Glioblastoma의 치유를 찾아서(Looking for the cure of Glioblastoma)

곽호신 생화학분자생물학회 2011 생화학분자생물학회 소식 Vol.31 No.4

Recent Advancements of Treatment for Leptomeningeal Carcinomatosis

곽호신,Sang Hyun Lee,박원서,Sang Hoon Shin,유헌,이승훈 대한신경외과학회 2015 Journal of Korean neurosurgical society Vol.58 No.1

Treatment of Leptomeningeal carcinomatosis (LMC) from solid cancers has not advanced noticeably since the introduction of intra-cerebrospinal fluid (CSF) chemotherapy in the 1970’s. The marginal survival benefit and difficulty of intrathecal chemotherapy injection has hindered its wide spread use. Even after the introduction of intraventricular chemotherapy with Ommaya reservoir, frequent development of CSF flow disturbance, manifested as increased intracranial pressure (ICP), made injected drug to be distributed unevenly and thus, the therapy became ineffective. Systemic chemotherapy for LMC has been limited as effective CSF concentration can hardly be achieved except high dose methotrexate (MTX) intravenous administration. However, the introduction of small molecular weight target inhibitors for primary cancer treatment has changed the old concept of ‘blood-brain barrier’ as the ultimate barrier to systemically administered drugs. Conventional oral administration achieves an effective concentration at the nanomolar level. Furthermore, many studies report that a combined treatment of target inhibitor and intra-CSF chemotherapy significantly prolongs patient survival. Ventriculolumbar perfusion (VLP) chemotherapy has sought to increase drug delivery to the subarachnoid CSF space even in patients with disturbed CSF flow. Recently authors performed phase 1 and 2 clinical trial of VLP chemotherapy with MTX, and 3/4th of patients with increased ICP got controlled ICP and the survival was prolonged. Further trials are required with newly available drugs for CSF chemotherapy. Additionally, new LMC biologic/pharmacodynamic markers for early diagnosis and monitoring of the treatment response are to be identified with the help of advanced molecular biology techniques.

시상부위에 발생한 단일성 뇌농양 : 증례 보고 및 문헌고찰 Report of Two Cases and Review of the Literature

곽호신,김동규,이상형,정희원,이현구,김현집,한대희 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

The authors present two cases of solitary thalamic abscess which were intially diagnosed as malignant thalamic glioma. After treatment with steroids and osmotic agents, the patients' clinical conditions improved after two to three days. However, sudden deterioration of consciousness level developed and the CT scan showed acute hydrocephalus with increment of thalamic low-density lesions. We performed extraventricular drainage and obtained CSF containing numerous inflammatory cells. This suggested the possibility that the lesion was a pyogenic abscess. which progressed to ventriculitis, rather than a malignant glioma. Stereotactic aspiration of the lesion confirmed thalamic abscess. These findings and review of previous reports of thalamic abscess suggested that early diagnosis and stereotactic drainage of the thalamic abscess is of primary importance.

삼차신경통과 반측 안면 경련에 대한 미세혈관 감압술의 단기성적

곽호신,정천기,김현집,오창환,정영섭,김동규,정희원,최길수,한대희 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.4

The result of microvascular decompression (MVD) in 105 consecutive cases is presented. The symptomatic vasculoneural compressions including tumor, vascular malformation, or aneurysm are excluded in this study group. The 41 patients with trigeminal neuralgia (TN) were all treated by posterior fossa exploration (PFE). Eighteen of them were treated with MVD only, another 14 with partial sensory rhizotomy (PSR) only, and in the other 9 patients, MVD and PSR were performed together. Sixty-two of 64 hemifacial spasm (HFS) cases were treated succesfully with MVD via PFE. However in one case of which the offending vessel was not identified, neurolysis was camed out. The other case who had both TN and HFS, died due to intraoperative cardiac arrest The result of operation was evaluated at one month after the operation. In TN, among thirty-nine (98%) patients who resulted in pain-improvement, 32 (82%) experienced complete resohition of the pain.,The rate of complete pain-relief was higher in the 'MVD only group' than in 'group with PSR': Amomg 62 (94%) cases of HFS, 29 (47%) patients obtained 'complete cure' and 'improvement-only' respectively only 4 (6%) patients had no change of the spasm. The preoperative clinical characteristics, intraoperative surgical fingdings and postoperative outcomes were itemized and analyzed to find out the prognostic factors. The our results are compared with others in the literature.

장기 생존한 교모세포종 환자의 예후인자 분석

곽호신,황승균,김정은,백선하,김동규,정희원 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.31 No.1

Objectives:The authors analyze the clinical characteristics of the long-term survivors and elucidate the biological factors responsible for long-term survival. Methods:The 166 cases of histologically confirmed glioblastoma from Jan 1983 to Aug 1999 were included. Medical records and radiological findings were reviewed to analyze age, performance status, location and number of the tumor, the amount of peri-tumoral edema, the extent of surgical resection and history of radiation and/or chemotherapy. The overall survival was 13.6 months and the 1-year survival rate was 59%. The thirteen patients(6.9%), lived more than three years after diagnosis, defined as the long-term survivors. Results:Performance status(KPS≥70), number of masses(single with no CSF seeding), and hemispheric location(not involving basal ganglia and/or brain stem) showed favorable influence on the patient survival in univariate analysis. Also post-operative radiation and chemotherapy resulted in significant improvement of the survival. However, in multivariate analysis, age(under 40 years) was the most significant prognostic factor. All the other factors which was significant in univariate analysis except the location of the tumor, also verified as significant prognostic factors in multivariate analysis. The long-term survivors had at least more than five out of seven significant prognostic factors in multivariate analysis. And these factors occurred more frequently and showed significances in the long-term survivors than the other patient group except the debulking surgery. Conclusion:The age at the diagnosis and invasiveness resulted in multiple tumor and/or CSF seeding were the most significant prognostic factors. Key words:Glioblastoma;Long-term survivor;Age;Multifocal tumors.

음성 데이타 처리를 위한 데이타베이스 검색 언어의 설계 및 구현

곽호신,박영배 명지대학교 공학기술연구소 1990 공학기술연구소 논문집 Vol.5 No.-

Various problems of speech database system were discussed and a new logical structure of speech database was presented. To handle the speech data, variable length data must be processed as well as fixed length data. A new retrieval language for speech data was presented. This query style language can be used to analyze speech, and the embedded retrieval language retrieve phonemes of arbitary speech pattern. The tool was implemented using C Language on IBM-PC/386 and could be used for speech data retrieval.

척수내 원발성 교세포종의 수술성적과 그 관련인자에 대한 고찰 : Analysis of Related Factors

곽호신,정천기,김현집,조병규,최길수,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.8

Presented below are the author s report of the result of surgical treatment of 53 intramedullary gliomas. In the anaysis of survival data. twenty patients with low grade glioma(except the ependymoma) were followed for a period of mean 54 months, from 1 to 103 months. Five of these patients had died from progression of the disease and the 5 year survival rate was 75%. Nine pateints from the above group recieved postoperative radiation therapy.6 with no apparent benefit in terms of survival rate. The median survival of thirteen patients with high grade glioma patients were 11 months and there were signficant increase of median survival time in patients recieving radiation therapy, from 4 to 17 months(P=0.04) The histological grade is the important factor in determining the survival of glioma pateints(P=0.01). In sixteen, out of 20 ependymoma patients, radical removal(>95%) was achived and the patients showed no signs of recurrence until the mean follow-up period of 42 months. Two of the 4 ependymoma patients, whose tumors were partially removed, suffered recurrence and had to be re-operated. We concluded that the radical removal in epndymomas is a significant factor in determining recurrence(P=0.009). The effect of radical removal on survival is not verified statistically. Total removal is more frequently performed in ependymomas than in gliomas(p=0.03). As to functional outcome, better outcome is expected in radical removal on long-term follow-up(p=0.00506)). more so in ependymoma than in glioma. lntramedullary gliomas are extremely rare Therefore sufficient data is unavailable for the determination of efficient treatment plan. However, recently, aggressive surgical treatment with the aid of microsurgical techniques has become a trial option.

뇌실외 배액 후 출혈한 수아세포종 : 증례보고 Report of 2 Cases

곽호신,정영섭,왕규창,조병규,한대희 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.4

The authors experienced 2 cases of medulloblastoma in which active hemorrhage occurred after external ventricular drainage(EVD). A 5 yeardd girl suffered from cerebellar fit and brain CT Scan showed severe hydrocephalus. So EVD was performed and the pressure was measured about 80cm H2O. After a gradual reduction of EVD pressure for 15 minutes, fresh blood gushed out through the EXD catheter. The other case was a 7 year-old girl whose tumor bled after intraoperative EVD, just before dural incision. Both tumors were highly vascular in operative field. The first case was ;)ed-ridden at 5 months after surgery and the second case was on postoperative chemotherapy in a good general condition with minimal neurological deficits. Previous reports in the literatures including 2 cases of hemorrhage associated with EVD in medulloblastoma were reviewed The relatively high incidence of tumor hemorrhage in medulloblastoma and its detrimental influence on the outcome are emphasized

Lumboperitoneal Shunt Combined With Ommaya Reservoir Enables Continued Intraventricular Chemotherapy for Leptomeningeal Metastasis With Increased Intracranial Pressure

우병준,곽호신,권지웅,신상훈,유헌 대한뇌종양학회 2022 Brain Tumor Research and Treatment Vol.10 No.4

Background : Intra-cerebrospinal fluid (CSF) chemotherapy for leptomeningeal metastasis (LM) can be delivered intraventricularly via an Ommaya reservoir. However, hydrocephalus associated with LM can interfere with chemotherapeutic drug distribution, and ventriculoperitoneal shunts can prevent drug distribution to the extra-ventricular CSF space. This study examined the feasibility of combining a lumboperitoneal (LP) shunt with an Ommaya reservoir to both control intracranial pressure and allow for intraventricular chemotherapy. Methods: We identified 16 patients with LM who received both an Ommaya reservoir and an LP shunt, either concurrently or sequentially, and subsequently received intraventricular chemotherapy. The feasibility of this combination for intraventricular chemotherapy was evaluated by assessing 1) the distribution of intraventricularly injected drugs in CSF samples collected 0, 6, and 12 h post-injection and 2) adverse events associated with the procedure and drug administration. Results: Patients received a median of seven rounds (range 1–37) of intraventricular chemo- therapy during a median follow-up period of 5.2 months after LP shunt insertion. Pharmacokinetic data were obtained from six patients. Baseline methotrexate (MTX) levels from Ommaya reservoirs var- ied from 339.9 µM to 1,523.5 µM. CSF sampled from LP shunt reservoirs revealed an elimination half- life (t1/2) of 2.63 h, and the mean ratio of MTX concentration at 12 h to that at baseline was 0.05±0.05, ensuring drug distribution from the ventricle to the spinal canal. Nine patients (56%) underwent revision surgery due to catheter migration, malfunction, or infection. Among these patients, CSF infections at- tributable to intraventricular chemotherapy (n=3) occurred, but no infections occurred in later cases af- ter we began to employ a complete aseptic technique. Conclusion : LP shunt combined with Ommaya reservoir insertion is a feasible option for achiev- ing both intracranial pressure control and the continuation of intraventricular chemotherapy in patients with LM

비정형성 및 악성 뇌수막종의 임상분석 : 52례 연구

박홍준,곽호신,황승균,김정은,이상형,정희원,김동규,조병규,Park, Hong-Jun,Gwak, Ho-Shin,Hwang, Sung-Kyun,Kim, Jeong Eun,Lee, Sang Hyung,Jung, Hee-Won,Kim, Dong Gyu,Cho, Byung-Kyu 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9

Objective : Atypical and malignant meningiomas(AM, MM) are known to be rare and show aggressive behavior. Limited data are available concerning the clinical features, effectiveness of surgical removal and role of radiation therapy with AM, MM. The authors report our experience of AM, MM, with respect to clinical features. Methods : Twenty-four cases of AM and 28 cases of MM, who were operated between 1988 and 1999 were retro-spectively studied review of medical records and radiological findings. These were compared with control group of 24 cases of menigiomas manifestating usual clinical course, which are selected arbitrarily among operative cases between Apr. 1999 and Dec. 1999. Mean follow-up periods were 26(1-91) months for AM and 23(1-62) for MM. Authors analyzed the prognostic factors for survival, and statistical analysis were accomplished by Kaplan-Meier method and log-rank test. Results : Differences of clinical features between control groups and these atypical and malignant meningioma group were not significant. However, the location of MM was frequent in non-basal area(p<0.01). In AM, there were 4 patients of recurrence, and 3 patients of mortality. Among mortality cases, only one patient died of tumor progression, the other patients died of other causes. The survival at 2 year and 5 year in this group were 88% and 74% respectively, and in MM, 11 patients died due to tumor progression and 2 had spinal metastasis. The survival at 2 year and 5 year were 72% and 20%, respectively. For extent of resection, total removal(Simpson grade 1 or 2) was less often achieved in MM compared with AM(50% vs. 83%). Extent of resection of tumor and postoperative radiation therapy did not affect survival in both AM, MM. Conclusions : Clinical behavior of AM showed more benign than that of MM. Prognostic factor for survival is not related extent of resection of tumor and postoperative radiation therapy. However, further investigation with long-term follow-up and additional cases is mandatory.