• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.185-189
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• 2008

Objective : The authors present their experiences with stereotactic multiplanar reformatted (MPR) computed tomography (CT)-guided catheter placement for thrombolysis of spontaneous intracerebral hematoma (sICH) and their clinical results. Methods : In 23 patients with sICH, MPR CT-guided catheter placement was used to select the trajectory and target point of hematoma drainage. This group was comprised of 11 men and 12 women, and the mean age was 57.5 years (range, 31-79 years). The patients' initial Glasgow Coma Scale scores ranged from 7 to 15 with a median of 11. The volume of the hematoma ranged from 24 mL to 86 mL (mean 44.5 mL). A trajectory along the main axis of the hematoma was considered to be optimal for thrombolytic therapy. The trajectory was calculated from the point of entry through the target point of the hematoma using reformatted images. Results : The hematoma catheter was left in place for a median duration of 48.9 hours (range 34 to 62 hours). In an average of two days, the average residual hematoma volume was 6.2 mL (range 1.4 mL to 10.2 mL) and was reduced by an average of 84.7% (range 71.6% to 96.3%). The residual hematoma at postoperative seven days was less than 5 mL in all patients. There was no treatment-related death during hospitalization. Conclusion : The present study indicates that stereotactic MPR CT-guided catheter placement for thrombolysis is an accurate and safe procedure. We suggest that this procedure for stereotactic removal of sICH should be considered for the optimization of the trajectory selection in the future.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.26-30
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• 2008

Objective : The authors developed a stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C. Development and verification procedures were described in this article. Methods : The device was designed to satisfy three requirements. The mechanical accuracy in positioning was to be managed within 0.5 mm. The strength of the device and structure were to be compromised to provide enough strength to hold a small animal during irradiation and to interfere the gamma ray beam as little as possible. The device was to be used in combination with the Leksell G-$frame^{(R)}$ and $KOPF^{(R)}$ rat adaptor. The irradiation point was determined by separate imaging sequences such as plain X-ray images. Results : The absolute dose rate with the device in a Leksell Gamma Knife was 3.7% less than the value calculated from Leksell Gamma $Plan^{(R)}$. The dose distributions measured with $GAFCHROMIC^{(R)}$ MD-55 film corresponded to those of Leksell Gamma $Plan^{(R)}$ within acceptable range. The device was used in a series of rat experiments with a 4 mm helmet of Leksell Gamma Knife. Conclusion : A stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C has been developed so that it fulfilled above requirements. Absorbed dose and dose distribution at the center of a Gamma Knife helmet are in acceptable ranges. The device provides enough accuracy for stereotactic irradiation with acceptable practicality.

• 한국의학물리학회지:의학물리
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• 제3권1호
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• pp.53-62
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• 1992

최근 두개부 종양의 방사성물질의 자입과 방사선입체조사에 의한 뇌수술이 개발되어 의료계 에 많은 관심을 끌고 있다. 또한 방사선수술등은 비관혈적인 체외조사이므로 뇌정위수술용 좌표계의 전산화단층촬영을 이용한 표적중심결정이 매우 중요하다. 현재 알려진 방법은 뇌정위수술용좌표계의 전산화단층찰영에 대한 직교성하에서 비교적 정확하게 표적의 위치를 결정하게 되나, 임상현장에서 직교성유지는 실제 어려운 실정이다. 이에 필자들은 임의의 비직교성 스켄하에서 정확한 표적좌표를 얻기위한 알고리즘을 사용하였으며, 표적오차는 평균 0.02$\pm$0.3mm를 보였다.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.109-115
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• 2009

Objective: The decision to adopt a conservative or surgical modality for a relatively small volume of spontaneous intracerebral hemorrhage (SICH) is difficult and often controversial, especially when consciousness is tolerable. The authors examined the results of stereotactic-guided evacuation of SICH for relatively small volumes with respect to functional outcome. Methods: This prospective study was performed on 387 patients with SICH who underwent stereotactic-guided evacuation (n = 204, group A) or conservative treatment (n = 183, group B) during the past 8 years. The primary end-point was recovery of functional status, which was estimated using the Modified Barthel Index (MBI) and the modified Rankin Scale (mRS). Results: All patients had a Glasgow coma scale (GCS) score of $\geq$ 13 and unilateral hemiparesis of less than motor power grade 3. Group demographic characteristics and initial neurological statuses were similar. In all cases, the volume of SICH involved was < 30 cm$^3$ and location was limited to basal ganglia and thalamus. At 6-month follow-ups, MBI was 90.9 in group A and 62.4 in group B (p < 005), and MRS was 1.2 in group A and 3.0 in group B (p < 0.05). Better motor function and stereotactic-guided evacuation had a significant effect on a functional recovery in regression analyses. Conclusion: Even in patients with a small volume of SICH, stereotactic-guided evacuation improved functional recovery in activities in daily life than conservative treatment did.

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.514-520
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• 2000

Objective : Stereotactic psychosurgery is known as one of effective means of treating in some medically intractable psychiatric illness. However, it is unfamiliar and it's long-term clinical result has not reported in our country. The authors evaluated its long-term results of pscychosurgery and discussed its neuroanatomical basis. Methods : Since 1993, eight patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses. All were referred from psychiatrist of these disorders, one was aggressive behavior, five were obsessive-compulsive disorders(OCD), and two were depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were done for aggressive behavior, and limbic leukotomy was done for OCD and depression with anxiety. The results of OCD were evaluated with with YBOCS(Yale-Brown obsessive compulsive scale) and VAS (visual analogue scale), CGI(clinical global impairment) in OCD, and OAS(overt aggression scale), MMS, WAIS were checked for the evaluation of aggressive behavior. Hamilton depression scale(HAMD) was used for evaluation of depression. Ventriculography was used in the first five patients and MR-guided stereotaxy was used in recent three cases for localization of target. The lesions were made with radiofrequency lesion generator. Results : With long-term follow up(mean 45 months) in five OCDs, mean YBOCS declined from 34 to 3(n=5). All returned to previous social life. In OAS scores of aggressive behavior during six-year follow up, scores declined from 8 to 2 with clinical improvement. In two patients with depression with anxiety, HAMD declined from 28.5 to 16.5(n=2). There was no operative mortality and no significant morbidity except one case of mild transient urinary incontinence. Conclusion : With these long-term results, authors assumed that stereotactic psychosurgery could be one of safe and effective mtherapeutic methods in several medically intractable psychiatric illness.

• 보건의료기술평가
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• 제6권2호
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• pp.142-147
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• 2018

Objectives: The purpose of this study is to evaluate the safety and effectiveness of Robot-Assisted Brain Stereotactic Surgery with a systematic review. Methods: Electronic literature was searched using KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library on 6th April 2017. Two authors screened 1218 citations. Duplicated articles of 456 excluded, the remaining 762 articles were reviewed with title and abstract. Results: A total of 8 studies were selected in this review. The device used in all studies was $ROSA^{TM}$. In one cohort study comparing the intervention ($ROSA^{TM}$) with the control (conventional stereotactic surgery), hematoma was reported no significant difference between groups. In six descriptive studies, one study reported hematoma 10% (10/100) and temporary nerve impairment 6% (6/100) using the ROSA; while five descriptive study did not report any complications. In one cohort, the localization precision were 1.2 mm in the intervention group and 1.1 mm in the control group; the localization success rate as 78.2% in the intervention group and 76.2% in the control group in one cohort; and the average time for surgery as 130 min for the intervention group and 352 min for the control group in one cohort. Four studies reported the localization success rate as 100%; two out of three articles reported the overall time for surgery as 56 min and 90 min, while one article reported the time as less than one hour in 50% of patients (50/100); two articles reported in epilepsy patients, the condition after the surgery was Engel level I in 66.2%, 75% patients, Engel level II-III in 25%, 26.5% patients, and Engel level 4 in 7.3% patients. Conclusion: Robot-Assisted Brain Stereotactic Surgery is a safe and accurate technique that can significantly reduce the time for the brain stereotactic surgery. However, further studies are needed to generalize the results.

• 한국의학물리학회지:의학물리
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• 제2권2호
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• pp.121-128
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• 1991

뇌정위적 방사선 수술 시 정확한 3차원적 선량분포에 대한 정보가 필요한다. 3차원적 치료계획은 최적선량분포를 얻기위한 것이며 환자 데이타, 선량분포, 방사선 조사 요소들에 대한 3차원적인 관계를 다루어야만 한다. 원형 조사면에 대한 single 조사면 선량 데이타와 3차원 선량 알고리듬을 이용하여 non-coplanar moving arcs 에 대한 3차원적 선량모델이 개발되었다. 뇌정위적 방사선 수술시 3차원 선량 알고리듬의 적용과 여러경우에 대한 응용에 대하여 논의되어진다.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.826-831
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• 2000

The major indication of endoscope in neurosurgical field is intraventricular procedures. Recently, it can be used selectively in the intraaxial mass lesion associated cavity. For example, cystic mass, with liquefied necrosis, and blood clot can be approached with this technique. The authors present its usage in brain abscess ruptured into lateral ventricle. The neuroendoscope was introduced into abscess cavity through stereotactic guidance, the pus was then removed through continuous irrigation and suction under direct video visualization. The intraventricular pus was also cleaned through gentle, direct endoscopic irrigation and suction. The postoperative clinical course was uneventful. Brief overview is given for this intraaxial neuroendoscopic procedure.

• 한국의학물리학회지:의학물리
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• 제12권2호
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• pp.171-175
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• 2001

본 연구에서는 고정틀 정위방사선치료장비에 사용되는 치료계획시스템과 무고정틀 정위방사선치료시스템에 사용되는 치료계획시스템을 이용하여 intracranial 표적을 대상으로 치료계획을 수립하였다. 치료계획을 평가하기 위하여 RTOG-9005 규정서에서 정위방사선치료계획의 정도관리를 위하여 사용한 Planning Target Volume Coverage를 확인하고 Conformity Index(CI)와 Homogeneity Index(HI)를 구하였다. 이들 값으로부터 두 치료계획시스템에서 계산한 치료계획이 동일함을 알 수 있었다.

• Journal of Yeungnam Medical Science
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• 제36권3호
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• pp.192-200
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• 2019

Stereotactic body radiotherapy (SBRT) is an advanced form of radiotherapy (RT) with a growing interest on its application in the treatment of hepatocellular carcinoma (HCC). It can deliver ablative radiation doses to tumors in a few fractions without excessive doses to normal tissues, with the help of advanced modern RT and imaging technologies. Currently, SBRT is recommended as an alternative to curative treatments, such as surgery and radiofrequency ablation. This review discusses the current status of SBRT to aid in the decision making on how it is incorporated into the HCC management.