출혈을 동반한 뇌종양 환자의 임상적 고찰

이원창,박동준,차승헌,송근성,최창화,이영우 釜山醫師會 2001 釜山醫師會誌 Vol.37 No.12

Stereotactic Radiosurgery for Intracranial Tumors

서창옥 (Chang Ok Suh),정상섭 (Sang Sup Chung),추성실 (Sung Sil Chu),김영수 (Young Soo Kim),윤도흠 (Do Heum Yoon),김선호 (Sun Ho Kim),노준규 (John Juhn Kyu Loh),김귀언 (Gwi Eon Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.1

연세대학교 의과대학 세브란스병원에서는 1988년 8월 10MV 선형 가속기를 이용한 방사선 뇌수술(radiosurgery, stereotactic external beam irradiation)을 시작한 이래 1991년 12월까지 총 24예의 두개강내 종양에 대하여 방사선 뇌수술을 시행하였다. 대상 환자들의 조직학적 유형은 뇌수막종이 5예, 두개인두종이 3예, 악성임파종이 1예, 전이성 뇌종양이 2예 있었다. 대상환자들은 몇가지 다른 질병상태에서 방사선 뇌수술을 받았는데, 10예는 뇌정위적 생검이나 신경방사선학적 영상만으로 진단을 한 후 일차적인 치료로 방사선 뇌수술을 시행했으며, 9예에서는 수술 후 잔류 종양에 대하여 방사선 뇌수술을 시행하였다. 또 3예에서는 방사선 치료후 재발한 종양에 대해 구제요법으로 시행하였고, 2예에서는 외부 방사선 조사와 함께 추가 방사선조사로써 시행되었다. 6개월 이상 추적 조사된 환자 16명 중에서 7명 (뇌수막종 2예, 신경교종 4예, 악성임파종 1예)이 CT Scan 또는 MRI상 종양의 완전 소멸을 보였고 나머지 9예는 모두 종양 크기의 감소를 보였다. 방사선 수술시 급성 부작용은 없었고 4예에서 만성 합병증이 나타났는데 3예에서 신경학적 증상의 발현과 함께 CT Scan상 뇌부종이 나타났었고 1예의 두개인두종에서는 방사선에 의한 시신경 손상으로 생각되는 시력 소실이 있었다. 저자들의 경험 예들은 조직학적 유형이 다양하고 증례수가 많지 않고 추적 조사 기간이 짧기 때문에 결론을 얻기 어렵지만 정위적 방법으로 종양에 다량의 방사선을 일시에 조사함으로써 완전 관해까지의 우수한 종양 제어효과를 얻을 수 있었다. 그러나 여러 가지 종류의 뇌종양의 치료에 있어서 방사선 뇌수술이 생존율 향상이나 삶의 질의 향상에 기여할 수 있는지를 알기 위해서는 더 많은 증례를 통하여 경험을 축적하여야 할 것이다. Between August 1988 and December 1991, 24 patients with intracranial tumors were treated with stereotactic radiosurgery (RS) using a 10 MV linear accelerator at Severance Hospital. Yonsei University College of Medicine. There were 5 meningiomas. 3 craniopharyngiomas. 9 glial tumors, 2 solitary metastases, 2 acoustic neurinomas, 2 pineal tumors. and 1 non-Hodgkin's lymphoma. Ten patients were treated as primary treatment after diagnosis with stereotactic biopsy or neuroimaglng study, Nine patients underwent RS for post-op. residual tumors and three patients as a salvage treatment for recurrence after external Irradiation, Two patients received RS as a boost followed by fractionated conventional radiotherapy. Among sixteen patients who were followed more than 6 months with neuroimage. seven patients (2 meningiomas, 4 benign glial tumors. one non-Hodgkin's lymphoma) showed complete response on neuroimage after RS and nine patients showed decreased tumor size. There was no acute treatment related side reaction. Late complications include three patients with symptomatic peritumoral brain edema and one craniopharyngioma with optic chiasmal injury. Through this early experience, we conclude that stereotactically directed single high doses of irradiation to the small intracranial tumors is effective for tumor control. However, in order to define the role of radiosurgery in the management of intracranial tumors. we should get the long-term results available to demonstrate the benefits versus potential complications of this therapeutic modality.

Diagnosis Value of Membrane Glycolipids Biochemistry Index in Intracranial and Gastrointestinal Tumors

Lv, Jun,Lv, Can-Qun,Mei, Ping,Qi, Shi-Mei Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.7

The diagnostic value of membrane glycolipid biochemistry index, the lipid-bound sialic acid (LSA) and total sialic acid (TSA) in cerebrospinal fluid (CSF) was evaluated in 30 intracranial and 65 gastrointestinal tumors. The plasma LSA, TSA and red cell membrane sialic acid (R-SA) in were determined according to the method of Sevenmerhulm. Our results showed that the levels of LSA and TSA in CSF of intracranial tumor patients was higher than that of normal group(p<0.01). The concentration of TSA and LSA in patients with malignant glioma was higher than that of benign meningioma patients(P<0.01). No significance was found between intracranial halmatoma patients and normal control group for levels of membrane glycolipids (p>0.05). Results also found that the plasma LSA, TSA and R-SA of gastric carcinoma were significantly higher than those of control group (p<0.05); while no significant difference was found in the plasma LSA, TSA and R-SA levels between chronic gastritis, gastrohelcoma and normal control group (p>0.05). Plasma LSA, TSA and R-SA levels of gastric carcinoma patient were significantly higher than those of chronic gastritis patients and gastrohelcoma patients(p<0.05). It was also found that plasma LSA, TSA and R-SA contents were significantly higher in large intestine carcinoma patients than in benign in stestine tumor patients (p<0.05) while no significant difference was found between intestine benign tumor and normal control group (p>0.05). The levels of LSA, TSA and R-SA were obviously higher in the patients with metastasis than in the ones without (p<0.05.) The membrane glycolipid biochemistry index LSA and TSA in CSF are sensive markers for diagnosing intracranial tumors. For gastrointestinal malignant tumors the plasma LSA TSA and red blood cell membrane SA may be considered as auxiliary indicators for diagnosis. They can be used for distinguishing benign from malignant tumors.

송과선 및 이소성 송과선 생식세포종의 감마 나이프 수술 후 재발 양상

조흥래(Heung Lae Cho),손승창(Se ung Chang Sohn) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.2

목 적 :본 연구의 목적은 뇌 생식 세포종 환자들의 방사선치료 시 가장 적절한 조사 영역을 알아보고자 시행하였다. 대상 및 방법 : 1993년부터 1998년 까지 뇌 생식세포종으로 진단되거나 또는 추정되어 감마 나이프를 시행 받은 환자 19 명을 대상으로 분석하였다. 송과선 9예, 안상(suprasellar) 1예, 그 외 2군데 이상 다발성 병소가 9예였다. 조직이 확인이 된 예는 7예이었고 배아종(germ cell tumor)이 5명, 내배엽동종(endodermal sinus tumor)이 2명이었다. 종양의 부피는 2.4 cm3부터 74 cm3 까지 이었다. 감마나이프 방사선 치료는 50% 등선량 곡선을 중심으로 10 Gy부터 20 Gy에 걸쳐 조사되었다. 추적 기간은 10개월에서부터 54개월까지였다. 결 과 :총 19명 중 14명(74%)에서 재발을 하였다. 완전 관해와 부분 관해는 각각 2명(11%), 10명(53%)이었다. 무반응은 7명(36%)이었다. 원발 병소가 있었던 자리에서 재발한 경우가 2예, 치료 조사영역을 벗어났으나 원발 병소와 연결되어서 그 주위로 재발한 경우가 6예 이었다. 원발 병소와 떨어져서 뇌실 재발이 된 경우 3예, 척수 전이가 된 경우가 4예 이었다. 종양의 부피가 20 cm3 이하인 경우는 8예이었으며 이중 2예는 치료 조사영역 내에서만 재발한 경우, 4예는 원발 병소와 연이어져서 치료 부위 주위로 재발한 경우, 1예는 척수 전이된 경우이었다. 종양의 부피가 20 cm3 보다 큰 경우는 6예 이었으며 그 중 원발 병소와 연이어져서 치료 부위 주위에 재발한 경우 1예, 원발병소와 떨어져서 뇌실 전이가 된 경우가 2예, 척수 전이를 일으킨 경우가 3예였다. 재발을 하지 않은 5예는 종양의 부피가 20 cm3 이하인 경우이고 모두 단일 병소이며 종양지표가 모두 정상이었다. 척수 전이는 4예(21%)에서 발생하였으며 모두 뇌실 침범이 있는 경우에 발생하였다. 총 9명의 다발성 병소 중 국소 재발만을 한 경우는 3경우이었고 나머지는 모두 치료 조사영역을 벗어나 원발 병소와 떨어져서 재발하였다. 결 론 :감마 나이프 치료가 뇌 생식세포종에 대한 치료로서는 부적절한 치료이며 이것은 감마 나이프의 특성인 작은 치료 용적과 조사 선량의 부적절함에서 기인하는 것으로 판단된다. 뇌 생식 세포종에서 병소 부위 만을 치료하는 경우 종양의 부피와 다발성 병소의 뇌실 침범 유무가 치료 성공의 열쇠이다. 20 cm3 이하, 단일 병소, 뇌실 침범이 없는 경우, 정상적인 종양지표, 등이 가장 이상적인 적응증이 될 수 있다. 다발성 병소에서 뇌실 침범이나 뇌실 병소가 있을 경우는 예방적 뇌 척수 조사를 고려해야 할 것으로 생각된다. 병소의 크기가 20 cm3 보다 클 경우, 다발성 병소인 경우, 종양지표의 증가가 있는 경우에는 확정적인 제안을 하기는 어렵지만 전 뇌실 조사 또는 부분방사선 조사가 시도될 수 있을 것으로 생각되며 이 경우가 선행 화학 요법과 함께 치료할 수 있는 대상이며, 앞으로 이 부분에 대한 연구가 계속 이루어질 것으로 생각된다. Purpose :This study was performed to determine the optimal treatment volume of patients treating with adiation therapy for intracranial germ cell tumor. Materials and Methods : From 1993 to 1998, 19 patients with intracranial germ cell tumors treated by gamma knife radiosurgery were analyzed. The location of tumor was as follows; 9 cases on pineal region, 1 case on suprasellar region, and 9 cases of multiple lesion. 7 patients were pathologically verified; 5 cases of germ cell tumor and 2 cases of non germinomatous germ cell tumor. Tumor volume was ranged from 2.4 cm3 to 74 cm3 . Irradiation dose was 10 Gy to 20 Gy with 50% isodose curve. Follow up period was 10 months to 54 months. Results : Recurrences were observed in 14 cases among 19 (74%) patients. Complete remission and partial remission were achieved in 2 (11%) and 10 (53%) respectively. No response was observed in 7 (36%). 2 cases were recurred within original tumor bed. 6 cases were recurred beyond but contiguous with tumor bed. Ventricular relapses separated from pretreatment tumor bed were 3. Spinal recurrences were 4. Among 8 recurred cases of which tumor volume is smaller than 20 cm3 , 2 were recurred within original tumor bed, 4 were recurred beyond but contiguous with tumor bed, and 1 spinal recurrence. Meanwhile, 6 cases of which tumor volume larger than 20 cm3 , 1 case was recurred beyond but contiguous with tumor bed, 2 ventricular recurrences separated with original tumor bed, and 3 spinal recurrences. 5 cases which did not show any recurrence sign showed characteristics of single lesion, tumor volume smaller than 20cm3 and normal tumor marker. All of 4 cases of spinal recurrences happened in the case having ventricular invasion or lesion. Among 9 cases having multiple lesion, only 3 cases recurred within original tumor bed or around tumor bed, the other 6 cases recurred separated from pretreatment tumor bed. Conclusion :Gamma knife radiosurgery is not recommended for the treatment of intracranial germ cell tumor. It is because of small treatment volume and inadequate radiation dose that are characteristics of gamma knife radiosurgery. Tumor volume, ventricular invasion or ventricular lesion in multiple lesion are important factors to be considered for the wide field radiation therapy. Tumor volume smaller than 20 cm3 , single lesion, no ventricular lesion or invasion, and normal tumor marker are ideal indications for small involved field radiation therapy. Prophylactic spinal irradiation seems to be necessary whn there is ventricular lesion, ventricular invasion, and multiple lesions. When the tumor volume is larger than 20 cm3 , multiple lesions, abnormal tumor marker, and whole ventricular irradiation or partial brain irradiation would be possible and neoadjuvant chemotherapy would be most beneficial in these group.

두개강내 낭성 뇌종양의 임상분석

이동훈,이영우 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.10

낭성 두개내 종양은 일반적으로 고형성 종양보다 예후가 좋으며, 여러 인자들이 예후 결정에 관여하는데 종양의 조직형태, 환자의 연령, 치료전 전신상태, 수술 적출량, 방사선투사량 등의 여러 인자가 있다. 저자는 최근 3년간에 걸쳐 체험한 전형적인 두개강내 낭성 종양 20례를 분석 고찰한바 다음과 같이 요약할 수 있었다. 1) 연령 분포는 5세에서 71세 사이로 다양하게 분포하였으며 관찰대상 20례중 남자가 12례, 여자가 8례였다. 2) 내원 당시 주요 증상은 두통, 오심, 구토, 운동장애, 간질, 시력장애, 의식장애 등이였다. 3) 관찰대상 20례중, 조직병리학적 검사결과 성상세포종 6례, 상의세포종 3례, 수아세포종 2례, 두개 인두종 2례, 혈관모세포종 2례, 해면양 혈관종 2례, 배아세포종 1례, 희돌기교세포종 1례, 뇌수막종 1례로 확진 되어졌다. 4) 치료방법으로는 수술적 치료에다 방사선치료, 항암요법을 각자 또는 병용하여 시행하였다. 5) 치료결과는 20례중 13례에서 이상의 치료로서 상당히 양호한 결과를 얻었으나 4례에서는 불량한 결과를 얻었다. 6) 수술 합병증으로 뇌부종이 3례에, 두개강내 출혈이 1례에 있었고 발생하여 이들 4례 모두가 불량한 결과를 보였고, 3례에서는 폐렴, 폐울혈 등 호흡기 합병증이 발병했고, 4례에서는 요로감염이 발생했다. 7) 추적조사결과에서 뇌종양이 재발되어 1년 6개월만에 재수술을 받았으며, 술후 악화되었던 1례에서 운동장애 및 의식장애 있었으나 치료후 약간의 호전을 보였으며, 1례에서는 전신상태의 악화로 1년후 사망하였다. In general, intracranial cystic tumors have better prognosis compared with intracranial solid tumors. There are many factors that determine the prognosis such as histopathological type, age of patient, preoperative condition, operative technique and radiothreapy. The author presents the results of treatment of intracranial typical cystic tumor that observed in recent 3 years. The results obtained in 20 cases were as follows : 1) Age distribution was varied to be 5-71 years, and among the 20 cases 12 cases were male and 8 cases female. 2) Chief complaints were headache, nausea, vomiting, motor weakness, seizure disorder, visual disturbance and decreased consciousness level. 3) Histopathological findings in the 20 cases were astrocytoma in 6 cases, ependymoma in 3 cases, medulloblastoma in 2 cases, craniopharyngioma in 2 cases, hemangioblastoma in 2 cases, cavernous angioma in 2 cases, meningioma in 1 case, oligodendroglioma in 1 case and germinoma in 1 case. 4) Therapeutic methods were resection of tumor mass, radiotherapy and chemotherapy, and/or combination. 5) At therapeutic results, 13 cases had good outcome, but 4 cases had poor prognosis. 6) Postoperative complications were brain edema in 3 cases, intracrainal hemorrhage in 1 case, pneumonia in 3 cases, and urinary infection in 4 cases. 7) At follow up studies, one case had recurrence and the reoperation was made for removal of mass at 1.5 years after primary resection.

복수의 두개내 원발성 종양 - 증례 보고 -

조태구,신형진,홍승철,박관,서연림,김종현 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.7

소아의 소뇌교각 종양

조병규,왕규창,김현집,심보성,최길수 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.4

From 1957 to June 1987, authors experienced 8 cases of pediatric brain tumor located in the cerebellopotine angle(CPA) which were operated upon at the Department of Neurosurgery of Seoul National University Hospital. The proportion of the pediatric CPA tumors in the total pediatric brain tumors was 4%(8/197), and that in the pediatric posterior fossa tumors was 8%(8/100). The pathologic diagnoses of the 8 cases were ependymoma (2 cases), medulloblastoma (2 cases), astrocytoma (1 case), primitive neuroectodermal tumor (1 case), trigeminal schwannoma (1 case) and Masson's hemangioendothelioma (1 case). The proportion of CPA location in the posterior fossa ependymomas was 13% (2/16), and those of the posterior fossa medulloblastomas and astrocytomas were 4% (2/50 and 1/28, respectively). The initial presentations were symptoms of increased intracranial pressure in 5 cases, and those of cranial nerve dysfunction in 3 cases. On admission, all of 8 cases showed signs of increased intracranial pressure and among the cranial nerve dysfunctions, facial nerve dysfunction was most common (5 cases). It seemed that it was due to close relationship between these tumors and fourth ventricle, and the patients' age which was too young to complain of subtle subjective sensory dysfunctions. The operative findings showed medial displacement and compression of the cerebellum, brain stem and cranial nerves, enlargement of surrounding subarachnoid space or arachnoid cyst formation, tumor growth into the cranial nerve canals, and encasement of nerves or vessels by the tumor. The sites of origin were lateral recess of fourth ventricle in 4 cases (2 ependymomas and 2 medulloblastomas), and surrounding brain tissue in the other 2 glioma cases. And a representative case was presented.

CASE REPORT : A Case of Giant Skull Base Chondroma

( June Young Heo ),( Sung Jin Cho ) 대한뇌종양학회 대한신경종양학회 2014 Brain Tumor Research and Treatment Vol.2 No.2

Intracranial chondroma is a rare benign tumor. Here, we present the case of a 29-year-old female who was afflicted with left eye blindness and ptosis. Brain computerized tomography and magnetic resonance imaging revealed the presence of a giant calcified mass accompanied by a solid mass in the middle and posterior fossa. A differential diagnosis regarding chordoma, chondrosarcoma, and other chondroid tumors based on radiologic information was inconclusive. The lesion was resected completelyunder a microscope using a combined pterional and subtemporal approach. The pathologic report confirmed the diagnosis of chondroma. No evidence of neurological worsening was observed. The tumor had a calcified mass with mature hyaline cartilage surrounded by a thick fibrous capsule. We dissected the periphery of the tumor mass and removed it via aspiration. It was readily distinguished from normal brain parenchymal tissue. The large calcified mass at the center of the tumor had relatively high vascularity, and a high-speed drill and various rongeurs were used to remove the tumor.

뇌종양과 동반된 뇌동맥류 3례 : Report of Three Cases

정영선,김민호,한동환,심기범,홍승관 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.11

Thr authors present three cases of intracranial aneurysm associated with brain tumors. Two cases were unruptured intracranial aneurysms(one was located at the origin of anterior choroidal artery of right internal carotid artery and the other at the bifurcation of right middle cerebral artery), which were found incidentally during the transcranial approaches to pituitary adenoma and right frontal glioblastoma multiforme respectively. As preoperative angiography was not performed in those cases, there was some difficulty in clipping the neck of the aneurysms. The third case presented with sudden headache and vomiting, and her brain computed tomography, magnetic resonance imaging and cerebral angiography showed subarachnoid hemorrhage, five anterior and one posterior circulation aneurysms as well as a pituitary adenoma. The patient refused the operation. It is well known that some brain tumors, such as pituitary adenoma, glioma, meningioma, are often associated with intracranial aneurysms. In planning the treatment of those brain tumors, preoperative angiography seems essential to know the status of the vessels adjacent to the tumors and to rule out incidental aneurysms.

CT를 이용한 뇌정위외과술의 합병증과 종양생검의 정확성에 대한 분석 : Its Complications and Diagnostic Accuracy of Biopsy

김종현,이승훈,이창훈 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

Surgical resection may not be the appropriate first treatment for all intracranial mass lesions, especially for deep or midline lesions. And a precise histopathological diagnosis is mandatory to develop adequate and specific treatments. The advent of modern imaging and CT-compatible stereotactic frames has greatly simplified the performance of stereotactic procedure for small and deep seated brain tumors. We present a 44-month experience on 94 stereotactic procedures of intracranial mass lesions, using Brown-Roberts-Wells(BRW) and Cosman-Roberts-Wells(CRW) systme. Procedures were undertaken with the patient under the local anesthesia for biopsy(78 precedures), cyst aspiration and/or Ommaya reservoir insertion(9 procedures), and brachytherapy(5 procedures) and under the general anesthesia for stereotactic-guided microsurgery(2 procedures). Procedural objectives were satisfactorily accomplished with no mortality and an overall complication rate of 8.5%(8 of 94 procedures). The postoperative complications were transient and not serious, except aggravation of obstructive hydrocephalus in two cases of lateral ventricular tumors. Specific and correct histological diagnoses were achieved in 73(94%) of 78 biopsy. We could not obtain a specific diagnosis in 3 cases (2 cases of reactive gliosis, 1 case of necrosis). And in two cases with diagnosis of anaplastic astrocytoma and oligodendroglioma grade Ⅰ on the bases of surgical specimens by craniotomy, stereotactic biopsy revealed astrocytoma grade Ⅱ and nonspecific inflammation respectively. Our data suggest that CT-guided stereotactic biopsy is a reliable and safe method for histologic diagnosis of brain-tumoral conditions and the method of choice for deep-seated and midline lesions.