• Investigative Magnetic Resonance Imaging
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• 제19권2호
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• pp.117-121
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• 2015

Chordoid glioma is a rare, low-grade brain neoplasm typically located in the third ventricle. Herein, we report an unusual case of histologically confirmed chordoid glioma located in the pituitary fossa and suprasellar region, not attached to the third ventricle. A 57-year-old woman presented with a 2-month history of headache and visual disturbance. Magnetic resonance imaging revealed an ovoid mass in the pituitary fossa and suprasellar region, compressing the optic chiasm without involvement of the third ventricle. The tumor showed low signal intensity on T1-weighted images and iso- to high signal intensity on T2-weighted images, with strong and homogenous contrast enhancement. Subtotal resection was performed via the transcranial approach, and the patient subsequently received adjuvant gamma knife radiosurgery. However, the residual mass showed disease progression 5 months after the initial surgery.

• Journal of Korean Neurosurgical Society
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• 제61권6호
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• pp.753-760
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• 2018

Objective : We investigated the effect of optimization in dose-limiting shell method on the dosimetric quality of CyberKnife (CK) plans in treating brain metastases (BMs). Methods : We selected 19 BMs previously treated using CK between 2014 and 2015. The original CK plans ($CK_{original}$) had been produced using 1 to 3 dose-limiting shells : one at the prescription isodose level (PIDL) for dose conformity and the others at low-isodose levels (10-30% of prescription dose) for dose spillage. In each case, a modified CK plan ($CK_{modified}$) was generated using 5 dose-limiting shells : one at the PIDL, another at intermediate isodose level (50% of prescription dose) for steeper dose fall-off, and the others at low-isodose levels, with an optimized shell-dilation size based on our experience. A Gamma Knife (GK) plan was also produced using the original contour set. Thus, three data sets of dosimetric parameters were generated and compared. Results : There were no differences in the conformity indices among the $CK_{original}$, $CK_{modified}$, and GK plans (mean 1.22, 1.18, and 1.24, respectively; p=0.079) and tumor coverage (mean 99.5%, 99.5%, and 99.4%, respectively; p=0.177), whereas the $CK_{modified}$ plans produced significantly smaller normal tissue volumes receiving 50% of prescription dose than those produced by the $CK_{original}$ plans (p<0.001), with no statistical differences in those volumes compared with GK plans (p=0.345). Conclusion : These results indicate that significantly steeper dose fall-off is able to be achieved in the CK system by optimizing the shell function while maintaining high conformity of dose to tumor.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.334-340
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• 2015

Objective : Pineal parenchymal tumors (PPTs) in adults are rare, and knowledge regarding their optimal management and treatment outcome is limited. Herein, we present the clinical results of our series of PPTs other than pineoblastomas managed by stereotactic radiosurgery (SRS) at upfront setting. Methods : Between 1997 and 2014, nine consecutive adult patients with the diagnosis of PPTs, either pineocytoma or pineal parenchymal tumor of intermediate differentiation, were treated with SRS. There were 6 men and 3 women. The median age was 39 years (range, 31-53 years). All of the patients presented with symptoms of hydrocephalus. Endoscopic third ventriculostomy and biopsy was done for initial management. After histologic diagnosis, patients were treated with Gamma Knife with the mean dose of 13.3 Gy (n=3) or fractionated Cyberknife with 32 Gy (n=6). Results : After a mean follow-up of 78.6 months (range, 14-223 months), all patients were alive and all of their tumors were locally controlled except for one instance of cerebrospinal fluid seeding metastasis. On magnetic resonance images, tumor size decreased in all patients, resulting in complete response in 3 patients and partial response in 6. One patient had experienced temporary memory impairment after SRS, which improved spontaneously. Conclusion : SRS is effective and safe for PPTs in adults and can be considered as a useful alternative to surgical resection at upfront setting.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.431-435
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• 2014

A fifty-year-old female non-smoker with no other specific medical history visited our institute. She complained of axial back pain with no other neurological deficit. Chest X-ray, chest computed tomography (CT) scan, CT-guided needle aspiration biopsy, whole-body positron emission tomography, spine CT and spine magnetic resonance image findings suggested NSCLC with epidermal growth factor receptor (EGFR) mutation, multiple brain metastases, and two isolated metastases to the T3 and L3 vertebral bodies. She underwent chemotherapy with gefitinib ($Iressa^{TM}$) for NSCLC and gamma knife surgery for multiple brain metastases. We performed a two-staged, total en bloc spondylectomy of the T3 and L3 vertebral bodies based on several good prognostic characteristics, such as the lack of metastases to the appendicular bone, good preoperative performance status, and being an excellent responder (Asian, never-smoker and adenocarcinoma histology) to EGFR inhibitors. Improved axial back pain after the surgery enabled her to walk with the aid of a thoracolumbosacral orthosis brace on the third postoperative day. Her Karnofsky performance status score (KPS) was 90 at the time of discharge and has been maintained to date 3 years after surgery. In selected NSCLC patients with good prognostic characteristics, we suggest that locally curative treatment such as total en bloc spondylectomy or radiosurgery should be emphasized to achieve longer term survival for the selected cases.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.427-433
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• 2018

Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.

• The Korean Journal of Pain
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• 제18권2호
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• pp.218-221
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• 2005

This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.

• Radiation Oncology Journal
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• 제35권2호
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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.

• 한국광학회지
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• 제10권5호
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• pp.430-438
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• 1999

근적외선 파장영역에서 시분해 분광용 레이저 광원개발을 위해 발진파장이 반사경의 파장 선폭에 의해 제한된 수십 펨토초 펄스폭의 고출력 티타늄 사파이어 레이저를 개발하였다. 한쪽 프리즘 끝에 미세 stepping-motor로 제어되는 kniff-edge slits를 사용하여 발진파장을 선택하였으며, 파장가변영역은 770nm~870nm이었고, 이 파장영역에서 얻은 펄스폭은 40 fs 미만이었다. 가장 짧은 펄스폭은 약 17 fs 이었으며 이때의 파장중심은 820nm이고 선폭은 72nm이었다. 약 5W 출력의 아르곤 레이저 여기광을 사용하여 위의 파장영역에서 얻은 평균출력은 440 mW~580 mW 이었다. 연속발진 경우와 Kerr-lens mode locking 경우의 이득매질에서의 빔의 크기를 계산하여 이득변조값 ${\lambda}=2.5{\times}10_{-8}$ W을 수치적으로 얻었고, 이로부터 Ginzberg Landau 방정식을 사용하여 40 fs 미만의 펄스폭이 발생됨을 보였다.

• 한국방사선학회논문지
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• 제14권3호
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• pp.235-243
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• 2020

허허리뼈 전만각(LLA)은 허리뼈의 곡률을 평가하는 데 사용할 수 있는 지표이다. 허리뼈의 구조적 안정성과 추간판 각도(IDA)에서 척추의 각 부분의 안정성을 측정할 수 있다. 특히, 본 연구 자료에 따르면 허리뼈에 대한 비만과 전만각 사이에는 강한 양의 상관관계가 있는 것으로 나타났다. 또한, 비만의 경우 IDA가 큰 이유는 해부학적 구조의 약화와 중력 효과의 결과인 것으로 보인다. 비만은 정상적인 시상면 균형을 방해하고 최소한의 에너지로 똑바른 자세를 유지하지 못한다. 따라서 비만은 허리뼈 전만증을 변화시켜 요통을 유발하는 중요한 요소가 될 수 있다.

• 한국방사선학회논문지
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• 제14권6호
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• pp.781-790
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• 2020

음주 시작연령을 변수로 하여 30세 이상 50세 이하의 중장년층 남성을 대상으로 뇌 백질과 회백질의 손상 유무를 파악할 수 있는 확산텐서영상을 검사하여 영상을 획득한 후 Tract-Based Spatial Statics(TBSS)방법으로 뇌 회백질 부위의 해마 영역 부위 신경섬유로의 비등방도 FA(fractional anisotropy)값을 측정 분석한 결과 모든 영역에서 음주 시작연령이 낮을수록 비등방성 측정값이 낮게 관찰되었지만 FA 값은 통계적으로 유의하였다. 본 연구에서 측정한 FA 결과 값이 나타내는 연구결과는 즉, 음주 시작연령이 빠를수록 뇌 회백질의 해마 영역의 모든 신경학적이고 해부학적인 뇌 영역의 세부적인 형태학적 변화와 신경섬유조직에 심각하게 영향을 준다고 할 수 있으며 신경섬유로를 위해 및 손상시키고 알코올과 관련된 기능적 형태학적 변이에 영향을 끼친다고 할 수 있다.