Role of Craniofacial Resection for Malignant Tumors Involving the Anterior Skull Base: Surgical Experience in a Single Institution

( You-sub Kim ),( Kyung-sub Moon ),( Gun-woo Kim ),( Sang Chul Lim ),( Kyung-hwa Lee ),( Woo-youl Jang ),( Tae-young Jung ),( In-young Kim ),( Shin Jung ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2015 Brain Tumor Research and Treatment Vol.3 No.2

Background Craniofacial resection (CFR) has been regarded as a standard treatment for various tumors involving the anterior skull base. The purpose of this study was to evaluate the results of CFR for the patients with anterior skull base malignancies in our hospital. Methods We retrospectively analyzed 17 patients with anterior skull base malignancies treated with CFR between 2001 and 2012. Mean follow-up duration was 41 months (range, 2-103 months). Results Intracranial involvement was found in 11 patients (65%) and orbital extension in 6 patients (35%). Classical bifrontal craniotomy was combined with endoscopic endonasal approach in 14 patients and external approach in 3 patients. Vascularized flap was used for reconstruction of the anterior fossa floor in 16 patients (94%). The most common pathological type was squamous cell carcinoma (6 patients). Gross total resection was achieved in all cases. Postoperative complications developed in 4 patients (24%) and included local wound problem and brain abscess. One patient with liver cirrhosis died from unexpected varix bleeding after the operation. Although postoperative treatment, such as radiotherapy or chemotherapy, was performed in 14 patients, local recurrence was seen in 6 patients. The mean overall survival time after the operation was 69.0 months (95% confidence interval: 47.5-90.5 months) with a 1-, 2-, and 5-year survival rate of 82.3%, 76.5%, and 64.7%, respectively. Postoperative radiotherapy was found to be the powerful prognostic factor for favorable survival. Conclusion Considering the higher local control rate and acceptable complication or mortality rate, CFR with adjuvant radiotherapy is a gold standard treatment option for malignant tumors involving anterior skull base, especially with extensive intracranial involvement.

The Korean Society for Neuro-Oncology (KSNO) Guideline for Adult Diffuse Midline Glioma: Version 2021.1

( Hong In Yoon ),( Chan Woo Wee ),( Young Zoon Kim ),( Youngbeom Seo ),( Jung Ho Im ),( Yun-Sik Dho ),( Kyung Hwan Kim ),( Je Beom Hong ),( Jae-Sung Park ),( Seo Hee Choi ),( Min-Sung Kim ),( Jangsup 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2021 Brain Tumor Research and Treatment Vol.9 No.1

Background There have been no guidelines for the management of adult patients with diffuse midline glioma (DMG), H3K27M-mutant in Korea since the 2016 revised WHO classification newly defined this disease entity. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for DMG since 2019. Methods The Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. As ‘diffuse midline glioma’ was recently defined, and there was no international guideline, trials and guidelines of ‘diffuse intrinsic pontine glioma’ or ‘brain stem glioma’ were thoroughly reviewed first. Results The core contents are as follows. The DMG can be diagnosed when all of the following three criteria are satisfied: the presence of the H3K27M mutation, midline location, and infiltrating feature. Without identification of H3K27M mutation by diagnostic biopsy, DMG cannot be diagnosed. For the primary treatment, maximal safe resection should be considered for tumors when feasible. Radiotherapy is the primary option for tumors in case the total resection is not possible. A total dose of 54 Gy to 60 Gy with conventional fractionation prescribed at 1-2 cm plus gross tumor volume is recommended. Although no chemotherapy has proven to be effective in DMG, concurrent chemoradiotherapy (± maintenance chemotherapy) with temozolomide following WHO grade IV glioblastoma’s protocol is recommended. Conclusion The detection of H3K27M mutation is the most important diagnostic criteria for DMG. Combination of surgery (if amenable to surgery), radiotherapy, and chemotherapy based on comprehensive multidisciplinary discussion can be considered as the treatment options for DMG.

The Korean Society for Neuro-Oncology (KSNO) Guideline for Antiepileptic Drug Usage of Brain Tumor: Version 2021.1

( Jangsup Moon ),( Min-sung Kim ),( Young Zoon Kim ),( Kihwan Hwang ),( Ji Eun Park ),( Kyung Hwan Kim ),( Jin Mo Cho ),( Wan-soo Yoon ),( Se Hoon Kim ),( Young Il Kim ),( Ho Sung Kim ),( Yun-sik Dho 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2021 Brain Tumor Research and Treatment Vol.9 No.1

Background To date, there has been no practical guidelines for the prescription of antiepileptic drugs (AEDs) in brain tumor patients in Korea. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for AED usage in brain tumors since 2019. Methods The Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of the keywords. Results The core contents are as follows. Prophylactic AED administration is not recommended in newly diagnosed brain tumor patients without previous seizure history. When AEDs are administered during peri/postoperative period, it may be tapered off according to the following recommendations. In seizure-naive patients with no postoperative seizure, it is recommended to stop or reduce AED 1 week after surgery. In seizure-naive patients with one early postoperative seizure (<1 week after surgery), it is advisable to maintain AED for at least 3 months before tapering. In seizure-naive patients with ≥2 postoperative seizures or in patients with preoperative seizure history, it is recommended to maintain AEDs for more than 1 year. The possibility of drug interactions should be considered when selecting AEDs in brain tumor patients. Driving can be allowed in brain tumor patients when proven to be seizure-free for more than 1 year. Conclusion The KSNO suggests prescribing AEDs in patients with brain tumor based on the current guideline. This guideline will contribute to spreading evidence-based prescription of AEDs in brain tumor patients in Korea.

The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade II Cerebral Gliomas in Adults: Version 2019.01

( Young Zoon Kim ),( Chae-Yong Kim ),( Chan Woo Wee ),( Tae Hoon Roh ),( Je Beom Hong ),( Hyuk-Jin Oh ),( Seok-Gu Kang ),( Shin-Hyuk Kang ),( Doo-Sik Kong ),( Sung Hwan Kim ),( Se-Hyuk Kim ),( Se Hoon 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2019 Brain Tumor Research and Treatment Vol.7 No.2

Background There was no practical guideline for the management of patients with central nervous system tumor in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has developed the guideline for glioblastoma. Subsequently, the KSNO guideline for World Health Organization (WHO) grade II cerebral glioma in adults is established. Methods The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords regarding diffuse astrocytoma and oligodendroglioma of brain in adults. Results Whenever radiological feature suggests lower grade glioma, the maximal safe resection if feasible is recommended globally. After molecular and histological examinations, patients with diffuse astrocytoma, isocitrate dehydrogenase (IDH)-wildtype without molecular feature of glioblastoma should be primarily treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy (Level III) while those with molecular feature of glioblastoma should be treated following the protocol for glioblastomas. In terms of patients with diffuse astrocytoma, IDH-mutant and oligodendroglioma (IDH-mutant and 1p19q codeletion), standard brain radiotherapy and adjuvant PCV (procarbazine+lomustine+vincristine) combination chemotherapy should be considered primarily for the high-risk group while observation with regular follow up should be considered for the low-risk group. Conclusion The KSNO’s guideline recommends that WHO grade II gliomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors and clinical characteristics of patients.

The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade III Cerebral Gliomas in Adults: Version 2019.01

( Young Zoon Kim ),( Chae-Yong Kim ),( Jaejoon Lim ),( Kyoung Su Sung ),( Jihae Lee ),( Hyuk-Jin Oh ),( Seok-Gu Kang ),( Shin-Hyuk Kang ),( Doo-Sik Kong ),( Sung Hwan Kim ),( Se-Hyuk Kim ),( Se Hoon K 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2019 Brain Tumor Research and Treatment Vol.7 No.2

Background There was no practical guideline for the management of patients with central nervous system tumor in Korea in the past. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisci-plinary academic society, developed the guideline for glioblastoma successfully and published it in Brain Tumor Research and Treatment, the official journal of KSNO, in April 2019. Recently, the KSNO guideline for World Health Organization (WHO) grade III cerebral glioma in adults has been established. Methods The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searches in PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords. Scope of the disease was confined to cerebral anaplastic astrocytoma and oligodendroglioma in adults. Results Whenever radiological feature suggests high grade glioma, maximal safe resection if feasible is globally recommended. After molecular and histological examinations, patients with anaplastic astrocytoma, isocitrate dehydrogenase (IDH)-mutant should be primary treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy whereas those with anaplastic astrocytoma, NOS, and anaplastic astrocytoma, IDH-wildtype should be treated following the protocol for glioblastomas. In terms of anaplastic oligodendroglioma, IDH-mutant and 1p19q-codeletion, and anaplastic oligodendroglioma, NOS should be primary treated by standard brain radiotherapy and neoadjuvant or adjuvant PCV (procarbazine, lomustine, and vincristine) combination chemotherapy. Conclusion The KSNO’s guideline recommends that WHO grade III cerebral glioma of adults should be treated by maximal safe resection if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors.

Genomic and Molecular Characterization of Brain Tumors in Asian and Non-Asian Patients of Los Angeles: A Single Institution Analysis

( Courtney Duong ),( Thien Nguyen ),( John P. Sheppard ),( Vera Ong ),( Lawrance K. Chung ),( Daniel T. Nagasawa ),( Isaac Yang ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2017 Brain Tumor Research and Treatment Vol.5 No.2

Background Worldwide, approximately 2% of new cancers are of the brain. Five-year survival rates among brain cancer patients have been reported as a little over a third. Differences in clinical outcomes between brain tumor patients of different races remain poorly understood. Methods A retrospective chart review was performed on brain tumor resection patients≥18 years old. Demographics, treatment variables, and survival outcomes were collected. Primary outcomes were length of stay, recurrence rate, progression-free survival (PFS), and overall survival (OS). Results A total of 452 patients were included in analysis. Females and males had nearly a 1:1 ratio (n=242 and n=220, respectively). Mean age was 54.8 years (SD: 14.5 range: 18-90). Females composed 69% (n=48) of Asian patients; males constituted 31% (n=22). Mean age of the Asian pa-tients was 55.9 years (SD: 14.6 range: 26-89). Asian-only cohort tumor pathologies included glioblas-toma (GBM) (n=14), high-grade glioma (n=7), low-grade glioma (n=4), meningioma (n=38), and metastases (n=7). Of the 185 meningioma patients, non-Asian patients comprised 79% of the group (n=146). Of the 65 GBM patients in total, non-Asian patients made up 89% of the GBM cohort (n=58). There were no statistically significant differences between these groups of both cohorts in recurrence (p= 0.1580 and p=0.6294, respectively), PFS (p=0.9662 and p=0.4048, respectively), or OS (p=0.3711 and p=0.8183, respectively). Conclusion Studies evaluating the survival between patients of different racial backgrounds against several tumor varieties are rare. Patients of certain racial backgrounds may need additional consider-ation when being attended to despite the same mutational composition as their counterparts. Repeated studies using national databases may yield more conclusive results.

The Korean Society for Neuro-Oncology (KSNO) Guideline for Glioblastomas: Version 2018.01

( Young Zoon Kim ),( Chae-Yong Kim ),( Jaejoon Lim ),( Kyoung Su Sung ),( Jihae Lee ),( Hyuk-Jin Oh ),( Seok-Gu Kang ),( Shin-Hyuk Kang ),( Doo-Sik Kong ),( Sung Hwan Kim ),( Se-Hyuk Kim ),( Se Hoon K 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2019 Brain Tumor Research and Treatment Vol.7 No.1

Background There has been no practical guidelines for the management of patients with central nervous system (CNS) tumors in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, started to prepare guidelines for CNS tumors from February 2018. Methods The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. Results First, the maximal safe resection if feasible is recommended. After the diagnosis of a glioblastoma with neurosurgical intervention, patients aged ≤70 years with good performance should be treated by concurrent chemoradiotherapy with temozolomide followed by adjuvant temozolomide chemotherapy (Stupp’s protocol) or standard brain radiotherapy alone. However, those with poor performance should be treated by hypofractionated brain radiotherapy (preferred)±concurrent or adjuvant temozolomide, temozolomide alone (Level III), or supportive treatment. Alternatively, patients aged >70 years with good performance should be treated by hypofractionated brain radiotherapy+concurrent and adjuvant temozolomide or Stupp’s protocol or hypofractionated brain radiotherapy alone, while those with poor performance should be treated by hypofractionated brain radiotherapy alone or temozolomide chemotherapy if the patient has methylated MGMT gene promoter (Level III), or supportive treatment. Conclusion The KSNO’s guideline recommends that glioblastomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to the individual comprehensive condition of the patient.

소뇌에 발생한 다형성 교모세포종 -증례보고-

이준국 ( Joon Kook Lee ),김창현 ( Chang Hyun Kim ),이호국 ( Ho Kook Lee ),최종훈 ( Jong Hun Choi ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1

Although glioblastoma multiforme(GBM) is the most common primary central nervous system(CNS) tumor, primary GBM which developed in the cerebellum has been rarely reported. We present a case of histopathologically proven cerebellar GBM in a 68-years-old woman. The clinical course was rapidly progressed like other GBMs, and suboccipital craniectomy with telovelar approach and gross total tumor removal was performed. Pathological diagnosis was a GBM. We describe about clinical presentation, radiologic differential diagnosis, and treatment with literature review.

다발성 원발 악성종양 및 다형성 교모세포증을 동반한 환자에서 발생한 원격 부상 신경교종 증후군 - 증례보고 -

최현준 ( Hyun Jun Choi ),최찬영 ( Chan Young Choi ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.2

It has been well known that postoperative hemorrhage can occur in the surgical bed, especially after incomplete resection of highly vascularized tumor, such as glioblastoma. A 55-year old female patient who has breast cancer and multifocal glioblastoma mimicking brain metastasis together showed postoperative hemorrhage in the surgical bed and spontaneous postoperative bleeding of remote tumor site, which was called distant wounded glioma syndrome. In multifocal glioblastoma, histological confirmation may be necessary to differentiate from brain metastasis, even in the presence of a known primary malignancy of other organ. Perioperative careful examination for patient’s coagulation system may also be necessary to prevent or treat distant wounded glioma syndrome

Lateral Ventricular Meningioma Presenting with Intraventricular Hemorrhage

( Ji Soo Moon ),( Seung Heon Cha ),( Won Ho Cho ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2019 Brain Tumor Research and Treatment Vol.7 No.2

A 35-year-old female visited emergency department for a sudden onset of headache with vomiting after management for abortion at local department. Neurological examination revealed drowsy mentality without focal neurological deficits. CT showed 3.2×3.4 cm hyperdense intraventricular mass with intraventricular hemorrhage. The intraventricular hemorrhage was found in lateral, 3rd, and 4th ventricles. MRI showed well enhancing intraventricular mass abutting choroid plexus in the trigone of the right lateral ventricle. CT angiography showed tortuous prominent arteries from choroidal artery in tumor. Her neurological status deteriorated to stupor and contralateral hemiparesis during planned preoperative workup. Urgent transtemporal and transcortical approach with decompressive craniectomy for removal of intraventricular meningioma with hemorrhage was done. Grossly total removal of ventricular mass was achieved. Pathological finding was meningotheliomatous meningioma of World Health Organization (WHO) grade I. The patient recovered to alert mentality and no motor deficit after intensive care for increased intracranial pressure. However, visual field defect was developed due to posterior cerebral artery territory infarction. The visual deficit did not resolve during follow up period. Lateral ventricular meningioma with spontaneous intraventricular hemorrhage in pregnant woman is very uncommon. We report a surgical case of lateral ventricular meningioma with rapid neurological deterioration for intraventricular hemorrhage.