• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.124-127
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• 2011

A 43-year-old male presenting with headache and dizziness underwent craniotomy and gross total resection of an extraaxial tumor was achieved via left occipital interhemispheric approach. The tumor was diagnosed as papillary meningioma arising from the left falcotentorium with such pathologic characteristics of bronchoalveolar adenocarcinoma. At postoperative day 40, he developed generalized tonic clonic seizure and then progressed to a status epilepticus pattern. Brain magnetic resonance imaging showed irregular leptomeningeal enhancement with a significant peritumoral area. Through a cerebrospinal fluid (CSF) study, we identified the meningioma cells of the papillary type from the CSF. At the postoperative day 60, he fell into semicomatose state, and the computed tomography imaging showed low density on both cerebral hemispheres, except the basal ganglia and cerebellum, with overall brain swelling and an increased intracranial pressure. He died on the following day. We experienced a rare case of a papillary meningioma with leptomeningeal seeding.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.385-387
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• 2011

Leptomeningeal metastasis is a devastating complication of advanced stage cancer. It is frequently accompanied by hydrocephalus and intracranial hypertension that must be treated by ventriculoperitoneal shunts. However, there are actual risks of peritoneal seeding or accumulation of malignant ascites after the cerebrospinal fluid diversion procedure, though it has not been reported. Here, we present the case of a patient with non-small cell lung cancer with leptomeningeal metastasis in whom malignant ascites developed after a subduroperitoneal shunt.

• Journal of Korean Neurosurgical Society
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• 제49권6호
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• pp.334-338
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• 2011

Objective : The incidence of leptomeningeal dissemination from malignant glioma is rare, so the clinical features of this are not well documented yet We attempted to determine the clinical features of leptomeningeal dissemination from malignant gliomas. Methods : We retrospectively analyzed 11 cases of leptomeningeal dissemination of malignant glioma, who were treated at our institution between 2006 and 2009. We investigated the clinical features of these patients by considering the following factors : tumor locations, the events of ventricular opening during surgery and the cerebrospinal fluid (CSF) profiles, including the cytology. Results : The group was composed of 9 males and 2 females. The histological diagnosis of their initial intracranial tumors were 4 primary glioblastoma, 3 anaplastic astrocytoma, 1 anaplastic oligoastrocytoma, 2 ganglioglioma and 1 pleomorphic xanthoastrocyotma with anaplastic features. The mean age of the patients at the time of the initial presentation was $42.8{\pm}10.3$ years. The mean time between surgery and the diagnosis of spinal dissemination was $12.3{\pm}7.9$ (3-28) months. The mean overall survival after dissemination was $2.7{\pm}1.3$ months. All our patients revealed a history of surgical opening of the ventricles. Elevated protein in the CSF was reported for eight patients who had their CSF profiles checked. Conclusion : We propose that in the malignant gliomas, the surgical opening of ventricles can cause the spinal leptomeningeal dissemination and the elevated protein content of CSF may be a candidate marker of leptomeningeal dissemination.

• 대한영상의학회지
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• 제84권4호
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• pp.970-976
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• 2023

29세 남성에서의 미만성 연수막성 신경교종을 증례 보고한다. 이 질환은 드문 중추신경계 종양으로, 대부분 소아에서 발견되며 성인에서는 소수만 보고되어 있다. 본 환자는 만성 두통으로 내원하여 MRI를 시행하였다. 뇌 MRI에서 경도의 수두증과 다수의 테두리 조영증강을 보이는 병변이 안장위 수조에서 보였으며, FLAIR에서 신호가 억제되지 않는 다수의 비조영증강 낭종성 병변이 양측 기저핵, 시상 및 대뇌에서 관찰되었다. 척추 MRI에서는 요추 및 천추부위의 미만성 연수막 조영증강이 보였다. 생식세포종양의 연수막 파종을 의심하였고 경접형골 종양제거술을 시행 받았다. 병리학 검사에서 미만성 연수막성 신경교종으로 확진되었고, 차세대 염기서열 검사에서 FGFR1 유전자의 돌연변이가 발견되었다. 결론적으로 연수막 결절성 조영증강과 FLAIR에서 신호가 억제되지 않는 다수의 비조영증강 낭종성 뇌 병변이 함께 관찰될 경우 연수막 조영증강을 보이는 여러 다른 질환들과의 감별 진단에 도움이 된다.

• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.393-401
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• 2018

The prognosis of brain tumors in children has improved for last a few decades. However, the prognosis remains dismal in patients with recurrent brain tumors. The outcome for infants and young children in whom the use of radiotherapy (RT) is very limited because of unacceptable long-term adverse effect of RT remains poor. The prognosis is also not satisfactory when a large residual tumor remains after surgery or when leptomeningeal seeding is present at diagnosis. In this context, a strategy using high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) has been explored to improve the prognosis of recurrent or high-risk brain tumors. This strategy is based on the hypothesis that chemotherapy dose escalation might result in improvement in survival rates. Recently, the efficacy of tandem HDCT/auto-SCT has been evaluated in further improving the outcome. This strategy is based on the hypothesis that further dose escalation might result in further improvement in survival rates. At present, the number of studies employing tandem HDCT/auto-SCT for brain tumors is limited. However, results of these pilot studies suggest that tandem HDCT/auto-SCT may further improve the outcome. In this review, we will summarize our single center experience with tandem HDCT/auto-SCT for recurrent or high-risk brain tumors.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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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.

• Radiation Oncology Journal
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• 제27권3호
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• pp.140-144
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• 2009

목 적: 전이성 뇌종양 환자에서 전뇌조사를 시행받은 160명의 환자를 대상으로 원발 종양 가중치에 따른 생존율을 후향적으로 분석해보고자 하였다. 대상 및 방법: 2002년부터 2008년 사이에 인하대병원에서 전이성 뇌종양으로 진단받은 암환자들 중 전뇌 조사 방사선 치료 30 Gy를 받은 160명의 환자를 대상으로 후향적으로 분석하였다. 원발성 종양이 유방암인 경우는 20명, 폐암인 경우는 103명이었다. 160명의 환자 중 척수 연수막 전이(leptomeningeal seeding) 환자를 제외한, 142명의 환자를 대상으로 예후 인자 및 Recursive Partitioning Aanalysis (RPA) 분류에 따른 생존율, 중앙생존기간과, RPA 분류에 원발 종양의 종류에 따라 가중치를 둔 새로운 Weighted Partitioning Analysis (WPA) 분류에 따른 생존율과 중앙생존기간을 분석하였고 RPA분류와 비교 분석하였다. 결 과: RPA분류에 의한 중앙생존기간은 분류 I (8명), 분류 II (76명), 분류 III (58명)가 각각 20.0개월, 10.0개월, 3.0개월이었으며(p=0.003), WPA 분류의 경우에는 분류 I (3명), 분류 II (9명), 분류 III (70명), 분류 IV (60명)가 각각 36개월, 23.7개월, 10.9개월, 8.6개월로(p=0.001) RPA 분류보다 더 우위성을 보였다. 결 론: 새로운 예후 지표인 WPA 분류가 기존의 RPA 분류보다 전이성 뇌종양 환자에서 치료 방침을 결정함에 있어 도움을 줄 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.329-335
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• 2013

Objective : Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods : From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. Results : In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 $mm^3$ (range, 4.5-27745 mm3) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 $mm^3$ was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p<0.001, and hazard risk=1.46, p=0.046, respectively). Conclusion : GKRS has shown to be an effective and safe treatment modality for treating brain metastases of primary breast cancer. Most metastatic brain lesions initially respond to GKRS, though, many patients have further CNS progression in subsequent periods. Patients with poor Karnofsky performance status and multiple metastatic lesions are at risk of CNS progression and poor survival, and a more frequent and strict surveillance protocol is suggested in such high-risk groups.

• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.271-281
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• 2021

Objective : Immune checkpoint inhibitors (ICIs) are approved for treating non-small-cell lung cancer (NSCLC); however, the safety and efficacy of combined ICI and Gamma Knife radiosurgery (GKS) treatment remain undefined. In this study, we retrospectively analyzed patients treated with ICIs with or without GKS at our institute to manage patients with brain metastases from NSCLC. Methods : We retrospectively reviewed medical records of patients with brain metastases from NSCLC treated with ICIs between January 2015 and December 2017. Of 134 patients, 77 were assessable for brain responses and categorized into three groups as follows : group A, ICI alone (n=26); group B, ICI with concurrent GKS within 14 days (n=24); and group C, ICI with non-concurrent GKS (n=27). Results : The median follow-up duration after brain metastasis diagnosis was 19.1 months (range, 1-77). At the last follow-up, 53 patients (68.8%) died, 20 were alive, and four were lost to follow-up. The estimated median overall survival (OS) of all patients from the date of brain metastasis diagnosis was 20.0 months (95% confidence interval, 12.5-27.7) (10.0, 22.5, and 42.1 months in groups A, B, and C, respectively). The OS was shorter in group A than in group C (p=0.001). The intracranial disease progression-free survival (p=0.569), local progression-free survival (p=0.457), and complication rates did not significantly differ among the groups. Twelve patients showed leptomeningeal seeding (LMS) during follow-up. The 1-year LMS-free rate in treated with ICI alone group (69.1%) was significantly lower than that in treated with GKS before ICI treatment or within 14 days group (93.2%) (p=0.004). Conclusion : GKS with ICI showed no favorable OS outcome in treating brain metastasis from NSCLC. However, GKS with ICI did not increase the risk of complications. Furthermore, compared with ICI alone, GKS with ICI may be associated with a reduced incidence of LMS. Further understanding of the mechanism, which remains unknown, may help improve the quality of life of patients with brain metastasis.