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대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회> 대한뇌종양학회지> 증례 : kr빠른 진행을 보이는 역형성 다형성 황색성상세포종 -증례보고-

증례 : kr빠른 진행을 보이는 역형성 다형성 황색성상세포종 -증례보고-

Primary Anaplastic Pleomorphic Xanthoastrocytoma with Rapid Progression -Case Report-

구원모 ( Won Mo Gu ) , 유창영 ( Chang Young Yoo ) , 양승호 ( Seung Ho Yang ) , 성재훈 ( Jae Hoon Sung ) , 손병철 ( Byung Chul Son ) , 이상원 ( Sang Won Lee )
  • : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회
  • : 대한뇌종양학회지 11권1호
  • : 연속간행물
  • : 2012년 03월
  • : 45-48(4pages)
대한뇌종양학회지

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A 42 year-old man presented with transient motor aphasia and memory impairment for 2 months. Magnetic resonance imaging
(MRI) with gadolinium showed a single enhanced mass in the left temporal lobe. The patient underwent gross total tumor resection under awake surgery with the frameless navigation system. Pathological diagnosis was pleomorphic xanthoastrocytoma (PXA) with anaplastic features. Immunohistochemical staining showed 12 mitoses per 10 high power fields and over 50% of the cells were Ki-67 immunoreactive. Postoperatively, local irradiation (60 Gy×40 days) began. Two weeks later, follow-up MRI showed rapid progression of tumor growth and huge perilesional edema. We report a case of primary anaplastic PXA with aggressive behavior despite surgical excision and irradiation.

UCI(KEPA)

I410-ECN-0102-2014-500-001972565

간행물정보

  • : 의약학분야  > 신경외과학
  • :
  • :
  • : 반년간
  • : 1598-530x
  • :
  • : 학술지
  • : 연속간행물
  • : 2002-2012
  • : 269


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11권2호(2012년 09월) 수록논문
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1임상 : 내시경을 사용한 경비적 경접형동 수술에서의 뇌척수액 유출 예방에 대한 고찰

저자 : 박준상 ( Jun Sang Park ) , 강석구 ( Seok Gu Kang ) , 홍용길 ( Yong Gil Hong ) , 전신수 ( Sin Soo Jeun )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 77-82 (6 pages)

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Objectives:The endoscopic endonasal transsphenoidal approach (EETSA) is increasingly being used to treat pituitary adenomas and other sellar/suprasellar pathologies. One important complication of the transsphenoidal approach is cerebrospinal fluid (CSF) leakage, which occurs in 0.4 to 9% of cases. We report our experience with EETSA and describe the me-thods that we use to prevent CSF leakage. Methods:A single surgeon performed EETSA on 170 consecutive patients between Feb 2004 and Apr 2011. Patients were divided into three groups based on their CSF leakage status as follows: no CSF leakage, minor CSF leakage, and major CSF leakage. Sellar floor reconstruction was performed according to this classification. In the no-CSF leakage group, sellar floor reconstruction was performed with oxidative cellulose (Surgicel®) only. In the second group (minor CSF leakage), sellar floor reconstruction was performed using autologous fat and bone grafts. Patients in the third group (major CSF leakage) underwent an additional reconstructive procedure of the skull base using the pedicled septal mucosal flap. Results:Of 170 patients, 30 (17.6%) showed CSF leakage in the operation field ; 24 (14.1%) were classified as having minor CSF leakage and 6 (3.5%) patients were classified as having major CSF leakage. Post-operative CSF leakage occurred in only two cases. Conclusion:CSF leakage, though relatively common in the operation field, can be prevented effectively with adequate reconstruction techniques. Assignment of patients to one of three groups based on their CSF leakage in the operation field and sellar floor reconstruction based on this classification resulted in favorable postoperative outcomes.

2임상 : 원발성 신경교육종에 대한 단일기관의 임상성적

저자 : 변준호 ( Joon Ho Byun ) , 윤정호 ( Jung Ho Yun ) , 조영현 ( Young Hyun Cho ) , 김정훈 ( Jeong Hoon Kim ) , 김창진 ( Chang Jin Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 83-87 (5 pages)

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Objectives:Primary gliosarcoma (GSM) is a rare central nervous system tumor with few reports described in the literature. Here, we present our clinical experience and the outcome of primary GSM patients in a single medical center. Method:Primary GSM patients who were treated at our institution between 1990 and 2011 were selected retrospectively. All patients were analyzed by meticulous chart review including clinical and pathologic data. Overall survival was analyzed by Kaplan-Meier survival analysis. Results:Eleven patients were diagnosed with primary GSM. It was 1.7% of glioblastoma (GBM) during the same period. The overall median survival of the 11 patients was 12 months (range : 3 to 177 months). Patients who underwent maximal safe resection had a prolonged median survival compared to those who only underwent biopsy of the tumor (12 vs. 6 months, p=0.288). All patients received adjuvant postoperative radiotherapy and 7 of 11 patients received chemotherapy with temozolomide. Four patients received gamma-knife radiosurgery for local recurrence; however, treatment method by gamma-knife radiosurgery was not significantly associated with prolonged survival in this study. Patients who received re-explorative surgery for resectable recurred tumors had a prolonged median survival compared to those who had non-resectable recurred tumors (14 vs. 6 months, p=0.0082). Conclusion:We present 11 primary GSM patients who were treated according to the standard treatment for GBM. Despite aggressive multimodality treatment, the life expectancy of GSM is very short until now. Therefore, large and comprehensive clinical investigations are needed to establish the standard treatment for primary GSM.

3임상 : 악성 뇌교종의 유전자 검사 : 방사선학적 특징과 예후와의 관계

저자 : 유재원 ( Jae Won Yu ) , 김영준 ( Young Zoon Kim ) , 송영진 ( Young Jin Song ) , 김대철 ( Dae Cheol Kim ) , 한진영 ( Jin Yeong Han ) , 김기욱 ( Ki Uk Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 88-95 (8 pages)

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Objectives:Numerous genetic alterations are related to tumorigenesis and influence the radiological features of malignant glial tumor. We performed a cytogenetic analysis from a fresh tumor specimen and analyzed its relationship with radiological features and prognosis. Materials and Methods:Among the 29 patients with malignant glial tumor involved in cytogenetic analysis, 19 cases showing chromosomal abnormality were analyzed. Cytogenetic analysis was performed with pathologically proven fresh surgical specimen. Both medical records and radiological findings were reviewed to define the tumor, to evaluate peritumoral edema and to assess treatment results. Results:The most frequent genetic abnormality was observed in chromosome 7 (57.8 %). Complex karyotype presenting three or more abnormalities was noted in 11 cases (57.8 %). Chromosomal abnormalities, noted in more than three cases, were whole loss of Y (7 cases), whole gain of 7 (6 cases), whole gain of 2, whole gain of 5, whole gain of 12, 19q gain, 6p loss, 9p loss, and whole gain of 13 (3 cases). We reported that loss of chromosome 7 related to MDR-1 (Multidrug resistant gene) were correlated with good response of chemotherapy. Conclusions:A chromosomal analysis of malignant glioma can be perfomed to discover tumorigenic factors and to evaluate radiological features. Results of karyotyping is closely related to the clinical outcome and may be utilized in developing new therapeutic modalities.

4임상 : 경접형동 접근에 의한 뇌하수체 선종 제거술 후 발생한 지연성 저나트륨혈증 : 임상 연구

저자 : 김정재 ( Jung Jae Kim ) , 김선호 ( Sun Ho Kim ) , 김의현 ( Eui Hyun Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 96-101 (6 pages)

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Objective:Delayed hyponatremia is a common complication after transsphenoidal surgery (TSS) for pituitary adenomas. We retrospectively evaluated our patients and tried to find possible associated risk factors of delayed hyponatremia. Methods:From 2006 until 2010, total 575 cases of pituitary adenomas were operated with TSS in a single institution. Thirty-one patients (5.3%) with delayed hyponatremia were compared to other 544 patients without delayed hyponatremia in the aspects of age, sex, Hardy classification, tumor size, hormonal type and activity on preoperative combined pituitary function test. Their postoperative outcomes were also evaluated in the aspects of tumor removal fashion and hormonal outcome on postoperative combined pituitary function test. Results:In 31 patients, delayed hyponatremia started 7.0 days after surgery (range : postoperative day 3-10). At the time of diagnosis of hyponatremia, serum level of sodium ranged from 111 mmol/L to 132 mmol/L (mean : 120.5 mmol/L) and mean duration of treatment was 4.l days (range : 2-9 days). Piecemeal tumor removal was more frequent in a group with delayed hyponatremia (p=0.035). The presence of postoperative hypopituitarism and aggravation of pituitary function were observed more frequently in a group with delayed hyponatremia (p=0.002 and p=0.017, respectively). Conclusion:Delayed hyponatremia is a common complication after TSS and potentially fatal. Piecemeal fashioned tumor removal, postoperative hypopituitarism and aggravation of pituitary function are associated with higher chance of delayed hyponatremia.

5임상 : 뇌실질 전이가 있는 비소세포성 폐암 환자에서의 연수막 전이 빈도 및 예후 인자

저자 : 나영철 ( Young Cheol Na ) , 김지희 ( Ji Hee Kim ) , 김창환 ( Chang Hwan Kim ) , 장원석 ( Won Seok Chang ) , 장진우 ( Jin Woo Chang ) , 박용구 ( Yong Gou Park )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 102-107 (6 pages)

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Objectives:The object of this study is to evaluate the incidence, survival and the prognostic factors in patients with leptomeningeal metastasis from non-small cell lung cancer. Methods:The study included fifty-five consecutive patients diagnosed with brain parenchymal metastasis on magnetic resonance image (MRI) clinically from non-small cell lung cancer between July 2010 and February 2011. All the patients underwent lumbar puncture for cerebrospinal fluid examination including cytology examination with cytokeratine immunostain. If the patients showed positive in cerebrospinal cytology or leptomeningeal enhancement on T1 weighted gadolinium enhanced MRI, whole spine MRI with gadolinium enhancement was also taken for evaluation of spinal disease. For evaluation of prognostic factors, we investigated the patient's age, interval from the time of diagnosis of systemic disease to the time of diagnosis of leptomeningeal metastasis, interval from the time of diagnosis of parenchymal metastasis to the time of diagnosis of leptomeningeal metastasis, performance status of the patients, and following treatment modality after diagnosis of leptomeningeal metastasis. Result:In eleven (20%) of the fifty-five patients, the diagnosis of leptomeningeal metastasis was made on the basis of MRI findings and the results from cerebrospinal fluid cytology. Among those eleven patients, eight (72.7%) had positive cerebrospinal fluid cytology at the time of initial examination. Eight of the eleven patients underwent an operation for intraventricular catheter and reservoir placement in order to receive intraventricular chemotherapy. In six (75%) of the eight intraventricular chemotherapy patients, the negative conversion of cerebrospinal fluid cytology was achieved during induction chemotherapy of four weeks. The overall median survival for the eleven patients after the diagnosis of leptomeningeal metastasis and the eight subsequent intraventricular chemotherapy patients was 62 days (95% confidence interval 27.4 96.6). The most possible prognostic factor was the intervals from primary disease to leptomeningeal metastasis (p=0.071). Conclusion:In this study, we found that relatively high proportion of the patients of non-small cell lung cancer with parenchymal metastases were co-morbided by leptomeningeal metastases, and revealed that the interval from primary disease to leptomeningeal metastasis could be an important factor for survival. However, further well-designed investigations, with larger sample sizes, must be conducted to evaluate other prognostic factors as well as new drugs, and to define the optimal treatment combinations and route.

6임상 : 측뇌실 삼각에 발생한 뇌실내 수막종에 있어 상부 두정-후두 피질경유 접근법의 임상 결과 ; 24례 보고

저자 : 박세환 ( Se Hwan Park ) , 조진모 ( Jin Mo Cho ) , 김의현 ( Eui Hyun Kim ) , 김선호 ( Sun Ho Kim ) , 이규성 ( Kyu Sung Lee ) , 장종희 ( Jong Hee Chang )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 108-113 (6 pages)

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Introduction:Intraventricular meningiomas are uncommon subtype of intracranial meningiomas. Trigonal meningiomas consist of the majority of intraventricular meningiomas. The superior parieto-occipital transcortical approach is the most popular approach for removal of them. We analyzed our experience in removal of the trigonal meningiomas that were resected using the superior parieto-occipital transcortical approach. Patients and Methods:Twenty-four patients underwent surgical removal of trigonal meningioma from 1997 to May 2012. Demographics, clinical features, surgical outcomes, histopathologic results and prognosis were analyzed. Results:Study population had a mean age of 51.2 years and a female preponderance of 1 : 1.7. The most common presenting symptom was chronic headache, which was followed by memory impairment, visual disturbance and hemiparesis. Total removal of the tumor was achieved in all cases. Twenty-two (91.7%) tumors were World Health Organization (WHO) grade I while two cases were WHO grade III. There were two cases of intracerebral hemorrhage in the surgical corridor, one case of transient contralateral hemiparesis with cognitive decline, one case of transient contralateral homonymous hemianopsia, one case of aggravation of visual field defect, and one case of hydrocephalus which was successfully treated by ventriculo-peritoneal shunt. Conclusion:The superior parieto-occipital approach is suitable for most of the trigonal meningiomas and total removal of them can be achieved safely.

7임상 : Leksell Gamma Knife Perfexion과 Model C의 치료계획 효용성 비교 : 임상연구

저자 : 김정재 ( Jung Jae Kim ) , 김기홍 ( Gi Hong Kim ) , 박용구 ( Yong Gou Park ) , 장종희 ( Jong Hee Chang )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 114-117 (4 pages)

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Objective:The purpose of this study was to compare the dose planning between the Leksell Gamma Knife Perfexion (LGK PFX) and the Leksell Gamma Knife C (LGK C) using variable indices. Methods:A total of 100 cases, which were composed of 35 meningiomas, 20 vestibular schwannomas, 35 metastases, and 10 pituitary adenomas, were enrolled in this study. First, these cases were treated with the LGK PFX and then, were re-planned with the LGK C. We compared these two models in terms of the number of shots, the percentage of coverage, the conformity index (CI), Paddick's conformity index (PCI), the gradient index (GI), and the beam on time. Results:The LGK PFX completely outperformed the LGK C in terms of GI and the LGK PFX tended to have a longer beam on time than that of the LGK C. However, in patients with schwannomas, the LGK PFX outperformed the LGK C in terms of the CI, PCI, and GI, and in patients with pituitary adenomas, the LGK PFX outperformed the LGK C in terms of the percentage of coverage, PCI, and GI with statistical significance. Conclusion:The LGK PFX is an entirely redesigned radiosurgery unit accompanied by the development of software. The LGK PFX is supposed to achieve highly conformal dose prescription consisting of many isocenters with a reasonable treatment time.

8증례 : 신경섬유종증 제1형, 2형과 구분되는 신경집종증에 대한 1례

저자 : 양순범 ( Soon Bum Yang ) , 장웅규 ( Ung Kyu Chang ) , 윤상민 ( Sang Min Youn )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 118-121 (4 pages)

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Multiple schwannomas without vestibular schwannomas (schwannomatosis) are new classification of neurofibromatoses. Understanding of this disease entity is emerging, recently. We experienced a case of schwannomatosis, and reviewed some literatures related to schwannomas. A 45-year-old woman visited our hospital with low back pain and radiating leg pain. The patient's spine MR images revealed that she had multiple intradural extramedullary masses in lumbar spinal canal, extending to paravertebral space through neural foramen. On brain MR images, there were no vestibular schwannomas. We took a operation to resolve her symptoms. After we removed the intradural extramedullary masses in lumbar spinal canal, her symptoms were improved.

9증례 ; 적갈색방사선학적 악성이나 조직학적으로 양성을 보인 신경절교종 - 증례보고 -

저자 : 김환수 ( Hwan Soo Kim ) , 정세헌 ( Se Heun Joung ) , 허원 ( Weon Heo ) , 이동열 ( Dong Youl Rhee )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 122-126 (5 pages)

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Gangliogliomas are rare tumors of the central nervous system, composed of neoplastic ganglion cells and neoplastic glial cells. They are characterized by slow growing, low incidence of malignancy, surgically curable, and usually occurred in children and young adults. We report a case of ganglioglioma occurred in 21 year-old male which radiological findings were compatible with the malignancy but histologically diagnosed as benign, with review of literatures.

10증례 : 송과체에 발생한 교모세포종

저자 : 강무성 ( Moo Sung Kang ) , 홍창기 ( Chang Ki Hong ) , 김세훈 ( Se Hoon Kim ) , 이규성 ( Kyu Sung Lee )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 2호 발행 연도 : 2012 페이지 : pp. 127-132 (6 pages)

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Pineal gland tumors comprise 0.4-1% of adult intracranial tumors. Glioblastoma, which is the most frequent glioma in brain tumors, is extremely rare in the pineal region. A 74-year-old man complaining of gait disturbance, urinary incontinence, and memory disturbance underwent ventroperitoneal (VP) shunt under the impression of obstrctive hydrocephalus that occurred secondarily to a tumor in the pineal gland. He refused treatment for the tumor. The symptoms were improved after the VP shunt. Six months postoperatively, he experienced a reaggravation of symptoms. An increase in tumor size was disclosed in brain imaging studies. The patient underwent an occipital craniotomy with occipital trans-tentorial approach. Pathological findings were consistent with glioblastoma. This case emphasizes the importance of considering glioblastoma as a differential diagnosis of pineal gland tumors, particularly if peritumoral heterogenous enhancement is observed. The role of surgery, chemotherapy, and radiotherapy on survival duration is not yet well established. Therefore, studies exploring the effect of each modalities on survival duration are needed.

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1임상 : 상두개강내에 상의 세포종의 임상적 결과와 여후 인자

저자 : 이수헌 ( Su Heon Lee ) , 차승헌 ( Seung Heon Cha ) , 남경협 ( Kyoung Hyup Nam ) , 조원호 ( Won Ho Cho )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 3-8 (6 pages)

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Objective: Ependymomas are infrequently seen tumors that have been defined as neoplasm arising from ependymal cells lining the ventricles and the central canal of the spinal cord. As prognostic factor, histological features and surgical resection and the efficacy of prophylactic radiation remain controversial in the management of intracranial ependymoma. We analyzed a series of patients with intracranial ependymoma to review our strategy of treatment and prognostic factor. Materials and Methods: Between Jan 2001 and Dec 2008, 11 patients have been under treatment at our institute. Seven cases involved Grade II lesion according to the World Health Organization (WHO) classification of ependymoma, and four cases involved Grade III lesion. Postoperative radiation was performed in eight cases and chemotherapy was administered in three childhood patients. We analyzed the result of treatment and prognosis according to recurrence of tumor. Results: Overall recurrence rates were significantly lower in patients with Grade II ependymoma and in patients who had undergone gross total resection of the tumor. Three patients (27.3%) revealed progression or recurrence from 12 to 65 months (median 29.7 months) after diagnosis. In two patients, the ependymoma recurred only at the original tumor site. One patients experienced both local and distant relapse as spinal seeding. Histologic grade and extent of resection were related with tumor recurrence or progression. Among eight cases underwent adjuvant radiotherapy (Five cases of Grade II, Three cases of Grade III), three cases of Grade III revealed tumor progression and none of Grade II cases showed tumor progression. Conclusion: Histologic grade is the important prognostic factor with respect to patient survival, tumor recurrence and tumor progression. Although there was no statistical significance, progression rate is higher in young age and infratentorial tumors. Grade III ependymoma is more common in young age and infratentorial area.

2임상 : 후두개와 유표피 낭종; 임상특징과 치료결과

저자 : 박정훈 ( Jung Hoon Park ) , 김일만 ( Eal Maan Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 9-15 (7 pages)

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Objectives: Posterior fossa epidermoid tumors (PFETs) intimately involve cranial nerves and vascular structures, and may be tightly adherent to them and to the brain stem. The present report details the clinical characteristics of PFETs and assess their therapeutic outcomes. Methods: We reviewed the clinical manifestations, radiographic features, operative findings, and surgical outcomes in 22 patients of PFETs treated surgically for a period of 15 years. The male to female ratio was 3 : 8 and the mean age of the pa-tients was 46 years. Results: Tumors varied in size from 20 to 59 mm (mean 29.6 mm). The most frequent location was the cerebellopontine angle (15 cases) and other locations included cerebellar vermis (2 cases), medulla (2 cases), petroclivus (2 cases), and 4th ventricle (1 case). Common clinical features were trigeminal neuralgia in 11 cases, cerebellar signs 7 cases, headache 5 cas-es, facial weakness or spasm 5 cases, and hearing disturbance 4 cases. Total and subtotal resections were achieved in 15 cas-es (68.2%) and seven cases respectively. The trigeminal neuralgia resolved in the 8 cases (72.7%), as well as the headache in all patients. Complications affected the cranial nerves included diplopia (13.6%), facial palsy (9.1%), dysphagia (4.5%), and facial paresthesia (4.5%). Three cases (13.6%) developed aseptic meningitis postoperatively. At the time of discharge, 15 patients (68.2%) were in excellent condition with complete improvement of the neurological abnormalities. Conclusion: Microsurgery is the only effective treatment for PFETs, and radical resection of the entire tumor including the capsule, whenever possible, generally results in a good outcome, with minimum recurrence rates.

3임상 : 정5개 이상 뇌전이암에 대한 정위 방사선 수술

저자 : 이원석 ( Won Seok Lee ) , 김영훈 ( Young Hoon Kim ) , 한정호 ( Jung Ho Han ) , 김재용 ( Chae Yong Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 16-22 (7 pages)

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Objectives: This study aimed to evaluate the therapeutic efficacy of stereotactic radiosurgery (SRS) for 5 or more brain metastases and find associated prognostic factors. Patients and Methods: Thirty-nine patients with 5 or more brain metastases were treated with SRS. The mean patient age was 57.1±13.8 years (range, 22-84), and 12 (30.8%) patients were male. The primary cancers were non-small cell lung cancer (NSCLC)(n=27), small cell lung cancer (n=2), breast cancer (n=3), gastrointestinal cancer (n=2), genito-urinary cancer (n=3), and sarcoma (n=2). The mean number of metastases was 11.0±6.5 (range, 5-33). The mean tumor volume was 0.76±2.09 cm3 (range, 0.002-15.40), and the mean marginal radiation dose was 19.20 Gy±2.83 Gy (range, 10-24) at a 54.26±9.12 % isodose line. Results: The median overall survival (OS) and progression-free survival (PFS) after SRS were 14.6 months (95% CI, 7.3-21.9) and 9.1 months (95% CI, 5.9-12.3), respectively. Local control failure occurred in 12 patients (30.8%), and distant disease progression developed in 8 patients (20.5%). In the multivariate analysis, primary NSCLC and Karnof-sky`s Performance Score (KPS) were significantly associated with OS (p=0.023 and 0.040, respectively). The early tu-mor response was the only independent prognostic factor (p=0.008) for PFS.  Conclusion: SRS was an effective treatment option for patients with 5 or more brain metastases, improving both OS and PFS in patients with multiple brain metastases.

4임상 : 상추체사대부 수막종 수술 후 삶의 질 평가

저자 : 김문석 ( Moon Seok Kim ) , 양승호 ( Seung Ho Yang ) , 김일섭 ( Il Sup Kim ) , 홍재택 ( Jae Taek Hong ) , 성재훈 ( Jae Hoon Sung ) , 손병철 ( Byung Chul Son ) , 이상원 ( Sang Won Lee )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 23-27 (5 pages)

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Objectives: This study was performed to assess the quality of life (QoL) of the patients with petroclival meningioma treat-ed with surgery with/without radiotherapy. Methods: From 2005 to 2010, 12 patients with newly diagnosed petroclival meningioma underwent surgery at a single in-stitution. The status of preoperative and postoperative (6 months) QoL was assessed using EORTC QLQ-C30 and Brain Cancer Module (BN20). Results: The most frequent preoperative symptoms were headache and dizziness. Total, subtotal, and partial resections were achieved in five, two, and five patients, respectively. Radiation therapy was performed in four patients with subtotal or par-tial resection. The postoperative complications were cranial nerve palsy (n=3), hemiparesis (n=2), and meningitis (n=2). Delayed hydrocephalus was found in two patients treated with additional radiosurgery. Motor dysfunction, bladder control, nausea/vomiting, dyspnea, insomnia, appetite loss, and constipation deteriorated and worsened the status of patients` QoL. However, headache, future uncertainty, and visual disorder improved. Conclusion: Postoperative QoL of the patients with petroclival meningiomas could be associated with surgery with/with-out radiation-related morbidity. Besides the treatment-associated morbidity and mortality rates, QoL issues should be eval-uated in the research of skull base tumors in the future.

5임상 : 22후두개와 혈관모세포종 ; 임상소견과 수술성적

저자 : 박정훈 ( Jung Hoon Park ) , 김일만 ( Eal Maan Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 28-32 (5 pages)

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Objectives: Surgical treatment of hemangioblastomas (HBs) is complicated by their vascularity and the occurrence in the posterior cranial fossa. The authors elucidate clinical presentations, radiographic features, and surgical results in pa-tients with infratentorial HBs. Methods: Thirty-six consecutive patients (22 males ; mean age 46.5 years) with 40 infratentorial HBs were retrospec-tively enrolled. All patients were examined neurologically, radiologically, and pathologically to ascertain the therapeutic results and recurrence rates. Among 36 patients, there were two Von Hippel-Lindau disease and others were sporadic. Results: The common symptoms before surgery were headache (53.0%), dizziness (42.0%), and vomiting (38.9%). On magnetic resonance images (MRI), 35 (87.5%) tumors were located in cerebellar hemisphere, 2 (5.0%) in cerebellar ver-mis, and 3 (7.5%) in the brain stem. Twenty-nine tumors (72.5%) were mainly cystic and the remaining were solid. The main feeding arteries were posterior inferior cerebellar arteries (PICAs) in twenty tumors (50%). Tumors were removed totally in 35 patients and subtotally in 1. Six patients (16.7%) showed a complicated postoperative course. Three patients (8.3%) required shunt surgery for obstructive hydrocephalus. Two recurrent tumor was notable 16 years and 5 years after surgery, respectively.  Conclusion: Most posterior fossa HBs can be safely resected based on the improved surgical planning by MRI and angi-ography. But, HBs involved brain stem still remains a challenging, with high rate of operative morbidity and mortality.

6임상 : 발생하수술 전 잘못 진단되었던 뇌하수체 선종과 터키안결절 뇌수막종 환자들의 영상학적 소견과 임상 양상에 관한 분석

저자 : 조진모 ( Jin Mo Cho ) , 김의현 ( Eui Hyun Kim ) , 김선호 ( Sun Ho Kim ) , 이규성 ( Kyu Sung Lee ) , 장종희 ( Jong Hee Chang )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 33-37 (5 pages)

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Objectives:Preoperative differentiation of the histologic etiology of masses involving the sellar and suprasellar region is very important because it determines the treatment modalities, surgical approaches, and the degree of resection. We ana-lyze the imaging findings and clinical symptoms of pituitary adenomas and tuberculum sellae meningiomas which preop-eratively diagnosed as each other falsely. Patients and Methods:Preoperative magnetic resonance images (MRI) and angiography findings of 14 patients with pathologically diagnosed as pituitary adenomas or tuberculum sellae meningioma which considered as each other were reviewed retrospectively. For all patients, the clinical history, laboratory data, MRI and results of ophthalmological ex-aminations were retrospectively reviewed. The following features, usually accepted as useful criteria in the differential diagnosis of these lesion were reviewed; Clinical Symptoms, hormonal deficiency, visibility of pituitary stalk, pattern of enhancement, presence of dural tail sign, presence of tumor brushing on the angiographic findings. Results:All findings except angiographic tumor brushing, were not consistent with each other. All patients presented with visual field defect and have no hormonal deficiency or symptoms. All lesions showed dura based one, no cleavage plane from the pituitary gland or stalk may be due to its large size, and homogeneous enhancement. There was no case of angi-ographic tumor brushing in pituitary adenoma patients. Conclusion:Differentiating pituitary adenoma and tuberculum sellae meningioma can be difficult. MRI is the most com-monly used method for diagnosis in these lesions. However, it is not sufficient for differential diagnosis for these lesions sometimes. Our results shows angiography finding could be a help to differentiate two pathologies. Preoperative cautious evaluation is essential and we think that angiography could be considered to differentiate two lesions.

7임상 : 연구에비소세포폐암의 뇌전이암에 대한 정위적 방사선 수술의 치료 효과

저자 : 이원석 ( Won Seok Lee ) , 김영훈 ( Young Hoon Kim ) , 한정호 ( Jung Ho Han ) , 김재용 ( Chae Yong Kim )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 38-44 (7 pages)

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Objectives: This study was performed to evaluate the therapeutic efficacy of stereotactic radiosurgery (SRS) for non-small cell lung cancer (NSCLC) brain metastases and to assess the associative factors for patients` survival.  Methods: Seventy-three consecutive patients with 387 brain metastases from NSCLC were treated with SRS. The mean age of patients was 61.9±11.7 years (range, 34-84), and 44 (60.3%) patients were male. The mean number of tumors was 5.3±6.6 (range, 1-33). The mean tumor volume was 1.38±3.60 cm3 (range, 0.01-25.40), and the mean marginal radiation dose was 19.37 Gy±2.98 Gy (range, 7.00-25.00) at 53.91±8.32 % isodose line.  Results: The median overall survival (OS) after SRS was 17.2 months (95% CI, 7.3-27.1), and the actuarial OS rate 54.4 and 40.3% at the first and second year, respectively. In the multivariate analysis, the Karnofsky`s Performance Score was the only independent prognostic factor (HR=2.942 ; 95% CI, 1.337-6.476 ; p=0.007) for OS. Local control failure occurred in 17 patients (23.3%), and distant disease progression developed in 19 patients (26.0%) at a mean follow-up duration of 11.3±8.6 months. Neurological deficits and early tumor response (≤1 month) were significant prognostic factors for disease progression.  Conclusion: SRS was an effective treatment option for patients with brain metastases from NSCLC. Initial status of pa-tients was the most important indicators for survival and disease progression after SRS for NSCLC brain metastases.

8증례 : kr빠른 진행을 보이는 역형성 다형성 황색성상세포종 -증례보고-

저자 : 구원모 ( Won Mo Gu ) , 유창영 ( Chang Young Yoo ) , 양승호 ( Seung Ho Yang ) , 성재훈 ( Jae Hoon Sung ) , 손병철 ( Byung Chul Son ) , 이상원 ( Sang Won Lee )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 45-48 (4 pages)

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A 42 year-old man presented with transient motor aphasia and memory impairment for 2 months. Magnetic resonance imaging
(MRI) with gadolinium showed a single enhanced mass in the left temporal lobe. The patient underwent gross total tumor resection under awake surgery with the frameless navigation system. Pathological diagnosis was pleomorphic xanthoastrocytoma (PXA) with anaplastic features. Immunohistochemical staining showed 12 mitoses per 10 high power fields and over 50% of the cells were Ki-67 immunoreactive. Postoperatively, local irradiation (60 Gy×40 days) began. Two weeks later, follow-up MRI showed rapid progression of tumor growth and huge perilesional edema. We report a case of primary anaplastic PXA with aggressive behavior despite surgical excision and irradiation.

9증례 : 례뇌하수체 선종과 동반되어 안상조에 발생한 지주막 낭종

저자 : 남경협 ( Kyoung Hyup Nam ) , 차승헌 ( Seung Heon Cha ) , 조원호 ( Won Ho Cho ) , 최병관 ( Byung Kwan Choi )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 49-52 (4 pages)

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Objectives: Arachnoid cysts are a relatively rare pathological entity, and a suprasellar arachnoid cyst is quite rare. We report on an extremely rare case of a suprasellar arachnoid cyst associated pituitary adenoma and discuss the possible pathogenesis.  Clinical Presentation: A 24-year-old man was admitted to the hospital with a history of headache, visual field defect, gait disturbance, syncope, and urinary incontinence. Computed tomography showed severe hydrocephalus. Preoperative magnetic resonance images revealed a mass lesion in the sella turcica with suprasellar extension and a coexisting large supra- and parasellar cyst. Transcranial surgery was performed for the removal of the tumor mass and cyst. Ventricle size normalized after the operation. He exhibited an uneventful recovery without neurologic deficits or endocrinologic abnor-malities.  Conclusion: We present clinical, radiological, and histopathological findings and discuss the possible pathogenesis of a suprasellar arachnoid cyst associated pituitary adenoma.

10증례 : 례부재성 안장증후군 양상의 터어키안 내부 지주막 낭종으로 인한 범뇌하수체 기능저하증의 수술적 치료 -증례보고-

저자 : 박준상 ( Jun Sang Park ) , 박익성 ( Ik Seong Park ) , 조광욱 ( Kwang Wook Jo )

발행기관 : 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 간행물 : 대한뇌종양학회지 11권 1호 발행 연도 : 2012 페이지 : pp. 53-56 (4 pages)

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Differentiating between empty sella syndrome (ESS) and isolated intrasellar arachnoid cysts (ISAC) in cases of panhypopituitarism is critical for determining appropriate treatment strategies. However, the radiological properties of these lesions are quite similar on computed tomography (CT) and magnetic resonance imaging (MRI). CT cisternography using radiopaque dye is a useful modality for identifying symptomatic ISAC without para- or suprasellar extension. We present a successful case of surgically treated symptomatic ISAC, which had been previously diagnosed and treated medically without improvement.

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