• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.245-248
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• 2006

Objective : To evaluate the effectiveness of Novalis shaped beam radiation treatment as an adjuvant treatment in patients with craniopharyngiomas. Methods : We reviewed 8 patients with craniopharyngiomas who had recurring tumors during follow-up or had residual lesions after primary surgery. Three of 8 patients were found to have recurrence after gross total excision of the tumor and 5 patents had residual lesions after subtotal resection. All patients were treated with fractionated stereotactic radiation treatment[FSRT] using Novalis system. The mean age of patients was 28 years [range $16{\sim}52$]. The median irradiation dose per fraction was 17Gy [range $1.7{\sim}2.0$]. The median fraction number was 23 [range $15{\sim}25$], and the median total dose was 39.1 Gy [range $25.5{\sim}42.5$]. Follow-up included MR imaging, and ophthalmologic and endocrine examinations. Results : The median follow-up period was 23 months [range $12{\sim}43$]. The local tumor control rate was 87.5%. One patient had a recurring tumor, in which cystic change developed 2 months after FSRT. Four patients showed a decrease in size of their tumor, while 3 patients remained stable. Seven out of 8 patients had hormonal dysfunction that remained unchanged after initial surgery. No further progression of visual impairment was observed. Conclusion : FSRT using Novais system is effective and safe for the treatment of recurring or residual craniopharyngiomas without toxicity like optic neuropathy.

• Journal of Korean Neurosurgical Society
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• 제51권5호
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• pp.272-275
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• 2012

Objective : Choroid plexus papillomas (CPPs) are generally regarded as benign tumors with typical radiologic and pathologic findings. However, they sometimes have unusual findings. We have analyzed radiologic findings and pathologic growth patterns on CPPs. Methods : The study group included 5 male and 5 female patients (age range, 3 months to 58 years : median, 29 years). The study group included 3 pediatric and 7 adult patients. All patients underwent surgery; 9 patients had a gross total resection and 1 patient had a subtotal resection. We analyzed the radiologic findings (location, size, mottle-like appearance, enhancement, calcifications, and hydrocephalus) and pathologic growth patterns (typical papillary, papillary and solid, and papillary and tubular). Results : The median follow-up duration was 21.3 months (range, 4-47.8 months). There were no recurrences after initial treatment. All patients had benign CPPs. Pediatric CPPs were 3.2 cm masses (range, 2.7-4 cm) with homogeneous enhancement and a mottle-like appearance, which pathologically showed the papillary growth pattern. Hydrocephalus was present in all pediatric patients. Postoperatively, subdural hygroma had occurred in two patients. In adults, CPPs were located in the fourth ventricle in 6 patients and suprasellar area in 1 patient. The size varied from 0.5-4.2 cm. Hydrocephalus and calcifications occurred in 3 and 4 patients, respectively. Three patients showed the heterogeneous enhancement without a mottle-like appearance and pathologically showed combined papillary and solid growth in 2 patients and papillary and tubular growth in one. Postoperatively, two patients with large masses had injuries of the brainstem and underwent shunt procedures for aggravation of hydrocephalus. Conclusion : CPPs may show unusual radiologic findings, which preoperatively give the difficulty to be differentiated from other tumors. CPPs with unusual radiologic findings showed the combined pathologic growth patterns.

• 대한후두음성언어의학회지
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• 제22권2호
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• pp.119-125
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• 2011

Background and Objectives : Temporary or permanent vocal paralysis can be occurred after head and neck surgery such as thyroid cancer, esophageal resection, and chest operation including lung parenchymal resection, due to a vagus or recurrent laryngeal nerve injury. The authors aimed to determine the clinical efficacy of using Calcium-Hydroxyapatite (CaHA) for permanent unilateral vocal cord palsy patients. Materials and Method : Between July 2008 to July 2010, among patients with chief complain of hoarseness and aspiration, only who were diagnosed as unilateral vocal cord palsy under laryngoscopy, were selected. The patients included 3 females and 13 males age range between 29 to 79 and average age was 60 years old. Results : The hoarseness range were $8.94{\pm}0.77$, $4.63{\pm}1.02$, $4.31{\pm}1.30$ statistically showing significant postoperative improve at preoperative, 1 week and 3 months. Also aspiration were $7.44{\pm}2.48$, $3.63{\pm}1.82$, $3.19{\pm}1.91$ statistically improved during the same period. The result of voice analysis showed that the frequency range shows decrease at 1 week and 3 months after the injection compared to that of the preoperative result in both male and female group (Male: $161.63{\pm}32.78$ Hz, $139.13{\pm}30.63$ Hz, $146.67{\pm}34.20$ Hz ; Female: $244.62{\pm}26.62$ Hz, $244.91{\pm}42.03$ Hz, $237.50{\pm}38.95$ Hz). The Maximal phonation time were $2.75{\pm}1.06$ (sec), $8.88{\pm}3.46$ (sec), $8.44{\pm}3.71$ (sec) statistically showing significant postoperative improve at preoperative, 1 week and 3 months. Conclusion : Injection laryngoplasty with CaHA in unilateral vocal cord paralysis is very safe and efficient procedure to improve a voice disorder, a swallowing difficulty, and a quality of life for those patients with a sacrificed RLN, a cancer invasion of the nerve, and a prolonged vocal cord paralysis which is more than six to twelve months.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.84-95
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• 2022

Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results : The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

• Radiation Oncology Journal
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• 제26권4호
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• pp.229-236
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• 2008

목 적: 본 연구는 미분화 갑상선암 환자에서 방사선치료에 대한 치료순응도와 치료 성적을 분석하고자 하였다. 대상 및 방법: 1993년부터 2002년까지 미분화 갑상선암으로 외부방사선치료를 시행받았던 17명을 대상으로 후향적으로 분석하였다. 외부방사선치료는 14명에서 수술 후에 시행하였고, 3명에서 조직검사 후에 시행하였다. 수술이 시행되었던 14명의 수술 방법은 9명은 근치적절제술 5명은 고식적절제술이었다. 고분화 갑상선암이 6명에서 동반되어 있었고, 진단 당시 암의 크기가 5 cm보다 컸던 경우는 14명이었다. 총방사선량은 $6{\sim}70\;Gy$ (중앙선량, 37.5 Gy)이었고, 11명은 예정된 방사선치료를 끝낼 수 있었고, 6명에서는 방사선치료가 중단되었다. 추적기간은 $1{\sim}104$개월로 중앙값이 5개월, 평균값이 20개월이었다. 결 과: 5명에서는 방사선치료를 시작할 당시에 육안적 종양이 없었으며, 5명 모두 종양의 재성장 없이 방사선치료를 잘 끝낼 수 있었다 나머지 12명에서는 방사선치료를 시작할 당시 육안적 종양이 있었는데, 이 중 4명은 근치적절제술 후에 바로 암이 자란 경우였고, 5명은 고식적절제술, 3명은 조직검사만을 받은 상태였다. 육안적 종양이 있었던 12명 중 6명 만이 예정된 방사선치료를 끝낼 수 있었는데, 2명에서는 방사선치료로 종양의 크기가 현저히 감소하였고, 2명은 약간 감소, 2명은 무반응이었다. 전체 환자의 생존기간은 $1{\sim}104$개월의 범위로 중앙 생존기간은 5개월이었고, 평균 생존기간은 21개월이었다. 1년 2년, 5년 생존율은 41%, 24%, 12%이었다. 원발암수, 종양크기, 수술, 방사선치료 완료가 의미있는 예후인자였다. 장기 생존자는 단기 생존자에 비해 진단 당시와 방사선치료 시작 당시에 암의 크기가 작은 경향이 있었다. 결 론: 진단 당시 암의 크기가 5 cm 이하, 방사선치료 전에 수술 시행(근치적 또는 고식적), 수술 부위에 종양의 빠른 재성장이 없는 환자들이 수술후 방사선치료의 좋은 지원자가 될 수 있음을 시사하며, 그와 반대인 경우는 방사선치료가 중단되기 쉽고 생존기간이 짧았기 때문에 방사선치료의 역할이 매우 부족하여 방사선치료를 시행하지 않을 수도 있겠다.

• 대한족부족관절학회지
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• 제10권2호
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• pp.179-183
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• 2006

Purpose: To review the results of surgical treatment for superficial peroneal and sural nerve lesion unrelated to laceration. Materials and Methods: Eleven superficial peroneal and sural nerve lesions in eleven patients were surgically treated at our hospital with follow up of average 20.7 months (range, 9-64 months). The anatomical locations of the lesion were on superficial peroneal nerve in seven patients including two patients having ganglion and sural nerve in four patients. Two patients were male and the average age at surgery was 41.5 years (range, 23-57 years). Six cases developed after repetitive sprain and five cases had no trauma history. Clinical results were assessed according to the criteria of Pfeiffer and Cracchiolo. Results: The methods of operation were proximal resection of the nerve lesion in nine cases and removal of ganglion only in two cases. The results were excellent in four cases, good in five cases, fair in one case and poor in one case. Ten cases (10 patients) were satisfied with the result of treatment. Conclusion: We can expect satisfactory results of surgical treatment for superficial peroneal and sural nerve lesion unrelated to laceration.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.13-19
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• 1993

Although the etiology of $Kienb\"{o}ck's$ disease is clearly related to avascular changes in the lunate, but the actual cause leading to this vascular impairment has remained elusive. Therefore, a great many different surgical procedures have been proposed for the correction of the multiple factors leading to lunate collapse or for the treatment of the lunatomalacia. The treatment modalities includes lunate excision, intercarpal arthrodesis, lunate implant resection arthroplasty, joint levelling operation(e.g ulnar lengthening & radial shortening), pronater quadratus pedicle graft and vascular loop graft. In the period from Jan. 1981 to Dec. 1992, we performed operative treatment in 19 cases of $Kienb\"{o}ck's$ disease. Among them, 6 cases were treated with vascular loop graft. We analysed all patients who were treated with vascular loop graft after followed up of 4 year 6 months, on an average(range from 1 year to 8 year 10 months). The results analysed are as follows, 1. All cases were stage III according to Lichtman's classification. 2. Ulnar variance was -1.5(range$-2{\sim}0$), on an average. 3. The average age of patients were 37.7years old(range 31-41). 4. Postoperatively, there were considerable restoration of range of motion and complete relief of pain in all cases, but continued decrease of grip power in one case. 5. Decreased sclerosis, loss of fragmentation and new bone formation were appeared in the last follow up film, in all cases. The vascular loop graft considered as a useful method for the treatment of the $Kienb\"{o}ck's$ disease.

• 한국멀티미디어학회논문지
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• 제22권12호
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• pp.1339-1346
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• 2019

In the characteristic of the brain malignant, the blood vessels and tumors have the same color and shape, and the boundary distinction is not clear, Therefore, it is difficult to observe the naked eye. Because of the high invasiveness, the risk of recurrence is high. Therefore, complete resection of the tumor is essential. The method for distinguishing the boundary between blood vessels and tumors is a fluorescence contrast method using indocyanine green (ICG), a fluorescence contrast agent. In ICG, the concentration range analysis is very important because the fluorescence expression state varies depending on the concentration. However, since the analysis result of the fluorescence expression condition is insufficient according to the current concentration, this paper proposes by analyzing the initial protocol of the concentration range. 780 nm infrared light was irradiated to the ICG sample to observe the fluorescence expression through a near infrared (NIR) camera. The wavelength is measured by using a spectrum instrument (ocean view) to observe the fluorescence expression wavelength of 811nm. As a result of analyzing the mol concentration according to each sample, the fluorescence expression range was found to be 16.15-0.16M and the optimum fluorescence concentration on the brightest part was found to be 3.23-0.81M.

• Radiation Oncology Journal
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• 제31권2호
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• pp.72-80
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• 2013

Purpose: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. Materials and Methods: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. Results: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). Conclusion: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.

• Journal of Gastric Cancer
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• 제18권3호
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• pp.218-229
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• 2018

Purpose: This study investigated whether the metabolic avidity of primary tumors and/or metastatic lymph nodes (LNs) measured by $^{18}F$-fluorodeoxyglucose ($^{18}F-FDG$) positron emission tomography/computed tomography (PET/CT) was related to survival after surgery in patients with advanced gastric cancer (AGC). Materials and Methods: One hundred sixty-eight patients with AGC who underwent preoperative $^{18}F-FDG$ PET/CT and curative resection were included. The $^{18}F-FDG$ avidity of the primary gastric tumor and LNs was determined quantitatively and qualitatively. The diagnostic performance of $^{18}F-FDG$ PET/CT was calculated, and the prognostic significance of $^{18}F-FDG$ avidity for recurrence-free survival (RFS) and overall survival (OS) was assessed. Results: In all, 51 (30.4%) patients experienced recurrence, and 32 (19.0%) died during follow-up (median follow-up duration, 35 months; range, 3-81 months); 119 (70.8%) and 33 (19.6%) patients showed $^{18}F-FDG$-avid primary tumors and LNs, respectively. $^{18}F-FDG$ PET/CT showed high sensitivity (73.8%) for the detection of advanced pathologic T ($pT{\geq}3$) stage and high specificity (92.2%) for the detection of advanced pN (${\geq}2$) stage. $^{18}F-FDG$ avidity of LNs was significantly associated with RFS (P=0.012), whereas that of primary tumors did not show significance (P=0.532). Univariate and multivariate analyses revealed that $^{18}F-FDG$ avidity of LNs was an independent prognostic factor for RFS (hazard ratio=2.068; P=0.029). Conclusions: $^{18}F-FDG$ avidity of LNs is an independent prognostic factor for predicting RFS. Preoperative $^{18}F-FDG$ PET/CT can be used to determine the risk and prognosis of patients with AGC after curative resection.