• Journal of Korean Neurosurgical Society
• /
• 제58권4호
• /
• pp.379-384
• /
• 2015

Objective : To investigate the risks and pattern of evolution of peritumoral brain edema (PTE) after stereotactic radiosurgery (SRS) for asymptomatic intracranial meningiomas. Methods : A retrospective study was conducted on 320 patients (median age 56 years, range 24-87 years) who underwent primary Gamma Knife radiosurgery for asymptomatic meningiomas between 1998 and 2012. The median tumor volume was 2.7 cc (range 0.2-10.5 cc) and the median follow-up was 48 months (range 24-168 months). Volumetric data sets for tumors and PTE on serial MRIs were analyzed. The edema index (EI) was defined as the ratio of the volume of PTE including tumor to the tumor volume, and the relative edema indices (rEIs) were calculated from serial EIs normalized against the baseline EI. Risk factors for PTE were analyzed using logistic regression. Results : Newly developed or increased PTE was noted in 49 patients (15.3%), among whom it was symptomatic in 28 patients (8.8%). Tumor volume larger than 4.2 cc (p<0.001), hemispheric tumor location (p=0.005), and pre-treatment PTE (p<0.001) were associated with an increased risk of PTE. rEI reached its maximum value at 11 months after SRS and decreased thereafter, and symptoms resolved within 24 months in most patients (85.7%). Conclusion : Caution should be exercised in decision-making on SRS for asymptomatic meningiomas of large volume (>4.2 cc), of hemispheric location, or with pre-treatment PTE. PTE usually develops within months, reaches its maximum degree until a year, and resolves within 2 years after SRS.

• Investigative Magnetic Resonance Imaging
• /
• 제19권1호
• /
• pp.1-9
• /
• 2015

Purpose: Several morphometric studies have been performed to investigate brain abnormalities in congenitally deaf people. But no report exists concerning structural brain abnormalities in congenitally deaf adolescents. We evaluated the regional volume changes in gray matter (GM) using voxel-based morphometry (VBM) in congenitally deaf adolescents. Materials and Methods: A VBM8 methodology was applied to the T1-weighted magnetic resonance imaging (MRI) scans of eight congenitally deaf adolescents (mean age, 15.6 years) and nine adolescents with normal hearing. All MRI scans were normalized to a template and then segmented, modulated, and smoothed. Smoothed GM data were tested statistically using analysis of covariance (controlled for age, gender, and intracranial cavity volume). Results: The mean values of age, gender, total volumes of GM, and total intracranial volume did not differ between the two groups. In the auditory centers, the left anterior Heschl's gyrus and both inferior colliculi showed decreased regional GM volume in the congenitally deaf adolescents. The GM volumes of the lingual gyri, nuclei accumbens, and left posterior thalamic reticular nucleus in the midbrain were also decreased. Conclusions: The results of the present study suggest that early deprivation of auditory stimulation in congenitally deaf adolescents might have caused significant underdevelopment of the auditory cortex (left Heschl's gyrus), subcortical auditory structures (inferior colliculi), auditory gain controllers (nucleus accumbens and thalamic reticular nucleus), and multisensory integration areas (inferior colliculi and lingual gyri). These defects might be related to the absence of general auditory perception, the auditory gating system of thalamocortical transmission, and failure in the maturation of the auditory-to-limbic connection and the auditorysomatosensory-visual interconnection.

• Journal of Korean Neurosurgical Society
• /
• 제52권4호
• /
• pp.325-333
• /
• 2012

Objective : The indications and optimal surgical treatments for intracranial cysts are controversial. In the present study, we describe long-term clinical and neuroimaging results of surgically treated intracranial cysts in children. The goal of this study is to contribute to the discussion of the debate. Methods : This study included 110 pediatric patients that underwent surgeries to treat intracranial cysts. Endoscopic cyst fenestrations were performed in 71 cases, while craniotomies and cyst excisions (with or without fenestrations) were performed in 30 patients. Cystoperitoneal shunts were necessary for nine patients. Long-term results were retrospectively assessed with medical and neuroimaging records. Results : Clinical and radiological improvement was reported in 87.3% and 92.8% of cases, respectively, after endoscopic neurosurgery, and in 93.3% and 100% using open microsurgery whereas 88.9% and 85.7% after shunt operation. There were no statistical differences in clinical outcomes (p=0.710) or volume reductions (p=0.177) among the different surgeries. There were no mortalities or permanent morbidities, but complications such as shunt malfunctions, infections, and subdural hematomas were observed in 56% of the patients that had shunt operations. A total of 13 patients (11.8%) underwent additional surgeries due to recurrences or treatment failures. The type of surgery performed did not influence the recurrence rate (p=0.662) or the failure rate (p=0.247). Conclusion : Endoscopic neurosurgeries are less invasive than microsurgeries and are at least as effective as open surgeries. Thus, given the advantages and complications of these surgical techniques, we suggest that endoscopic fenestration should be the first treatment attempted in children with intracranial cysts.

• Journal of Korean Neurosurgical Society
• /
• 제57권5호
• /
• pp.315-322
• /
• 2015

Intracranial germ cell tumors (ICGCT) occur in 2-11% of children with brain tumors between 0-19 years of age. For treatment of germinoma, relatively low radiation doses with or without chemotherapy show excellent 10 year survival rate of 80-100%. Past studies showed that neoadjuvant chemotherapy combined with focal radiotherapy resulted in unacceptably high rates of periventricular tumor recurrence. The use of generous radiation volume which covers the whole ventricular space with later boost treatment to primary site is considered as standard treatment of intracranial germinomas. For non-germinomatous germ cell tumors (NGGCT), 10-year overall survival rate is still much inferior than that of intracranial germinoma despite intensive chemotherapy and high-dose radiotherapy. Craniospinal radiotherapy combined with cisplatin-based chemotherapy provides the best treatment outcome for NGGCT; 60-70% of overall survival rate. There is a debate on the surgical role whether surgery can contribute to improved treatment outcome of NGGCT when added to combined chemoradiotherapy. Because higher dose of radiotherapy is required for treatment of NGGCT than for germinoma, it is tested whether whole ventricular irradiation can replace craniospinal irradiation in intermediate risk group of NGGCT to minimize radiation-related late toxicity in the recent studies. To minimize the treatment-related neural deficit and late sequelae while maintaining long-term survival rate of ICGCT patients, optimized administration of chemotherapy and radiotherapy should be selected. Use of technically upgraded radiotherapy modalities such as intensity-modulated radiotherapy or proton beam therapy is expected to bring an improved neurocognitive outcome with longitudinal assessment of the patients.

• Radiation Oncology Journal
• /
• 제35권2호
• /
• pp.153-162
• /
• 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.

• 한국콘텐츠학회논문지
• /
• 제12권7호
• /
• pp.247-254
• /
• 2012

본 연구는 2010년 3월부터 2011년 9월까지 뇌동맥류로 H병원에 내원한 환자 중 혈관조영술을 시행하여 코일 색전술을 받은 53명의 환자를 대상으로 뇌동맥류의 체적에 따른 코일의 길이 특성을 평가하였다. 뇌동맥류에 대한 색전술을 시행한 환자의 뇌동맥류에 대하여 볼륨렌더링기법으로 체적을 구하였으며, 코일색전술을 실시한 후 코일의 체적 및 길이를 구하여 체적율을 계산하였다. 뇌동맥류의 크기에 따른 색전체적율은 6mm 이하에서는 $43.11{\pm}3.11%$, 6~10mm에서는 $36.07{\pm}2.03%$, 10~15mm 이상은 40.91%, 20mm 이상에서는 38.25%를 나타내어 권고된 체적율과 유사한 수치를 나타내었다. 뇌동맥류의 형태에 구분 없이 체적에 따른 코일 길이는 직경 0.25mm인 한 가지 코일을 사용한 경우 20~$100mm^3$의 $1mm^3$ 당 0.65cm로 조사되었다. saccular type의 aneurysm volume에 사용한 경우 20~$150mm^3$의 $1mm^3$ 당 0.62cm, multi lobulated type의 aneurysm volume에 사용한 경우 20~$90mm^3$의 $1mm^3$ 당 0.60cm로 조사되었다.

• Journal of Yeungnam Medical Science
• /
• 제10권2호
• /
• pp.493-505
• /
• 1993

저자들은 1예의 선천성 피부결손증을 경험하고 국소피판술과 피부이식으로써 치료하고 술후 발생된 부분적 괴사는 습윤치료로써 자연치유시켜 만족스러운 결과를 얻었고, 4예의 craniosynostosis 환자를 진단하고 modified Marchac's method, Persing's method를 이용하고 교정하였고 CT를 이용한 뇌용적 측정으로 예후를 판정할 수 있었다.

• Investigative Magnetic Resonance Imaging
• /
• 제13권1호
• /
• pp.63-73
• /
• 2009

배경: 두개강내 용적에 대한 수동과 자동 측정법이 여성 주요 우울증 환자의 해마의 용적측정술과 modulated voxel-based morphometry (mVBM)의 결과에 미치는 영향을 알아보고자 한다. 방법: 21명의 여성 주요 우울증 환자와 성별, 나이의 분포가 비슷한 20명의 여성 정상인을 연구대상에 포함시켰다. 해마와 두개강내 용적은 수동으로 측정하였고, FreeSurfer 프로그램을 이용하여 두개강내 용적을 자동으로 측정하였다. 또한 회색질과 백색질의 부피도 SPM을 이용하여 자동으로 측정하였다. 결과: 수동으로 측정한 두개강의 용적을 통제변인으로 하여 분석한 통계분석의 결과가 FreeSurfer에 의해 측정된 두개강내 용적이나 뇌실질의 용적을 통제변인으로 한 통계분석의 결과보다 우울증 환자의 해마부피 감소와 mVBM 분석의 국조적 부피감소를 보다 민감하게 보여주었다. 수동적인 방법과 FreeSurfer에 의해 측정된 두개강내 용적은 정상인에서는 차이가 없었지만 (p = 0.696), 우울증 환자의 두개강 부피는 FreeSurfer를 이용해 측정한 두 개강의 부피가 더 작았다 (p = 0.000002). 우울증 환자의 전체 회색질의 부피는 수동으로 측정한 두개강의 용적을 통제변인으로 적용하였을 때 정상인의 회색질의 부피보다 작았고 (p = 0.000002), 해마의 부피도 수동으로 측정한 두 개 강의 부피를 통제변인으로 통계처리를 했을 때는 우울증환자의 해마가 뚜렷한 위축을 보였지만 (오른쪽, p = 0.014; 왼쪽, p = 0.004), 다른 측정법을 통제변인으로 했을 때는 유의하지 않았다 (p > 0.05). mVBM 분석에서는 수동으로 측정한 두개강의 부피를 통제변인으로 사용했을 때만 다중비교교정 후에 유의한 결과를 보였다 (FDR p < 0.05). 결론: 수동적인 방법으로 측정한 두개강의 용적이 FreeSurfer에 의해 자동으로 측정된 두개강의 용적이나 뇌실질의 부피보다 해마용적측정술과 mVBM 의 결과에 있어서 더 효율적으로 우울증이 있는 그룹과 없는 그룹의 차이를 보여주는 것에 민감한 결과를 보였다.

• 대한의용생체공학회:의공학회지
• /
• 제27권3호
• /
• pp.94-100
• /
• 2006

The effectiveness of the treatment of intracranial aneurysms with endovascular coiling depends on coil packing density, the location of aneurysm, its neck dimensions with respect to the aneurysm dome, and its size with respect to the surrounding tissue. Clinical data also suggests that the aneurysm neck size is the main predictor of aneurysm recanalization. In this study, the force impinging on the aneurysm neck in an idealized aneurysm was calculated by using a three dimensional finite volume method for the non-Newtonian incompressible laminar flow. To quantify the effect of neck size on the impingement force, calculations were performed for aneurysm neck diameters (Da) varying from 10% to 100% of the parent artery diameter (Dp). Also, maximum impingement forces were represented by a function of the ratio of the aneurysm neck to the diameter of the parent vessel. The results show that the hemodynamic forces exerted on the coil mass at the aneurysm neck due to the pulsatile blood flow are larger for wide necked aneurysms.

• Journal of Trauma and Injury
• /
• 제35권1호
• /
• pp.43-45
• /
• 2022

Epidural hematoma (EDH) can sometimes be life-threatening, although small-volume EDHs can resolve spontaneously like other intracranial hematomas. However, in rare cases, EDH can transform into a chronic form instead of disappearing. In contrast to subdural hematoma, there is no agreed-upon definition or treatment of chronic EDH. A 41-year-old male patient with acute EDH in the bilateral paravertical area due to partial rupture of the sagittal sinus was operated first, and then remnant contralateral hematoma was treated conservatively. One month after surgery, he showed hemiparesis, and brain imaging revealed chronic EDH at the location of the remnant acute hematoma. We performed surgery again to treat chronic EDH through a large craniotomy. Although many cases of EDH are self-limited, clinicians must keep in mind that some cases of EDH, especially those of venous origin and arising in young people, can become chronic and require surgical treatment.