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Ahn SJ, Joo B, Park M, Park HH, Suh SH, Ahn SG, Yoo J. Dural Metastasis in Breast Cancer: MRI-Based Morphological Subtypes and Their Clinical Implications. Cancer Res Treat 2024:crt.2024.138. [PMID: 38514195 DOI: 10.4143/crt.2024.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose To investigate the clinical factors associated with breast cancer (BRCA) dural metastases (DMs), their impact on prognosis compared to brain parenchymal metastases (BPMs) alone, and differences between DM subtypes, aiming to inform clinical decisions. Materials and Methods We retrospectively analyzed 119 patients with BRCA with brain metastasis, including 91 patients with BPM alone and 28 patients with DM. Univariate and multivariate analyses were performed to compare the clinical characteristics between the two groups and within subtypes of DM. Overall survival after DM (OSDM) and the interval from DM to leptomeningeal carcinomatosis (LMC) were compared using Kaplan-Meier analysis. Results DM was notably linked with extracranial metastasis, luminal-like BRCA subtype (p=0.033), and skull metastases (p<0.001). Multiple logistic regression revealed a strong association of DM with extracranial and skull metastases, but not with subtype or hormone receptor (HR) status. Patients with DM did not show survival differences compared with patients with BPM alone. In the subgroup analysis, nodular type DM correlated with HER2 status (p=0.044), whereas diffuse type DM was significantly associated with a higher prevalence of the luminal-like subtype (p=0.048) and the presence of skull metastasis (p=0.002). Patients with diffuse DM did not exhibit a significant difference in OSDM but had a notably shorter interval from DM to LMC compared to those with nodular DM (p=0.049). Conclusion While the impact of DM on the overall prognosis of patients with BRCA is minimal, our findings underscore distinct characteristics and prognostic outcomes within DM subgroups.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Park HH, Yoo J, Oh HC, Froelich S, Lee KS. The Anterolateral Approach, Revisited for Benign Jugular Foramen Tumors With Predominant Extracranial Extension: Microsurgical Anatomy and Case Series (SevEN-012). Oper Neurosurg (Hagerstown) 2023; 25:e135-e146. [PMID: 37195061 DOI: 10.1227/ons.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/19/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension. METHODS A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed. RESULTS A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits. CONCLUSION ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Paris, France
- Paris VII-Diderot University, Paris, France
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
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Yoo J, Cha YJ, Ahn SJ, Park HH. NIMG-11. THE EXTENT OF NECROSIS IN BRAIN METASTASES MAY PREDICT SUBTYPES OF PRIMARY CANCER AND OVERALL SURVIVAL IN PATIENTS RECEIVING CRANIOTOMY. Neuro Oncol 2022. [PMCID: PMC9660758 DOI: 10.1093/neuonc/noac209.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Although necrosis is common in brain metastasis (BM), its biological and clinical significances remain unknown. We evaluated necrosis extent differences by primary cancer subtype and correlated BM necrosis to overall survival post craniotomy. We analyzed 145 BM patients receiving craniotomy. Necrosis to tumor ratio (NTR) was measured. Patients were divided into two groups by NTR: BMs with sparse necrosis and with abundant necrosis. Clinical features were compared. To investigate factor relevance for BM necrosis, multivariate logistic regression, random forests, and gradient boosting machine analyses were performed. Kaplan–Meier analysis and log-rank tests were performed to evaluate the effect of BM necrosis on overall survival. Lung cancer was a more common origin for BMs with abundant necrosis (42/72, 58.33%) versus sparse necrosis (23/73, 31.51%, p< 0.01). Primary cancer subtype and tumor volume were the most relevant factors for BM necrosis (p< 0.01). BMs harboring moderately abundant necrosis showed longer survival, versus sparse or highly abundant necrosis (p=0.03). Lung cancer BM may carry larger necrosis than BMs from other cancers. Further, moderately abundant necrosis in BM may predict a good prognosis post craniotomy.
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Affiliation(s)
- Jihwan Yoo
- Gangnam Severance Hospital , Seoul , Republic of Korea
| | - Yoon Jin Cha
- Gangnam Severance Hospital , Seoul , Republic of Korea
| | - Sung Jun Ahn
- Gangnam Severance Hospital , Seoul , Republic of Korea
| | - Hun Ho Park
- Gangnam Severance Hospital , Seoul , Republic of Korea
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Chang JH, Yoo J, Kim KH, Kim W, Yoon HI, Kim SH, Moon JH, Park HH, Kim EH, Suh CO, Kang SG. SURG-25. PATTERNS OF RECURRENCES ACCORDING TO THE EXTENT OF RESECTION IN PARIETNS WITH GLIOBLASTOMA, IDH-WILDTYPE: A RETROSPECTIVE STUDY. Neuro Oncol 2022. [PMCID: PMC9660827 DOI: 10.1093/neuonc/noac209.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
OBJECTIVE
In glioblastoma (GBM) patients, controlling the microenvironment around the tumor using various treatment modalities, including surgical intervention, is essential in determining the outcome of treatment. This study was conducted to elucidate whether recurrence patterns differ according to the extent of resection (EOR) and whether this difference affects prognosis.
METHODS
This single-center study included 358 eligible patients with histologically confirmed isocitrate dehydrogenase (IDH)-wild-type GBM from November 1, 2005, to December 31, 2018. Patients were assigned to one of three separate groups according to EOR: supratotal resection (SupTR), gross-total resection (GTR), and subtotal resection (STR) groups. The patterns of recurrence were classified as local, marginal, and distant based on the range of radiation. The relationship between EOR and recurrence pattern was statistically analyzed.
RESULTS
Observed tumor recurrence rates for each group were as follows: SupTR group, 63.4%; GTR group, 75.3%; and STR group, 80.5% (p = 0.072). Statistically significant differences in patterns of recurrences among groups were observed with respect to local recurrence (SupTR, 57.7%; GTR, 76.0%; STR, 82.8%; p = 0.036) and distant recurrence (SupTR, 50.0%; GTR, 30.1%; STR, 23.2%; p = 0.028). Marginal recurrence showed no statistical difference between groups. Both overall survival and progression-free survival were significantly increased in the SupTR group compared with the STR and GTR groups (p < 0.0001).
CONCLUSIONS
In this study, the authors investigated the association between EOR and patterns of recurrence in patients with IDH-wild-type GBM. The findings not only show that recurrence patterns differ according to EOR but also provide clinical evidence supporting the hypothesized mechanism by which distant recurrence occurs.
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Affiliation(s)
- Jong Hee Chang
- Severance Hospital, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Jihwan Yoo
- Gangnam Severance Hospital , Seoul , Republic of Korea
| | - Kyung Hwan Kim
- Yonsei University Health System , Seoul , Republic of Korea
| | - Woohyun Kim
- Yonsei University Health System , Seoul , Republic of Korea
| | - Hong In Yoon
- Yonsei Cancer Center, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Se Hoon Kim
- Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Ju Hyung Moon
- Severance Hospital, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Hun Ho Park
- Gangnam Severance Hospital , Seoul , Republic of Korea
| | - Eui Hyun Kim
- Severance Hospital, Yonsei University , Seoul , Republic of Korea
| | | | - Seok-Gu Kang
- Yonsei University College on Medicine , Seoul , Republic of Korea
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Yoo J, Kim HJ, Kim SM, Park HH. Prognostic factors to predict the efficacy of surgical interventions against brain metastasis secondary to thyroid cancer. Eur Thyroid J 2022; 11:e220087. [PMID: 35900775 PMCID: PMC9346320 DOI: 10.1530/etj-22-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Brain metastasis in differentiated thyroid cancer (DTC) is rare (frequency < 1%) and has a poor prognosis. Treatment strategies for brain metastasis are not well established. Objectives We conducted a retrospective analysis to identify predictive factors for patient outcomes and verify surgical indications for patients with brain metastasis and DTC. Methods The study included 34 patients with pathologically confirmed DTC with brain metastasis from March 2008 to November 2020. The associations between overall survival (OS) and clinical factors were evaluated. Cox regression analysis was used to determine the relationship between clinical factors and OS. To assess the survival benefit of craniotomy, Kaplan-Meier survival analysis was performed for each variable whose statistical significance was determined by Cox regression analysis. Results The median OS of the entire patient sample was 11.4 months. Survival was affected by the presence of lung metastasis (P = 0.033) and the number of brain metastases (n > 3) (P = 0.039). Only the subgroup with the number of brain metastases ≤3 showed statistical significance in the subgroup analysis of survival benefit following craniotomy (P = 0.048). Conclusions The number of brain metastases and the existence of lung metastasis were regarded more essential than other clinical factors in patients with DTC in this study. Furthermore, craniotomies indicated a survival benefit only when the number of brain metastases was ≤3. This finding could be beneficial in determining surgical indications in thyroid cancer with brain metastasis.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Seoul, Republic of Korea
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hee Jun Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, Republic of Korea
| | - Seok Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Seoul, Republic of Korea
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Yoo J, Joo B, Park J, Park HH, Park M, Ahn SJ, Suh SH, Kim JJ, Oh J. Delirium-related factors and their prognostic value in patients undergoing craniotomy for brain metastasis. Front Neurol 2022; 13:988293. [PMID: 36226079 PMCID: PMC9548882 DOI: 10.3389/fneur.2022.988293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Delirium is characterized by acute brain dysfunction. Although delirium significantly affects the quality of life of patients with brain metastases, little is known about delirium in patients who undergo craniotomy for brain metastases. This study aimed to identify the factors influencing the occurrence of delirium following craniotomy for brain metastases and determine its impact on patient prognosis. Method A total of 153 patients who underwent craniotomy for brain metastases between March 2013 and December 2020 were evaluated for clinical and radiological factors related to the occurrence of delirium. Statistical analysis was conducted by dividing the patients into two groups based on the presence of delirium, and statistical significance was confirmed by adjusting the clinical characteristics of the patients with brain metastases using propensity score matching (PSM). The effect of delirium on patient survival was subsequently evaluated using Kaplan–Meier analysis. Results Of 153 patients, 14 (9.2%) had delirium. Age (P = 0.002), sex (P = 0.007), and presence of postoperative hematoma (P = 0.001) were significantly different between the delirium and non-delirium groups. When the matched patients (14 patients in each group) were compared using PSM, postoperative hematoma showed a statistically significant difference (P = 0.036) between the delirium and non-delirium groups. Kaplan–Meier survival analysis revealed that the delirium group had poorer prognosis (log-rank score of 0.0032) than the non-delirium group. Conclusion In addition to the previously identified factors, postoperative hematoma was identified as a strong predictor of postoperative delirium. Also, the negative impact of delirium on patient prognosis including low survival rate was confirmed.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Juyeong Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Jin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jooyoung Oh
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Jooyoung Oh
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Yoo J, Park HH, Kang SG, Chang JH. Recent Update on Neurosurgical Management of Brain Metastasis. Brain Tumor Res Treat 2022; 10:164-171. [PMID: 35929114 PMCID: PMC9353165 DOI: 10.14791/btrt.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
Abstract
Brain metastasis (BM), classified as a secondary brain tumor, is the most common malignant central nervous system tumor whose median overall survival is approximately 6 months. However, the survival rate of patients with BMs has increased with recent advancements in immunotherapy and targeted therapy. This means that clinicians should take a more active position in the treatment paradigm that passively treats BMs. Because patients with BM are treated in a variety of clinical settings, treatment planning requires a more sophisticated decision-making process than that for other primary malignancies. Therefore, an accurate prognostic prediction is essential, for which a graded prognostic assessment that reflects next-generation sequencing can be helpful. It is also essential to understand the indications for various treatment modalities, such as surgical resection, stereotactic radiosurgery, and whole-brain radiotherapy and consider their advantages and disadvantages when choosing a treatment plan. Surgical resection serves a limited auxiliary function in BM, but it can be an essential therapeutic approach for increasing the survival rate of specific patients; therefore, this must be thoroughly recognized during the treatment process. The ultimate goal of surgical resection is maximal safe resection; to this end, neuronavigation, intraoperative neuro-electrophysiologic assessment including evoked potential, and the use of fluorescent materials could be helpful. In this review, we summarize the considerations for neurosurgical treatment in a rapidly changing treatment environment.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Park HH, Yoo J, Oh HC, Cha YJ, Kim SH, Hong CK, Lee KS. Regrowth factors of WHO grade I skull base meningiomas following incomplete resection. J Neurosurg 2022; 137:1656-1665. [PMID: 35453107 DOI: 10.3171/2022.3.jns2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The role of adjuvant radiation therapy following incomplete resection of WHO grade I skull base meningiomas (SBMs) is controversial, and little is known regarding the behavior of residual tumors. The authors investigated the factors that influence regrowth of residual WHO grade I SBMs following incomplete resection. METHODS From 2005 to 2019, a total of 710 patients underwent surgery for newly diagnosed WHO grade I SBMs. The data of 115 patients (16.2%) with incomplete resection and without any adjuvant radiotherapy were retrospectively assessed during a mean follow-up of 78 months (range 27-198 months). Pre-, intra-, and postoperative clinical and molecular factors were analyzed for relevance to regrowth-free survival (RFS). RESULTS Eighty patients were eligible for analysis, excluding those who were lost to follow-up (n = 10) or had adjuvant radiotherapy (n = 25). Regrowth occurred in 39 patients (48.7%), with a mean RFS of 50 months (range 3-191 months). Significant predictors of regrowth were Ki-67 proliferative index (PI) ≥ 4% (p = 0.017), Simpson resection grades IV and V (p = 0.005), and invasion of the cavernous sinus (p = 0.027) and Meckel's cave (p = 0.027). After Cox regression analysis, only Ki-67 PI ≥ 4% (hazard ratio [HR] 9.39, p = 0.003) and Simpson grades IV and V (HR 8.65, p = 0.001) showed significant deterioration of RFS. When stratified into 4 scoring groups, the mean RFSs were 110, 70, 38, and 9 months for scores 1 (Ki-67 PI < 4% and Simpson grade III), 2 (Ki-67 PI < 4% and Simpson grades IV and V), 3 (Ki-67 PI ≥ 4% and Simpson grade III), and 4 (Ki-67 PI ≥ 4% and Simpson grades IV and V), respectively. RFS was significantly longer for score 1 versus scores 2-4 (p < 0.01). Tumor consistency, histology, location, peritumoral edema, vascular encasement, and telomerase reverse transcriptase promoter mutation had no impact on regrowth. CONCLUSIONS Ki-67 PI and Simpson resection grade showed significant associations with RFS for WHO grade I SBMs following incomplete resection. Ki-67 PI and Simpson resection grade could be utilized to stratify the level of risk for regrowth.
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Affiliation(s)
- Hun Ho Park
- 1Department of Neurosurgery, Gangnam Severance Hospital, and
| | - Jihwan Yoo
- 1Department of Neurosurgery, Gangnam Severance Hospital, and
| | - Hyeong-Cheol Oh
- 1Department of Neurosurgery, Gangnam Severance Hospital, and
| | - Yoon Jin Cha
- 2Department of Pathology, Yonsei University Health System, Seoul, Republic of Korea
| | - Se Hoon Kim
- 2Department of Pathology, Yonsei University Health System, Seoul, Republic of Korea
| | - Chang-Ki Hong
- 1Department of Neurosurgery, Gangnam Severance Hospital, and
| | - Kyu-Sung Lee
- 1Department of Neurosurgery, Gangnam Severance Hospital, and
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Yoo J, Cha YJ, Park HH, Park M, Joo B, Suh SH, Ahn SJ. The Extent of Necrosis in Brain Metastases May Predict Subtypes of Primary Cancer and Overall Survival in Patients Receiving Craniotomy. Cancers (Basel) 2022; 14:cancers14071694. [PMID: 35406466 PMCID: PMC8997083 DOI: 10.3390/cancers14071694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Although necrosis is common in brain metastasis (BM), its biological and clinical significances remain unknown. We evaluated necrosis extent differences by primary cancer subtype and correlated BM necrosis to overall survival post-craniotomy. We analyzed 145 BMs of patients receiving craniotomy. Necrosis to tumor ratio (NTR) was measured. Patients were divided into two groups by NTR: BMs with sparse necrosis and with abundant necrosis. Clinical features were compared. To investigate factor relevance for BM necrosis, multivariate logistic regression, random forests, and gradient boosting machine analyses were performed. Kaplan−Meier analysis and log-rank tests were performed to evaluate the effect of BM necrosis on overall survival. Lung cancer was a more common origin for BMs with abundant necrosis (42/72, 58.33%) versus sparse necrosis (23/73, 31.51%, p < 0.01). Primary cancer subtype and tumor volume were the most relevant factors for BM necrosis (p < 0.01). BMs harboring moderately abundant necrosis showed longer survival, versus sparse or highly abundant necrosis (p = 0.04). Lung cancer BM may carry larger necrosis than BMs from other cancers. Further, moderately abundant necrosis in BM may predict a good prognosis post-craniotomy.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (J.Y.); (H.H.P.)
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea;
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (J.Y.); (H.H.P.)
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
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Yoo J, Lim SH, Jung IH, Park HH, Han J, Hong CK. Factors Associated With Abducens Nerve Palsy in Patients Undergoing Surgery for Petroclival Meningiomas. J Neuroophthalmol 2022; 42:e209-e216. [PMID: 34974485 DOI: 10.1097/wno.0000000000001473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND During the surgical resection of petroclival meningiomas, preserving the cranial nerves is crucial. The abducens nerve is particularly vulnerable during surgery. However, the preoperative risk factors and postoperative prognosis of abducens nerve palsy (ANP) are poorly understood. METHODS We retrospectively analyzed 70 patients who underwent surgery for petroclival meningiomas between May 2010 and December 2019, divided into gross-total resection (GTR) and subtotal resection (STR) groups. The relationship of preoperative clinical factors with the incidence and recovery of postoperative ANP was analyzed. RESULTS Postoperative ANP was observed in 23 patients (32.9%). Multivariable logistic regression revealed that the tumor-to-cerebellar peduncle T2 imaging intensity index (TCTI) (P < 0.001) and internal auditory canal invasion (P = 0.033) contributed to postoperative ANP. GTR was achieved in 37 patients (52.9%), and 10 (27.0%) of them showed ANP. STR was achieved in 33 patients (47.1%), and 13 (39.4%) of them showed ANP. Recovery from ANP took a median of 6.6 months (range, 4.5-20.3 months). At 6 months after the operation, recovery of the abducens nerve function was observed in 16 patients (69.0%); of whom, 4 (40.0%) were in the GTR group and 12 (92.3%) were in the STR group (P = 0.025). CONCLUSIONS TCTI and internal auditory canal invasion were the risk factors for postoperative ANP. Although intentional STR did not prevent ANP immediately after the operation, recovery of the abducens nerve function after surgery was observed more frequently in the STR group than in the GTR group.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery (JY, SHL, IHJ, HHP), Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, Seoul, Korea ; Yonsei University College of Medicine (JY), Seoul, Republic of Korea ; Department of Ophthalmology (JH), Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea ; and Department of Neurosurgery (CKH), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
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Yoo J, Yoon SJ, Kim KH, Jung IH, Lim SH, Kim W, Yoon HI, Kim SH, Sung KS, Roh TH, Moon JH, Park HH, Kim EH, Suh CO, Kang SG, Chang JH. Patterns of recurrence according to the extent of resection in patients with IDH-wild-type glioblastoma: a retrospective study. J Neurosurg 2021; 137:1-11. [PMID: 34972087 DOI: 10.3171/2021.10.jns211491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In glioblastoma (GBM) patients, controlling the microenvironment around the tumor using various treatment modalities, including surgical intervention, is essential in determining the outcome of treatment. This study was conducted to elucidate whether recurrence patterns differ according to the extent of resection (EOR) and whether this difference affects prognosis. METHODS This single-center study included 358 eligible patients with histologically confirmed isocitrate dehydrogenase (IDH)-wild-type GBM from November 1, 2005, to December 31, 2018. Patients were assigned to one of three separate groups according to EOR: supratotal resection (SupTR), gross-total resection (GTR), and subtotal resection (STR) groups. The patterns of recurrence were classified as local, marginal, and distant based on the range of radiation. The relationship between EOR and recurrence pattern was statistically analyzed. RESULTS Observed tumor recurrence rates for each group were as follows: SupTR group, 63.4%; GTR group, 75.3%; and STR group, 80.5% (p = 0.072). Statistically significant differences in patterns of recurrences among groups were observed with respect to local recurrence (SupTR, 57.7%; GTR, 76.0%; STR, 82.8%; p = 0.036) and distant recurrence (SupTR, 50.0%; GTR, 30.1%; STR, 23.2%; p = 0.028). Marginal recurrence showed no statistical difference between groups. Both overall survival and progression-free survival were significantly increased in the SupTR group compared with the STR and GTR groups (p < 0.0001). CONCLUSIONS In this study, the authors investigated the association between EOR and patterns of recurrence in patients with IDH-wild-type GBM. The findings not only show that recurrence patterns differ according to EOR but also provide clinical evidence supporting the hypothesized mechanism by which distant recurrence occurs.
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Affiliation(s)
- Jihwan Yoo
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
- 2Yonsei University College of Medicine
- 3Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Seon-Jin Yoon
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
- 4Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine
| | - Kyung Hwan Kim
- 5Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine
| | - In-Ho Jung
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
| | - Seung Hoon Lim
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
| | - Woohyun Kim
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
| | - Hong In Yoon
- 5Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine
| | - Se Hoon Kim
- 6Department of Pathology, Yonsei University College of Medicine, Seoul
| | - Kyoung Su Sung
- 7Department of Neurosurgery, Dong-A University College of Medicine, Busan
| | - Tae Hoon Roh
- 8Department of Neurosurgery, Ajou University School of Medicine, Suwon
| | - Ju Hyung Moon
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
| | - Hun Ho Park
- 3Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Eui Hyun Kim
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
| | - Chang-Ok Suh
- 9Department of Radiation Oncology, CHA Bundang Medical Center, CHA University College of Medicine, Bundang; and
| | - Seok-Gu Kang
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
- 10Department of Medical Science, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jong Hee Chang
- 1Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine
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12
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Park HH, Roh TH, Choi S, Yoo J, Kim WH, Jung IH, Yun IS, Hong CK. Endoscopic Transorbital Approach to Mesial Temporal Lobe for Intra-Axial Lesions: Cadaveric Study and Case Series (SevEN-008). Oper Neurosurg (Hagerstown) 2021; 21:E506-E515. [PMID: 34528091 DOI: 10.1093/ons/opab319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Endoscopic transorbital approach (ETOA) has been proposed as a minimally invasive technique for the treatment of skull base lesions located around mesial temporal lobe (MTL), mostly extra-axial pathology. OBJECTIVE To explore the feasibility of ETOA in accessing intraparenchymal MTL with cadaveric specimens and describe our initial clinical experience of ETOA for intra-axial lesions in MTL. METHODS Anatomic dissections were performed in 4 adult cadaveric heads using a 0° endoscope. First, a stepwise anatomical investigation of ETOA to intraparenchymal MTL was explored. Then, ETOA was applied clinically for 7 patients with intra-axial lesions in MTL, predominantly high-grade gliomas (HGGs) and low-grade gliomas (LGGs). RESULTS The extradural stage of ETOA entailed a superior eyelid incision followed by orbital retraction, drilling of orbital roof, greater and lesser wing of sphenoid bone, and cutting of the meningo-orbital band. For the intradural stage, the brain tissue medial to the occipito-temporal gyrus was aspirated until the temporal horn was opened. The structures of MTL could be aspirated selectively in a subpial manner without injury to the neurovascular structures of the ambient and sylvian cisterns, and the lateral neocortex. After cadaveric validation, ETOA was successfully performed for 4 patients with HGGs and 3 patients with LGGs. Gross total resection was achieved in 6 patients (85.7%) without significant surgical morbidities including visual field deficits. CONCLUSION ETOA provides a logical line of access for intra-axial lesions in MTL. The safe and natural surgical trajectory of ETOA can spare brain retraction, neurovascular injury, and disruption of the lateral neocortex.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Tae Hoon Roh
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seonah Choi
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Hyun Kim
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - In-Ho Jung
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - In-Sik Yun
- Department of Plastic surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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13
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Yoo J, Park HH, Yun IS, Hong CK. Clinical applications of the endoscopic transorbital approach for various lesions. Acta Neurochir (Wien) 2021; 163:2269-2277. [PMID: 33394139 DOI: 10.1007/s00701-020-04694-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The endoscopic transorbital approach (ETOA) was recently added to the neurosurgical armamentarium. Although this approach could result in less injury to normal brain tissue, shorter operation times, and smaller scars, its clinical applications have not been fully investigated. We, therefore, sought to share our unique experiences of exploring the application of this approach in various diseases. METHODS From June 2017 to March 2019, we conducted ETOAs via the superior eyelid crease in 22 patients for the treatment of lesions confined to the middle fossa with and without slight extension to the posterior fossa. These lesions included 5 gliomas, 11 meningiomas, 3 schwannomas, 1 lymphoma, 1 cavernous hemangioma in the orbital wall, and 1 hemangiopericytoma mimicking schwannoma. Perioperative radiologic findings and clinical outcomes were recorded. RESULTS Gross total resection was accomplished in three (60%) patients with gliomas, nine (81.8%) with meningiomas, two (66.7%) with schwannomas, and one (33.3%) with another lesion. The mean bleeding count was 1051.4 ± 961.1 cc, and major complications were observed in only two (9.1%) cases (one major cerebral artery infarction and one reoperation due to a large amount of bleeding). A cerebrospinal fluid leak was reported in two (9.1%) patients, and transient eye movement palsy was noted in four (18.2%) patients without permanent disability. CONCLUSIONS The endoscopic transorbital approach could be considered to be feasible for various lesions with different characteristics. After carefully considering the lesion anatomy, consistency, and vascular relationships, using this approach, we could achieve a satisfactory extent of resection without severe complications.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
- Yonsei University, College of Medicine, Seoul, Korea
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - In-Sik Yun
- Department of Plastic Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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14
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Jung IH, Yoo J, Park HH, Hong CK. Differences in surgical outcome between petroclival meningioma and anterior petrous meningioma. Acta Neurochir (Wien) 2021; 163:1697-1704. [PMID: 33555377 DOI: 10.1007/s00701-021-04753-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Petroclival meningiomas (PC MNGs) and anterior petrous meningiomas (AP MNGs) have similar locations. However, these are different tumors clearly divided by the trigeminal nerve. There has never been a study on the comparison of the surgical outcomes of these two meningiomas. In this study, we compared and analyzed the surgical outcome of PC MNGs and AP MNGs. METHODS The charts of 85 patients diagnosed with PC MNGs of AP MNGs who underwent surgical treatment were retrospectively reviewed. And we analyzed the characteristics of 49 PC MNGs (57.6%) and compared them with those of 36 AP MNGs. RESULTS Preoperative brainstem edema was observed in 11 patients (22.4%) of the PC MNG group and 1 patient (2.8%) of the AP MNG group (p = 0.024). Total tumor removal was achieved in 21 patients (58.3%) of the AP MNG group, but only 17 patients (34.7%) of the PC MNG group were able to completely (p = 0.047). In addition, sixth cranial nerve palsy occurred in 17 patients (34.7%) of the PC MNG group and 4 patients (11.1%) of the AP MNG group (p = 0.025). CONCLUSIONS In this study, we found that PC MNGs has a worse surgical outcome than AP MNGs, because PC MNGs were difficult to completely remove and were more likely to damage abducens nerve.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University, College of Medicine, 211 Eonji-ro, Gangnamgu, Seoul, 06273, Republic of Korea.
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15
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Park HH, Park SH, Oh HC, Jung HH, Chang JH, Lee KS, Chang WS, Hong CK. The behavior of residual tumors following incomplete surgical resection for vestibular schwannomas. Sci Rep 2021; 11:4665. [PMID: 33633337 PMCID: PMC7907355 DOI: 10.1038/s41598-021-84319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/15/2021] [Indexed: 11/09/2022] Open
Abstract
The management of vestibular schwannoma (VS) with residual tumor following incomplete resection remains controversial and little is known regarding postoperative tumor volume changes. The behavior of residual tumors was analyzed for 111 patients who underwent surgery for newly diagnosed VS between September 2006 and July 2017. The postoperative tumor volume changes were assessed during a mean follow-up of 69 months (range 36–147 months). Fifty-three patients underwent imaging surveillance following incomplete resection. There was no residual tumor growth in 44 patients (83%). A significant regression of residual tumor volume was noted in the no growth group at postoperative 1 year (p = 0.028), 2 years (p = 0.012), but not from 3 years onwards. Significant predictors of regrowth were immediate postoperative tumor volume ≥ 0.7 cm3 (HR 10.5, p = 0.020) and residual tumor location other than the internal auditory canal (IAC) (HR 6.2, p = 0.026). The mean time to regrowth was 33 months (range 5–127 months). The 2-, 5-, and 10-year regrowth-free survival rates were 90.6%, 86.8%, and 83%, respectively. In conclusion, significant residual tumor regression could occur within 2 years for a VS with an immediate postoperative tumor volume less than 0.7 cm3 or residual tumor in IAC.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyeong-Cheol Oh
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyun-Ho Jung
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Gamma Knife CenterSeverance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
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16
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Park HH, Kim WH, Jung HH, Chang JH, Lee KS, Chang WS, Hong CK. Radiosurgery vs. microsurgery for newly diagnosed, small petroclival meningiomas with trigeminal neuralgia. Neurosurg Rev 2020; 43:1631-1640. [PMID: 32642933 DOI: 10.1007/s10143-020-01346-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
Trigeminal neuralgia (TN) is an excruciating pain that can occur with petroclival meningiomas (PCMs). Gamma knife radiosurgery (GKRS) is an appealing option for small PCMs, but the role of microsurgery (MS) compared to GKRS is not well defined for small PCMs with regard to TN relief. From January 2009 to September 2019, 70 consecutive patients were treated by GKRS or MS for newly diagnosed, small (< 3.5 cm) PCMs with TN. GKRS or MS were performed for 35 patients each. The surgical outcome and TN control according to Barrow Neurological Institute (BNI) score were retrospectively analyzed and compared between GKRS and MS. The predominant origin of PCMs was upper clival (49%) with trigeminal nerve compression at the medial dorsal root entry zone. Tumor control rates were equally 94% with GKRS or MS for a mean tumor size and volume of 2.3 cm and 5.3 cm3, respectively. The preoperative BNI scores were mostly II (40%) and IV (37%) with GKRS and MS, respectively. TN relief without medications (BNI scores I and II) was achieved in 13 of 35 patients (37%) with GKRS and 32 of 35 patients (91%) with MS during a mean follow-up of 50.5 months. The most common complications after GKRS and MS were dysesthesia (23%) and diplopia (9%), respectively. MS could be more effective than GKRS in providing prompt, medication-free pain relief from TN for small PCMs. The risks of MS have to be considered carefully in experienced hands, especially for small PCMs.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Woo Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hyun-Ho Jung
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Gamma Knife Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
- Brain Research Institute, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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17
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Roh TH, Moon JH, Park HH, Kim EH, Hong CK, Kim SH, Kang SG, Chang JH. Association between survival and levetiracetam use in glioblastoma patients treated with temozolomide chemoradiotherapy. Sci Rep 2020; 10:10783. [PMID: 32612203 PMCID: PMC7330022 DOI: 10.1038/s41598-020-67697-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/29/2020] [Indexed: 12/22/2022] Open
Abstract
This study was conducted to assess whether levetiracetam (LEV) affects the survival of patients with glioblastoma (GBM) treated with concurrent temozolomide (TMZ) chemotherapy. To this end, from 2004 to 2016, 322 patients with surgically resected and pathologically confirmed isocitrate dehydrogenase (IDH)-wildtype GBM who received TMZ-based chemoradiotherapy were analysed. The patients were divided into two groups based on whether LEV was used as an anticonvulsant both at the time of surgery and the first visit thereafter. The median overall survival (OS) and progression-free survival (PFS) were compared between the groups. The OS was 21.1 and 17.5 months in the LEV (+) and LEV (−) groups, respectively (P = 0.003); the corresponding PFS was 12.3 and 11.2 months (P = 0.017). The other prognostic factors included age, extent of resection, O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, and Karnofsky Performance Status (KPS) score. The multivariate analysis showed age (hazard ratio [HR], 1.02; P < 0.001), postoperative KPS score (HR 0.99; P = 0.002), complete tumour resection (HR 0.52; P < 0.001), MGMT promoter methylation (HR 0.75; P < 0.001), and LEV use (HR 0.72; P = 0.011) were significantly associated with OS. In conclusion, LEV use was associated with prolonged survival in patients with GBM treated with concurrent TMZ chemoradiotherapy.
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Affiliation(s)
- Tae Hoon Roh
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Park HH, Ronconi D, Hanakita S, Watanabe K, Labidi M, Bernat AL, Froelich S. Endoscopic endonasal approach to the mesial temporal lobe: anatomical study and clinical considerations for a selective amygdalohippocampectomy. Acta Neurochir (Wien) 2020; 162:881-891. [PMID: 31834499 DOI: 10.1007/s00701-019-04163-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Selective amygdalohippocampectomy (AH) is a surgical option for patients with medically intractable seizures from mesial temporal lobe pathology. The transcranial route is considered the best method to achieve this goal. However, the standard approach through the neocortex is still invasive. The risks can be minimized if the mesial temporal lobe is resected while preserving the lateral temporal lobe and the Meyer's loop. This study explores the feasibility of selective AH by endoscopic endonasal approach (EEA) in cadaveric specimens. METHODS The endoscopic anatomy of the mesial temporal lobe and the feasibility of a successful selective AH were studied in six hemispheres from three injected human cadavers. Quantitative analyses on the extent of resection and angles of exposure were performed based on CT and MRI studies of pre- and post-selective AH and measurements taken during dissections. RESULTS The EEA V1-V2 corridor provided a direct and logical line of access to the mesial temporal lobe, following its natural trajectory with no brain retraction and minimal exposure of the pterygopalatine fossa. The components of the mesial temporal lobe were resected just as selectively and easily as the transcranial route, but without compromising the structures of the lateral temporal lobe or the Meyer's loop. CONCLUSIONS The EEA V1-V2 corridor demonstrated its selective resectability and accessibility of the mesial temporal lobe in cadaveric specimens. The clinical value of this approach should be explored responsibly by a surgeon with both competent microsurgical skills and experiences in EEA.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Daniel Ronconi
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Shunya Hanakita
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Kentaro Watanabe
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Moujahed Labidi
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France.
- Paris VII-Diderot University, Paris, France.
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19
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Park HH, Yoo J, Yun IS, Hong CK. Comparative Analysis of Endoscopic Transorbital Approach and Extended Mini-Pterional Approach for Sphenoid Wing Meningiomas with Osseous Involvement: Preliminary Surgical Results. World Neurosurg 2020; 139:e1-e12. [PMID: 32001400 DOI: 10.1016/j.wneu.2020.01.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Sphenoid wing meningiomas (SWMs) can be treated with complete surgical resection and the recently introduced endoscopic transorbital approach (ETOA) offers a minimally invasive alternative. In this study, the surgical outcome of ETOA and the extended mini-pterional approach (eMPTA) for SWMs with osseous involvement is compared. METHODS From October 2015 to May 2019, 24 patients underwent surgery for SWMs with osseous involvement. Among them, tumor resection was performed by ETOA for 11 patients (45.8%) and eMPTA for 13 patients (54.2%). The tumor characteristics, surgical outcome and morbidity, and approach-related aesthetic outcome were analyzed and compared retrospectively between ETOA and eMPTA based on SWM classification. RESULTS The location of SWMs was mostly the middle sphenoid ridge (group III) (45.8%), followed by the greater sphenoid wing (group IV) (29.2%). Simpson resection grades I/II were achieved in 9 of 11 patients (81.8%) with ETOA and 11 of 13 patients (84.6%) with eMPTA. There were no differences in tumor characteristics between the 2 approaches. Surgery time, surgical bleeding, and hospital length of stay were significantly shorter with ETOA. Three patients had transient surgical morbidities such as diplopia (n = 1), ptosis (n = 1), and cerebrospinal fluid leak (n = 1) after ETOA. No differences could be seen in surgical morbidities between ETOA and eMPTA. CONCLUSIONS ETOA can provide direct access to the sphenoid bone and resectability with a more rapid and minimally invasive exposure than does eMPTA. Maximal subtotal resection with extensive sphenoid bone decompression for tumors with cavernous sinus infiltration is the key to a good clinical outcome, regardless of the surgical approach.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - In-Sik Yun
- Department of Plastic Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
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Park HH, Hong SD, Kim YH, Hong CK, Woo KI, Yun IS, Kong DS. Endoscopic transorbital and endonasal approach for trigeminal schwannomas: a retrospective multicenter analysis (KOSEN-005). J Neurosurg 2019; 133:467-476. [PMID: 31226689 DOI: 10.3171/2019.3.jns19492] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Trigeminal schwannomas are rare neoplasms with an incidence of less than 1% that require a comprehensive surgical strategy. These tumors can occur anywhere along the path of the trigeminal nerve, capable of extending intradurally into the middle and posterior fossae, and extracranially into the orbital, pterygopalatine, and infratemporal fossa. Recent advancements in endoscopic surgery have suggested a more minimally invasive and direct route for tumors in and around Meckel's cave, including the endoscopic endonasal approach (EEA) and endoscopic transorbital superior eyelid approach (ETOA). The authors assess the feasibility and outcomes of EEA and ETOA for trigeminal schwannomas. METHODS A retrospective multicenter analysis was performed on 25 patients who underwent endoscopic surgical treatment for trigeminal schwannomas between September 2011 and February 2019. Thirteen patients (52%) underwent EEA and 12 (48%) had ETOA, one of whom underwent a combined approach with retrosigmoid craniotomy. The extent of resection, clinical outcome, and surgical morbidity were analyzed to evaluate the feasibility and selection of surgical approach between EEA and ETOA based on predominant location of trigeminal schwannomas. RESULTS According to predominant tumor location, 9 patients (36%) had middle fossa tumors (Samii type A), 8 patients (32%) had dumbbell-shaped tumors located in the middle and posterior cranial fossae (Samii type C), and another 8 patients (32%) had extracranial tumors (Samii type D). Gross-total resection (GTR, n = 12) and near-total resection (NTR, n = 7) were achieved in 19 patients (76%). The GTR/NTR rates were 81.8% for ETOA and 69.2% for EEA. The GTR/NTR rates of ETOA and EEA according to the classifications were 100% and 50% for tumors confined to the middle cranial fossa, 75% and 33% for dumbbell-shaped tumors located in the middle and posterior cranial fossae, and 50% and 100% for extracranial tumors. There were no postoperative CSF leaks. The most common preoperative symptom was trigeminal sensory dysfunction, which improved in 15 of 21 patients (71.4%). Three patients experienced new postoperative complications such as vasospasm (n = 1), wound infection (n = 1), and medial gaze palsy (n = 1). CONCLUSIONS ETOA provides adequate access and resectability for trigeminal schwannomas limited in the middle fossa or dumbbell-shaped tumors located in the middle and posterior fossae, as does EEA for extracranial tumors. Tumors predominantly involving the posterior fossa still remain a challenge in endoscopic surgery.
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Affiliation(s)
| | | | - Yong Hwy Kim
- 3Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - In-Sik Yun
- 5Plastic Surgery, Gangnam Severance Hospital, Yonsei University Health System; Departments of
| | - Doo-Sik Kong
- 6Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine; and
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21
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Roh TH, Kang SG, Moon JH, Sung KS, Park HH, Kim SH, Kim EH, Hong CK, Suh CO, Chang JH. Survival benefit of lobectomy over gross-total resection without lobectomy in cases of glioblastoma in the noneloquent area: a retrospective study. J Neurosurg 2019; 132:895-901. [PMID: 30835701 DOI: 10.3171/2018.12.jns182558] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Following resection of glioblastoma (GBM), microscopic remnants of the GBM tumor remaining in nearby tissue cause tumor recurrence more often than for other types of tumors, even after gross-total resection (GTR). Although surgical oncologists traditionally resect some of the surrounding normal tissue, whether further removal of nearby tissue may improve survival in GBM patients is unknown. In this single-center retrospective study, the authors assessed whether lobectomy confers a survival benefit over GTR without lobectomy when treating GBMs in the noneloquent area. METHODS The authors selected 40 patients who had undergone GTR of a histopathologically diagnosed isocitrate dehydrogenase (IDH)-wild type GBM in the right frontal or temporal lobe and divided the patients into 2 groups according to whether GTR of the tumor involved lobectomy, defined as a supratotal resection (SupTR group, n = 20) or did not (GTR group, n = 20). Progression-free survival (PFS), overall survival (OS), and Karnofsky Performance Status (KPS) scores were compared between groups (p ≤ 0.05 for statistically significant differences). RESULTS The median postoperative PFS times for each group were as follows: GTR group, 11.5 months (95% CI 8.8-14.2) and SupTR group, 30.7 months (95% CI 4.3-57.1; p = 0.007). The median postoperative OS times for each group were as follows: GTR group, 18.7 months (95% CI 14.3-23.1) and SupTR group, 44.1 months (95% CI 25.1-63.1; p = 0.040). The mean postoperative KPS scores (GTR, 76.5; SupTR, 77.5; p = 0.904) were not significantly different. In multivariate analysis, survival for the SupTR group was significantly longer than that for the GTR group in terms of both PFS (HR 0.230; 95% CI 0.090-0.583; p = 0.002) and OS (HR 0.247; 95% CI 0.086-0.704; p = 0.009). CONCLUSIONS In cases of completely resectable, noneloquent-area GBMs, SupTR provides superior PFS and OS without negatively impacting patient performance.
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Affiliation(s)
- Tae Hoon Roh
- 1Yonsei University Graduate School, Seoul.,2Department of Neurosurgery, Brain Tumor Center, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Seok-Gu Kang
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul
| | - Ju Hyung Moon
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul
| | - Kyoung Su Sung
- 4Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan
| | - Hun Ho Park
- 5Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul
| | - Se Hoon Kim
- 6Department of Pathology, Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul; and
| | - Eui Hyun Kim
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul
| | - Chang-Ki Hong
- 5Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul
| | - Chang-Ok Suh
- 7Department of Radiation Oncology, Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- 3Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul
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Park HH, Kim EH, Ku CR, Lee EJ, Kim SH. Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion. World Neurosurg 2018; 117:e280-e289. [DOI: 10.1016/j.wneu.2018.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 12/19/2022]
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Park HH, Park JY, Chin DK, Lee KS, Hong CK. The timing of fusion surgery for clival chordoma with occipito-cervical joint instability: before or after tumor resection? Neurosurg Rev 2018; 43:119-129. [PMID: 30116987 DOI: 10.1007/s10143-018-1020-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/16/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
Clival chordoma with occipito-cervical (OC) joint invasion can result in preoperative and postoperative instability. The authors investigate the appropriate timing of OC fusion to prevent instability-, fusion-, and surgery time-related morbidity. Twenty-two consecutive patients underwent surgery for clival chordoma from December 2008 to September 2014. OC fusion was performed for patients with OC joint invasion and instability due to preoperative destruction of the occipital condyle or extensive postoperative condylectomy. The data in relation to OC joint instability, fusion, and surgery time were analyzed retrospectively and compared between OC fusion before and after tumor resection. Of the 22 patients, 8 with tumor invasion of the OC joint underwent OC fusion. OC fusion was performed after tumor resection in one-stage for four patients and before tumor resection in two-stage for four patients. There was OC joint instability from tumor destruction of the occipital condyle in seven patients (87.5%). Patients with OC fusion after tumor resection encountered complications such as surgery site wound dehiscence, encephalitis, and cardiac arrest with consequent mortality in one patient. These complications were avoided in subsequent patients where OC fusion was performed before tumor resection. There were no differences in the extent of tumor resection between OC fusion before and after tumor resection. Two-stage OC fusion before tumor resection can reduce instability-, fusion-, and surgery time-related morbidity and achieve feasible tumor resection when OC joint instability is expected. The extent of tumor invasion and brain stem compression should be considered when fusion precedes tumor resection.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jeong-Yoon Park
- Department of Spine Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Dong-Kyu Chin
- Department of Spine Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Kyu-Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea.
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Labidi M, Watanabe K, Hanakita S, Park HH, Bouazza S, Bernat AL, Froelich S. The Chopsticks Technique for Endoscopic Endonasal Surgery-Improving Surgical Efficiency and Reducing the Surgical Footprint. World Neurosurg 2018; 117:208-220. [PMID: 29886295 DOI: 10.1016/j.wneu.2018.05.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Variations and additions to the endoscopic endonasal exposure have been proposed around a modular strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life, is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments. OBJECTIVE Our objective was to achieve the same skull base exposures and tumor resections and limit the surgical footprint on sinonasal structures and patients' quality of life. METHODS Our team developed a surgical technique in which the endoscope and a malleable rotative aspirator are held by the nondominant hand and the other main instrument in the dominant hand. This modification, which we call the chopsticks technique, allows the surgeon to use minimalistic exposures with an improved dynamic perception of the surgical field and reduced conflicts between the instruments. The endonasal structures that are left intact help support the instruments. The same surgical objectives, in terms of exposure and resection, are achieved. We describe our technique and a series of patients operated with this uninarial 3-instruments technique to discuss relevant operative nuances. CONCLUSIONS We propose a technical modification that allows the surgeons to benefit from the advantages of a bimanual technique while still holding the endoscope. In our opinion, this technique may improve dynamic understanding of the anatomy and surgical efficiency and reduce the footprint of the surgery.
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Affiliation(s)
- Moujahed Labidi
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Kentaro Watanabe
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Shunya Hanakita
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Hun Ho Park
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | | | - Anne-Laure Bernat
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Paris VII-Diderot University, Paris, France
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Roh TH, Park HH, Kang SG, Moon JH, Kim EH, Hong CK, Ahn SS, Choi HJ, Cho J, Kim SH, Lee SK, Kim DS, Kim SH, Suh CO, Lee KS, Chang JH. Long-term outcomes of concomitant chemoradiotherapy with temozolomide for newly diagnosed glioblastoma patients: A single-center analysis. Medicine (Baltimore) 2017; 96:e7422. [PMID: 28682902 PMCID: PMC5502175 DOI: 10.1097/md.0000000000007422] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study analyzed outcomes of surgery followed by concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) in patients with newly diagnosed glioblastoma (GBM) at a single institution. Outcomes were retrospectively reviewed in 252 consecutive patients with newly diagnosed GBM who underwent surgery followed by CCRT with TMZ at the authors' institution between 2005 and 2013. At initial operation, 126 (50.0%), 55 (21.8%), 45 (17.9%), and 26 (10.3%) patients underwent gross total resection (GTR), subtotal resection, partial resection (PR), and biopsy, respectively. Their median overall survival (OS) was 20.8 months (95% confidence interval [CI] 17.7-23.9 months) and their median progression-free survival was 12.7 months (95% CI 11.2-14.2 months). The O-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 78 (34.1%) of the 229 patients assayed, and an isocitrate dehydrogenase 1 mutation was detected in 7 (6.6%) of the 106 patients analyzed. Univariate analyses showed that patient age, involvement of eloquent areas, involvement of the subventricular zone, presence of leptomeningeal seeding, Karnofsky Performance Status, extent of resection (EOR), MGMT promoter methylation, and presence of an oligodendroglioma component were prognostic of OS. Multivariate analysis showed that age, involvement of eloquent areas, presence of leptomeningeal seeding, EOR, and MGMT promoter methylation were significantly predictive of survival. OS in patients with GBM who undergo surgery followed by CCRT with TMZ is enhanced by complete resection. Other factors significantly prognostic of OS include that age, involvement of eloquent areas, presence of leptomeningeal seeding, and MGMT promoter methylation.
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Affiliation(s)
- Tae Hoon Roh
- Yonsei University Graduate School, Seoul
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Hun Ho Park
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Seok-Gu Kang
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Eui Hyun Kim
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Sung Soo Ahn
- Department of Radiology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Hye Jin Choi
- Department of Medical Oncology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Jaeho Cho
- Department of Radiation Oncology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Seung Koo Lee
- Department of Radiology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Dong Seok Kim
- Department of Neurosurgery
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Ho Kim
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
| | - Kyu Sung Lee
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery
- Brain Tumor Center, Severance Hospital, Yonsei University Health System
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Park HH, Lee KS, Hong CK. Vertebral Artery Transposition Via an Extreme-Lateral Approach for Anterior Foramen Magnum Meningioma or Craniocervical Junction Tumors. World Neurosurg 2016; 88:154-165. [DOI: 10.1016/j.wneu.2015.12.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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Park HH, Hong CK, Jung HH, Chang WS, Kim CH, Lee WS, Lee SC, Park YG, Chang JH. The Role of Radiosurgery in the Management of Benign Head and Neck Tumors. World Neurosurg 2016; 87:116-23. [DOI: 10.1016/j.wneu.2015.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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Park HH, Oh MC, Kim EH, Kim CY, Kim SH, Lee KS, Chang JH. Use of optical coherence tomography to predict visual outcome in parachiasmal meningioma. J Neurosurg 2015; 123:1489-99. [DOI: 10.3171/2014.12.jns141549] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The authors investigated the value of retinal nerve fiber layer (RNFL) thickness in predicting visual outcome after surgery for parachiasmal meningioma.
METHODS
Forty-nine eyes of 25 patients who underwent craniotomy and resection of a parachiasmal meningioma were analyzed retrospectively. Visual parameters including visual field (VF) (recorded as the mean deviation [MD]), visual acuity (VA), and RNFL thickness (via optical coherence tomography) were measured before and 1 week, 6 months, and 1 year after surgery. Postoperative visual outcome was compared among the patients with a thin or normal RNFL. A separate analysis of data pertaining to 22 eyes of 13 patients with severe VF defects (MD ≤ −10 dB) was performed to compare visual outcome for those with a thin or normal RNFL.
RESULTS
Of the 23 eyes that showed VF improvement, 22 (95.7%) had normal RNFL thickness. The positive predictive value of normal RNFL thickness for VF improvement was 78.6%. The VF of patients with normal RNFL thickness improved in 6 months and continued improving 1 year after surgery (MD −5.9 dB before surgery, −5.5 dB 1 week after surgery, −2.8 dB 6 months after surgery [p < 0.01], and −1.1 dB 1 year after surgery [p < 0.01]). In contrast, those with a thin preoperative RNFL showed deterioration at first and then slower, worse visual recovery after surgery (MD −18.1 dB before surgery, −22.4 dB 1 week after surgery, −21.2 dB 6 months after surgery, and −19.1 dB 1 year after surgery). VA also showed significant progress 6 months after surgery in patients with normal RNFL thickness (0.6 before surgery, 0.7 one week after surgery, 0.9 six months after surgery [p = 0.025], and 0.9 one year after surgery [p = 0.050]) compared to those with a thin RNFL (0.3 before surgery, 0.2 one week after surgery, 0.3 six months after surgery, and 0.4 one year after surgery). Preoperative differences in VF MD and VA were noted between the 2 groups (p < 0.01). Even patients with severe VF defects and normal RNFL thickness improved by 11.1 dB by 1 year after surgery compared with patients with a thin RNFL (−0.01 dB) (p < 0.01). Patients with normal RNFL thickness also did better in VA improvement (from 0.7 to 1.1) than those with a thin RNFL (from 0.2 to 0.3), but these results were not statistically significant.
CONCLUSIONS
RNFL thickness measured by optical coherence tomography has significant value as a prognostic factor of postoperative visual recovery for parachiasmal meningioma. Patients with normal RNFL thickness before surgery are more likely to have visual improvement after surgery than patients with a thin RNFL.
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Affiliation(s)
- Hun Ho Park
- Departments of 1Neurosurgery and
- 3Brain Tumor Center, and
| | | | - Eui Hyun Kim
- Departments of 1Neurosurgery and
- 3Brain Tumor Center, and
- 4Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | | | - Sun Ho Kim
- Departments of 1Neurosurgery and
- 3Brain Tumor Center, and
- 4Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Departments of 1Neurosurgery and
- 3Brain Tumor Center, and
- 4Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Hee Chang
- Departments of 1Neurosurgery and
- 3Brain Tumor Center, and
- 4Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea
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Chang JH, Park HH, Roh TH, Kim EH, Kang SG, Kim SH, Ahn SS, Cho J, Suh CO. NTCT-01RADIATION NECROSIS IN GLIOBLASTOMA PATIENTS: THE IMPACT OF EXTENT OF RESECTION. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov226.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Balik V, Sulla I, Park HH, Sarissky M. In vitro testing to a panel of potential chemotherapeutics and current concepts of chemotherapy in benign meningiomas. Surg Oncol 2015; 24:292-9. [DOI: 10.1016/j.suronc.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/05/2015] [Accepted: 06/07/2015] [Indexed: 01/02/2023]
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Kim EH, Roh TH, Park HH, Moon JH, Hong JB, Kim SH. Direct suture technique of normal gland edge on the incised dura margin to repair the intraoperative cerebrospinal fluid leakage from the arachnoid recess during transsphenoidal pituitary tumor surgery. Neurosurgery 2015; 11 Suppl 2:26-31; discussion 31. [PMID: 25584954 DOI: 10.1227/neu.0000000000000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND During transsphenoidal surgery for pituitary adenomas with large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect at the arachnoid recess between the resected dura margin and the anterior edge of a normal pituitary gland (type 1 CSF leakage). OBJECTIVE To evaluate the usefulness of a direct suture technique of the normal gland edge on the incised dural margin to repair intraoperative CSF leakage from the arachnoid recess. METHODS Between November 2005 and December 2012, 861 patients with pituitary adenomas were operated on with transsphenoidal surgery, and intraoperative CSF leakage was encountered in 432 patients. Type 1 CSF leakage developed in a total of 122 patients, and their defects were repaired with the direct suture technique in 51 patients, whereas a fleece-coated fibrin glue patch alone was applied onto the defect in the other 71 patients. This direct suture technique required an additional 5 to 20 minutes in most cases. RESULTS We experienced no case of postoperative CSF rhinorrhea in the 51 patients whose defects were repaired by the direct suture technique and only 1 case of CSF rhinorrhea in 71 patients whose defects were repaired with a fleece-coated fibrin glue patch alone. There was no statistical difference in the outcome between 2 groups. Postoperative lumbar CSF drainage was not performed in any case. CONCLUSION Our 2 different repair techniques for arachnoid recess tears are very reliable methods for managing this type of CSF leakage. The direct suture technique may be more appropriate for type 1 CSF leakage with a wider gap and more prominent CSF leakage.
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Affiliation(s)
- Eui Hyun Kim
- *Department of Neurosurgery, ‡Pituitary Tumor Clinic, and §Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Jin GH, Choi GR, Park HH, Lee TS, Lee SB. Defining gross tumor volume using positron emission tomography/computed tomography phantom studies. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2473-6. [PMID: 24110228 DOI: 10.1109/embc.2013.6610041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tumor volume and standard uptake value (SUV) calculated from positron emission tomography/computed tomography (PET/CT) images differ from their real values. Besides errors introduced by scintillation materials, photomultiplier tubes, and image reconstruction algorithms, measurements are affected by patients' prostheses, body movements, and body shape. To address these problems, we calculated tumor volume and SUV using the standard phantom (PET Phantom-NEMA IEC/2001) and obtained calibration constants. We found that while tumor volume increases with increasing SUV and tumor diameter, it also increases with increasing SUV and decreasing tumor diameter. Conversely, tumor volume decreases with decreasing SUV and tumor diameter and with decreasing SUV and increasing diameter. These results suggest that a correction factor should be applied to SUV and tumor volume obtained from PET/CT images.
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Kim DW, Kang JH, Lim YS, Lee MH, Seo WS, Park HH, Seo KH, Park MG. Pretreatment of polyethylene terephthalate substrate for the growth of Ga-doped ZnO thin film. J Nanosci Nanotechnol 2011; 11:1617-1620. [PMID: 21456250 DOI: 10.1166/jnn.2011.3355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The effect of the pretreatment of polyethylene terephthalate (PET) substrate on the growth of transparent conducting Ga-doped ZnO (GZO) thin film was investigated. Because of its high gas and moisture absorption and easy gas permeation, PET substrate was annealed at 100 degrees C in a vacuum chamber prior to the sputtering growth of GZO thin film for the outgassing of impurity gases. GZO thin film was deposited on the pretreated PET substrate by rf-magnetron sputtering and significantly improved electrical properties of GZO thin film was achieved. Electrical and structural characterizations of the GZO thin films were carried out by 4-point probe, Hall measurement, and scanning electron microscopy, and the effects of the pretreatment on the improved properties of GZO thin films were discussed. This result is not only useful to PET substrate, but also could be applicable to other plastic substrates which inevitably containing the moisture and impurity gases.
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Affiliation(s)
- D W Kim
- Green Ceramics Division, Korea Institute of Ceramic Engineering and Technology, Seoul 153-801, Korea
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Kim JW, Kim EY, Park HH, Jung JE, Kim HD, Shin HJ, Lim WK. Homodimers of mutant tryptophan synthase alpha-subunits in Escherichia coli. Biochem Biophys Res Commun 2001; 289:568-72. [PMID: 11716512 DOI: 10.1006/bbrc.2001.6022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tryptophan synthase alpha-subunit from Escherichia coli functionally exists as a heterotetramer of alpha(2)beta(2) with beta-subunit. While wild-type and mutant (F139W, T24M/F139W, and T24L/F139W) alpha-subunits were expressed as a monomer from recombinant plasmids in Escherichia coli, T24A/F139W, T24S/F139W, and T24K/F139W mutant alpha-subunits were abnormally expressed as soluble homodimers in addition to monomers. Monomers of dimer-forming mutant alpha-subunits retain high affinity to beta-subunit, high activity in stimulating catalytic activities of beta-subunit, and nearly intact content of secondary structure, indicating that the global structures of these monomers are identical to that of F139W alpha-subunit. However, fluorescence spectra of Trp139 and ANS binding indicate that significant perturbations occur in the mutant proteins. Interestingly, these defective properties of monomers caused by residue replacement were partially repaired by the dimer formation. As a result, it is suggested that dimers may be formed by domain or loop swapping, and that residue 24 may play important role in maintaining on-pathway of alpha-subunit folding.
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Affiliation(s)
- J W Kim
- Department of Molecular Biology, College of Natural Sciences, Pusan National University, Pusan, 609-735, Korea
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Abstract
A cDNA library of mRNA from flounder leukocytes stimulated with bacterial lipopolysaccharide (LPS) and hemagglutinin was constructed to clone cytokine genes of this fish. Initial screening of this library with human cytokine gene probes was not productive and clones with inserts of over 400 nucleotides (nt) were randomly sequenced, and a homologue of the vertebrate interleukin-8 (IL-8) gene was isolated. The flounder IL-8 cDNA encompassed 884 nt, including a coding region of 330 nt. Four cysteines characteristic of CXC chemokines were identified at conserved locations in the putative protein. The deduced amino acid sequence showed 36 and 35% sequence identity with counterpart genes in monkey and human, respectively, and 52% sequence similarity with these genes. However, the putative flounder IL-8 amino acid sequence showed 25% identity and 52% similarity to that of lamprey, the only other piscine IL-8 gene that has been cloned. Flounder IL-8 transcripts were detected in the head-kidney and spleen of LPS-injected flounder and leukocytes stimulated with LPS. It was not detected in the muscle or liver of LPS-injected flounder, tissues taken from non-stimulated flounder and non-stimulated leukocytes.
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Affiliation(s)
- E Y Lee
- Department of Microbiology, Pukyong National University, 599-1, Daeyeon 3-Dong, Nam-Gu, Pusan, 608-737, South Korea
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Abstract
Streptomyces setonii (ATCC 39116) degrades various single aromatic compounds such as phenol or benzoate via an ortho-cleavage pathway using catechol 1,2-dioxygenase (C12O). A PCR using degenerate primers based on the conserved regions of known C12O-encoding genes amplified a 0.45-kbp DNA fragment from S. setonii total DNA. A Southern hybridization analysis and size-selected DNA library screening using the 0.45-kbp PCR product as a probe led to the isolation of a 6.4-kbp S. setonii DNA fragment, from which the C12O-encoding genetic locus was found to be located within a 1.4-kbp DNA fragment. A complete nucleotide sequencing analysis of the 1.4-kbp DNA fragment revealed a 0.84-kbp open reading frame, which showed a strong overall amino acid similarity to the known high-G+C Gram-positive (but significantly less to the Gram-negative) bacterial mesophilic C12Os. The heterologous expression of the cloned 1.4-kbp DNA fragment in Escherichia coli demonstrated that this C12O possessed a thermophilic activity within a broad temperature range (up to 65 degrees C) and showed a higher activity against 3-methylcatechol than catechol or 4-methylcatechol, but no activity against protocatechuate.
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Affiliation(s)
- H R An
- Department of Environmental Science, Hankuk University of Foreign Studies, 449-791, Kyunggi-Do, South Korea
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Lee M, Kang J, Lee CH, Haam S, Park HH, Kim WS. Oxygen transfer characteristics in a pilot scale surface aeration vessel with Simcar aerator. Environ Technol 2001; 22:57-68. [PMID: 11286056 DOI: 10.1080/09593332208618305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The volumetric mass transfer coefficient, KLa, was determined by dynamic method in a surface aerated pilot scale squared vessel up to 0.531 m3 equipped with Simcar type impeller. Through surface aeration, the oxygen transfer characteristics were investigated with the variations of operating variables such as stirring speed, impeller diameter, liquid height and power input per liquid volume (P0/V). It was seen from the results of different oxygen concentration absorption that the dynamic method might lead to errors in KLa when air was used for absorption. To provide reliable KLa values measured by dynamic, the KLa data using pure oxygen were used and confirmed with feeding steady-state method (FSM). As expected, KLa depends on P0/V, impeller size and liquid height. However, for Simcar type impeller, the KLa shows linear dependency on P0/V in contrast to majority of correlations reported in the literature which shows KLa variation of (P0/V)0.65 for disk type impeller. Moreover, it was interesting to find that the bubble behaviors inside the vessel computed by computational fluid dynamics (CFD) could explain qualitatively the KLa changes with operating variables. For the purpose of scale-up procedures, the empirical correlations for predicting KLa were developed within +/- 2% accuracy.
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Affiliation(s)
- M Lee
- Department of Chemical Engineering, Yonsei University, Sodaemun-ku, Seoul 120-749, Korea
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Abstract
As Th1 and Th2 cytokines, IFN-gamma/alpha and IL-4 counterregulate diverse immune functions. In particular, IFN-gamma and IFN-alpha have been reported to markedly suppress the IL-4-induced IgE production and type II IgE receptor (FcepsilonRII/CD23) expression. Because modulation of IL-4R may be an important mechanism in the regulation of IL-4 response, we have investigated the effect of IFN-gamma/alpha on IL-4R expression and signal transduction mechanisms involved in this process. In human mononuclear cells and B cells isolated from tonsil or peripheral blood, IL-4 up-regulates IL-4R(alpha) expression at surface protein and mRNA levels, and the IL-4-induced IL-4R(alpha) is significantly down-regulated by both IFN-gamma and IFN-alpha to a similar extent. The inhibitory effects of IFN-gamma/alpha on the IL-4R mRNA expression require a lag period of about 8 h, and are sensitive to cycloheximide treatment, which suggests that the suppressive effect of IFNs on IL-4R gene expression is a secondary response requiring de novo synthesis of IFN-induced factors. Under such conditions that the inhibitory effects of IFNs are observed, IFNs do not affect the IL-4-induced STAT6 activation and IL-4R transcription, as analyzed by EMSA and nuclear run-on assays, respectively. Subsequently, mRNA stability studies have indicated that the action of IFN-gamma/alpha is primarily mediated by an accelerated decay of IL-4-induced IL-4R mRNA. Thus, it appears that, as already shown in the case of the IL-4-induced FcepsilonRII regulation, posttranscriptional inhibition of IL-4-inducible genes by mRNA destabilization is a common mechanism by which type I and II IFNs antagonize the IL-4 response in human immune cells.
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Affiliation(s)
- E Y So
- Department of Biological Science and Institute for Basic Science, SungKyunKwan University, Suwon, Korea
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Abstract
The present study deals with the morphological changes of the degenerating primordial and primary follicles induced by gamma-radiation. Prepubertal female mice of 3 weeks old ICR strain were gamma-irradiated with the dose of LD(80(30)) (8.3 Gy). The ovaries were collected at 3, 6 and 12 h after irradiation. The largest cross-sections were prepared by histological semithin sections for microscopical observations. The ratio (%) of normal to atretic follicles decreased with time after the irradiation in primordial follicles and in primary follicles as well. At 6 h after irradiation, the number of degenerated primordial follicles increased. Germinal vesicles disappeared and lipid droplets increased in number. Granulosa cells became round in shape and apoptotic cells started to appear. The ooplasmic membrane was not recognizable. The ratio of normal to atretic primordial follicles in the control group was 62.5. Then it became lower with time after the irradiation. It went down to 51.6, 49.0, 11.1 and 7.1 at 0, 3, 6 and 12 h, respectively. The ratio of normal to atretic primary follicles in the control mouse ovary was 81.3. It was 80.0, 75.0, 45.5 and 33. 3 at 0, 3, 6 and 12 h after irradiation, respectively. It is concluded that the ionizing radiation acutely induces the degeneration of primordial and primary follicles. The pattern of degeneration is one of the following: (1) apoptosis of one or more granulosa cells with a relatively intact oocyte, (2) apoptosis of an oocyte with intact follicle cells, or (3) apoptotic degenerations of both kinds of cells. These results can provide morphological clues for the identification of the degenerating primordial and primary follicles in normal and irradiated mouse ovaries.
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Affiliation(s)
- C J Lee
- Korea Atomic Energy Research Institute, Yusong P.O. Box 105, Taejon, South Korea
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Han YM, Park HH, Lee JM, Kim JC, Hwang PH, Lee DK, Kim CS, Choi KC. Effectiveness of preoperative transarterial chemoembolization in presumed inoperable hepatoblastoma. J Vasc Interv Radiol 1999; 10:1275-80. [PMID: 10527208 DOI: 10.1016/s1051-0443(99)70231-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and therapeutic role of preoperative transarterial chemoembolization (TACE) of hepatoblastoma. MATERIALS AND METHODS Four patients (one boy, three girls) with unresectable hepatoblastoma were treated twice with preoperative TACE in an effort to improve the surgical and clinical outcome. The patients ranged in age from 8 to 27 months (mean, 15 months). The first TACE was performed superselectively in tumor feeding arteries. The second TACE was performed 3 weeks later. Surgical hepatic resection was performed 1 month after the second TACE. Contrast-enhanced computed tomography (CT) was used to evaluate changes in size, volume, internal texture, and margin of the masses. The toxicity of the chemotherapeutic drugs was evaluated by blood chemistry analysis (AST/ALT, alpha-FP) performed before and after TACE, and after surgery. RESULTS TACE allowed subsequent surgical resection in all four patients, who remained disease free 16-52 months after operation. There were no major problems related to TACE. There was no chemotherapeutic agent toxicity from TACE. The average largest diameters and volumes of the tumors decreased by 31% (8.3 to 5.6 cm) and 69% (317 to 93 cm2), respectively. CONCLUSION TACE provided subsequent successful surgical resection and good long-term results in all four patients. The hepatoblastomas were initially considered inoperable because of extensive hepatic involvement and indistinct margins.
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Affiliation(s)
- Y M Han
- Department of Diagnostic Radiology, Chonbuk National University Medical School, Chonju City, Republic of Korea.
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Park HJ, Lee YW, Park HH, Lee YS, Kwon IB, Yu JH. Induction of quinone reductase by a methanol extract of Scutellaria baicalensis and its flavonoids in murine Hepa 1c1c7 cells. Eur J Cancer Prev 1998; 7:465-71. [PMID: 9926295 DOI: 10.1097/00008469-199812000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effect of extracts of scutellariae radix (Scutellaria baicalensis Georgi) and its flavonoids, baicalin, baicalein and wogonin, on induction of quinone reductase (QR) in the Hepa 1c1c7 murine hepatoma cell line was examined. A significant and dose-dependent induction of QR activity was observed in the methanol extract of scutellariae radix and baicalin. HPCL analysis showed that baicalin was contained as a main component in the methanol extract of scutellariae radix, indicating that baicalin may be the major active principle of QR induction mediated by scutellariae radix extract. To elucidate the mechanism of baicalin-mediated induction of QR enzyme activity, the effect on QR mRNA levels in Hepa 1c1c7 cell cultures was investigated. Using reverse transcriptase-polymerase chain reaction techniques, time- and dose-dependent induction of QR mRNA levels by baicalin were demonstrated in Hepa 1c1c7 cells. On the basis of these results, the scutellariae radix extract or baicalin can be regarded as a readily available, promising, novel cancer chemopreventive agent.
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Affiliation(s)
- H J Park
- Department of Biological Science, Lotte Group R & D Center, Seoul, Korea
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Hwang C, Lee C, Lee SW, Jeong I, Park HH, Tanaka S, Kamada M. Fermi-level pinning of Ag on Si(111)-(7 x 7). Phys Rev B Condens Matter 1995; 52:16325-16328. [PMID: 9981021 DOI: 10.1103/physrevb.52.16325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Chung KS, Park HH, Ting K, Takita H, Apte SS, Kuboki Y, Nishimura I. Modulated expression of type X collagen in Meckel's cartilage with different developmental fates. Dev Biol 1995; 170:387-96. [PMID: 7649371 DOI: 10.1006/dbio.1995.1224] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mammalian Meckel's cartilage undergoes regionally diverse histodifferentiation: the caudal end of Meckel's cartilage extends to the developing ear and gives rise to malleus and incus through endochondral ossification while its major distal region differentiates into sphenomandibular ligament and the anterior ligament of the malleus tympanic plate through fibrous transformation. Since the entire Meckel's cartilage develops up to chondrocyte hypertrophy, the regional extracellular matrix components in the hypertrophic Meckel's cartilage may differ in association with the diverse developmental fates. In this project, the expressions of cartilage collagens were investigated in developing rat Meckel's cartilage and particular interest was given to type X collagen. A cDNA, HP114, encoding the NC1 domain of rat alpha 1(X) collagen was cloned, and a synthetic peptide based on the sequence deduced from HP114 was used to generate a monospecific antibody. In situ hybridization of newborn rat condylar and angular cartilages undergoing endochondral ossification showed restricted labeling with the alpha 1(X) collagen probe in the hypertrophic chondrocyte layer. In contrast, the alpha 1(X) collagen probe totally failed to label the major distal portion of Meckel's cartilage even in the hypertrophic cartilage zone. Immunohistochemistry using the anti-type X collagen monospecific antibody consistently failed to recognize the epitope in the corresponding portion of Meckel's cartilage throughout the experimental periods of gestational Day 17, newborn, and Postnatal Day 7, while the strictly localized positive staining was found in the posterior part of Meckel's cartilage which gave rise to malleus and incus. Since major cartilage collagens type II and type IX were found to be present throughout Meckel's cartilage, we postulate that the regulatory molecular mechanism of type X collagen expression may be closely associated with the developmental fates of fibrous transformation and endochondral ossification in mammalian Meckel's cartilage.
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Affiliation(s)
- K S Chung
- Department of Orthodontics, Harvard School of Dental Medicine, Boston, Massachusetts 02115, USA
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Abstract
Forty-one hemimandible allografts were transplanted in young rabbits immunosuppressed with cyclosporine. The majority of the grafts demonstrated normal wound healing, and growth of hair, bone, and teeth. The mandibular body and the premolars showed significant growth in length. The allografted mandibles functioned sufficiently that the rabbits took oral nourishment soon after surgery. Long-term survival was limited by a toxic "wasting syndrome" specific for rabbits under treatment with cyclosporine.
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Affiliation(s)
- J Randzio
- Division of Plastic Surgery, University of California, Irvine
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Gold ME, Randzio J, Kniha H, Kim BS, Park HH, Stein JP, Booth K, Gruber HE, Furnas DW. Transplantation of vascularized composite mandibular allografts in young cynomolgus monkeys. Ann Plast Surg 1991; 26:125-32. [PMID: 2006838 DOI: 10.1097/00000637-199102000-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In the search for donor tissue for massive craniofacial defects, the transplantation of somatic tissue allografts was explored. Four young, out-bred cynomolgus monkeys were the recipients of orthotopic hemimandibular allotransplants from nonrelated cynomolgus monkeys. The transplant consisted of one-half of the mandible with attached muscle, skin, and mucosa. Cyclosporine 15 mg/kg/day was given subcutaneously each day. The 4 monkeys were observed for 13, 27, 63, and 65 days, respectively. All transplants showed primary wound healing and hair growth. The 2 longest survivors chewed, ate a normal diet, and gained weight. Two allografts showed severe rejection signs at 2 to 3 weeks, and the monkeys were euthanized. One monkey had a second episode of rejection that could not be reversed, and it was killed. The fourth monkey died of undetermined causes.
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Affiliation(s)
- M E Gold
- Division of Plastic Surgery, University of California, Irvine
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Abstract
Seventeen forelimbs were transplanted orthotopically from young Dutch rabbits to young New Zealand rabbits treated with cyclosporine. The transplanted limbs demonstrated significant bone growth. The growth in the transplanted limbs was about 75 to 80% of that observed in the unoperated limb. The long bones of the 3 longest surviving rabbits (133 days, 150 days, 150 days) studied radiographically demonstrated increases in length over their original lengths (humerus 22%, ulna 26%, and radius 31%). Hair and nail growth were noted at about day 10. Response to pain stimuli (withdrawal of forelimb) and functional use (ambulation with 50% weight bearing) was seen at two to three months. Permanent survival was not achieved because of a species-specific toxic wasting syndrome from cyclosporine.
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Affiliation(s)
- H Kniha
- Division of Plastic Surgery, University of California, Irvine
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