• Clinical and Experimental Pediatrics
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• v.58 no.1
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• pp.28-32
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• 2015

Purpose: Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome. Methods: We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain. Results: Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was $18{\pm}10.5$ months, and diagnosis after symptom onset was made at the mean age of $11{\pm}9.7$ months. The mean z score was $-3.15{\pm}1.14$ for weight, $-0.12{\pm}1.05$ for height, $1.01{\pm}1.58$ for head circumference, and $-1.76{\pm}1.97$ for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care. Conclusion: Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis.

• The Korean Journal of Cytopathology
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• v.5 no.2
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• pp.90-98
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• 1994

There has been a marked increase in the utility of aspiration cytology for pathologic diagnosis. It may be applied to any kinds of organs and substitutes surgical biopsy. Be cause of the high risk of complication and difficulties In localization, aspiration cytology in the central nervous system (CNS) has been used with less frequency compared to other sites. However, with the advent of sophisticated imaging instruments, aspiration cytology of lesions in the CNS is being used increasingly. We present cytologic features of brain tumors as well as corresponding histologic findings. Eight types of tumors were aspirated intraoperatively and stained with the Papanicolaou method; 1 anaplastic astrocytoma, 1 glioblastoma multiforme, 1 ependymoma, 1 malignant ependymoma, 1 central neurocytoma, 1 primitive neuroectodermal tumor, 1 benign neurogenic tumor and 1 germinoma. Cytologic features of the CNS neoplasms were quite similar to those of histology except one spindle cell tumor. Reviewing various CNS neoplasms, it appears that cytology may be a useful diagnostic method.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.956-962
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• 2007

In cancer patients showing nausea and vomiting, a number of factors can be considered as the cause including brain tumor, electrolyte imbalance, gastrointestinal diseases or types of chemotherapy agents and dose of the drugs. Though nausea and vomiting can be minimized through the use of various anti-emetic drugs, many people still suffer from severe nausea and vomiting with poor quality of life compared with patients who do not show significant nausea and vomiting. In this report, we introduce a case of a cancer patient who suffered from severe nausea and vomiting. The patient was female and 59 years old with NSCLC (non small cell lung cancer) with metastatic brain tumor. Though western conventional medical treatment was used to reduce the symptoms, persistent nausea and vomiting were noted during the admission period. Herbal decoction Gamibokryungbanha-tang was used for nausea and vomiting which were uncontrolled under conventional western medicine; the patient showed remarkable improvement in terms of frequency and severity of nausea and vomiting. Further study will be needed in order to determine the long-term effectiveness of oriental medical treatment on cancer patient with nausea and vomiting.

• Radiation Oncology Journal
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• v.35 no.2
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• pp.153-162
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• 2017

Purpose: To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. Materials and Methods: Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ${\pm}$ boost (WBRT ${\pm}$ boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). Results: The WBRT ${\pm}$ boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ${\pm}$ boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ${\geq}42.3Gy$ compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). Conclusions: Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.20 no.2
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• pp.147-156
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• 2013

Purpose: The study was done to define complementary and alternative medicine (CAM) use among primary brain tumor patients and factors influencing use. Methods: The study was conducted with convenience sampling in 5 neuro-oncology centers in Seoul and Gyeonggi Province. Data were collected using a 25-item questionnaire developed by the researchers. Results: Of 250 patients approached, 231 (92.4%) agreed to participate. Overall, 26.8% of the respondents used CAM and the average cost for CAM use was 300,000 KRW. More than 72% of CAM users did not disclose CAM use to their health care professionals. The most frequently used therapy was natural products including mushrooms. Logistic regression analysis revealed that an education level of university or higher (OR=2.92, 95% CI=1.56-5.44, p=.001), unemployment (OR=1.99, 95% CI=1.04-3.80, p=.037), and WHO grade III & IV tumors (OR=2.18, 95% CI=1.07-4.72, p=.048) were significant factors influencing CAM use. Conclusion: Three out of ten brain tumor patients spend substantial sum of money for CAM. In these situations, health care professionals should be aware of this phenomenon and provide adequate information and consultation to the patients.

• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.289-296
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• 2021

Objective : Though the operating microscope (OM) has been the standard optical system in neurosurgery, a new technology called three-dimensional (3D) exoscope has emerged as an alternative. Herein, two types of 3D exoscopes for brain tumor surgery are presented. In addition, the advantages and limitations compared with the OM are discussed. Methods : In the present study, 3D exoscope VOMS-100 or VITOM 3D was used in 11 patients with brain tumor who underwent surgical resection; the Kinevo 900 OM was used only in emergency. After completion of all surgeries, the participants were surveyed with a questionnaire regarding video image quality on the display monitor, handling of equipment, ergonomics, educational usefulness, 3D glasses, and expectation as a substitute for the OM. Results : Among 11 patients, nine patients underwent neurosurgical resection with only 3D exoscope; however, two patients required additional aid with the OM due to difficulty in hemostasis. Regarding video image quality, VITOM 3D was mostly equivalent to the OM, but VOMS-100 was not. However, both 3D exoscopes showed advantages in accessibility of instruments in the surgical field and occupied less space in the operating theater. Differences in ergonomics and educational usefulness between the exoscopes were not reported. Respondents did not experience discomfort in wearing 3D glasses and thought the exoscopes could be currently, and in the future, used as a substitute for the OM. Conclusion : Although many neurosurgeons are not familiar with 3D exoscopes, they have advantages compared with the OM and similar image quality. Exoscopes could be a substitute for OM in the future if some limitations are overcome.

• Investigative Magnetic Resonance Imaging
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• v.26 no.1
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• pp.32-42
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• 2022

Purpose: To evaluate the clinical benefit of 2D contrast-enhanced T2 fluid-attenuated inversion recovery (CE-T2 FLAIR) image for detecting leptomeningeal metastasis (LM) in the brain metastasis work-up for lung cancer. Materials and Methods: From June 2017 to July 2019, we collected all consecutive patients with lung cancer who underwent brain magnetic resonance image (MRI), including contrast-enhanced 3D fast spin echo T1 black-blood image (CE-T1WI) and CE-T2 FLAIR; we recruited clinico-radiologically suspected LM cases. Two independent readers analyzed the images for LM in three sessions: CE-T1WI, CE-T2 FLAIR, and their combination. Results: We recruited 526 patients with suspected lung cancer who underwent brain MRI; of these, we excluded 77 (insufficient image protocol, unclear pathology, different contrast media, poor image quality). Of the 449 patients, 34 were clinico-radiologically suspected to have LM; among them, 23 were diagnosed with true LM. The calculated detection performance of CE-T1WI, CE-T2 FLAIR, and combined analysis obtained from the 34 suspected LM were highest in the combined analysis (AUC: 0.80, 0.82, and 0.89, respectively). The inter-observer agreement was also the highest in the combined analysis (0.68, 0.72, and 0.86, respectively). In quantitative analyses, CNR of CE-T2 FLAIR was significantly higher than that of CE-T1WI (Wilcoxon signed rank test, P < 0.05). Conclusion: Adding CE-T2 FLAIR might provide better detection for LM in the brain-metastasis screening for lung cancer.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.751-757
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• 2022

Objective : Tumours of the brain are a rare occurrence accounting for approximately 2% of all neoplasms in adults. Few studies have been done in Nigeria on the profile of brain tumours. The aim of this study is to determine the profile of brain tumours in general and determine the change in Kanofsky Performance Score (KPS) after treatment. Methods : This is a prospective hospital-based study in Kaduna. All consecutive patients over 18 years of age with diagnosis of brain tumours from January 2016 to December 2019 were included in the study. Demographic and clinical data was collected using a proforma during the study. Patients who received treatment were followed up for 12 months. The primary outcome data was the difference in the quality of life as measured by KPS at the point of first contact and at 1-month after treatment and at 12-month follow up. Data obtained was analysed with SPSS version 25.0 for Windows. Descriptive statistics was done to determine the profile. Paired t-test at 95% confidence interval was done to check for significant correlation between the mean KPS. Results : A total of 39 consecutive patients were included in the study. There was a slight male preponderance with a M : F of 1.17 : 1. Meningioma and metastasis were more common in females while gliomas and pituitary tumours were more common in males. The mean age of patients was 49.8 years and standard deviation of 11.8 years. Pituitary tumours were the most common tumours. The most common location of the tumour was frontal lobe followed by the pituitary gland. The mean duration of symptoms before neurosurgical consultation was 38 weeks. The most common presenting symptoms of patient with brain tumour was headache. The quality of life improve compare to the baseline in 81% of patient at discharge and at 1 year follow up. The overall mortality rate was 25.6%. Conclusion : The most common brain tumour in our study is pituitary tumour. Most patients present late. The most common presenting symptoms is headache. There is significant improvement in the KPS of patients following treatment. The overall mortality rate at 1-year post treatment is 25.6%.

• Tuberculosis and Respiratory Diseases
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• v.69 no.5
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• pp.381-384
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• 2010

Progressive ptosis and headache developed in a 50-year-old woman with non-small cell lung cancer. Although brain magnetic resonance imaging showed improved cerebellar metastasis after prior radiotherapy without any other abnormality, the follow-up examination taken 6 months later revealed metastasis to the cavernous sinus. The diagnosis of metastasis to the cavernous sinus is often difficult because it is a very rare manifestation of lung cancer, and symptoms can occur prior to developing a radiologically detectable lesion. Therefore, when a strong clinical suspicion of cavernous sinus metastasis exists, thorough neurologic examination and serial brain imaging should be followed up to avoid overlooking the lesion.

• Journal of Oral Medicine and Pain
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• v.47 no.4
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• pp.217-221
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• 2022

Neurogenic muscular atrophy is muscle wasting and weakness caused by trauma or disease of the nerve that innervates the muscle. We describe a case of unilateral trigeminal neuropathy and neurogenic muscular atrophy of the masticatory muscle caused by a tumor in the foramen ovale. A 59-year-old man visited our clinic complaining of difficulty in right-sided mastication. There were no evident clinical signs and symptoms of temporomandibular disorder. However, severe atrophy of the right masseter and temporalis muscles and hypesthesia of the right side mandibular nerve area were confirmed. Through T1 and T2 signals on magnetic resonance imaging (MRI), a mass suspected of a neurogenic tumor was observed in the foramen ovale and cavernous sinus. Severe atrophy of all masticatory muscles on the right side was observed. This rare case shows trigeminal neuropathy caused by a tumor around the foramen ovale and atrophy of the ipsilateral masticatory muscles. For an accurate diagnosis, it is essential to identify the underlying cause of muscle atrophy with neurologic symptoms present. This can be done through a more detailed clinical examination, including sensory testing and brain MRI, and consider a referral to neurology or neurosurgery for the differential diagnosis of the intracranial disorder.