• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.591-596
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• 2017

Objective : Frameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth. Methods : During a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study. Results : Nine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas. Conclusion : In conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.

• Radiation Oncology Journal
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• 제7권1호
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• pp.101-112
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• 1989

The treatment planning and dosimetry of small fields for stereotactic radiosurgery with 10 MV x-ray isocentrically mounted linear accelerator is presented. Special consideration in this study was given to the variation of absorbed dose with field size, the central axis percent depth doses and the combined moving beam dose distribution. The collimator scatter correction factors of small fields $(1\times1\~3\times3cm^2)$ were measured with ion chamber at a target chamber distance of 300cm where the projected fields were larger than the polystyrene buildup caps and it was calibrated with the tissue equivalent solid state detectors of small size (TLD, PLD, ESR and semiconductors). The central axis percent depth doses for $1\timesl\;and\;3\times3cm^2$ fields could be derived with the same acuracy by interpolating between measured values for larger fields and calculated zero area data, and it was also calibrated with semiconductor detectors. The agreement between experimental and calculated data was found to be under $2\%$ within the fields. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor regions was performed with dose planning computer system (Therac 2300) and was verified with film dosimetry. The more the number of strips and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. The circular cone, we designed, improves the alignment, minimizes the penumbra of the beam and formats ball shape of treatment area without stellate patterns. These dosimetric techniques can provide adequate physics background for stereotactic radiosurgery with small radiation fields and 10MV x-ray beam.

• 한국의학물리학회지:의학물리
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• 제24권3호
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• pp.145-153
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• 2013

정위적 체부 방사선치료(Stereotactic Body Radiation Therapy, SBRT)는 척추 전이암을 치료하는데 있어서 점점 증가하고 있다. 표적 종양의 급격한 선량 변화와 등선량 분포를 얻기 위해서, 세기조절방사선치료(Intensity-modulated radiation therapy, IMRT)와 체적변조회전치료(Volumetric-modulated arc therapy, VMAT)는 척추 방사선수술에 있어서 필수적인 치료기법이다. 이 연구의 목적은 표적 종양을 위한 International Spine Radiosurgery (ISRC) Consortium의 consensus guideline으로 그려진 표적에 있어서 IMRT와 VMAT의 치료기법을 질적으로 비교하고자 한다. 경부, 흉부, 요추 부위에 종양치료를 받은 3명의 환자를 선택 하였다. 표적 종양은 ISRC의 consensus guideline을 바탕으로 정의 하였다. $T_B$는 vertebral body만 포함하였고, $T_{BPT}$는 vertebral body, pedicle, transverse process를 포함하였다. 그리고 $T_{ST}$는 spinous process와 transverse process를 포함하여 그렸다. Maximum spinal cord선량은 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 12.46 Gy, 12.17 Gy, 11.36 Gy였고, IMRT, RA1, RA2에서 각각 11.81 Gy, 12.19 Gy, 11.99 Gy였다. 평균 감소(90%~50%) 선량 거리 (mm)는 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 3.5 mm, 3.3 mm, 3.9 mm였고, IMRT, RA1, RA2에서 각각 3.7 mm, 3.7 mm, 3.3 mm였다. 가장 복잡한 $T_{BPT}$의 경우에서 IMRT, RA1, RA2의 conformity index는 각각 0.621, 0.761, 0.817 이었고, rDHI는 0.755, 0.796, 0.824 였다. IMRT와 VMAT 모두 척추 정위적 방사선수술에서 표적 종양에 급격한 선량 변화와 등선량 분포를 전달하였다. 그러나 표적 종양이 vertebral body, pedicle, transverse process를 포함한다면, IMRT 치료기법은 VMAT 치료기법과 비교해서 conformity index 측면에서 불충분하였다. 그럼에도 불구하고, IMRT 치료기법은 RA1, RA2와 비교해서 대부분의 영역에서 maximum spinal cord 선량을 줄이는데 더 효과적이었다.

• 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.

• 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.

• Radiation Oncology Journal
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• 제10권1호
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• pp.95-100
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• 1992

LINAC 뇌정위적 방사선 수술은 multiple noncoplanar arc, 3 차원 선량 계산 및 많은 조사 변수들이 사용되기 때문에 간단한 경우에도 최적 선량분포를 얻기 위해서는 많은 시간이 요구된다. 본 논문에서는 실험적 방법과 분석적 방법을 통한 유용한 방법을 제시하기 위한 것으로서, 보다 자세한 방법 및 내용은 앞으로의 발표 논문에서 다루게 된다. 실험적 방법으로 2가지 방법에의하면, 첫번째 방법은 multiple isocenter를 이용하는 것이고, 두번째 방법은 beam's eye view와 field shaping을 이용한 conformal therapy이다. 분석적 방법은 최적 조사조건을 찾기 위하여 computer-aided design optimization 방법을 이용하는 것이다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2005년도 제30회 춘계학술대회
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• pp.47-50
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• 2005

The aim of radiosurgery cures a patient to deliver the lower dose at the normal organ and the higher dose at the tumor. Therefore accuracy of the dose is required to gain effect of radiosurgery in surgical planning. In this paper, we developed the methods of target approximation for a fast treatment planning. Nominally, the stereotactic radiosurgery(SRS) using Linac and Gamma knife produces spherical dose distribution through circular collimators using multiple arcs and 201 holes on semi-spherical helmet by $^{60}Co$. We developed an automatic radiosurgical plan about spherical packing arrangement. To automatically plan the SRS, new planning methods based on cylinder and cube structure for target shaping was developed. This approach using heuristic and stochastic algorithm is a useful radiosurgical plan without restrictions in the various tumor shapes and the different modalities.

• 한국의학물리학회지:의학물리
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• 제31권3호
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• pp.63-70
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• 2020

Stereotactic radiosurgery is one of the most sophisticated forms of modern advanced radiation therapy. Unlike conventional fractionated radiotherapy, stereotactic radiosurgery uses a high dose of radiation with steep gradient precisely delivered to target lesions. Lars Leksell presented the principle of radiosurgery in 1951. Gamma Knife^® (GK) is the first radiosurgery device used in clinics, and the first patient was treated in the winter of 1967. The first GK unit had 179 cobalt 60 sources distributed on a hemispherical surface. A patient could move only in a single direction. Treatment planning was performed manually and took more than a day. The latest model, Gamma Knife^® Icon^TM, shares the same principle but has many new dazzling characteristics. In this article, first, a brief history of radiosurgery was described. Then, the physical properties of modern radiosurgery machines and physicists' endeavors to assure the quality of radiosurgery were described. Intrinsic characteristics of modern radiosurgery devices such as small fields, steep dose distribution producing sharp penumbra, and multi-directionality of the beam were reviewed together with the techniques to assess the accuracy of these devices. The reference conditions and principles of GK dosimetry given in the most recent international standard protocol, International Atomic Energy Agency TRS 483, were shortly reviewed, and several points needing careful revisions were highlighted. Understanding the principles and physics of radiosurgery will be helpful for modern medical physicists.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.456-462
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• 2001

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.738-743
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• 2000

Objectives : The less invasive stereotactic surgery of hypertensive intracerebral hematoma has been preferred. Many techniques were developed to facilitate aspiration of a dense blood clot in acute stage. Authors describe a method for evacuation of putaminal hematoma via computerized tomography(CT)-aided free-hand stereotactic infusion of urokinase and frequent negative pressure aspiration. Patients and Methods : A total of ten patients with spontaneous putaminal hematoma underwent surgery with negative pressure aspiration in the three-year period. All procedures were performed within 12 hours of insult. A silicone ventricular catheter was inserted into the center of hematoma through a burr hole at the Kocher's point under local anesthesia. In a typical case of putaminal hematoma, the trajectory of catheter was pointed the center of hematoma parallel to sagittal plane vertically and the external auditory meatus posteriorly. Immediately after the first trial of hematoma aspiration low-dose urokinase solution(2,000IU/5ml saline) was administrated through the catheter and drain was clipped for 30 minutes. Subsequently, the partially liquified hematoma was manually aspirated using a 10ml syringe with a negative pressure of less than 2 to 3ml. The procedure was carefully repeated every 1 hour until the hematoma was near totally evacuated. Results : The patients population consisted composed of 4 men and 6 women with a mean age of 61.6 years. All had major neurological deficits preoperatively. The mean hematoma volume was 44.3 ml and hematoma was drained for 20 to 48 hours. No complications such as rebleeding, meningitis, or malplaced catheter were noted. Outcome was moderately disabled in four patients and good recovery in three patients. Conclusion : Although the frequent negative pressure aspiration and low-dose urokinase infusion has the disadvantage of possbility of rebleeding and infection, it is consisdered to be an effective method because it allows a simple, safe, and complete removal of hematoma.