonadal GCT, predilection to one sex, and geographic difference in incidence all present enigmas and fascinating challenges. The treatment of iGCT has advanced for germinoma to date; thus, clinical attention has shifted from survival to long-term quality of life. However, for non-germinomatous GCT, current protocols provide only modest improvement and more innovative therapies are needed. Recently, next-generation sequencing studies have revealed the genomic landscape of iGCT. Novel mutations in the KIT-RAS-MAPK and AKT-MTOR pathways were identified. More importantly, methylation profiling revealed a new method to assess the pathogenesis of iGCT. Molecular research will unleash new knowledge on the origin of iGCT and solve the many mysteries that have lingered on this peculiar neoplasm for a long time.

• Radiation Oncology Journal
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• v.35 no.2
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• pp.153-162
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• 2017

Purpose: To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. Materials and Methods: Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ${\pm}$ boost (WBRT ${\pm}$ boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). Results: The WBRT ${\pm}$ boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ${\pm}$ boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ${\geq}42.3Gy$ compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). Conclusions: Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.

• Imaging Science in Dentistry
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• v.32 no.1
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• pp.49-53
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• 2002

Orofacial pain can be caused by intracranial disorders or can be musculoskeletal, vascular, internal derangemental, and neurologic in origin. The neurologic pain is derived from structural and functional disorders of nerve, and the trigeminal neuralgia is the typical manifestation. Trigeminal neuralgia is known from centuries ago, and is one of the most common pains in human. We present our experience with three patients who have trigeminal neuralgia. The first case is a 50-year-old female who had no specific evidence radiographically. Second is a 50-year-old male with microvascular compression on right trigeminal nerve. The third case is a 60-year-old female who had a neoplasm in cerebellopontine angle with associated mass effect.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.696-700
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• 2000

The authors report a case of atypical meningioma in the fourth ventricle. Intraventricular meningioma is not uncommon intracranial neoplasm, especially that in the trigone of lateral ventricle, however, those in the third and fourth ventricle are very rare. There are only two cases of atypical meningiomas in the fourth ventricle among 29 cases of fourth ventricular meningiomas reported 17 literature. The clinical features, findings of magnetic resonance image and operation of our case, and review of literature are presented.

• Radiation Oncology Journal
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• v.34 no.1
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• pp.1-9
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• 2016

Overexpression of human epidermal growth factor receptor 2 (HER2) is found in about 20% of breast cancer patients. With treatment using trastuzumab, an anti-HER2 monoclonal antibody, systemic control is improved. Nonetheless, the incidence of brain metastasis does not be improved, rather seems to be increased in HER2-positive breast cancer. The mainstay treatment for brain metastases is radiotherapy. According to the number of metastatic lesions and performance status of patients, radiosurgery or whole brain radiotherapy can be performed. The concurrent use of a radiosensitizer further improves intracranial control. Due to its large molecular weight, trastuzumab has a limited ability to cross the blood-brain barrier. However, small tyrosine kinase inhibitors such as lapatinib, has been noted to be a promising agent that can be used as a radiosensitizer to affect HER2-positive breast cancer. This review will outline general management of brain metastases and will focus on preclinical findings regarding the radiosensitizing effect of small molecule HER2 targeting agents.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.15-22
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• 2000

Objective : This study was undertaken to evaluate the benefits and risks of the stereotactic biopsy in brain lesions. We assessed the diagnostic accuracy and morbidity rate associated with the stereotactic biopsy. Methods : The authors present a review of 47 patients, who underwent stereotactic biopsy using Cosman-Roberts-Wells(CRW) stereotactic apparatus during last six years. Results : Target locations were supratentorial in 36 cases, infratentorial in 9 and multiple in 2. According to pathological diagnosis, the largest group was neoplasm(29) followed by infection(9), infarction(2), cyst(2), and non-specific(5). Definitive diagnosis could be made in 42 of 47 cases(89.4%). When the mass lesion had been suspected as neoplastic condition, the diagnostic rate was 96.7%(29/30). It was being much higher than that of non-neoplastic lesion, 76.5%(13/17). The treatment modality was changed in 15 cases(32%) because the result of stereotactic biopsy was different from clinical diagnosis. Subsequent craniotomy after stereotactic biopsy was then performed in 6 cases, and the pathological diagnoses were precisely coincident in all of these cases. There were two complications(4.3%) : One intratumoral hemorrhage in glioblastoma and a transient hemiparesis in benign astrocytoma. There was no mortality in this series. Conclusion : The precise histological verification is crucial to determine the adequate treatment modality in intracranial lesions. Stereotactic biopsy is a safe and accurate diagnostic procedure for intracranial lesions with a low complication rate.

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.439-444
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• 2014

A 5-year-old, 2.7 kg female maltese dog was presented a local veterinary clinic with one week history of hindlimb lameness associated with patellar luxation. Reduction of bilateral medial patellar luxation was operated using trochlear resection and lateral reinforcement technique. Three weeks after the surgery, the dog showed bending spine with pain in thoracic and lumbar region, continuous ataxia and intermittent convulsion. Magnetic resonance imaging scanning revealed a hyperintense mass in right frontal lobe of brain and abnormal cavitation from cervical cord to third lumbar cord. Histopathologically, neoplasm in brain composed of meningothelial cells showed loosely reticular or lace-like morphology with numerous extracellular cystic spaces of variable size and shape. Neoplastic cells were positive for vimentin and negative for neuron specific enolase and glial fibrillary acidic protein. Irregular shaped enlarge central canal-like cavity was existed in cervical and lumbar cords. In our best knowledge, this report described the clinical findings, imaging and histopathologic characteristics of unusual intracranial microcystic meningioma with secondary syringomyelia in a dog.

• Radiation Oncology Journal
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• v.15 no.3
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• pp.207-213
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• 1997

Purpose : Intracranial germinoma is the most radiocurable tumor of theprimary intracranial neoplasm. But, the optimum radiation dose and target volume remain controversial In this retrospective study, we analysed the spreading pattern at presentation and the pattern of the failure and survival of intracranial germinoma, Materials and Methods : From 1989 to 1996, 23 Patients were treated for intracranial germinoma at Department of Radiation Oncology, Twenty-one Patients were treated at their initial Presentation and 2 Patients were treated for recurrent disease. Six patients had multiple tumor masses on MRI and 7patients had ventricular seeding on MRI. The examination of cerebrospinal fluid cytology was done in 15 patients and 3 out of 15 patients had positive cerebrospinal cytology. In tumor marker study of $\alpha-FP\;and\;\beta-hCG$, 6 patients had mildly elevated $\beta-hCG$ in serum or cerebrospinal fluid. Twentyone Patients were treated with whole craniospinal axis irradiation and 2 Patients were given whole ventricular radiation therapy. The total dose was ranged between 4500cGy and 5600cGy to primary tumor site (median 5580cGy) Dose to the entire ventricular system ranged from 1980cGy to 3960 cGy (median 2700cGy) and dose to the spinal axis ranged from 2160cGy to 3900cGy (median 2700cGy) Results : Of 23 patients, 21 Patients are alive without evidence of diseasefor median 4 years follow-up. One Patient who had markedly elevated $\alpha-FP\;and\;\beta-hCG$, suffered from Persistent disease after radiation therapy and received 2 cycles of chemotherapy. She died 9 months after chemotherapy One patient who developed ventricular seeding after gamma-knife was treated with whole craniospinal irradiation, he died after 1 year due to probably brain necrosis. The hematologic toxicity of 3 or 4 grade were seen in 7 patients and patient's endocrinologic dysfunction was not deteriorated after radiation therapy. One patient had been treated with growth hormone replacement due to short stature. Conclusions : This retrospective study has confirmed the excellent result of radiation therapy in intracranial germinoma. The complication rate during or after radiation therapy is considered within acceptable range. ft is necessary to further investigate the optimal dose and treatment volume of radiation therapy. The role of chemotherapy in the treatment of intracranial germinoma should be further investigated.