두개인두종에 대한 정위적 분할 방사선 수술 -증례보고-

이기택 ( Gi Taek Yee ),최광영 ( Gwang Young Choi ),최찬영 ( Chan Young Choi ),손문준 ( Moon Jun Shon ),이동준 ( Dong Joon Lee ),황금철 ( Gum Cheol Hwang ),황충진 ( Chung Jin Whang ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

A sixteen years old male patient was treated with the fractionated stereotactic radiosurgery(FSR) using Novalis system. The patient had surgery initially at other hospital before FSR and suffered from visual and endocrine dysfunctions which was required hormone replacement. Seven months after FRS, we found marked decrease of tumor volume. Now he is followed for 1 year. There is a still controversy regarding the ideal management of craniopharyngiomas. Radical resection is hazardous and can produce unacceptable mortality and morbidity. Many authors noted that postoperative conventional radiotherapy or Gamma knife radiosurgery after limited excision achieved better results than total excision of tumor for survival and postoperative complications. FRS delivered precise radiation to a target volume in close proximity to surrounding critical structures resulted in tumor regression. FRS using the relocatable mask frame may have a good role for adjuvant treatment of recurred or relapsed craniopharyngiomas.

체외충격파를 이용한 두부손상 모델에서 ¹H 자기공명 영상의 변화와 ^(31)P 자기공명분광법으로 관찰한 뇌의 고에너지 인 대사에 관한 실험적 연구

권양,황충진,최길수 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

The purpose of this study is to describe the ¹H MR imaging findings of focal brain injury by ESWL(Extracoporal Shock Wave Lithotripsy) and to evaluate the changes of high energy phosphate metabolism of the injury using ^(31)P MR spectroscopy. Spectral changes of high energy phosphate metabolites. including Pi(inorganic phosphate). PCr(phosphocreatine). and Adenosine Triphosphate(ATP) were monitored in both trauma(n=5) and control(n=5) groups over 8 hour period following injury. And 'H MR imagings were obtained to evaluate the focal cerebral lesions(n= 10) and compared with the gross and histologic findings of the specimen. The results were as follows : 1) In proton density-weighted MR images. focal areas of high signal intensity were seen in the cerebral hemispheres in S out of 8 traumatized cats(24KV. 500x shock wave). There were corresponding edematous changes in the white and gray matter and petechial hemorrhage in the cortex on gross and histopathologic studies. In 2 traumatized cats(24KV. 1000x shock wave). there were large hematomas in the cerebrum. 2) The decrease of brain pH was maximum in 30 minutes after ESWL injury in the trauma group(n=5) when compared with the control group, but statistical difference between two groups was insignificant. 3) In the trauma group. initial decrease of PCr/Pi was found in 30 to 60 minutes with return to control levels by 2 hour after injury(p<0.05). followed by a second decline in 4 hour that persisted for the remaining 5 hour observation period(p<0.05). 4) No significant changes in ATP concentration were observed during the experimental period. In conclusion, the changes seen above after focal brain injury using ESWL may be indicative of altered energy production, which may account for the reduced capacity of the cell to recover from traumatic injury.

정위적 방사선수술로 치료한 AOVM의 임상분석

권양,이정교,권병덕,이동준,황충진 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.4

In recent years, an increasing number of patient with AOVMs have been recognized using MRI. When an AOVM is located in a region associated with an unacceptable surgical risk, stereotactic radiosurgry offers an alternative treatment. We treated 21 patients with AOVM using gamma knife radiosurgery from June, 1990 to December, 1993 at Asan Medical Center. The indications for radiosurgery were as follows : 1) Patients who had episodes of hemorrhage from a lesion that had the characteristic images of AOVM in MRI. 2) Patients who had seizures and the focus of these seizures corresponded to the lesion. 3) Patients were excluded if the lesions were located superfically or were accessible to microsurgery. Nine patients presented with hemorrhages and twelve with seizures. The marginal dose was ranged from 10 to 25 Gy at or above the 50% isodose line. Of eight patients followed 12 months or less after radiosurgery, two patients had improved neurologic deficits and one had decreased the seizure frequency with mediciation. Among seven patients followed 12-24 months, MRI showed a reduction of the lesion in one patient and no change in five patients. One patient had perifocal edema. In two patients with seizures, one patient was seizure free without medication and one patient was controlled with medication. In six patients between 24 and 44 months, two patients had smaller lesions and three patients had perifocal edema. Among four patients who had seizures, one patient was seizure free without medication and three had decreased the seizure frequency with medication. Postoperative complications developed two patients, but one patient showed improvement of neurologic deficits after a short period of steroid medication. Stereotactic radiosurgery offers a treatment to a selective patients with intracranial AOVMs.

중추신경계 생식세포종양 : 13예의 임상 병리학적 분석 Clinicopathological analysis of 13 cases

최기영,공경엽,이정교,황충진,유은실,이인철 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

To elucidate the clinicopathological characteristics of the intracranial germ cell tumors, retrospectively examined were 13 cases that were histologically confirmed in Asan Medical Center between January 1990 and August 1992. Germ cell tumors of the central nervous system consisted of 10 cases of germinomas, one cases of endodermal sinus tumor, one embryonal carcinoma, and one mixed germ cell tumor(immature teratoma + choriocarcinoma + embryonal carcinoma). All the germinomas presented during the first three decades of life, and they were most common in the second decade with median age of 12 and were equally divided between the sexes. Germinomas were located almost exclusively in midline structures, particularly suprasellar area and/or pineal region. Occasionally, germinomas occured away from the midline in such sites as the thalamus or basal ganglia. in the suprasellar location the triad of diabetes insipidus, visual defect and hypopituitarism was typically produced. Cytological examinations of CSF or intraoperative aspiration were much useful in the diagnosis of germinomas. Histological features of the germ cell tumors were generally agreed with serum or CSF levels of tumor markers such as HCG, AFP and CEA. However, two of ten germinomas disclosed discrepency between them. Therefore, stressed was the importance of collective consideration for both tissue diagnosis and tumor marker studies. Most germ cell tumors responded to radiation therapy with or without adjuvant chemotherapy following initial surgical biopsy, at least for the short-term follow-up periods.

뇌하수체선종의 외과적 치료에 대한 임상적 분석

김정훈,김창진,권양,임승철,이정교,권병덕,황충진 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.4

From June, 1989 to December, 1993, 162 patients were diagnosed as a pituitary adenoma and treated by a surgical procedure. These patients were analyzed in terms of preoperative and postoperative hormonal level, grade, stage, size and treatment modalities. The results were as follows : 1) The ratio of male versus female was 1 : 2.1. Female was predominant in twenties and thirties and male in forties. 2) The incidence of prolactinoma was 37.6% and non-functioning adenoma 37.1%, acromegaly 16.0%, Cushing’s disease 5.6%. Marked female preponderence was noticed in prolactinoma and Cushing’s disease. 3) The incidence of microadenoma in Cushing’s disease was higher than the other tumor types. 4) The remission rate of prolactinoma was 54.1% and acromegaly 69.2%, Cushing’s disease 66.7% and it was not correlated with tumor type. 5) Preoperative hormonal level was not correlated with grade, stage and size. 6) In prolactinoma, the remission rate was correlated with grade, stage, preoperative prolactin level, but not with size. 7) In acromegaly, the remission rate was correlated with grade, stage, but not with size and preoperative growth hormone level. 8) In Cushing’s disease, the remission rate was not correlated with grade, stage, size and preoperative ACTH level. 9) The residual mass was noticed in 44.5% of patients and correlated with grade, stage and size. 10) The treatment modalities were surgery, surgery/bromocriptine, surgery/radiation therapy(including gamma knife surgery), surgery/bromocriptine/radiation therapy. Although surgery had the best treatment result, it had the lower preoperative hormonal level than the other treatment cases.