• Journal of the Korean Society of Radiology
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• v.17 no.2
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• pp.243-248
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• 2023

This study aims to analyze the secondary carcinogenesis rate caused by exposure of organs at risk of damage using a glass dosimeter during radiosurgery in vestibular schwannoma disease. Using a pediatric phantom of human tissue equivalent material, the volume of the tumor was set to a total of three volumes: 0.506 cm³, 1.008 cm³, and 2.032 cm³, and a radiosurgery plan was established with an average dose of 18.4 ± 3.4 Gy. After mounting the human body phantom on the table of surgical equipment, glass dosimeters were placed on the right eye, left eye, thyroid gland, thymus, right lung, and left lung to measure the exposure dose, respectively. In this study, the incidence of secondary cancer due to exposure to damaged organs during gamma knife radiosurgery in vestibular schwannoma disease with the largest tumor volume of 2.032 cm³ was measured with a glass dosimeter. This study studies the risk of secondary radiation exposure dose that can occur during stereotactic radiosurgery, and it is considered that it will be used as basic data in the field of radiation damage related to the stochastic effect of radiation in the future.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.54-56
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• 2014

Intracranial tumors secondary to radiotherapy are rare. In this group gliomas are the rarest. Only 6 cases of glioblastoma multiforme (GBM) have been reported in patients undergoing radiotherapy (RT) for craniopharyngiomas of which only 4 have been in children less than 18 years of age. In recent years RT has become a mainstay of adjuvant therapy for recurrent or partially excised craniopharyngiomas. We report a child of 12 years who had previously undergone RT for a suprasellar craniopharyngioma and presented 10 years later with a GBM. This is the 5th pediatric case in literature demonstrating a GBM after RT for a craniopharyngioma. The implications of subjecting the pediatric population to RT for a benign lesion versus the outcome of gross total removal and management of RT induced tumors is discussed and the need to avail of safer alternatives such as stereotactic radiosurgery is stressed.

• Radiation Oncology Journal
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• v.31 no.4
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• pp.267-272
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• 2013

Although significant advances in the treatment of intrahepatic lesions, it is reported that the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. We report a patient with lung, liver, brain, bone and subcutaneous metastasis from HCC who has survived more than 7 years maintaining relatively good performance status as a result of repeated therapies. A 55-year-old male patient with HCC underwent right lobectomy of the liver and cholecystectomy in September 2006. He received wedge resection for lung metastasis twice (July 2009, January 2011) and Gamma Knife stereotactic radiosurgery for brain metastasis (April 2011). Over the last 3 years, he has developed metastasis in subcutaneous tissues, muscle, and bone with pain. He has undergone 7 courses of radiotherapies for subcutaneous tissues, muscle, and bone metastasis and been prescribed sorafenib and he is still capable of all self-care.

• 대한방사선방어학회:학술대회논문집
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• 2010.04a
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• pp.146-147
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• 2010

• Journal of Korean Neurosurgical Society
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• v.60 no.3
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• pp.294-300
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• 2017

Hypothalamic hamartoma (HH) is a benign indolent lesion despite the presentation of refractory epilepsy. Behavioral disturbances and endocrine problems are additional critical symptoms that arise along with HHs. Due to its nature of generating epileptiform discharge and spreading to cortical region, various management strategies have been proposed and combined. Surgical approaches with open craniotomy or endoscopy, stereotactic approaches with radiosurgery and gamma knife surgery or radiofrequency thermos-coagulation, and laser ablation have been introduced. Topographical dimension and the surgeon's preference are key factors for treatment modalities. Endoscopic disconnection has been one of the most favorable options performed in treating HHs. Here we discuss presurgical evaluation, patient selection, surgical procedures, and complications.

• Journal of Korean Neurosurgical Society
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• v.38 no.1
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• pp.65-67
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• 2005

Intracranial chloroma may occur in leukemia, although they are rare. A 23-year-old female complained diplopia. Brain magnetic resonance MR imaging showed tumors in the both cavernous sinus, both tentorial and anterior falx. Gamma-Knife radiosurgery was performed with maximal dose; 20Gy, marginal dose; 10Gy. Peripheral blood smear revealed leukemia, and bone marrow aspiration biopsy showed acute lymphocytic leukemia. Two weeks later, MR image for the stereotactic biopsy noticed markedly decreased tumor size. Biopsy result was lymphocytic leukemia. She received conventional radiation therapy, chemotherapy, and bone marrow transplantation. Brain involvement by acute lymphocytic leukemia is very rare. Even though chloroma are sensitive to radiation therapy, prognosis is poor because of the gravity of the underlying disease and association with impending blast transformation. The authors reports a intracranial chloroma by acute lymphocytic leukemia.

• Journal of Korean Neurosurgical Society
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• v.67 no.3
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• pp.280-288
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• 2024

Brain arteriovenous malformations (bAVMs) are aberrant arteriovenous shunts through a vascular nidus with no intervening capillary beds. They are one of the commonest causes of spontaneous intracranial haemorrhage in children and may be associated with significant morbidity and mortality in cases of rupture. Treatment strategies include microsurgical resection, endovascular embolisation, stereotactic radiosurgery, multimodality treatment with a combination thereof, and particularly in high-grade bAVMs, conservative management. Clinicians involved in treating bAVMs need to have familiarity with the natural history pertaining to bAVMs in terms of risk of rupture, risk factors elevating rupture risk as well as understanding the clinical manifestations of bAVMs. This invited review serves to provide a synthesis on natural history and clinical presentation of bAVMs with particular focus in children to inform decision-making pertaining to management.

• Journal of Korean Neurosurgical Society
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• v.67 no.3
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• pp.299-307
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• 2024

Cerebral cavernous malformation (CCM) is a vascular anomaly commonly found in children and young adults. Common clinical presentations of pediatric patients with CCMs include headache, focal neurological deficits, and seizures. Approximately 40% of pediatric patients are asymptomatic. Understanding the natural history of CCM is crucial and hemorrhagic rates are higher in patients with an initial hemorrhagic presentation, whereas it is low in asymptomatic patients. There is a phenomenon known as temporal clustering in which a higher frequency of symptomatic hemorrhages occurs within a few years following the initial hemorrhagic event. Surgical resection remains the mainstay of treatment for pediatric CCMs. Excision of a hemosiderin-laden rim is controversial regarding its impact on epilepsy outcomes. Stereotactic radiosurgery is an alternative treatment, especially for deep-seated CCMs, but its true efficacy needs to be verified in a clinical trial.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.21-26
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• 1992

From July 1988 through November 1991,26 patients with inoperable arteriovenous malformations were treated with 6 MV linear accelerator at the Kangnam St. Mary's Hospital, Catholic University Medical College. There were 5 females and 21 males with median age of 29 years (range: $6\~63$ years) and median follow up times of 15 months (range: $4\~40$ months). The arteriovenous malformation volumes treated ranged from 1 cm diameter to 3.5 cm rectangular size. The prescribed doses at the isocenter varied from 15 to 30 Gy and were given as a single fraction. To date, all patients performed follow-up not only clinically but also through CT or angiography based radiologic modalities every 6 month. A complete obliteration was achieved in 6 ($23\%$) and partial obliteration in 8 ($31\%$) and no change in 1 ($4\%$). We observed 14 ($54\%$) responsiveness of arteriovenous malformations after radiosurgery by 2 years afterward. Whereas, the decision of the remaining 11 ($42\%$) patients was considered too early to expect the therapeutic response following radiosurgery. No complications through treatment related were observed, yet. Our initial outcome in these first 26 patients with arteriovenous malformations is recommended further follow-up.

• 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.