• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1024-1029
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• 2000

Objectives : With recent improvements in neuroimaging and the development of third and fourth-generation radiosurgical dose-planning soft ware, came a renewed interest in using radiosurgery for the treatment of movement disorders. Radiosurgery involves no opening of the cranium and no incisions, eliminating both the risk of hemorrhage from passing an electrode to the depths of meningitis from operative infection. It is for these reasons stereotactic radiosurgical treatment of movement disorders has value in a small subgroup of patients. The authors report four cases of Parkinson's disease and one case of dystonia that were treated by Gamma knife. Methods : Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make lesion in two Parkinson's disease patients. A radiation dose of 120Gy was delivered to nucleus using a single 4-mm collimator plug pattern following classic anatomical landmarks. Patients were followed for a median of 10.5 months(range 9-12 months). An independent neurological evaluation of tremor, based on the change in the United Parkinson's Disease Rating Scale tremor score(UPDRS), was correlated with a subjective evaluation. Gamma knife ventrolateral(V.O.P) thalamotomy was performed in one case of dystonia. A central dose of 150Gy was delivered and the patient was followed for 18 months. Gamma knife globus pallidus interna pallidotomy was performed in two Parkinson's disease patients. A radiation dose of 130Gy(range 120-140Gy) was delivered. Patients were followed for a median of 13 months(range 9-14 months). Result : Ventrolateral thalamotomy in dystonia produced regained left hand usage in order to be able to use the telephone. Ventralis intermedius thalamotomy produced an excellent improvement of the tremor in one case, mild improvement of the tremor in the other case of Parkinson's disease. A globus pallidus internalis(GPi) pallidotomy produced improvement of rigidity and dyskinesia : one other showed no change. There were no neurological complications. Conclusion : Gamma Knife thalamotomy considered a safe and effective technique for the treatment of tremor in Parkinson's disease. Although the results from Longer follow-up is not available yet, the short-term results seem to be encouraging.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.395-399
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• 2001

Primary spinal epidural lymphoma(SEL), i.e. occurring in the absence of any detectable extraspinal lymphoproliferative disorder, is an unusual cause of spinal cord compression. The authors report a 48-year-old, diabetic woman presented with back pain followed by acute paraparesis and voiding difficulty. She had been treated with acupunctures on her back before admission, and complete blood count showed leukocytosis with neutrophilia and increased erythrocyte sedimentation rate(ESR). Thoracic spine magnetic resonance imaging(MRI) revealed an epidural mass extending from T5 to T8 with compression of the spinal cord. Emergency decompressive laminectomy was performed with a tentative diagnosis of spinal epidural abscess, but a B-cell lymphoma was final pathologic diagnosis. Further staging showed no other sites of lymphoma, and the spinal lesion was treated by chemotherapy and radiotherapy. The authors stress that primary SEL can mimic spinal epidural abscess(SEA) in the diabetic patient and should be a diagnostic consideration in patients with a syndrome of acute spinal cord compression manifested by a prodrome of back pain and neuroimaging consistent with an epidural compressive lesion, especially in a diabetic.

• Journal of Korean Neurosurgical Society
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• v.30 no.12
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• pp.1361-1368
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• 2001

Objective : "Paraclinoid" aneurysms include those aneurysms arising from the internal carotid artery between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery. The authors reviewed and analysed the results of surgical approaches to paraclinoid aneurysms treated with transcranial surgery and endovascular surgery. Methods : Between January 1998 and May 1999, 14 patients were treated surgically through ipsilateral and contralateral pterional approaches, and anterior interhemispheric approach, and endovascular surgery for paraclinoid aneurysms. All transcranial approaches were performed by same surgeon. The medical records, neuroimaging studies and videotapes which had been recorded operations were reviewed retrospectively. Results : Twelve patients presented with subarachnoid hemorrhage and ICH. Nine of fourteen patients had multiple aneurysms. Thirteen cases were small and one was a large aneurysm. Six patients were treated through ipsilateral approaches, six contralateral pterional approaches, one anterior interhemispheric approach and one primarily by GDC embolization. All aneurysms treated through contralateral approaches were multiple aneurysms. Neck clipping was performed in 9(69.2%) of the thirteen aneurysms, wrapping in four cases, among them three cases were followed by GDC embolization. The surgical outcomes were : Glasgow Outcome Scale(GOS) I 71.4%, GOS II 21.4% and GOS V 7.1%. Conclusion : The surgical approaches to paraclinoid aneurysms should be chosen after careful anatomical evaluation of aneurysm and its neighboring structures. 3D-CT angiography and/or the raw data of MR angiography were useful. This study supports the usefulness of the contralateral approach to paraclinoid aneurysm associated with multiple aneurysms, unruptured and small aneurysms whose dome projecting medially, superiorly and dorsally. The determination of contralateral approach to small and medially projecting paraclinoid aneurysm may be stressful to operator, thus we believe anterior interhemispheric approach is better alternated. Also we recommend the endovascular surgery after reinforcement of aneurym neck and dome in the case with difficulty in clipping.

• Investigative Magnetic Resonance Imaging
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• v.18 no.4
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• pp.290-302
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• 2014

Purpose : Susceptibility-weighted magnetic resonance (MR) sequence is three-dimensional (3D), spoiled gradient-echo pulse sequences that provide a high sensitivity for the detection of blood degradation products, calcifications, and iron deposits. This pictorial review is aimed at illustrating and discussing its main clinical applications. Materials and Methods: SWI is based on high-resolution, 3D, fully velocity-compensated gradient-echo sequences using both magnitude and phase images. To enhance the visibility of the venous structures, the magnitude images are multiplied with a phase mask generated from the filtered phase data, which are displayed at best after post-processing of the 3D dataset with the minimal intensity projection algorithm. A total of 200 patients underwent MR examinations that included SWI on a 3 tesla MR imager were enrolled. Results: SWI is very useful in detecting multiple brain disorders. Among the 200 patients, 80 showed developmental venous anomaly, 22 showed cavernous malformation, 12 showed calcifications in various conditions, 21 showed cerebrovascular accident with susceptibility vessel sign or microbleeds, 52 showed brain tumors, 2 showed diffuse axonal injury, 3 showed arteriovenous malformation, 5 showed dural arteriovenous fistula, 1 showed moyamoya disease, and 2 showed Parkinson's disease. Conclusion: SWI is useful in detecting occult low flow vascular lesions, calcification and microbleed and characterising diverse brain disorders.

• Korean Journal of Acupuncture
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• v.30 no.3
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• pp.161-170
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• 2013

Objectives : Our study aimed to investigate the sustained effects of sham (SHAM) and verum acupuncture (ACUP) into the post-stimulus resting state. Methods : In contrast to previous studies, in order to define the changes in resting state induced by acupuncture, changes were evaluated with a multi-method approach by using regional homogeneity (ReHo) and amplitude of low frequency fluctuation (ALFF). Twelve healthy participants received SHAM and ACUP stimulation right GB34 (Yanglingquan) and the neural changes between post- and pre-stimulation were detected. Results : The following results were found; in both ReHo and ALFF, the significant foci of; left and right middle frontal gyrus, left medial frontal gyrus, left superior frontal gyrus, and right posterior cingulate cortex, areas that are known as a default mode network, showed increased connectivity. In addition, in ReHo, but not in ALFF, brain activation changes in the insula, anterior cingulate cortex, and the thalamus, which are associated with acupuncture pain modulation, were found. Conclusions : In this study, results obtained by using ReHo and ALFF, showed that acupuncture can modulate the post-stimulus resting state and that ReHo, but not ALFF, can also detect the neural changes that were induced by the acupuncture stimulations. Although more future studies with ReHo and ALFF will be needed before any firm conclusions can be drawn, our study shows that particularly ReHo could be an interesting method for future clinical neuroimaging studies on acupuncture.

• Korean Journal of Psychosomatic Medicine
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• v.8 no.1
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• pp.122-140
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• 2000

Somatization disorder is a chronic condition characterized by multiple somatic complaints that are not due to any apparent organic illness. Somatization disorder is related historically to hysteria and hysteria has been defined by the existence of somatic complaints for which no organic reason can be found. Therefore most theories of somatization have focused on the psychodynamic and sociological perspectives. However, the concept that the somatic presentation of emotional distress or psychiatric illness might have a neurobiological basis has also aroused considerable interest. Relative to this perspective, the case of Anna O. which has been considered the prototype of hysteria, was reformulated from a neuropsychological perspective. Several neurophysiological and neuropsychological studies, studies concerning hemispheric differences in symptom presentation of the patients with hysteria have been shown the evidences for the biological basis of somatization. Moreover, recent neuroimaging studies in somatization disorder also show that brain dysfunction in somatization. The author reviewed several candidate theories which could help to explain the process of somatization in the perspective of biological basis and proposed the new neuropsychological model of somatization. The author also examined the possible application of this model to the treatment of somatization disorder and discussed it's limitation and the future directions in this field.

• Journal of Gifted/Talented Education
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• v.20 no.2
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• pp.503-526
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• 2010

We investigated the brain activity in perceiving the emotional stimuli between a science invention group(n=13) and a general group(n=13). The science invention group, which mostly consisted of recipients of creativity prizes, scored 96% on creative personality tests(WKOPAY, SAM), whereas the general group performed at an average level on these tests. Analyzing the brain activity in perceiving the emotional stimuli(IAPS pictures), the science invention group than the general group showed higher activity in certain areas, such as MTG, STG, and so on. When correlation analysis was performed on the creative personality score and brain activity, MTG, STG, and so on areas showed significant correlations. There were more correlation areas in valence than in arousal. These results show that scientific creativity is related to emotional susceptibility. Thus, we insist that emotion be considered in the assessment and education programs for the gifted in science.

• Proceedings of the KSMRM Conference
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• 2002.11a
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• pp.50-56
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• 2002

최근 3-4년간 MR의 hardware와 software의 급격한 발전으로 마침내 작년 말에 3.0 Tesla whole body MR 장비가 미국 FDA의 공인을 받았다. 한국에서도 일찍부터 3T MR장비의 개발이 이루어 졌고 이미 설치되어 연구와 임상이 이용되고 있다. 여러 회사에서 개발 및 연구된 전신 3.0T MR 장비가 여러가지 가능성을 보이고 임상 도입 단계에 있지만 아직까지 실지 임상에서는 뇌신경계 분야가 주류를 이루고 있다. 지금 뇌신경계 분야에서 보편적으로 늘리 사용되고 있는 1.5T MR 장비는 모든 면에서 상당히 안정적으로 임상 및 연구에 이용되고 있다. 1-2년 전만 해도 3.0 T MR기기는 뇌신경계 영역에서도 임상적으로 늘리 사용되기에는 안정적인 면에서는 1.5T 기기에 비해서 떨어지는 것이 사실이었다. 그래서 주로 연구실 영역에서 많이 이용되고 있었다. 그러나 지금 본원에 설치 완료되어 임상에 적용한지 6개월 정도 이용한 예에서 보면 (about 2300 cases/6months) hardware, software적인 면에서 아직 조금의 불편함이 있지만 많은 부분이 충분히 인지되고 개선이 가능한 부분으로 거의 불편함이 사라질 것으로 기대되고 있고, 불편함을 넘을 수 있는 여러 가지 장점이 있다고 본다. 고자장 (>3.0 T) MRI의 매력은 자장에 비례적으로 SNR, spectral resolution이 높아지고, T1, BOLD등에 의한 대조도가 향상한다는 것이다. SNR의 증가는 temporal, spatial 분해능을 증가시키고, spectral resolution이 높아짐에 따라 MR spectroscopy상에서 주요 대사물질 이외 작은 대사물질에 관한 스펙트럼의 분석을 향상시킨다. 이처럼 고자장 MR은 근본적인 장점을 가지고 있고 이러한 장점이 고자장 MR 시대로 가야 할 이유을 모두 설명하고 있다고 생각된다.세포질등이 있으며, 이들중에서 lysosomes, peroxisomes, 그리고 미토콘드리아가 특정한 유전성 백질질환에 중요한 역할을 하는 것이 밝혀졌다. 이러한 질환들은 최소한 각 소기관에 의한 질환군으로 분류될 수 있다.SXR이 ER의 transactivation 효과를 약간 촉진한 반면 MDA-MB-231세포는 SXR을 제외한 CAR와 PPAR${\gamma}$에 의해 ER의 transactivation 효과가 약간 증가되는 경향을 보였다. 이러한 결과는 유방암세포에서는 CAR, SXR, PPAR${\gamma}$과 같은 xenobiotic nuclear receptor에 의한 ER transactivation 효과가 간암세포와는 다르게 나타나며, 유방암의 종류에 따라서 endogenous CAR, SXR, PPAR${\gamma}$수용체가 다르게 발현됨으로써 이들에 대한 반응이 서로 상이한 특징을 나타낼 수 있을 것으로 사료된다. 따라서 estrogen receptor에 의해 매개되는 estrogn의 전사활성조절기전이 표적세포에 따라 다른 경로를 포함 할 수 있음을 시사한다.서 흡착 능력이 우수하게 나타났으며, 황화수소는 펄라이트, 왕겨, 소나무수피에서 상대적으로 우수한 것으로 나타났으며, 혼합충전재는 암모니아의 경우 코코넛과 펄라이트의 비율이 7：3인 혼합 재료 3번과 소나무수피와 펄라이트의 비율이 7：3인 혼합 재료 6번에서 다른 혼합 재료에 비하여 우수한 것으로 나타났다. 4. 코코넛과 소나무수피의 경우 암모니아 가스에 대한 흡착 능력은 거의 비슷한 것으로 사료되며, 코코넛의 경우 전량을 수입에 의존하고 있다는 점에서 국내 조달이 용이하며, 구입 비용도 적게 소요되는 소나무수피를 사용하는 것이 경제적이라고 사료된다. 5. 마지막으로 악취제거 미생물균주를 접종한 소나무수피 50%와 펄라이트

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.228-234
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• 2001

Objective : The goal of this study was to identify variables that were predictive of recurrence in primary intracranial ependymomas. Methods : We analyzed variables affecting recurrence in 30 patients with primary intracranial ependymomas. Age, location, CSF cytology, seeding on neuroimaging study, tumor grade, extent of surgery, use of chemotherapy, chemotherapy regimen, use of radiotherapy, and radiotherapy field were entered to test their impacts on recurrence. Results : Follow-up ranged from 2 to 110 months. Tumors were recurred at the primary tumor site only in 13 patients (43.3%). The overall average recurrence free period was 55 months, with overall recurrence free rates at 3 and 6 years of 61.0% and 20.9%, respectively. Extent of surgery was the strongest variable affecting recurrence. The median recurrence free period and 3-year recurrence free rate were 72 months and 78.4% for patients having complete excision and 33 months and 0% for those having incomplete excision(p=0.05). Other prognostic variables like age, location, tumor grade, use of chemotherapy, and use of radiotherapy did not affect recurrence(p=0.2848, 0.7899, 0.1714, 0.2157, 0.7076, respectively). Conclusions : Intracranial ependymomas have a propensity to recur after treatment, and recurrence at the primary site is still the main obstacle to cure. Among various variables, only extent of resection had the strongest impact on recurrence. Additional studies may still be needed to precisely define the prognostic variables on recurrence in intracranial ependymomas.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.336-344
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• 2000

Objective : The treatment for prolactin secreting pituitary adenoma(prolactinoma) include pharmacology, surgery, radiation therapy or radiosurgery. The recent development of radiological imaging and microsurgery has made transsphenoidal microsurgery the treatment of choice for most prolactin secreting pituitary adenoma. Despite its low morbidity and mortality, relatively high recurrence and failure rate have been reported. Recent advances in neuroimaging provide a precise targeting in radiosurgery for treatment of prolactin secreting pituitary adenoma. In this regard, Gamma knife radiosurgery has been proposed as an alternative primary treatment modality or adjuvant therapy. Patients and Methods : Twenty three patients with prolactin secreting pituitary adenoma have been treated with Gamma knife radiosurgery in our institute from March 1992 to September 1998. We analyzed clinical, radiological and endocrinological changes in 21 patients who were followed up for an average of 35.7 months. Results : The mean age was 34.9 years and 16 patients were treated with Gamma knife radiosurgery as primary treatment and 5 patients underwent Gamma knife radiosurgery for residual tumors after microsurgery. The margin of the tumor was incorporated within the 40 to 80% and the mean marginal dose was 24.5 Gy. Clinical improvement in the last follow-up were present in 17 cases(81.0%) and 3 of 5 infertility patients became pregnant after Gamma knife radiosurgery. Tumor control rate after Gamma knife radiosurgery was 100%. Endocrinological normalization in the last follow-up were obtained in 12 cases(57.1%). In three cases, hormonal normalizations were present in early period(3-32 months) but serum hormone levels were elevated subsequently. Conclusion : We conclude that the Gamma knife radiosurgery for prolactin secreting pituitary adenoma seems to be safe and effective as adjuvant therapy after microsurgery and primary treatment modality in selective patients.