• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.235-243
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• 1992

Patterns of abnormality in regional cerebral perfusion and its relation to clinical severity was evaluated with 32 head injury patients using $^{99m}Tc-HMPAO$ single photon emission tomography (SPECT). The findings were compared with computed tomography (CT) done within 48 hours of each SPECT study. The initial SPECT study was done within 7 days of injury in 16 cases, between 1 week and 2 months in 12, and after over 2 months in 4. Nineteen of the patients underwent followup SPECT and CT after a mean interval of 1 to 2 months. The initial SPECT showed abnormalities in 96% (31/32) of the patients while CT showed abnormal findings in only 81% (26/32). There were a total of 54 supratentorial SPECT lesions in all. Ninity percent (49/54) of these were of regional hypoperfusion, while 5 lesions showed focal hyperperfusion. The lesions were most often localized in the frontal and temporal lobes. Fifty five percent (30/54) were areas not detected as a lesion on CT. Cerebellar diaschisis was observed in 50% (16/32) of the patients. The degree of perfusion abnormality was quantified by the product of differential activity and a size factor. Correlation between the degree of perfusion abnormality and the clinical severity (Glasgow coma scale) failed to show statistical significance (p=0.053). The amount of change in the degree of perfusion abnormality on follow up SPECT was compared to the amount of change in clinical severity. Perfusion abnormality showed a tendancy to improve in most patients, and the degree of improvement showed significant correlation with the amount of clinical improvement (p < 0.01).

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.266-272
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• 2001

Objectives : Chemotherapy remains part of the treatment triad that includes surgery and radiotherapy for the management of glioblastomas, but disappointing results of chemotherapy have raised the suggestion that chemotherapy should perhaps be abandoned. In order to determine the chemotherapy effect given in addition to radiotherapy, we performed a randomized clinical study of irradiation alone and combination of irradiation with chemotherapy in the treatment of glioblastomas. Methods : From 1991 to 1999, 204 consecutive patients suffering from supratentorial glioblastomas were treated in our hospital. We compared the survival rates/times of these patients according to the treatment modalities[group I-67 patients treated by surgery with radiotherapy and adjuvant chemotherapy(ACNU, paclitaxel, tamoxifen, and others) ; group II-106 by surgery with radiotherapy ; and group III-31 by surgery only]. Results : The overall median survival time was 12 months, with overall survival rates at 1 and 2 year of 46.7% and 16.6%, respectively. On univariate analysis, median survival and 1- and 2-year survival rates were statistically improved by the use of chemotherapy ; group I-15 months, 75.7%, and 25.9%, group II-11 months, 39.3%, and 15.4%, and group III-3 months, 9.7%, and 6.5%, respectively(p=0.0001). But, on multivariate analysis considering compounding variables, survival was independently associated only with radiotherapy(p=0.0112). Conclusion : These results suggest that the addition of chemotherapy to radiotherapy does not affect the overall survival in glioblastomas. Mainly long-survivor glioblastoma patients might benefit by adjuvant chemotherapy, which probably means patients with initial favorable prognostic factors(young age, minimal residual tumors, good performance status). It is necessary to continue to search for an effective chemotherapy regimen to prolong survival of patients with glioblastomas.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.211-215
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• 2001

Objective : The present study was performed to analyze treatment results for 22 cases of arachnoid cyst and to have appropriate surgical method in our department. Material and Methods : We performed a retrospective study in 22 cases in 11 years between 1989 to 2000 that could be followed up. The analysis was based on the results of patients age, sex distribution, developed area, clinical symptom, treatment method, and complication. Results : The age range of cyst development was between 7 months to 60 years with the average age of 21 years. As for sex distribution, 20 were male and 2 were female, with significantly more cyst development in males than females. Thirteen cases were developed in the sylvian fissure, 3 cases in the posterior fossa, 4 cases in the cerebral convexity of the supratentorial area, 1 case in the suprasella and 1 case in interhemiphere. Those cases with the sylvian fissure involvement included 6 cases of Type I, 4 cases of Type II, and 3 cases of Type III. As for the distribution according to hemisphere, more arachnoidal cysts were seen in the right hemisphere. The most common clinical symptom was headache, followed by seizure and speech disturbance. As for the treatment method in 22 cases, surgery was performed in 17 cases and conservative treatment in 5 cases. Fenestration was performed in 14 cases. 13 cases of them showed good outcome, and 1 case with delayed development showed no improvement. Cyst-peritoneal shunt was done in 2 cases. Both fenestration and cyst-peritoneal shunt were done in 1 case. Conclusion : Patients who perforemed fenestration were showed good outcome with few complication. We concluded that fenestration is the most appropriate surgical method for arachnoid cyst.

• Journal of Korean Neurosurgical Society
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• v.45 no.6
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• pp.341-349
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• 2009

Objective : The purpose of this study was to identify independent predictors of mortality and functional recovery in patients with primary intracerebral hemorrhage (PICH) and to improve functional outcome in these patients. Methods : Data were collected retrospectively on 585 patients with supratentorial PICH admitted to the Stroke Unit at our hospital between 1st January 2004 and the 31st July 2008. Using multivariate logistic regression analysis, the associations between all selected variables and 30-day mortality and 90-day functional recoveries after PICH was evaluated. Results : Ninety-day functional recovery was achieved in 29.1% of the 585 patients and 30-day mortality in 15.9%. Age (OR=7.384, p=0.000), limb weakness (OR=6.927, p=0.000), and hematoma volume (OR=5.293, p=0.000) were found to be powerful predictors of 90-day functional recovery. Furthermore, initial consciousness (OR=3.013, p=0.014) hematoma location (lobar, OR=2.653, p=0.003), ventricular extension of blood (OR=2.077, p=0.013), leukocytosis (OR=2.048, p=0.008), alcohol intake (drinker, OR=1.927, p=0.023), and increased serum aminotransferase (OR=1.892, p=0.035) were found to be independent predictors of 90-day functional recovery after PICH. On the other hand, a pupillary abnormality (OR=4.532, p=0.000) and initial unconsciousness (OR=3.362, p=0.000) were found to be independent predictors of 30-day mortality after PICH. Conclusion : The predictors of mortality and functional recovery after PICH identified during this analysis may assist during clinical decision-making, when advising patients or family members about the prognosis of PICH and when planning intervention trials.

• Journal of Korean Neurosurgical Society
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• v.66 no.4
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• pp.418-425
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• 2023

Objective : Deciphering the anatomy of posterior communicating artery (PCoA) aneurysms in relation to surrounding structures is essential to determine adjuvant surgical procedures. However, it is difficult to predict surgical structures through preoperative imaging studies. We aimed to present anatomical structures using preoperative high-resolution three-dimensional proton density-weighted turbo spin-echo magnetic resonance (PDMR) imaging with simple classification. Methods : From January 2020 to April 2022, 30 patients underwent PDMR before microsurgical clipping for unruptured PCoA aneurysms in a single tertiary institute. We retrospectively reviewed the radiographic images and operative data of these patients. The structural relationship described by PDMR and intraoperative findings were compared. Subsequently, we classified aneurysms into two groups and analyzed the rate of adjuvant surgical procedures and contact with the surrounding structures. Results : Correlations between preoperative PDMR predictions and actual intraoperative findings for PCoA aneurysm contact to the oculomotor nerve, temporal uncus, and anterior petroclinoid fold (APCF) reported a diagnostic accuracy of 0.90, 0.87, and 0.90, respectively. In 12 patients (40.0%), an aneurysm dome was located on the plane of the oculomotor triangle and was classified as the infratentorial type. Compared to the supratentorial type PCoA aneurysm, adjuvant procedures were required more frequently (66.7% vs. 22.2%, p=0.024) for infratentorial type PCoA aneurysm clipping. Conclusion : Preoperative PCoA aneurysm categorization using PDMR can be helpful for predicting surgical complexity and planning of microsurgical clipping.

• Journal of the Korean Society of Radiology
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• v.81 no.4
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• pp.979-984
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• 2020

Cri-du-chat syndrome is a rare genetic disorder in which the patient presents with a characteristic high-pitched monotonous cry and recurrent aspiration pneumonia, attributed to abnormalities in the larynx, epiglottis, and nervous system. The most prominent brain MRI findings are the presence of pontine and cerebellar hypoplasia, which primarily involve posterior cranial fossa structures. Although atrophy of supratentorial structures were also a common radiological finding, it was considered to be a secondary change due to pontine hypoplasia. Here, we present the case of a three-month-old patient presenting with cri-du-chat at our institution. The patient also showed the presence of prominent pontine hypoplasia similar to previously reported cases; however, contrary to other cases, there was a general delayed myelination of brain instead of decreased myelination of anterior limb of internal capsule. Since the larynx, pons, and cerebellum all originated from similar notochord level, which suggests anomaly in early stage of development, laryngeal, and brain anomaly characteristically observed in the cridu-chat syndrome.

• Radiation Oncology Journal
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• v.15 no.1
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• pp.11-18
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• 1997

Purpose : To evaluate the efficacy of combined treatment of surgery and chemoradiotherapy for supratentorial primitive neuroectodermal tumors (SPNET) and obtain the Prognostic factors and complications Materials and Methods .The a9e of 18 patients ranged from 1 to 27 years (median=5 years). There were 12 males and 6 females The extents of surgery were gross total (n:9), subtotal (n:8), biopsy only (n: 1). Craniospinal radiotherapy was delivered to all the patients except 2 patients who were treated only with the whole brain and primary lesion. Radiation dose were 3120-5800cGy (median=5460) to primary mass, 1500-4200cGy (median=3600cGy) to the whole brain and 1320-3600cGy (median= 2400 cGy) to the spinal axis. Chemotherapy was done in 13 patients. Median follow-up period was 45 months ranged from 1 to 89 months. Results : Patterns of failure were as follows; local recurrence (1), multiple intracranial recurrence (2), spinal seeding (3), craniospinal seeding (2) and multiple bone metastasis (1). Two of two patients who did not received craniospinal radiotherapy failed at spinal area. All the relapsed cases died at 1 to 13 months after diagnosis of progression. The 2- and 5-rear overall survival rates were $61\%\;and\;49\%$, respectively The a9e, sex, tumor location did not influence the survival but aggressive resection with combined chemotherapy showed better outcome. Among 9 survivors, complications were detected as radiation necrosis (n=1), hypopituitarism (n=2), cognitive defect(n=1), memory deficit (n=1), growth retardation (n=1). Conclusion : To improve the results of treatment of SPNET, maximal surgical resection followed by radiation therapy and chemotherapy is necessary. The extended radiation field including craniospinal axis may reduce the recurrence in spinal axis.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.985-994
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• 2000

Objective : There are some advantages of trigeminal evoked potential(TEP) recording compared to other somatosensory evoked potential(SSEP) recordings. The trigeminal sensory pathway has a pure sensory nerve branch, a broader receptive field in cerebral cortex, and a shorter pathway. Despite these advantages, there is little agreement as to what constitutes a normal response and what wave forms truly characterize the intraoperative TEP. This study presents the normative data of TEP recorded on the epidural surface of the rat with a platinum ball electrode. Materials & Methods : Under general anesthesia with urethane, the adult Sprague-Dawley male rats(300-350g) were given electrical stimulation with two stainless steel electrodes which were inserted into the subcutaneous layer of the area around whiskers. A reference electrode was positioned in the temporalis muscle ipsilateral to the recording site. Results : TEPs were recorded in the Par I area of somatosensory cortex and recorded most apparently on the point of 2mm posterior from the bregma and 6mm lateral from the midline. The typical wave form consisted of 5 peaks (N1-P1-N2-P2-N3 according to emerging order, upward negativity). Each latency to corresponding peaks was not influenced by the different intensities of stimulation, especially from 1 to 5mA. Average latencies of 5 peaks were in the following order ; 7.7, 11.1, 15, 22.3, 29.4ms. There was also no significant difference between latencies before and after administration of muscle relaxant(pancuronium). For the electrophysiological localization of recorded waves, the action potential of a single unit was recorded with glass microelectrode(filled with 2M NaCl, $3-5M{\Omega}$) in the thalamus of rat. A sharp wave was recorded in the VPM nucleus, in which the latency was shorter than that of N1. This suggests that all 5 peaks were generated by neural activities in the suprathalamic pathway. Conclusion : In terms of recording near-field potentials, our data also suggests that TEP in the rat may be superior to other SSEPs. In overall, these results may afford normative data for the studies of supratentorial lesions such as hydrocephalus or cerebral ischemia which can have an influence on near-field potentials.

• Radiation Oncology Journal
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• v.6 no.2
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• pp.177-182
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• 1988

A retrospective analysis was peformed on 23 patients with pineal region tumors treated with radiation from 1979 through 1985 at the Department of Therapeutic Radiology, Seoul National University Hospital. Histologic confirmation was done in only one case by surgical removal, and in the remaining 22 patients, the diagnosis was based on clinical and radiological findings. The radiation volume was the primary tumor site in 1 case, whole brain in 14 cases, and the whole craniospinal axis En 8 cases. The overall 5 year survival was $71.5\%$. The 5 year survival was $69.3\%$ for whole brain treated group and $73.3\%$ for craniospinal axis treated group. The survival for the two groups did not differ significantly. In two cases sites of recurrence were detected, one in supratentorial area, and the other in the lung. The results from this retrospective analysis and the review of other reports indicate that routine use of prophylactic spinal irradiation is not warranted in pineal region tumor, and the craniospinal irradiation is recommended in cases with high risk for subarachnoid seeding such as positive CSF cytology, surgical removal or biopsy.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.667-675
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• 2017

Objective : Total resection without consecutive postoperative whole brain radiation therapy is indicated for patients with a single or two sites of brain metastasis, with close follow-up by serial magnetic resonance imaging (MRI). In this study, we explored the effectiveness, usefulness, and safety of this follow-up regimen. Methods : From January 2006 to December 2015, a total of 109 patients (76 males, 33 females) underwent tumor resection as the first treatment for brain metastases (97 patients with single metastases, 12 with two metastases). The mean age was 59.8 years (range 27-80). The location of the 121 tumors in the 109 patients was supratentorial (n=98) and in the cerebellum (n=23). The origin of the primary cancers was lung (n=45), breast (n=17), gastrointestinal tract (n=18), hepatobiliary system (n=8), kidney (n=7), others (n=11), and unknown origin (n=3). The 121 tumors were totally resected. Follow-up involved regular clinical and MRI assessments. Recurrence-free survival (RFS) and overall survival (OS) after tumor resection were analyzed by Kaplan-Meier methods based on clinical prognostic factors. Results : During the follow-up, MRI scans were done for 85 patients (78%) with 97 tumors. Fifty-six of the 97 tumors showed no recurrence without adjuvant local treatment, representing a numerical tumor recurrence-free rate of 57.7%. Mean and median RFS was 13.6 and 5.3 months, respectively. Kaplan-Meier analysis revealed the cerebellar location of the tumor as the only statistically significant prognostic factor related to RFS (p=0.020). Mean and median OS was 15.2 and 8.1 months, respectively. There were no significant prognostic factors related to OS. The survival rate at one year was 8.2% (9 of 109). Conclusion : With close and regular clinical and image follow-up, initial postoperative observation without prompt postoperative radiation therapy can be applied in patients of brain metastasi(e)s when both the tumor(s) are completely resected.