• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1024-1029
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• 2000

Objectives : With recent improvements in neuroimaging and the development of third and fourth-generation radiosurgical dose-planning soft ware, came a renewed interest in using radiosurgery for the treatment of movement disorders. Radiosurgery involves no opening of the cranium and no incisions, eliminating both the risk of hemorrhage from passing an electrode to the depths of meningitis from operative infection. It is for these reasons stereotactic radiosurgical treatment of movement disorders has value in a small subgroup of patients. The authors report four cases of Parkinson's disease and one case of dystonia that were treated by Gamma knife. Methods : Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make lesion in two Parkinson's disease patients. A radiation dose of 120Gy was delivered to nucleus using a single 4-mm collimator plug pattern following classic anatomical landmarks. Patients were followed for a median of 10.5 months(range 9-12 months). An independent neurological evaluation of tremor, based on the change in the United Parkinson's Disease Rating Scale tremor score(UPDRS), was correlated with a subjective evaluation. Gamma knife ventrolateral(V.O.P) thalamotomy was performed in one case of dystonia. A central dose of 150Gy was delivered and the patient was followed for 18 months. Gamma knife globus pallidus interna pallidotomy was performed in two Parkinson's disease patients. A radiation dose of 130Gy(range 120-140Gy) was delivered. Patients were followed for a median of 13 months(range 9-14 months). Result : Ventrolateral thalamotomy in dystonia produced regained left hand usage in order to be able to use the telephone. Ventralis intermedius thalamotomy produced an excellent improvement of the tremor in one case, mild improvement of the tremor in the other case of Parkinson's disease. A globus pallidus internalis(GPi) pallidotomy produced improvement of rigidity and dyskinesia : one other showed no change. There were no neurological complications. Conclusion : Gamma Knife thalamotomy considered a safe and effective technique for the treatment of tremor in Parkinson's disease. Although the results from Longer follow-up is not available yet, the short-term results seem to be encouraging.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4609-4614
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• 2016

Purpose: To evaluate the therapeutic effects of copper reduction on angiogenesis-related factors in patients with glioblastoma multiforme treated by gamma knife radiosurgery. Materials and Methods: In the present block randomized, placebo-controlled trial, fifty eligible patients with a diagnosis of glioblastoma multiforme who were candidates for gamma knife radiosurgery were randomly assigned into two groups to receive daily either 1gr penicillamine and a low copper diet or placebo for three months. The intervention started on the same day as gamma knife radiosurgery. Serum interleukin-6 (IL-6), tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$), vascular endothelial growth factor (VEGF) and copper levels were measured at baseline and after the intervention. The serum copper level was used as the final index of compliance with the diet. In order to control probable side effects of intervention, laboratory tests were conducted at the beginning, middle and end of the study. Results: The patients had a mean age and Karnofsky Performance Scale of 43.7 years and 75 respectively. Mean serum copper levels were significantly reduced in intervention group. Mean survival time was 18.5 months in intervention group vs. 14.9 in placebo group. VEGF and IL-6 levels in the intervention group were also significantly reduced compared to the placebo group and $TNF-{\alpha}$ increased less. Conclusions: It seems that reducing the level of copper in the diet and dosing with penicillamine leads to decline of angiogenesis-related factors such as VEGF, IL-6 and $TNF-{\alpha}$. Approaches targeting angiogenesis may improve survival and can be used as a future therapeutic strategy.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.561-566
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• 2001

Objective : The purpose of this study are to evaluate the effectiveness of Gamma Knife radiosurgery(GKS) as a treatment of craniopharyngioma and to investigate the proper dose planning technique in GKS for craniopharyngioma. Method : Between May 1992 and March 1999, seven Gamma Knife radiosurgical procedures were done for residual tumor mass of 6 patients with craniopharyngioma after microsurgical resection. Conventional radiation therapy was not performed. In this study, their clinical, radiological and radiosurgical data were analyzed and the radiation dosage to the optic pathway, hypothalamus, pituitary stalk, and cavernous sinus were calculated and correlation with clinical outcome was evaluated. The mean follow-up period was 33.5 months(12.3-55.2 months). Result : The mean tumor volume was 4.4cc(0.4-18.0cc) and the maximum radiation dose ranged from 14 to 32 Gy(mean 20.9Gy). The radiation was given with isodose curve, 50-90% and the marginal dose varied within 8-22.4Gy(mean 12.7Gy). The mean number of isocenter was 4.3(1-12). The tumor was well controlled in all cases. In 5 of 7 cases, the size of tumor decreased to 10-50% of pre-GKS volume and remaining two showed no volume change. The mean dose to optic pathway was 5.7Gy(5.1-11.2Gy) and there were no complications. Conclusion : GKS seems to be effective for control of craniopharyngioma as an adjuvant treatment after microsurgical resection and even suboptimal dose for tumor margin is considered to be enough for tumor control. It is safe with careful dose planning to protect surrounding important structures, especially optic pathway. We believe conventional radiation therapy should be avoided because it has limitation for dose planning of additional treatments such as radiosurgery or intracystic instillation of radioisotope in case of recurrence.

• The Journal of Korean Medicine
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• v.30 no.5
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• pp.157-162
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• 2009

Objectives: The purpose of this study is reporting the possibility of the treatment of metastatic brain tumors with allergen removed Rhus verniciflua Stokes (aRVS) after gamma knife radiosurgery. Methods: A patient with lung cancer felt a headache about one year after conventional therapies, and metastatic brain tumors were diagnosed. He received gamma knife radiosurgery twice but refused to get more conventional therapies afterwards. So he has been treating with aRVS since then. Results: During 143 weeks of administration of aRVS, the size of brain masses has decreased continuously without extracranial metastasis and the patient has maintained a good performance status. Conclusions: This report suggests that aRVS may play a therapeutic role in the treatment of metastatic brain tumors. Further studies will be needed to determine the effect of aRVS on metastatic brain tumors.

• Progress in Medical Physics
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• v.14 no.3
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• pp.184-188
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• 2003

It is strongly recommended that periodic quality assurance should be carried out in the Gamma Knife that is used in radiosurgery since high radiation is delivered in one session. Since the protocols for Gamma Knife recommended by associations or agencies on quality assurance are absent in Korea, hospitals possessing the Gamma Knife have developed their own protocols. In order to develop a quality assurance protocol suitable for Korea, we reviewed the protocols of the Gamma Knife manufacturer, USA and Japan. we categorized the periodic items into three parts,: radiation dose, mechanical and safety part. The USA recommended and regulated more strict than the manufacturer. Japan recommended the items and frequency based on the USA. In conclusion, we tried to suggest a basic Gamma Knife quality assurance protocol suitable for Korea.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.159-167
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• 2007

Vestibular schwannoma (VS) is a benign tumor typically originated in the schwann cell of vestibular nerve and usually accompany hearing symptom. Microsurgical removal and radiosurgery have a great role for the treatment of VS. Recently radiosurgery has been considered as an alternative or primary treatment for VS with the tremendous increase of patients who were treated with gamma knife radiosurgery (GKS) though microsurgery still takes the premier. By many published results, it is proved that GKS is a effective and noninvasive technique for VS, especially small sized tumors with satisfactory tumor control rate. The authors assumed that GKS can be expected to achieve satisfactory tumor control rate for small VS under 5cc in volume. A major interest regarding radiosurgery nowadays is to determine the optimal radiation dose for hearing preservation to improve the quality of life of patients. The more high radiation dose are used for effective tumor growth control, the more radiation-related complications like as hearing deficit, the impairment of other cranial nerve function are increased. Since 1990's the mean radiation dose for tumor margin was more than 18 Gy, but there were high complication rate in spite of good tumor growth control. After the year of 2000, under the influence of advanced neuro-imaging techniques and radiosurgical planning system which enable clinicians to do more precise planning, marginal dose for VS has been decreased to 12-13 Gy and the radiation-related complications has been reduced. But because there may be a unexpected radiation induced complications as time goes by after the latency period, optimal radiation dose for VS should be established on the basis of more long term follow-up observation.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.127-130
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• 2015

A 59-year-old female presented with progressive right proptosis, chemosis and ocular pain. An imaging work-up including conventional catheter angiography showed a right-sided dural arteriovenous fistula of the cavernous sinus, which drained into the right superior petrosal sinus, right superior ophthalmic vein, and right inferior ophthalmic vein, and cortical venous reflux was seen via the right petrosal vein in the right posterior fossa. After failure of transvenous embolization, the patient underwent Gamma Knife radiosurgery (GKRS). At one month after GKRS, she developed increasing ocular pain and occipital headache. Repeat angiography showed partial obliteration of the fistula and loss of drainage via the superior and inferior ophthalmic veins with severe congestion, resulting in slow flow around the right cerebellar hemisphere. Prompt transarterial embolization relieved the patient's ocular symptoms and headache. We report on a case of paradoxical exacerbation of symptoms resulting from obstruction of the venous outflow after GKRS for treatment of a dural arteriovenous fistula of the cavernous sinus.

• Journal of Korean Neurosurgical Society
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• v.39 no.2
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• pp.96-101
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• 2006

Objective : The authors assess the long term effectiveness of gamma knife radiosurgery[GKS] for remnant or recurred craniopharyngiomas on tumor control and possibly set proper radiation dose for tumor control with utmost preservation of the adjacent structures. Methods : Sixteen GKS were done in 14 patients with recurred or remnant craniopharyngiomas after surgery. Mean follow up duration was 44.2 months [range $11.3{\sim}123.6\;months$]. Follow up MR imagings were analyzed. Results : Mean tumor volume was $3.6cm^3$ [range $0.6{\sim}18cm^3$] and mean margin dose was 12.2Gy [range $8{\sim}22.4Gy$]. Tumor control was achieved in 87.5% [14 of 16 tumors] which were either solid or cystic in nature. Dose to optic apparatus was mean 7.9Gy and no radiation related complications were observed. Conclusion : GKS seems to be effective treatment modality for craniopharyngiomas regardless of nature of tumor whether it is cystic or solid. Dose of 8 to 8.5Gy may be sufficient to achieve long term tumor control for remnant or recurred craniopharyngiomas.

• Korean Journal of Head & Neck Oncology
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• v.30 no.2
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• pp.119-122
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• 2014

Rhabdomyosarcoma is the most common sarcoma in children less than 15 years of age. Two major histological subtypes are embryonal and alveolar. Embryonal rhabdomyosarcoma is diagnosed by immunopathology and treatments require coordinated management plans that include surgery, chemotherapy, and usually radiotherapy. 8-month-old male infant visited with swelling in left parotid area. Computed tomography scan showed a heterogeneous mass in the left parotid area and the result of fine-needle aspiration cytology was suspicious malignancy. Left total parotidectomy was performed and CSF leakage was noted and repaired. Confirmed by positive reactions to desmin and myogenin, the diagnosis was embryonal rhabdomyosarcoma. On postoperative brain MRI, extension along the meninges was noted and for treatment, chemotherapy and gamma knife radiosurgery were done. Five years after initial surgical resection(3 years and 10 months after completion of chemotherapy and gamma knife radiosurgery), the child did not show any evidence of local recurrence or distant metastasis.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.77-81
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• 2015

Objective : The purpose of this study was to investigate changes in the plasma level of vascular endothelial growth factor (VEGF) after Gamma Knife radiosurgery (GKRS) for the treatment of meningioma. Methods : Fourteen patients with meningiomas had peripheral venous blood collected at the time of GKRS and at 1 week, 1 month, 3 month and 6 month visits. Plasma VEGF levels were measured using commercially available enzyme-linked immunosorbent assay. For controls, peripheral blood samples were obtained from 20 healthy volunteers. Results : The mean plasma VEGF level (29.6 pg/mL) in patients with meningiomas before GKRS was significantly lower than that of the control group (62.4 pg/mL, p=0.019). At 1 week after GKRS, the mean plasma VEGF levels decreased to 23.4 pg/mL, and dropped to 13.9 pg/mL at 1 month, 14.8 pg/mL at 3 months, then increased to 27.7 pg/mL at 6 months. Two patients (14.3%) with peritumoral edema (PTE) showed a level of VEGF 6 months after GKRS higher than their preradiosurgical level. There was no significant association found in an analysis of correlation between PTE and tumor size, marginal dose, age, and sex. Conclusion : Our study is first in demonstrating changes of plasma VEGF after stereotactic radiosurgery (SRS) for meningioma. This study may provide a stimulus for more work related to whether measurement of plasma level has a correlation with tumor response after SRS for meningioma.