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Jeon C, Chong K, Shin HJ, Kong DS. Endoscopic transorbital approach in children: surgical technique and early results. Neurosurg Focus 2024; 56:E12. [PMID: 38560935 DOI: 10.3171/2024.1.focus23858] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE In this study, the authors aimed to describe the endoscopic transorbital approach (ETOA) in children. METHODS Six pediatric patients (2 girls and 4 boys) underwent the ETOA for paramedian skull base lesions at a single institution between September 2016 and February 2023. RESULTS The median age at the time of surgery was 7.5 (range 4-18) years. The median follow-up period was 33 (range 9-60) months. In this series, the ETOA level of difficulty included stage 1 (n = 2, 33.3%), stage 3 (n = 3, 50%), and stage 5 (n = 1, 16.7%). The ETOA was performed for tumor resection in 4 cases; the final pathology consisted of fibrous dysplasia, pilocytic astrocytoma, metastatic neuroblastoma, and choroid plexus papilloma. The procedure was also performed for repair of a petrous apex meningocele and for lateral orbital wall decompression of traumatic lateral rectus muscle entrapment. One patient experienced a transient cranial nerve III palsy after the procedure. There were no operative deaths in this series. CONCLUSIONS In select cases, the ETOA can be considered a minimally invasive alternative for conventional skull base approaches in the armamentarium of pediatric skull base surgery. Further investigation and the accumulation of experience are warranted in the future to enhance the efficacy and applicability of the ETOA in pediatric patients.
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Affiliation(s)
- Chiman Jeon
- 1Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do
| | - Kyuha Chong
- 2Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Hyung Jin Shin
- 3Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Doo-Sik Kong
- 2Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
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Kim JY, Lee S, Kim G, Shin HJ, Lee EJ, Lee CS, Yoon S, Lee E, Lim A, Kim SH. Ameliorating effect of 2'-Fucosyllactose and 6'-Sialyllactose on lipopolysaccharide-induced intestinal inflammation. J Dairy Sci 2024:S0022-0302(24)00568-X. [PMID: 38490539 DOI: 10.3168/jds.2024-24325] [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: 10/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024]
Abstract
Human milk oligosaccharides (HMO) affect gut microbiota during neonatal development, particularly with respect to the immune system. Bovine milk-based infant formulas have low oligosaccharide contents. Thus, efforts to fortify infant formulas with HMO are being undertaken. Two major HMO, 2'-fucosyllactose (2'-FL) and 6'-sialyllactose (6'-SL), exert anti-inflammatory effects; however, the associations between anti-inflammatory effects induced by 2'-FL and 6'-SL co-treatment and gut microbiota composition and metabolite modulation remain unclear. Therefore, in this study, we evaluated the effects of a mixture of these HMO. To determine the optimal HMO ratio for anti-inflammatory effects and elucidate its mode of action, LPS-induced inflammatory HT-29 epithelial cells and intestinal inflamed suckling mice were treated with various mixtures of 2'-FL and 6'-SL. 2'-FL:6'-SL ratio of 5:1 was identified as the most effective pre-treatment HMO mixture in vitro; thus, this ratio was selected and used for low, middle, and high-dose treatments for subsequent in vivo studies. In vivo, high-dose HMO treatment restored LPS-induced inflammation symptoms, such as body weight loss, colon length reduction, histological structural damage, and intestinal gene expression related to inflammatory responses. High-dose HMO was the only treatment that modulated the major phyla Bacteroidetes and Firmicutes and the genera Ihubacter, Mageeibacillus, and Saccharofermentans. These changes in microbial composition were correlated with intestinal inflammation-related gene expression and short-chain fatty acid production. To our knowledge, our study is the first to report the effects of Ihubacter, Mageeibacillus, and Saccharofermentans on short chain fatty acid levels, which can subsequently affect inflammatory cytokine and tight junction protein levels. Conclusively, the HMO mixture exerted anti-inflammatory effects through changes in microbiota and metabolite production. These findings suggested that supplementation of infant formula with HMO may benefit formula-fed infants by forming unique microbiota contributing to neonatal development.
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Affiliation(s)
- J-Y Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea; Institute of Life Science and Natural Resources, Korea University, Seoul 02841, Republic of Korea
| | - S Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - G Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - H J Shin
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - E J Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - C S Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea; Institute of Life Science and Natural Resources, Korea University, Seoul 02841, Republic of Korea
| | - S Yoon
- Lotte R&D Center, Seoul, Republic of Korea
| | - E Lee
- Lotte R&D Center, Seoul, Republic of Korea
| | - A Lim
- Lotte R&D Center, Seoul, Republic of Korea
| | - S H Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea; Institute of Life Science and Natural Resources, Korea University, Seoul 02841, Republic of Korea.
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Kong DS, Shin HJ. Endoscopic Transorbital Surgery for Trigeminal Schwannoma: Introduction of a Novel Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:96-97. [PMID: 37819070 DOI: 10.1227/ons.0000000000000893] [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: 01/06/2023] [Accepted: 07/14/2023] [Indexed: 10/13/2023] Open
Abstract
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE The major indications of endoscopic transorbital approach include spheno-orbital meningiomas, cavernous sinus lesions, and Meckel cave lesion such as trigeminal schwannomas. It can avoid excessive brain retraction and allows for a fast recovery to the normal daily living activity. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT To access the cavernous sinus, the sagittal crest and meningo-orbital band should be identified and cut. ESSENTIAL STEPS OF THE PROCEDURE 1. Skin incision along the superior eyelid is performed. 2. Careful dissection of the soft tissue under the orbicularis is required not to injure the orbital septum. 3. After the lateral orbital rim is exposed, the periosteum and periorbita are elevated from the lateral orbital wall. 4. Drilling of the zygomatic bone within the orbit exposes the temporalis muscle first followed by the exposure of the temporal dura. It is essential to obtain adequate working room when the base of the greater sphenoidal wing is drilled. The sagittal crest should be removed, and the meningo-orbital band should be cut to expose the lateral cavernous sinus wall. PITFALLS/AVOIDANCE OF COMPLICATIONS For successful access through the orbit, endoscopic transorbital approach needs to minimize the retraction of the orbit. To achieve this goal, retraction of the orbit should be limited to a maximum of 10 minutes. VARIANTS AND INDICATIONS OF THEIR USE This approach can be combined with lateral orbitotomy. It provides a wider working room and makes surgery easier to access the lateral temporal lobe.The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Images at 1:29 reproduced from Corrivetti F, de Notaris M, Di Somma A, et al, "Sagittal crest": definition, stepwise dissection, and clinical implications from a transorbital perspective, Operative Neurosurgery , 22(5), p e206-e212, ©2022, by permission from the Congress of Neurological Surgeons. Video screen capture from The Neurosurgical Atlas at 1:06 used with permission from Aaron Cohen-Gadol; ©The Neurosurgical Atlas, all rights reserved.
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Affiliation(s)
- Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Capital Armed Forces Hospital, Seungnam, Gyeonggido, Korea
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Jang C, Hwang S, Jin TK, Shin HJ, Cho BK. Factors Affecting Cage Obliquity and the Relationship between Cage Obliquity and Radiological Outcomes in Oblique Lateral Interbody Fusion at the L4-L5 Level. J Korean Neurosurg Soc 2023; 66:703-715. [PMID: 37884282 PMCID: PMC10641422 DOI: 10.3340/jkns.2023.0071] [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: 04/05/2023] [Revised: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE This retrospective study investigated the factors that affect cage obliquity angle despite orthogonal maneuvers performed during oblique lateral interbody fusion (OLIF) and assessed the relationship between cage obliquity angle and radiological outcomes post-surgery. METHODS Twenty-nine males who underwent L4-L5 OLIF for lumbar degenerative disease between 2019 and 2021 with a followup duration greater than 12 months were analyzed. Radiological parameters were measured including psoas muscle volume, total psoas area index (total psoas muscle area [cm2]/height squared [m2]), distance from the iliac artery to the origin of the psoas muscle (DIAPM), angle between the origin of the psoas muscle and the center of the vertebral disc (APCVD), iliac crest height, disc height, lumbar flexibility (lumbar flexion angle minus extension angle), cage location ratio, cage-induced segmental lumbar lordosis (LL) (postoperative index level segmental LL minus used cage angle), foraminal height changes, fusion grade. RESULTS DIAPM, APCVD, iliac crest height, postoperative index level segmental LL, and cage-induced segmental LL were significantly correlated with OLIF cage obliquity angle. However, other radiological parameters did not correlate with cage obliquity. Based on multiple regression analysis, the predictive equation for the OLIF cage obliquity angle was 13.062-0.318×DIAPM+0.325×A PCVD+0.174×iliac crest height. The greater the cage obliquity, the smaller the segmental LL compared to the cage angle used. CONCLUSION At the L4-L5 level, OLIF cage obliquity was affected by DIAPM, APCVD, and iliac crest height, and as the cage obliquity angle increases, LL agnle achievable by the used cage could not be obtained.
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Affiliation(s)
- CheolWon Jang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - SungHwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Tae Kyung Jin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Kim JY, Hyun DY, Nam D, Shin HJ, Jung J, Cho SY, Jung K, Hwang D, Lee SW, Kim JY. Proteogenomic Analysis of Human Uterine Cervical Cancer (UCC) Reveals Treatment-Resistant Subtypes of UCC. Int J Radiat Oncol Biol Phys 2023; 117:S22. [PMID: 37784455 DOI: 10.1016/j.ijrobp.2023.06.277] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Locally advanced uterine cervical cancer (UCC) is treated by radiotherapy with concurrent chemotherapy, but heterogenous treatment responses are frequently observed. To better optimize therapeutic options based on molecular signatures, we performed proteogenomic analysis of UCC. MATERIALS/METHODS UCC tissue and blood samples were collected from patients who underwent primary radiotherapy ± chemotherapy at the National Cancer Center (NCC) in Korea from July 2004 to March 2020. Most samples were obtained via biopsy. Genomic DNA for WES was isolated from frozen biopsy tumor tissues and peripheral blood buffy-coat of patients. Both global proteome and phosphoproteome were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Whole exome sequencing, RNA sequencing, global proteomics and phosphoproteomics were performed using 253, 337, and 147 cervical cancer samples, respectively. Patient-derived xenograft were established using intratongue implantation using 2 primary cell lines from sub3 and sub5, and flow cytometric analysis was performed. RESULTS Fourteen significantly mutated genes (SMG) were found in our study cohort which include 5 newly identified SMGs. Mutation-phosphorylation analysis revealed association with apoptosis and actin cytoskeleton pathway. Proteogenomic analysis defined 6 molecular subtypes of UCC. Of those, 3 subtypes (i.e., Sub3, Sub5 and Sub6) were associated with treatment-resistant phenotypes. The cell-type deconvolution analysis suggested activated stroma with activation of cancer-associated fibroblast in Sub 3, while Sub5 showed low levels of activated stroma and high levels of myeloid immune cells. FACS analysis of UCC mouse models established from these 2 radio-resistant primary cell lines showed high component of PDGFRA+CAF infiltration in Sub 3, and high level of PVR+CD45+ immune cells mainly composed of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) in Sub5. For Sub6, genes and/or protein signatures represented mucin-related processes (e.g., mucin glycosylation/sugar metabolism), which are linked to metastasis-associated Tn antigen production. CONCLUSION The proteogenomic analysis thus suggests potential targets for radiotherapy-resistant subtypes of UCC; secretory factors from activated stroma and cancer-associated fibroblast (Sub3); RHOA signaling, PVR, and PMN-MDSCs (Sub5), and keratin/chondroitin sulfate proteoglycan and Tn antigen production (Sub6). Our study shows the importance of proteogenomic analysis in unveiling the subtype specific molecular pathways of UCC that are beyond reach by genomic data alone. The validity of our molecular pathway and cellular signatures linking these pathways should be further validated through detailed functional experiments and in larger UCC cohorts.
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Affiliation(s)
- J Y Kim
- National Cancer Center, Goyang, Korea, Republic of (South) Korea
| | - D Y Hyun
- School of Biological Sciences, Seoul National University, Seoul, Korea, Republic of (South) Korea
| | - D Nam
- Department of Chemistry and Center for Proteogenome Research, Korea University, Seoul, Korea, Republic of (South) Korea
| | - H J Shin
- Research Institute and Hospital, National Cancer Center, Korea, Goyang, Korea, Republic of (South) Korea
| | - J Jung
- Department of Anatomy and Cell Biology and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S Y Cho
- Research Institute and Hospital, National Cancer Center, Korea, Goyang-si, Korea, Republic of (South) Korea
| | - K Jung
- Department of Anatomy and Cell Biology and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - D Hwang
- School of Biological Sciences, Seoul National University, Seoul, Korea, Republic of (South) Korea
| | - S W Lee
- Department of Chemistry and Center for Proteogenome Research, Korea University, Seoul, Korea, Republic of (South) Korea
| | - J Y Kim
- Research Institute and Hospital, National Cancer Center, Korea, Goyang-si, Korea, Republic of (South) Korea
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Shin HJ, Son NH, Hwang SH, Song K. Reliability of synthetic diffusion-weighted imaging with a high b-value for paediatric abdominal MRI. Clin Radiol 2023; 78:616-621. [PMID: 37149417 DOI: 10.1016/j.crad.2023.04.003] [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: 12/29/2022] [Revised: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
AIM To evaluate the reliability of synthetic diffusion-weighted imaging (DWI) using a high b-value in comparison to conventional DWI for paediatric abdominal MRI. MATERIALS AND METHODS Paediatric patients (<19 years old) who underwent liver or pancreatobiliary MRI with DWI using 10 b-values (b = 0, 25, 50, 75, 100, 200, 400, 600, 800, 1,500 s/mm2) from March to October 2021 were included in this retrospective study. Using the software, synthetic DWI using b = 1,500 s/mm2 was generated automatically by selecting the b-value required as output. Conventional and synthetic DWI values for b = 1,500 s/mm2 were measured at the liver, spleen, paraspinal muscle, and mass lesions, if present, and apparent diffusion coefficient (ADC) values were calculated using the mono-exponential model. Intraclass correlation coefficients (ICCs) were calculated to assess the reliability of conventional and synthetic DWI and ADC values with b = 1,500 s/mm2. RESULTS Thirty paediatric patients (M:F = 22:8, mean 10.8 ± 3.1 years old) were included and four had tumours on abdominal MRI. ICC values were 0.906-0.995 between conventional and synthetic DWI and ADC with b = 1,500 s/mm2 in the liver, spleen and muscle. For mass lesions, ICC values were 0.997-0.999 for both synthetic DWI and ADC images. CONCLUSIONS Synthetic DWI and ADC values obtained using a high b-value showed excellent agreement with conventional DWI for the liver, spleen, muscle, and mass in paediatric MRI.
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Affiliation(s)
- H J Shin
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 16995, Republic of Korea.
| | - N-H Son
- Department of Statistics, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - S H Hwang
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 16995, Republic of Korea
| | - K Song
- Department of Paediatrics, Division of Paediatric Endocrinology, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 16995, Republic of Korea
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Jang C, Cho BK, Hwang SH, Shin HJ, Yoon SH. Leptomeningeal Spread at the Diagnosis of Glioblastoma Multiforme: A Case Report and Literature Review. Brain Tumor Res Treat 2022; 10:183-189. [PMID: 35929116 PMCID: PMC9353161 DOI: 10.14791/btrt.2022.0013] [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: 05/03/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. 18F-fluorodeoxy glucose positron emission tomography computed tomography (18F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.
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Affiliation(s)
- Cheolwon Jang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea.
| | - Sung Hwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Cho HW, Lee H, Ju HY, Yoo KH, Koo HH, Lim DH, Sung KW, Shin HJ, Suh YL, Lee JW. Risk Stratification of Childhood Medulloblastoma Using Integrated Diagnosis: Discrepancies with Clinical Risk Stratification. J Korean Med Sci 2022; 37:e59. [PMID: 35191235 PMCID: PMC8860767 DOI: 10.3346/jkms.2022.37.e59] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recent genomic studies identified four discrete molecular subgroups of medulloblastoma (MB), and the risk stratification of childhood MB in the context of subgroups was refined in 2015. In this study, we investigated the effect of molecular subgroups on the risk stratification of childhood MB. METHODS The nCounter® system and a customized cancer panel were used for molecular subgrouping and risk stratification in archived tissues. RESULTS A total of 44 patients were included in this study. In clinical risk stratification, based on the presence of residual tumor/metastasis and histological findings, 24 and 20 patients were classified into the average-risk and high-risk groups, respectively. Molecular subgroups were successfully defined in 37 patients using limited gene expression analysis, and DNA panel sequencing additionally classified the molecular subgroups in three patients. Collectively, 40 patients were classified into molecular subgroups as follows: WNT (n = 7), SHH (n = 4), Group 3 (n = 8), and Group 4 (n = 21). Excluding the four patients whose molecular subgroups could not be determined, among the 17 average-risk group patients in clinical risk stratification, one patient in the SHH group with the TP53 variant was reclassified as very-high-risk using the new risk classification system. In addition, 5 out of 23 patients who were initially classified as high-risk group in clinical risk stratification were reclassified into the low- or standard-risk groups in the new risk classification system. CONCLUSION The new risk stratification incorporating integrated diagnosis showed some discrepancies with clinical risk stratification. Risk stratification based on precise molecular subgrouping is needed for the tailored treatment of MB patients.
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Affiliation(s)
- Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunwoo Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon-Lim Suh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Koo J, Hwang S, Yoon SH, Shin HJ, Cho BK. Progression of Ossification of Posterior Longitudinal Ligament After Anterior Cervical Discectomy and Fusion in Military Patients Exposed to Minor Trauma. Korean J Neurotrauma 2022; 18:254-267. [PMID: 36381449 PMCID: PMC9634320 DOI: 10.13004/kjnt.2022.18.e55] [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] [Received: 06/26/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Ossification of the posterior longitudinal ligament (OPLL) can progress even after cervical spine surgery and may cause neurological injury as a result of minor trauma. The purpose of this study was to investigate the preventive factors associated with OPLL progression after anterior cervical discectomy and fusion (ACDF), a procedure commonly performed in clinical practice. Methods We retrospectively investigated 295 male soldiers who underwent ACDF surgery between 2012 and 2017. Patients who were followed up for >12 months using dynamic radiography and computed tomography (CT) were included in the study. Radiological parameters investigated included OPLL progression, C2-C7 angles on dynamic radiography, segmental angles, C2-C7 cervical sagittal vertical axis (C2-C7 SVA), and the T1 slope. These parameters were measured preoperatively and 1 year postoperatively. Results A total of 49 patients were enrolled, and 10 patients were confirmed to have OPLL progression. Comparison between the OPLL progression and non-progression groups showed no statistically significant differences in pre- and postoperative cervical range of motion. However, statistically significant differences were observed in the postoperative neutral C2-C7 angle (progression -3.9°±6.4° vs. non-progression -13.4°±7.9°, p=0.001) and the SVA change (progression 5.8±7.9 mm vs. non-progression -3.7±6.3 mm, p=0.00). The cutoff values were -8.01° for the postoperative neutral C2-C7 angle and 1.4 mm for SVA changes. Conclusion Increased SVA (>1.4 mm) and a small postoperative neutral C2-C7 angle (>-8.01°) 1 year after ACDF were associated with OPLL progression. It is important to be mindful of these factors during follow-up after ACDF, because additional surgical treatment may be necessary for OPLL progression due to neurological injury caused by minor trauma.
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Affiliation(s)
- Jungmyung Koo
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - SungHwan Hwang
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Jeon C, Choi JW, Kong DS, Shin HJ. Outcome of endoscopic transcortical intraventricular biopsy of isolated thickened pituitary stalk lesions in children. J Neurosurg Pediatr 2021:1-6. [PMID: 34861646 DOI: 10.3171/2021.9.peds21254] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the efficacy and safety of endoscopic transcortical intraventricular biopsy in pediatric patients with isolated thickened pituitary stalk lesions. METHODS From 1994 to 2018, 16 pediatric patients (8 males and 8 females) underwent endoscopic transcortical intraventricular biopsy at a single institution to establish an accurate pathological diagnosis for appropriate treatment strategies. RESULTS Preoperatively, the median diameter of the pituitary stalks was 5.31 ± 1.67 mm (range 3.86-9.17 mm). Overall, the diagnostic yield at endoscopic intraventricular biopsy was 93.8%. Histopathological diagnosis included germinoma (n = 10, 62.5%), Langerhans cell histiocytosis (n = 4, 25%), pilocytic astrocytoma (n = 1, 6.3%), and pituicytoma (n = 1, 6.3%). Two patients developed new diabetes insipidus after the procedure, and 3 patients had new postoperative hypothyroidism. There were no postoperative neurological deficits in this series. CONCLUSIONS Neuroendoscopic biopsy via the transcortical intraventricular corridor was shown to be safe and to aid in a reliable histopathological diagnosis in the management of isolated pituitary stalk lesions in pediatric patients. It can be considered a minimally invasive alternative to open biopsy via transcranial or endonasal corridors.
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Affiliation(s)
- Chiman Jeon
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Jung Won Choi
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Doo-Sik Kong
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Hyung Jin Shin
- 2Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Korea
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11
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Yoo GS, Yu JI, Cho S, Han Y, Oh Y, Lim DH, Nam HR, Lee JW, Sung KW, Shin HJ. Chronological Analysis of Acute Hematological Outcomes after Proton and Photon Beam Craniospinal Irradiation in Pediatric Brain Tumors. Cancer Res Treat 2021; 54:907-916. [PMID: 34665955 PMCID: PMC9296930 DOI: 10.4143/crt.2021.332] [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: 03/15/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to compare the early hematological dynamics and acute toxicities between proton beam craniospinal irradiation (PrCSI) and photon beam craniospinal irradiation (PhCSI) for pediatric brain tumors. Materials and Methods We retrospectively reviewed patients with pediatric brain tumors who received craniospinal irradiation (CSI). The average change in hemoglobin levels (ΔHbavg), absolute lymphocyte counts (ΔALCavg), and platelet counts (ΔPLTavg) from baseline values was evaluated and compared between the PrCSI and PhCSI groups at 1 and 2 weeks after the initiation of CSI, 1 week before and at the end of radiotherapy, and 3–4 weeks after the completion of radiotherapy using t-test and mixed-model analysis. Results The PrCSI and PhCSI groups consisted of 36 and 30 patients, respectively. There were no significant differences in ΔHbavg between the two groups at any timepoint. However, ΔALCavg and ΔPLTavg were significantly lower in the PhCSI group than in PrCSI group at every timepoint, demonstrating that PrCSI resulted in a significantly lower rate of decline and better recovery of absolute lymphocyte and platelet counts. The rate of grade 3 acute anemia was significantly lower in the PrCSI group than in in the PhCSI group. Conclusion PrCSI showed a lower rate of decline and better recovery of absolute lymphocyte and platelet counts than PhCSI in the CSI for pediatric brain tumors. Grade 3 acute anemia was significantly less frequent in the PrCSI group than in the PhCSI group. Further large-scale studies are warranted to confirm these results.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungkoo Cho
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoonjin Oh
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Rim Nam
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Song JY, Lee JI, Shin HJ, Lee J, Lee J. Gamma-Knife Radiosurgery for Hypothalamic Hamartoma-Related Epilepsy. Ann Child Neurol 2021. [DOI: 10.26815/acn.2021.00360] [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: 11/11/2022] Open
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13
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Lee WJ, Lee JI, Choi JW, Kong DS, Nam DH, Cho YS, Shin HJ, Seol HJ. Optimal Volume of the Residual Tumor to Predict Long-term Tumor Control Using Stereotactic Radiosurgery after Facial Nerve-preserving Surgery for Vestibular Schwannomas. J Korean Med Sci 2021; 36:e102. [PMID: 33904259 PMCID: PMC8076845 DOI: 10.3346/jkms.2021.36.e102] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Intended subtotal resection (STR) followed by adjuvant gamma knife radiosurgery (GKRS) has emerged as an effective treatment option for facial nerve (FN) preservation in vestibular schwannomas (VSs). This study aimed to identify the optimal cut-off volume of residual VS to predict favorable outcomes in terms of both tumor control and FN preservation. METHODS This retrospective study assessed the patients who underwent adjuvant GKRS for residual VS after microsurgery. A total of 68 patients who had been followed up for ≥ 24 months after GKRS were included. Tumor progression was defined as an increase in tumor volume (TV) of ≥ 20%. House-Brackmann grades I and II were considered to indicate good FN function. RESULTS The median residual TV was 2.5 cm³ (range: 0.3-27.4). The median follow-up period after the first adjuvant GKRS was 64 months (range: 25.7-152.4). Eight (12%) patients showed tumor progression. In multivariate analyses, residual TV was associated with tumor progression (P = 0.003; hazard ratio [HR], 1.229; 95% confidence interval [CI], 1.075-1.405). A residual TV of 6.4 cm³ was identified as the cut-off volume for showing the greatest difference in progression-free survival (PFS). The 5-year PFS rates in the group with residual TVs of < 6.4 cm³ (54 patients) and that with residual TVs of ≥ 6.4 cm³ (14 patients) were 93.3% and 69.3%, respectively (P = 0.014). A good FN outcome was achieved in 57 (84%) patients. Residual TV was not associated with good FN function during the immediate postoperative period (P = 0.695; odds ratio [OR], 1.024; 95% CI, 0.908-1.156) or at the last follow-up (P = 0.755; OR, 0.980; 95% CI, 0.866-1.110). CONCLUSION In this study, residual TV was associated with tumor progression in VS after adjuvant GKRS following STR. As preservation of FN function is not correlated with the extent of resection, optimal volume reduction is imperative to achieve long-term tumor control. Our findings will help surgeons predict the prognosis of residual VS after FN-preserving surgery.
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Affiliation(s)
- Won Jae Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Sun Cho
- Department of Otorhinolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Kim BS, Yeon JY, Shin HS, Kim JS, Hong SC, Shin HJ, Hwang YS, Lee JI. Gamma Knife Radiosurgery for Incidental, Symptomatic Unruptured, and Ruptured Brain Arteriovenous Malformations. Cerebrovasc Dis 2021; 50:222-230. [PMID: 33652439 DOI: 10.1159/000513280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/17/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study was performed to investigate clinical characteristics and outcome after gamma knife radiosurgery (GKS) in patients with incidental, symptomatic unruptured, or ruptured arteriovenous malformations (AVMs). METHODS A total of 491 patients with brain AVMs treated with GKS from June 2002 to September 2017 were retrospectively reviewed. All patients were classified into the incidental (n = 105), symptomatic unruptured (n = 216), or ruptured AVM (n = 170) groups. RESULTS The mean age at diagnosis of incidental, symptomatic unruptured, and ruptured AVMs was 40.3, 36.7, and 27.6 years, respectively. The mean nidus volume was 3.9, 5.7, and 2.4 cm3, respectively. Deep venous drainage was identified in 34, 54, and 76% patients, respectively. There were no significant differences in obliteration rates after GKS between the 3 groups (64.8, 61.1, and 65.9%, respectively) after a mean follow-up period of 60.5 months; however, patients with incidental AVM had a significantly lower post-GKS hemorrhage rate than patients with symptomatic unruptured or ruptured AVMs (annual hemorrhage rate of 1.07, 2.87, and 2.69%; p = 0.028 and p = 0.049, respectively). CONCLUSIONS There is a significant difference in clinical and anatomical characteristics between incidental, symptomatic unruptured, and ruptured AVMs. The obliteration rate after GKS is not significantly different between the 3 groups. Meanwhile, an older age at diagnosis and lower hemorrhage rate after GKS in incidental AVMs suggest that they have a more indolent natural course with a lower life-long risk of hemorrhage.
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Affiliation(s)
- Byung Sup Kim
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Shik Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jong-Soo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soon Hwang
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
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15
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Ma Y, Lim DH, Cho H, Lee JW, Sung KW, Yoo KH, Koo HH, Shin HJ, Suh YL. Tandem High-dose Chemotherapy without Craniospinal Irradiation in Treatment of Non-metastatic Malignant Brain Tumors in Very Young Children. J Korean Med Sci 2020; 35:e405. [PMID: 33316857 PMCID: PMC7735913 DOI: 10.3346/jkms.2020.35.e405] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Infants and very young children with malignant brain tumors have a poorer survival and a higher risk for neurologic deficits. The present study evaluated the feasibility and effectiveness of multimodal treatment including tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in minimizing use of radiotherapy (RT) in very young children with non-metastatic malignant brain tumors. METHODS Twenty consecutive patients younger than 3 years were enrolled between 2004 and 2017. Tandem HDCT/auto-SCT was performed after six cycles of induction chemotherapy. Local RT was administered only to patients with post-operative gross residual tumor at older than 3 years. Since September 2015, early post-operative local RT for patients with atypical teratoid/rhabdoid tumor or primitive neuroectodermal tumor was administered. RESULTS All 20 enrolled patients underwent the first HDCT/auto-SCT, and 18 proceeded to the second. Two patients died from toxicity during the second HDCT/auto-SCT, and four patients experienced relapse/progression (one localized and three metastatic), three of whom remained alive after salvage treatment including RT. A total of 17 patients remained alive at a median 7.8 (range, 2.5-5.7) years from diagnosis. Nine survivors received no RT, six survivors received local RT alone, and two survivors who experienced metastatic relapse after tandem HDCT/auto-SCT received both local and craniospinal RT. The 5-year overall, event-free, and craniospinal RT-free survival rates were 85.0% ± 8.0%, 70.0% ± 10.2%, and 75.0% ± 9.7%, respectively. Neuroendocrine and neurocognitive functions evaluated 5 years after tandem HDCT/auto-SCT were acceptable. CONCLUSION Our results suggest that non-metastatic malignant brain tumors in very young children could be treated with multimodal therapy including tandem HDCT/auto-SCT while minimizing RT, particularly craniospinal RT.
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Affiliation(s)
- Youngeun Ma
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heewon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Lee JW, Lim DH, Son MH, Sung KW, Cho HW, Ju HY, Hyun JK, Yoo KH, Jung HL, Koo HH, Suh YL, Joung YS, Shin HJ. MBCL-28. LONG-TERM FOLLOW-UP RESULTS OF REDUCED DOSE CRANIOSPINAL RADIOTHERAPY AND TANDEM HIGH-DOSE CHEMOTHERAPY IN PATIENTS WITH HIGH-RISK MEDULLOBLASTOMA. Neuro Oncol 2020. [PMCID: PMC7715583 DOI: 10.1093/neuonc/noaa222.504] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In this study, we report the follow-up results of reduced-dose of craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) in patients with high-risk medulloblastoma (MB). METHODS Newly diagnosed high-risk MB patients (metastatic disease, postoperative residual tumor > 1.5 cm2 or large cell/anaplastic histology) over 3 years of age were enrolled in this study. Two cycles of pre-RT chemotherapy, RT including reduced-dose CSRT (23.4 or 30.6 Gy), 4 cycles of post-RT chemotherapy and tandem HDCT were given. NanoString and DNA sequencing were done with archival tissues. RESULTS Forty patients were enrolled, and molecular subgrouping was possible in 21 patients (2 WNT, 3 SHH, 8 Group 3 and 8 group 4). All patients including two patients who experienced progression during the induction chemotherapy underwent HDCT. Relapse/progression occurred only in four patients (10-year cumulative incidence 10.4 ± 0.3%). However, six patients died from treatment-related mortality (TRM) (4 acute TRMs and 2 late TRMs) resulting in 18.5 ± 0.5% of 10-year cumulative incidence. Taken together, the 10-year event-free survival and overall survival were 71.1 ± 8.0% and 68.9 ± 8.5%, respectively. Late effects were evaluated in 25 patients and high-tone hearing loss, endocrine dysfunction, dyslipidemia, and growth retardation were common. CONCLUSIONS Strategy using tandem HDCT following reduced-dose CSRT showed promising results in terms of low relapse/progression rate, however, the high TRM rate indicates that modification of HDCT regimen and careful selection of patients who can have benefit from HDCT will be needed in the future study.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,Republic of Korea
| | - Meong Hi Son
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Kyung Hyun
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Park M, Han JW, Hahn SM, Lee JA, Kim JY, Shin SH, Kim DS, Yoon HI, Hong KT, Choi JY, Kang HJ, Shin HY, Phi JH, Kim SK, Lee JW, Yoo KH, Sung KW, Koo HH, Lim DH, Shin HJ, Kim H, Koh KN, Im HJ, Ahn SD, Ra YS, Baek HJ, Kook H, Jung TY, Choi HS, Kim CY, Park HJ, Lyu CJ. Atypical Teratoid/Rhabdoid Tumor of the Central Nervous System in Children under the Age of 3 Years. Cancer Res Treat 2020; 53:378-388. [PMID: 33138347 PMCID: PMC8053862 DOI: 10.4143/crt.2020.756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/29/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Atypical teratoid/rhabdoid tumor (ATRT) is a highly aggressive malignancy with peak incidence in children aged less than 3 years. Standard treatment for central nervous system ATRT in children under the age of 3 years have not been established yet. The objective of this study was to analyze characteristics and clinical outcomes of ATRT in children aged less than 3 years. Materials and Methods A search of medical records from seven centers was performed between January 2005 and December 2016. Results Forty-three patients were enrolled. With a median follow-up of 90 months, 27 patients (64.3%) showed at least one episode of disease progression (PD). The first date of PD was at 160 days after diagnosis. The 1- and 3-year progression-free survivals (PFS) were 51.2% and 28.5%, respectively. The 1- and 3-year overall survivals were 61.9% and 38.1%, respectively. The 3-year PFS was improved from 0% in pre-2011 to 47.4% in post-2011. Excluding one patient who did not receive any further therapy after surgery, 27 patients died due to PD (n=21), treatment-related toxicity (n=5), or unknown cause (n=1). In univariate analysis, factors associated with higher 3-year PFS were no metastases, diagnosis after 2011, early adjuvant radiotherapy, and high-dose chemotherapy (HDCT). In multivariate analysis, the use of HDCT and adjuvant radiotherapy remained significant prognostic factors for PFS (both p < 0.01). Conclusion Aggressive therapy including early adjuvant radiotherapy and HDCT could be considered to improve outcomes of ATRT in children under the age of 3 years.
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Affiliation(s)
- Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
| | - Jung Woo Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Hahn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Ah Lee
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
| | - Joo-Young Kim
- Department of Radiation Oncology, National Cancer Center, Goyang, Korea
| | - Sang Hoon Shin
- Neuro-Oncology Clinic, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
| | - Dong-Seok Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyery Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyeon Jin Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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18
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Lee JW, Lim DH, Sung KW, Cho HW, Ju HY, Hyun JK, Yoo KH, Koo HH, Suh YL, Joung YS, Shin HJ. Promising survival rate but high incidence of treatment-related mortality after reduced-dose craniospinal radiotherapy and tandem high-dose chemotherapy in patients with high-risk medulloblastoma. Cancer Med 2020; 9:5807-5818. [PMID: 32608158 PMCID: PMC7433836 DOI: 10.1002/cam4.3199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/11/2019] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In this study, we report the follow-up results of reduced dose of craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) in patients with high-risk medulloblastoma (MB). METHODS Newly diagnosed high-risk MB patients (metastatic disease, postoperative residual tumor >1.5 cm2 , or large cell/anaplastic histology) over 3 years of age were enrolled in this study. Two cycles of pre-RT chemotherapy, radiotherapy (RT) including reduced-dose CSRT (23.4 or 30.6 Gy), four cycles of post-RT chemotherapy, and tandem HDCT were administered. NanoString and DNA sequencing were performed using archival tissues. RESULTS In all, 40 patients were enrolled, and molecular subgrouping was possible in 21 patients (2 wingless, 3 sonic hedgehog, 8 Group 3, and 8 group 4). All patients including two patients who experienced progression during the induction chemotherapy underwent HDCT. Relapse/progression occurred only in four patients (5-year cumulative incidence [CI] 10.4 ± 0.3%). However, six patients died from treatment-related mortality (TRM) (four acute TRMs and two late TRMs) resulting in 18.5 ± 0.5% of 5-year CI. Taken together, the 5-year event-free survival and overall survival were 71.1 ± 8.0% and 73.2 ± 7.9%, respectively. Late effects were evaluated in 25 patients and high-tone hearing loss, endocrine dysfunction, dyslipidemia, and growth retardation were common. CONCLUSIONS The strategy using tandem HDCT following reduced-dose CSRT showed promising results in terms of low relapse/progression rate; however, the high TRM rate indicates that modification of HDCT regimen and careful selection of patients who can benefit from HDCT will be needed in the future study.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Kyung Hyun
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoo-Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Lee JW, Lim DH, Sung KW, Cho HW, Ju HY, Yoo KH, Koo HH, Kim JH, Suh YL, Shin HJ. Induction Chemotherapy Reduces Radiation Therapy Dose and Volume in the Treatment of Intracranial Germinoma: Results of the SMC-G13 Trial. Int J Radiat Oncol Biol Phys 2020; 108:649-656. [PMID: 32502506 DOI: 10.1016/j.ijrobp.2020.05.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE We performed a prospective single-arm trial (NCT02782754) to explore the feasibility of reducing radiation therapy (RT) dose when induction chemotherapy is combined in the treatment of intracranial germinoma with beta-human chorionic gonadotropin levels <200 mIU/mL. METHODS AND MATERIALS All patients aged 3 to 35 years from November 2012 to June 2018 were eligible for this study. Four cycles of induction chemotherapy were given before RT. Carboplatin/etoposide and cyclophosphamide/etoposide regimens were used in alternation every 3 weeks. A dose of 18 Gy of craniospinal RT for metastatic tumors, whole brain RT for basal ganglia tumors, or otherwise whole ventricular RT followed by 12.6 Gy of boost RT to the primary tumor bed was administered after induction chemotherapy. The primary endpoint of this study was progression-free survival. RESULTS A total of 41 consecutive patients were enrolled (location: suprasellar in 12, pineal in 12, both suprasellar and pineal in 11, and basal ganglia in 6 patients). Eleven patients had leptomeningeal seeding. Toxicity during chemotherapy was mild, except for bone marrow suppression. Tumor status after induction chemotherapy was complete response in 33 patients and partial response in 8. All but 2 patients completed the scheduled treatment. All patients but 1 remained event free during a median follow-up of 3.4 (range, 0.3-7.0) years from diagnosis. The 1 patient experienced relapse and died of tumor bleeding. Late effects were not significant except for neuroendocrine dysfunction already present at diagnosis. Vertical growth and cognitive function were not significantly disturbed by treatment. CONCLUSIONS This study showed the feasibility of reducing RT dose/volume with induction chemotherapy in pathologically pure germinoma with elevated beta-human chorionic gonadotropin levels up to 200 mIU/mL.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hee Won Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Young Ju
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Woodward SH, Jamison AL, Souter T, Shin HJ, Loew DE, Armontrout JA. 1068 Using Sleep to Avoid Inpatient PTSD Treatment. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1064] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
During inpatient psychiatric treatment, mattress actigraphy can be used to track nightly sleep in a zero-burden fashion to examine its relationships with other markers of treatment progress. We report here on associations between actigraphic sleep parameters and treatment markers in combat veteran engaged in inpatient treatment for posttraumatic stress disorder. We focus first on sleep scheduling, the best-validated outcome available from actigraphic data.
Methods
140 combat veteran inpatients provided between 5 and 164 nights of mattress actigraphy over the course of their inpatient psychiatric hospitalizations. The sample was characterized by multiple traumas and a high prevalence of comorbid mood and substance use disorders. Approximately one-half of the sample had undergone objective screening for OSA and for this subsample AHI < 20 was used as an inclusion criterion. Unscreened participants were required to have a BMI < 35. Inclusion also required mean actigraphic SE > 60%. The PTSD Checklist and Combat Exposure Scale were obtained at admission, from which a trauma load index was created by adding z-scores obtained from standardizing these scales.
Results
In a multiple regression analysis, after accounting for secular change in LOS, higher trauma loads (p < 0.001) and earlier bed times (p = 0.001) were both significantly associated with shorter lengths of stay (LOS; F(3,137) = 10.4, p < 0.001; adj. R-squared = 0.17). Trauma load and bed time did not interact (p = 0.7).
Conclusion
Avoidance is a criterial symptom of PTSD. Early bed times and early exits from treatment may both reflect the impact of syndromal avoidance on treatment, limiting its dosage and benefit. If so, prescribing later bed times may have utility in inpatient treatment programming.
Support
Award W81XWH-15-2-0005 from the Department of Defense, Military Operational Medicine Research Program and the Department of Veterans Affairs. This material is the result of work supported with resources and the use of facilities at the Palo Alto VA Medical Center.
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Affiliation(s)
| | | | - T Souter
- VA Palo Alto Health Care System, Palo Alto, CA
| | - H J Shin
- VA Palo Alto Health Care System, Palo Alto, CA
| | - D E Loew
- VA Palo Alto Health Care System, Palo Alto, CA
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Kim KH, Cho YS, Seol HJ, Cho KR, Choi JW, Kong DS, Shin HJ, Nam DH, Lee JI. Comparison between retrosigmoid and translabyrinthine approaches for large vestibular schwannoma: focus on cerebellar injury and morbidities. Neurosurg Rev 2019; 44:351-361. [PMID: 31758338 DOI: 10.1007/s10143-019-01213-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/06/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
This study aimed to compare the surgical outcomes and morbidities of retrosigmoid and translabyrinthine approaches for large vestibular schwannoma (VS), with a focus on cerebellar injury and morbidities. Eighty-six consecutive patients with large VS, with a maximal extrameatal diameter > 3.0 cm, were reviewed between August 2010 and September 2018. The surgical outcomes, operating time, volume change of perioperative cerebellar edema, and inpatient rehabilitation related to cerebellar morbidities were compared between the two approaches. In total, 53 and 33 patients underwent the retrosigmoid and translabyrinthine approaches, respectively. The median follow-up time was 34.5 months. Surgical outcomes, including the extent of resection, tumor recurrence, and facial nerve preservation, showed no significant differences between the two groups. Patients who underwent the retrosigmoid approach showed a marginal trend for postoperative lower cranial nerve (LCN) dysfunction (P = 0.068). Although the approaching procedure time was longer in the translabyrinthine group, the tumor resection time was significantly longer in the retrosigmoid group (P = 0.001). The median change in the volume of the perioperative cerebellar edema was significantly larger in the retrosigmoid group (P < 0.001) and significantly related to the retrosigmoid approach, solid VS, and tumor resection time. Most cerebellar and LCN deficits were transient; however, the patients in the retrosigmoid group underwent inpatient rehabilitation more than those in the translabyrinthine group (P = 0.018). Both surgical approaches show equivalent surgical outcomes. Notably, the translabyrinthine approach for large VS has advantages in that it reduces cerebellar injury and related morbidities.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kyung-Rae Cho
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kong DS, Young SM, Hong CK, Kim YD, Hong SD, Choi JW, Seol HJ, Lee JI, Shin HJ, Nam DH, Woo KI. Clinical and ophthalmological outcome of endoscopic transorbital surgery for cranioorbital tumors. J Neurosurg 2019; 131:667-675. [PMID: 30215555 DOI: 10.3171/2018.3.jns173233] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 12/30/2017] [Accepted: 03/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranioorbital tumors are complex lesions that involve the deep orbit, floor of the frontal bone, and lesser and greater wing of the sphenoid bone. The purpose of this study was to describe the clinical and ophthalmological outcomes with an endoscopic transorbital approach (TOA) in the management of cranioorbital tumors involving the deep orbit and intracranial compartment. METHODS The authors performed endoscopic TOAs via the superior eyelid crease incision in 18 patients (16 TOA alone and 2 TOA combined with a simultaneous endonasal endoscopic resection) with cranioorbital tumors from September 2016 to November 2017. There were 12 patients with sphenoorbital meningiomas. Other lesions included osteosarcoma, plasmacytoma, sebaceous gland carcinoma, intraconal schwannoma, cystic teratoma, and fibrous dysplasia. Ten patients had primary lesions and 8 patients had recurrent tumors. Thirteen patients had intradural lesions, while 5 had only extradural lesions. RESULTS Of 18 patients, 7 patients underwent gross-total resection of the tumor and 7 patients underwent planned near-total resection of the tumor, leaving the cavernous sinus lesion. Subtotal resection was performed in 4 patients with recurrent tumors. There was no postoperative CSF leak requiring reconstruction surgery. Fourteen of 18 patients (77.8%) had preoperative proptosis on the ipsilateral side, and all 14 patients had improvement in exophthalmos; the mean proptosis reduced from 5.7 ± 2.7 mm to 1.5 ± 1.4 mm. However, some residual proptosis was evident in 9 of the 14 (64%). Ten of 18 patients (55.6%) had preoperative optic neuropathy, and 6 of them (60.0%) had improvement; the median best-corrected visual acuity improved from 20/100 to 20/40. Thirteen of 18 patients showed mild ptosis at an immediate postoperative examination, all of whom had a spontaneous and complete recovery of their ptosis during the follow-up period. Three of 7 patients showed improvement in extraocular motility after surgery. CONCLUSIONS Endoscopic TOA can be considered as an option in the management of cranioorbital tumors involving complex anatomical areas, with acceptable sequelae and morbidity.
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Affiliation(s)
- Doo-Sik Kong
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Chang-Ki Hong
- 3Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University
| | - Yoon-Duck Kim
- 4Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine; and
| | - Sang Duk Hong
- 5Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Won Choi
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- 4Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine; and
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Shin HJ, Yoo H, Lee JH, Lee SR, Jeong K, Moon HS. 1542 Robotic Single Port Laparoscopy Using the Da Vinci Sp® Surgical System For Benign Gynecologic Disease; Preliminary Report. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim BS, Yeon JY, Kim JS, Hong SC, Shin HJ, Lee JI. Gamma Knife Radiosurgery for ARUBA-Eligible Patients with Unruptured Brain Arteriovenous Malformations. J Korean Med Sci 2019; 34:e232. [PMID: 31538418 PMCID: PMC6753365 DOI: 10.3346/jkms.2019.34.e232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 05/13/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A randomized trial of unruptured brain arteriovenous malformations (ARUBA) reported superior outcomes in conservative management compared to interventional treatment. There were numerous limitations to the study. This study aimed to investigate the efficacy of gamma knife radiosurgery (GKS) for patients with brain arteriovenous malformations (AVMs) by comparing its outcomes to those of the ARUBA study. METHODS We retrospectively reviewed ARUBA-eligible patients treated with GKS from June 2002 to September 2017 and compared against those in the ARUBA study. AVM obliteration and hemorrhage rates, and clinical outcomes following GKS were also evaluated. RESULTS The ARUBA-eligible cohort comprised 264 patients. The Spetzler-Martin grade was Grade I to II in 52.7% and III to IV in 47.3% of the patients. The mean AVM nidus volume, marginal dose, and follow-up period were 4.8 cm³, 20.8 Gy, and 55.5 months, respectively. AVM obliteration was achieved in 62.1%. The annual hemorrhage rate after GKS was 3.4%. A stroke or death occurred in 14.0%. The overall stroke or death rate of the ARUBA-eligible cohort was significantly lower than that of the interventional arm of the ARUBA study (P < 0.001) and did not significantly differ from that of the medical arm in the ARUBA study (P = 0.601). CONCLUSION GKS was shown to achieve a favorable outcome with low procedure-related morbidity in majority of the ARUBA-eligible patients. The outcome after GKS in our patients was not inferior to that of medical care alone in the ARUBA study. It is suggested that GKS is rather superior to medical care considering the short follow-up duration of the ARUBA study.
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Affiliation(s)
- Byung Sup Kim
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Soo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Jeon C, Park KA, Hong SD, Choi JW, Seol HJ, Nam DH, Lee JI, Shin HJ, Kong DS. Clinical Efficacy of Optical Coherence Tomography to Predict the Visual Outcome After Endoscopic Endonasal Surgery for Suprasellar Tumors. World Neurosurg 2019; 132:e722-e731. [PMID: 31421301 DOI: 10.1016/j.wneu.2019.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/20/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prediction of visual outcome after endoscopic endonasal tumor resection still remains a challenge. We investigated the prognostic value of the preoperative peripapillary retinal nerve fiber layer (pRNFL) using optical coherence tomography for visual outcome after endoscopic endonasal surgery (EES) for suprasellar tumors. METHODS We retrospectively analyzed 122 patients who underwent EES for sellar and suprasellar tumors between January 2016 and January 2018. We retrospectively analyzed the pre- and postoperative relationship between pRNFL thickness and visual outcome based on visual acuity (visual acuity score) and visual field (mean deviation [MD]). RESULTS Preoperatively, 216 eyes (mean global pRNFL thickness, 94.3 ± 12.4 μm; 88.5%) were included in the normal pRNFL group (≥70 μm) and 28 eyes (mean global pRNFL thickness, 54.3 ± 11.0 μm; 11.5%) were included in the thin pRNFL group (<70 μm). There was a very strong correlation between pre- and postoperative pRNFL thickness (r = 0.930). The thin pRNFL group showed a stronger correlation between pre- and postoperative MDs than the normal pRNFL group (r = 0.619 and r = 0.420, respectively; P < 0.01). Multivariate analyses identified pRNFL thickness as the only significant predictor of postoperative visual acuity (odds ratio [OR], 25.02; 95% confidence interval [CI], 7.68-81.50; P < 0.01) and visual field (OR, 39.46; 95% CI, 10.39-149.83; P < 0.01). CONCLUSIONS Preoperative pRNFL thickness plays a prognostic value in postoperative visual outcome after EES for sellar and suprasellar tumors. Patients with pRNFL thickness ≥70 μm before surgery are more likely to improve visual outcome than those with thickness <70 μm.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Ju DG, Jeon C, Kim KH, Park KA, Hong SD, Seoul HJ, Shin HJ, Nam DH, Lee JI, Kong DS. Clinical Significance of Tumor-Related Edema of Optic Tract Affecting Visual Function in Patients with Sellar and Suprasellar Tumors. World Neurosurg 2019; 132:e862-e868. [PMID: 31394363 DOI: 10.1016/j.wneu.2019.07.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/02/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Preoperative tumor-related edema of the optic tract (EOT) is often found along the white matter tract of the visual system. However, the relationship of EOT with visual function and outcome remains unclear. Therefore we aimed to elucidate whether the presence of EOT is associated with visual outcome in patients with sellar and suprasellar tumors. METHODS A total of 212 eyes of 106 patients who underwent endoscopic endonasal surgery for sellar and suprasellar tumors at our institution between March 2016 and August 2018 were included in this retrospective study. Data on patient characteristics, preoperative magnetic resonance imaging findings, and ophthalmologic evaluations were collected. Patients were assigned to 2 groups depending on preoperative magnetic resonance imaging findings (EOT group = 19 [17.9%], non-EOT group = 87 [82.1%]). Visual acuity, visual field (VF), global visual function score, VF index, VF mean deviation, and retinal nerve fiber layer thickness as determined by optical coherence tomography were compared between the groups before and after treatment. RESULTS In the EOT group, 4 patients had pituitary adenoma, 8 had craniopharyngioma, and 7 had other pathologies. There was no significant difference of pathologies between the groups. Preoperatively, EOT group showed significantly lower values of global visual function score, VF index, mean deviation, and retinal nerve fiber layer thickness than did the non-EOT group (P < 0.001). Postoperatively, the EOT group showed worse visual outcomes than did the non-EOT group. CONCLUSIONS This study reveals that EOT caused by sellar and suprasellar tumors is associated with worse visual function and poor improvement postoperatively.
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Affiliation(s)
- Dong Gyun Ju
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chiman Jeon
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seoul
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lee MH, Hong SD, Woo KI, Kim YD, Choi JW, Seol HJ, Lee JI, Shin HJ, Nam DH, Kong DS. Endoscopic Endonasal Versus Transorbital Surgery for Middle Cranial Fossa Tumors: Comparison of Clinical Outcomes Based on Surgical Corridors. World Neurosurg 2018; 122:e1491-e1504. [PMID: 30468930 DOI: 10.1016/j.wneu.2018.11.090] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 08/14/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Based on our experience with the endoscopic endonasal approach (EEA) and transorbital approach (TOA) for middle cranial fossa tumors, we evaluated the efficacy and limitations of visualization and the clinical outcomes associated with the approaches depending on the surgical corridors. In addition, we determined the optimal strategy for each approach. METHODS Between September 2015 and May 2018, we retrospectively reviewed clinical outcomes in 21 patients who underwent minimally invasive endoscopic surgery for middle cranial fossa tumors involving the cavernous sinus. We classified the endoscopic approaches into 4 groups: endonasal quadrangular transcavernous (type I), endonasal infratemporal (type II), transclival medial-to-lateral (type III), and transorbital (type IV) routes. Displacement of the internal carotid artery, extent of tumor involvement, and the surgical corridor to the tumor direction were the primary determinants of the approach. RESULTS The study enrolled 21 patients. Based on the classification of approaches, 6 patients underwent surgery via type I, 5 via type II, 1 via type III, 7 via type IV, and 2 via a combined approach. Among the 21 patients, gross total resection was performed in 12 (57.1%), subtotal resection in 6, and partial resection in 3. Comparison of the type I (EEA) with the type 4 (TOA) route showed that the gross total resection rate with the EEA was 33.3% compared with 71.4% with the TOA (P = 0.286). CONCLUSIONS Endoscopic surgery can be considered an alternative with acceptable sequelae and reduced morbidity for the management of middle cranial fossa tumors. Surgeons should be aware of the strengths and weaknesses of each surgical corridor and select the optimal approach for each patient based on the tumor.
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Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lee JW, Lim DH, Sung KW, Shin HJ. GERM-06. REDUCED RADIOTHERAPY DOSE AND VOLUME FOLLOWING CHEMOTHERAPY FOR INTRACRANIAL GERMINOMA WITH B-HCG LEVEL < 200 MIU/ML: PRELIMINARY RESULTS OF SMC G-13 TRIAL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Sung KW, Lim DH, Shin HJ. Tandem High-dose Chemotherapy and Autologous Stem Cell Transplantation in Children with Brain Tumors : Review of Single Center Experience. J Korean Neurosurg Soc 2018; 61:393-401. [PMID: 29742883 PMCID: PMC5957321 DOI: 10.3340/jkns.2018.0039] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 11/27/2022] Open
Abstract
The prognosis of brain tumors in children has improved for last a few decades. However, the prognosis remains dismal in patients with recurrent brain tumors. The outcome for infants and young children in whom the use of radiotherapy (RT) is very limited because of unacceptable long-term adverse effect of RT remains poor. The prognosis is also not satisfactory when a large residual tumor remains after surgery or when leptomeningeal seeding is present at diagnosis. In this context, a strategy using high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) has been explored to improve the prognosis of recurrent or high-risk brain tumors. This strategy is based on the hypothesis that chemotherapy dose escalation might result in improvement in survival rates. Recently, the efficacy of tandem HDCT/auto-SCT has been evaluated in further improving the outcome. This strategy is based on the hypothesis that further dose escalation might result in further improvement in survival rates. At present, the number of studies employing tandem HDCT/auto-SCT for brain tumors is limited. However, results of these pilot studies suggest that tandem HDCT/auto-SCT may further improve the outcome. In this review, we will summarize our single center experience with tandem HDCT/auto-SCT for recurrent or high-risk brain tumors.
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Affiliation(s)
- Ki Woong Sung
- Department of Pediatrics, Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Pediatrics, Neurosurgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee JW, Lim DH, Sung KW, Lee HJ, Yi ES, Yoo KH, Koo HH, Suh YL, Shin HJ. Multimodal treatment including tandem high-dose chemotherapy and autologous stem cell transplantation in children with anaplastic ependymomas. Pediatr Transplant 2018; 22:e13127. [PMID: 29453811 DOI: 10.1111/petr.13127] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
In this study, we evaluated the results of multimodal treatment that included tandem HDCT/auto-SCT in children with anaplastic ependymomas. Fourteen patients with anaplastic ependymomas were enrolled from 2006 to 2014. Six cycles of induction chemotherapy were administered to all patients before they underwent tandem HDCT/auto-SCT. Patients who were older than 3 years of age were administered RT after two cycles of induction chemotherapy. In patients under 3 years of age, RT was either omitted or delayed until they reached 3 years of age, if the patients experienced CR after tandem HDCT/auto-SCT. All patients, including two who experienced disease progression during induction treatment, underwent the first HDCT/auto-SCT, and 13 subsequently underwent the second HDCT/auto-SCT. One patient died from hepatic VOD during the second HDCT/auto-SCT; other toxicities occurring during tandem HDCT/auto-SCT were manageable. Relapses or progression occurred in seven patients, and five of seven of them remain alive till date after salvage treatment, including surgery and RT. The 5-year overall and event-free survival rates were 85.1% ± 9.7% and 50.0% ± 13.4%, respectively. These findings suggest that multimodal treatment including tandem HDCT/auto-SCT could be a feasible option for improving survival in children with anaplastic ependymomas.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeong Jin Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Shin HJ, Park JM, Kim KH, Shin DW, Park JS, Roh JY, Kim H. Comparison of the Analgesic Effect of an Ice Cube versus 4% Lidocaine Cream in Intradermal Antibiotic Skin Testing. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to compare the analgesic effect of an ice cube with that of 4% lidocaine cream (L.M.X.4®) for intradermal skin testing. Methods In this prospective randomised study, healthy adult volunteers were divided into ice cube and lidocaine analgesic pretreatment groups. Randomisation was performed using a randomisation table in blocks of four. Intradermal skin testing was performed after applying ice in the ice cube group and 5 mg of lidocaine cream in the lidocaine group. After the intradermal skin test, the pain intensity was investigated using the visual analog scale (VAS) on questionnaires. We calculated that a minimum of 24 subjects were required for statistical power of 80% at a significance level of 0.05 (two-sided). The groups' VAS scores were compared using the Mann-Whitney U-test. Results The study population consisted of 35 volunteers: 17 in the ice cube group and 18 in the lidocaine group. There were no differences in demographic characteristics between the two groups. The median VAS score was 20 (interquartile range: 0-35) in the ice cube group and 70 (interquartile range: 50-80) in the lidocaine group (p<0.001). Conclusions The results suggested the utility of an ice cube as analgesic pretreatment for intradermal skin testing in the emergency department.
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Lee WJ, Kang HJ, Shin HJ, Won CH, Chang SE, Choi JH, Lee MW. Neutrophilic urticarial dermatosis and Sweet-like neutrophilic dermatosis: under-recognized neutrophilic dermatoses in lupus erythematosus. Lupus 2017; 27:628-636. [DOI: 10.1177/0961203317736145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- W J Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - H J Kang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - H J Shin
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - C H Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S E Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J H Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M W Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lee JW, Lim DH, Sung KW, Lee HJ, Yi ES, Yoo KH, Koo HH, Suh YL, Shin HJ. Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for High-Grade Gliomas in Children and Adolescents. J Korean Med Sci 2017; 32:195-203. [PMID: 28049229 PMCID: PMC5219984 DOI: 10.3346/jkms.2017.32.2.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022] Open
Abstract
With the aim to investigate the outcome of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) for high-grade gliomas (HGGs), we retrospectively reviewed the medical records of 30 patients with HGGs (16 glioblastomas, 7 anaplastic astrocytomas, and 7 other HGGs) between 2006 and 2015. Gross or near total resection was possible in 11 patients. Front-line treatment after surgery was radiotherapy (RT) in 14 patients and chemotherapy in the remaining 16 patients including 3 patients less than 3 years of age. Eight of 12 patients who remained progression free and 5 of the remaining 18 patients who experienced progression during induction treatment underwent the first HDCT/auto-SCT with carboplatin + thiotepa + etoposide (CTE) regimen and 11 of them proceeded to the second HDCT/auto-SCT with cyclophosphamide + melphalan (CyM) regimen. One patient died from hepatic veno-occlusive disease (VOD) during the second HDCT/auto-SCT; otherwise, toxicities were manageable. Four patients in complete response (CR) and 3 of 7 patients in partial response (PR) or second PR at the first HDCT/auto-SCT remained event free: however, 2 patients with progressive tumor experienced progression again. The probabilities of 3-year overall survival (OS) after the first HDCT/auto-SCT in 11 patients in CR, PR, or second PR was 58.2% ± 16.9%. Tumor status at the first HDCT/auto-SCT was the only significant factor for outcome after HDCT/auto-SCT. There was no difference in survival between glioblastoma and other HGGs. This study suggests that the outcome of HGGs in children and adolescents after HDCT/auto-SCT is encouraging if the patient could achieve CR or PR before HDCT/auto-SCT.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeong Jin Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Shin HJ, Woo KI, Kim YD. Factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy. Clin Otolaryngol 2016; 42:550-556. [PMID: 27727517 DOI: 10.1111/coa.12767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the factors associated with rhinostomy shape after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction. DESIGN Retrospective comparative study. SETTING University hospital. PARTICIPANTS One hundred and two cases in 70 patients were included in the study. MAIN OUTCOME MEASURE All cases were classified into three groups according to the healed appearance of the rhinostomy: flat, ladle and ice scoop type. The flat shape was characterised by an opening with a flat surrounding and no clear border between the lacrimal sac and the nasal mucosa. The ladle shape had a depressed base without markings of a lacrimal sac. The ice scoop shape had a depressed base with a clear border between the lacrimal sac and the nasal mucosa. Anatomic success was defined as patency with syringing and endoscopic evidence of ostial patency. Functional success was defined as visualisation of fluorescein dye at the ostium and relief from epiphora. Clinical information and intra- and postoperative endoscopic video findings were compared between the three groups. RESULTS Of the 102 cases, 19 flat, 37 ladle and 46 ice scoop type rhinostomies were observed during the follow-up examinations. Among the variables studied, patient demographics and rhinostomy size and location did not differ between the three groups. However, intraoperative lacrimal sac findings (sac size, wall thickness and mobility), postoperative ostial shrinkage and rhinostomy movement were associated with postoperative rhinostomy shape (all P < 0.05). With regard to surgical outcomes, there were no differences in anatomical patency between the three groups. However, the flat group had a worse functional success rate (73.7%) than the ladle (91.9%) and ice scoop (97.8%) groups (P = 0.008). A higher degree of ostial shrinkage and poor rhinostomy movement was observed with the flat shape appearance, which had a small, thick and poorly mobile lacrimal sac. CONCLUSIONS Lacrimal sac characteristics play a prominent role in determining rhinostomy shape after endoscopic DCR. The rhinostomy shape, along with the degree of ostial shrinkage and rhinostomy movement, is predictive of functional success after endoscopic DCR.
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Affiliation(s)
- H J Shin
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - K I Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y-D Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chung JW, Kim SJ, Bang OY, Kim KH, Ki CS, Jeon P, Yeon JY, Kim JS, Hong SC, Shin HJ. Determinants of Basal Collaterals in Moyamoya Disease: Clinical and Genetic Factors. Eur Neurol 2016; 75:178-85. [DOI: 10.1159/000445348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
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Sung KW, Lim DH, Yi ES, Choi YB, Lee JW, Yoo KH, Koo HH, Kim JH, Suh YL, Joung YS, Shin HJ. Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Atypical Teratoid/Rhabdoid Tumor. Cancer Res Treat 2016; 48:1408-1419. [PMID: 27034140 PMCID: PMC5080816 DOI: 10.4143/crt.2015.347] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 09/10/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose We prospectively evaluated the effectiveness of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in improving the survival of patients with atypical teratoid/rhabdoid tumors while reducing the risks of late adverse effects from radiotherapy (RT). Materials and Methods For young children (< 3 years old), tandem HDCT/auto-SCT was administered after six cycles of induction chemotherapy. RT was deferred until after 3 years of age unless the tumor showed relapse or progression. For older patients (> 3 years old), RT including reduced-dose craniospinal RT (23.4 or 30.6 Gy) was administered either after two cycles of induction chemotherapy or after surgery, and tandem HDCT/auto-SCT was administered after six cycles of induction chemotherapy. Results A total of 13 patients (five young and eight older) were enrolled from November 2004 to June 2012. Eight patients, including all five young patients, had metastatic disease at diagnosis. Six patients (four young and two older) experienced progression before initiation of RT, and seven were able to proceed to HDCT/auto-SCT without progression during induction treatment. Three of six patients who experienced progression during induction treatment underwent HDCT/auto-SCT as salvage treatment. All five young patients died from disease progression. However, four of the eight older patients remain progression-freewith a median follow-up period of 64 months (range, 39 to 108 months). Treatment-related late toxicities were acceptable. Conclusion The required dose of craniospinal RT might be reduced in older patients if the intensity of chemotherapy is increased. However, early administration of RT should be considered to prevent early progression in young patients.
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Affiliation(s)
- Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bae Choi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Na HS, Shin HJ, Lee YJ, Kim JH, Koo KH, Do SH. Tranexamic acid, hip replacement and starch--a reply. Anaesthesia 2016; 71:476-7. [PMID: 26994544 DOI: 10.1111/anae.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H S Na
- Seoul National University Bundang Hospital, Seoul, Korea
| | - H J Shin
- Seoul National University Bundang Hospital, Seoul, Korea
| | - Y J Lee
- Seoul National University Bundang Hospital, Seoul, Korea
| | - J H Kim
- Seoul National University Bundang Hospital, Seoul, Korea
| | - K H Koo
- Seoul National University Bundang Hospital, Seoul, Korea
| | - S H Do
- Seoul National University Bundang Hospital, Seoul, Korea.
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Kim JE, Ahn JH, Jung KH, Lee HJ, Gong GY, Lee EM, Ha EJ, Son BH, Ahn SH, Ahn SD, Kim HH, Shin HJ, Kim SB. Abstract P1-14-15: A randomized phase lll trial of neoadjuvant sequential chemotherapy with 4 cycles of adriamycin plus cyclophosphamide followed by 4 cycles of docetaxel (AC4-D4) versus shorter 3 cycles of FEC followed by 3 cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-Shorter): First report of efficacy & toxicity profile. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-15] [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]
Abstract
Abstract
Background: The addition of a taxane to anthracycline-based chemotherapy provided an improved outcome in neoadjuant setting. Two neoadjuvant chemotherapy with 4 cycles of AC followed by 4 cycles of docetaxel (AC4-D4) and 3 cycles of FEC followed by 3 cycles of docetaxel (FEC3-D3) are widely used. Short duration of chemotherapy, 6 cycles rather than 8 cycles might be an attractive approach.
Methods: This is a randomized, single-center, prospective, parallel group, comparative phase III trial (NCT02001506). Patients (pts) with breast cancer of clinically stage II or III, or sized 1.5 cm with histologically proven lymph-node involvement were included. Pts were stratified according to hormone receptor and HER2 expression status and randomized to AC4-D4 and 3 cycles of FEC3-D3 treatment. The primary endpoint was pathological complete response, defined as the absence of invasive disease in the breast and axillary lymph nodes, analyzed by intention to treat.
Results: At the time of submission, a total of 207 pts were enrolled; 1 pt failed screening; 25 pts dropped out (5 pts in AC4-D4 arm and 2 pts in FEC3-D3 arm discontinue treatment due to progressive disease); 39 pts are still receiving neoadjuvant chemotherapy; 142 pts, who received surgery, were included for this analysis. In AC4-D4 arm, among 64 pts, 57 pts achieved clinical response (6 complete response [CR] and 51 partial response [PR]) and among them 9 pts achieved pathologic complete response [pCR]. In FEC3-D3 arm, among 78 pts, 66 pts achieved clinical response (7 CR and 59 PR) and among them 11 pts achieved pCR. Addition of docetaxel increased clinical response in both arms. The most common adverse event was febrile neutropenia. Without prophylactic G-CSF, grade ≥3 febrile neutropenia (FN) occurred 23/661 cycles (3.5%) in AC4-D4 arm and 23/552 cycles (4.2%) in FEC3-D3 arm, respectively. Grade 3 and 4 toxicities other than FN were reported at expected levels in both groups. Sixty-one severe adverse events were reported; 33 (including 23 FN) in AC4-D4 arm and 28 (including 23 FN) in FEC3-D3 arm.
Conclusion: Compared to AC4-D4, shorter duration of FEC3-D3 neoadjuvant chemotherapy showed similar efficacy of pCR rate of 14.0% (versus 14.1% in AC4-D4 arm). The most common and important adverse event was febrile neutropenia in both arms. Updated study findings will be provided.
Citation Format: Kim JE, Ahn J-H, Jung KH, Lee HJ, Gong G-Y, Lee E-M, Ha EJ, Son B-H, Ahn S-H, Ahn SD, Kim H-H, Shin HJ, Kim S-B. A randomized phase lll trial of neoadjuvant sequential chemotherapy with 4 cycles of adriamycin plus cyclophosphamide followed by 4 cycles of docetaxel (AC4-D4) versus shorter 3 cycles of FEC followed by 3 cycles of docetaxel (FEC3-D3) in node-positive breast cancer (Neo-Shorter): First report of efficacy & toxicity profile. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-15.
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Affiliation(s)
- JE Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Ahn
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - KH Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - HJ Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - G-Y Gong
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - E-M Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - EJ Ha
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - B-H Son
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Ahn
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - SD Ahn
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H-H Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - HJ Shin
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-B Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Koo HW, Jo KI, Yeon JY, Kim KH, Jeon P, Kim JS, Hong SC, Shin HJ, Lee JI. Clinical Features of Superficially Located Brain Arteriovenous Malformations with Transdural Arterial Communication. Cerebrovasc Dis 2016; 41:204-10. [PMID: 26789929 DOI: 10.1159/000443530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Contrary to deeply located brain arteriovenous malformations (AVMs), superficially located AVMs are more likely to have transdural arterial communications (TACs). However, the clinical and radiologic characteristics of patients presenting with AVMs and TACs are poorly understood. The purpose of this study is to determine whether clinicoradiological features of cerebral AVMs differ according to TAC. METHODS Between 2002 and 2012, 438 consecutive patients with a brain AVM were treated in our hospital. Among them were 124 patients with superficially located brain AVMs who met the inclusion and exclusion criteria of our study. We retrospectively reviewed the clinicoradiological features of their TACs to explore the variation in characteristics. RESULTS Thirty-two of the 124 patients with a superficially located AVM (25.8%) had TAC. Radiologic findings of brain AVM images with TAC showed that TAC occurred significantly more frequently among larger AVMs (with vs. without TAC, 11.2 vs. 4.0 ml) and among diffuse AVMs (56.3 vs. 28.3%, p = 0.004). Clinical findings indicate that TAC was associated with chronic headache (43.8 vs. 12.0%, p < 0.001) and older age (43.1 vs. 36.6 years, p = 0.037). CONCLUSIONS Brain AVM with TAC seems to be accompanied by distinctive clinical features, such as chronic headache and older age. Larger size and diffuseness of the AVM were also associated with TAC. Findings from this study and the prognostic significance of TAC should be further explored in a large prospective study.
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Affiliation(s)
- Hae-Won Koo
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sohn JH, Rha SY, Jeung HC, Shin HJ, Goo YS, Chung HC, Yang WI, Hahn SB, Shin KH, Min JS, Kim BS, Roh JK, Jang WI. Efficacy of Pre- and Postoperative Chemotherapy in Patients with Osteosarcoma of the Extremities. Cancer Res Treat 2015; 33:520-6. [PMID: 26680832 DOI: 10.4143/crt.2001.33.6.520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE We evaluated the treatment efficacy including survival and recurrence, and factors associated with recurrence in osteosarcoma patients treated with preoperative chemotherapy, surgery, and adjuvant chemotherapy. MATERIALS AND METHODS Forty nine patients with osteosarcoma were treated with preoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion for 3 cycles, followed by surgery. According to the pathologic response, if tumor was necrotized more than 90%, the same adjuvant chemotherapy was reintroduced for 3 cycles, and if the response was not enough, then the salvage regimen was introduced. Plain chest film and chest CT scan were taken monthly and every 3 months, respectively. When tumor recurred, the metastasectomy was performed whenever possible. RESULTS Forty three patients were evaluable with amedian follow up of 53 months. Five-year disease-free and overallsurvival rate was 47.0% and 66.9%, respectively. The recurrence was observed in 22 patients (51.2%) with median time of 12.5 months. Baseline alkaline phosphatase (ALP) was the only significant factor for recurrence (p=0.03) and the patients with the possibility of metastasectomy recurrence showed higher post-relapse survival compared to other treatment modalities (26 momths vs 5~12 months). CONCLUSION These results indicates that pre- and postoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion showed comparable treatment efficacy and acceptable toxicities.
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Na HS, Shin HJ, Lee YJ, Kim JH, Koo KH, Do SH. The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM®) analysis. Anaesthesia 2015; 71:67-75. [PMID: 26559015 DOI: 10.1111/anae.13270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 11/30/2022]
Abstract
We evaluated changes in rotational thromboelastometry (ROTEM(®) ) parameters and clinical outcomes in patients undergoing total hip replacement arthroplasty, with concomitant infusions of tranexamic acid and of 6% hydroxyethyl starch 130/0.4. Fifty-five patients were randomly assigned to either the tranexamic acid (n = 29) or the control (n = 26) group. Hydroxyethyl starch was administered in the range of 10-15 ml.kg(-1) during the operation in both groups. In the control group, the clot formation time and maximum clot firmness of APTEM showed significant differences when compared with those of EXTEM at one hour postoperatively, suggestive of fibrinolysis. In the tranexamic acid group, there was no significant difference between each postoperative EXTEM and APTEM parameter. In the tranexamic acid and control group, postoperative blood loss was 308 ml (210-420 [106-745]) and 488 ml (375-620 [170-910], p = 0.002), respectively, and total blood loss was 1168 ml (922-1470 [663-2107]) and 1563 ml (1276-1708 [887-1494], p = 0.003). Haemoglobin concentration was higher in the tranexamic acid group on the second postoperative day (10.5 (9.4-12.1 [7.9-14.0]) vs. 9.6 (8.9-10.5[7.3-16.0]) g.dl(-1) , p = 0.027). In patients undergoing total hip replacement arthroplasty, postoperative fibrinolysis aggravated by hydroxyethyl starch was attenuated by co-administration of 10 mg.kg(-1) tranexamic acid, which may have led to less postoperative blood loss.
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Affiliation(s)
- H S Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - H J Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Y J Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - J H Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - K H Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - S H Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
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Yeon JY, Shin HJ. Nonprogressive Unilateral Intracranial Arteriopathy in Children with Arterial Ischemic Stroke. J Korean Neurosurg Soc 2015; 57:401-7. [PMID: 26180606 PMCID: PMC4502235 DOI: 10.3340/jkns.2015.57.6.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 02/06/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
The nonprogressive unilateral intracranial arteriopathy known as transient (focal) cerebral arteriopathy is not a well-recognized arteriopathy among practitioners of Korea and Japan, although it cannot be easily differentiated from early moyamoya disease. This review summarizes the nomenclature, pathophysiology, diagnostic evaluation, clinico-radiological features, and management of nonprogressive (reversible or stable) unilateral arteriopathy based on the relevant literature and our own experiences. Nonprogressive unilateral arteriopathy should be strongly suspected in children presenting with basal ganglia infarction and arterial beading. The early identification of patients likely to have nonprogressive or progressive arteriopathy would ensure proper management and guide further research for secondary stroke prevention.
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Affiliation(s)
- Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shin HJ, Na HS, Do SH. A reply. Anaesthesia 2015; 70:762-3. [PMID: 25959195 DOI: 10.1111/anae.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- H J Shin
- Bundang Hospital, Seongnam, South Korea
| | - H S Na
- Bundang Hospital, Seongnam, South Korea
| | - S H Do
- Bundang Hospital, Seongnam, South Korea.
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Na HS, Shin HJ, Kang SB, Hwang JW, Do SH. A reply. Anaesthesia 2015; 70:363-4. [PMID: 25682822 DOI: 10.1111/anae.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H S Na
- Bundang Hospital, Seongnam, South Korea
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Paudel S, Park JE, Jang H, Shin HJ. Comparison of serum neutralization and enzyme-linked immunosorbent assay on sera from porcine epidemic diarrhea virus vaccinated pigs. Vet Q 2014; 34:218-23. [PMID: 25415042 DOI: 10.1080/01652176.2014.979512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Porcine epidemic diarrhea virus (PEDV) is an economically important pathogen of swine. OBJECTIVE Serum neutralization (SN) and enzyme-linked immunosorbent assay (ELISA) test results as well as the utility of spike proteins S1, S2, and S3 and entire nucleocapsid protein were compared. ANIMALS AND METHODS Serum samples from 400 pigs vaccinated against PEDV strain SM98P were collected from 78 farms in Korea. SN test and ELISA were performed to confirm the presence of antibodies. For prokaryotic expression of partial fragments of spike protein the size and location of S1, S2, and S3, and full nucleocapsid protein, polymerase chain reaction was performed using specific primers. RESULTS Comparison of these results demonstrated that there was a correlation between the SN and ELISA results. Sera with higher neutralizing activity also had higher IgG titer. The antibody profiling data presented the correlation of neutralizing activity with the level of spike protein antibody. In particular, the S3 region may have an important role in neutralizing activity. CONCLUSIONS We confirmed that the carboxy-terminal region that includes the endodomain of the S protein induced stronger neutralizing activity than the region that includes the ectodomain. CLINICAL RELEVANCE The region of the S protein may have a stronger neutralizing KPEDV-9 epitope and could be useful for the evaluation of future PEDV vaccine efficacy.
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Affiliation(s)
- S Paudel
- a Laboratory of Infectious Disease, College of Veterinary Medicine , Chungnam National University , Daejeon , South Korea
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Paudel S, Park JE, Jang H, Hyun BH, Yang DG, Shin HJ. Evaluation of antibody response of killed and live vaccines against porcine epidemic diarrhea virus in a field study. Vet Q 2014; 34:194-200. [PMID: 25398090 DOI: 10.1080/01652176.2014.973999] [Citation(s) in RCA: 23] [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] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Porcine epidemic diarrhea virus (PEDV) is an infectious, highly contagious virus, and is an etiological agent of acute entero-pathogenic diarrhea in swine. OBJECTIVES Evaluation of the antibody response of two types of PEDV vaccines is to be carried out. ANIMALS AND METHODS Sows were vaccinated with either live or killed commercial PEDV SM98 (GenBank: GU937797.1) vaccines. Four different groups of sows with five sows in each group were used in this study: the unvaccinated negative control group, the killed virus vaccination group with killed virus boosting (K/K), the live virus vaccinated group with live virus boosting (L/L), and the combination group vaccinated with live virus and subsequently boosted with killed vaccine (L/K). Sows were vaccinated intramuscularly twice at four and two weeks prior to farrowing with 2ml/head vaccine dose. Antibody titers in sow and piglet serum one week after farrowing and that in colostrum were compared by enzyme-linked immunosorbent assay (ELISA) and serum neutralization test. RESULTS Vaccination with K/K vaccine induced the highest level of IgG and IgA in sow serum, colostrum, and especially in piglet serum, with the lowest levels found in the L/L group. The major neutralizing activity was also found in the K/K group, particularly in colostrum, with piglets bearing higher neutralizing activity compared to sow sera. Among recombinant spike S1, S2, S3, and nucleocapsid N protein of PEDV, S3 protein presented the highest antibody level in the K/K group. CONCLUSION Killed PEDV SM98 vaccine induced higher antibody levels. CLINICAL IMPORTANCE This study clearly confirms that killed vaccine has induced higher antibody levels and may contribute to the design of future research and vaccine programs.
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Affiliation(s)
- S Paudel
- a Laboratory of Infectious Disease, College of Veterinary Medicine , Chungnam National University , Daejeon , Korea
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Noh JH, Cho KR, Yeon JY, Seol HJ, Shin HJ. Microsurgical treatment and outcome of pediatric supratentorial cerebral cavernous malformation. J Korean Neurosurg Soc 2014; 56:237-42. [PMID: 25368767 PMCID: PMC4217061 DOI: 10.3340/jkns.2014.56.3.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 04/01/2014] [Revised: 06/20/2014] [Accepted: 09/06/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical features and outcomes of pediatric cavernous malformation (CM) in the central nervous system. METHODS Twenty-nine pediatric patients with supratentorial CM underwent microsurgical excision. In selected cases, transparent tubular retractor system (TTRS) was used to reduce retraction injury and intraoperative neuromonitoring (IONM) was held to preserve functioning cortex. Patients' demographics and symptoms were reviewed and surgical outcomes were discussed. RESULTS THE MAIN INITIAL CLINICAL MANIFESTATIONS INCLUDED THE FOLLOWING : seizures (n=13, 45%), headache (n=7, 24%), focal neurological deficits (n=3, 10%), and an incidental finding (n=6, 21%). Overt hemorrhage was detected in 7 patients (24%). There were 19 children (66%) with a single CM and 10 (34%) children with multiple CMs. In 7 cases with deep-seated CM, we used a TTRS to minimize retraction. In 9 cases which location of CM was at eloquent area, IONM was taken during surgery. There was no major morbidity or mortality after surgery. In the 29 operated children, the overall long-term results were satisfactory : 25 (86%) patients had no signs or symptoms associated with CMs, 3 had controllable seizures, and 1 had mild weakness. CONCLUSION With the assistance of neuronavigation systems, intraoperative neuromonitoring, and TTRS, CMs could be targeted more accurately and excised more safely. Based on the satisfactory seizure outcome achieved, complete microsurgical excision in children is recommended for CMs presenting with seizures but removal of hemosiderin-stained areas seems to be unnecessary.
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Affiliation(s)
- Jung-Hoon Noh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Rae Cho
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Noh JH, Yeon JY, Park JH, Shin HJ. Cerebral arteriovenous malformation associated with moyamoya disease. J Korean Neurosurg Soc 2014; 56:356-60. [PMID: 25371789 PMCID: PMC4219197 DOI: 10.3340/jkns.2014.56.4.356] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/06/2014] [Accepted: 09/29/2014] [Indexed: 01/20/2023] Open
Abstract
The coexistence of moyamoya disease (MMD) with an arteriovenous malformation (AVM) is exceedingly rare. We report two cases of AVM associated with MMD. The first case was an incidental AVM diagnosed simultaneously with MMD. This AVM was managed expectantly after encephalo-duro-arterio-synangiosis (EDAS) as the main feeders stemmed from the internal carotid artery, which we believed would be obliterated with the progression of MMD. However, the AVM persisted with replacement of the internal carotid artery feeders by new external carotid artery feeders from the EDAS site. The AVM was eventually treated with gamma knife radiosurgery considering an increasing steal effect. The second case was a de novo AVM case. The patient was initially diagnosed with MMD, and acquired an AVM eight years later that was slowly fed by the reconstituted anterior cerebral artery. Because the patient remained asymptomatic, the AVM is currently being closely followed for more than 2 years without further surgical intervention. Possible differences in the pathogenesis and the radiologic presentation of these AVMs are discussed with a literature review. No solid consensus exists on the optimal treatment of MMD-associated AVMs. Gamma knife radiosurgery appears to be an effective treatment option for an incidental AVM. However, a de novo AVM may be managed expectantly considering the possible risks of damaging established collaterals, low flow characteristics, and probably low risks of rupture.
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Affiliation(s)
- Jung-Hoon Noh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Han Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jee TK, Seol HJ, Im YS, Kong DS, Nam DH, Park K, Shin HJ, Lee JI. Fractionated gamma knife radiosurgery for benign perioptic tumors: outcomes of 38 patients in a single institute. Brain Tumor Res Treat 2014; 2:56-61. [PMID: 25408926 PMCID: PMC4231616 DOI: 10.14791/btrt.2014.2.2.56] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 06/10/2014] [Revised: 07/13/2014] [Accepted: 07/31/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the efficacy and safety of fractionated Gamma Knife radiosurgery (GKRS) for perioptic lesions. METHODS Thirty-eight patients with perioptic tumors were treated at our institute from May 2004 to December 2008. All patients had a lesion in close contact with the optic apparatus. Twenty-four of these patients had undergone surgical resection before fractionated GKRS. Radiation was delivered in four sessions with 12 hours intervals between sessions. The mean target volume was 3,851 mm(3) and the median cumulative marginal dose was 20 Gy. The median follow-up was 38.2 months. Visual acuity and visual fields were analyzed according to visual impairment score using the German Ophthalmological Society guidelines. RESULTS Tumor control was achieved in 35 (94.6%) of the 37 patients with available follow-up images. Progressive tumor growth was observed in two craniopharyngioma patients (5.4%). Favorable visual outcomes in the postoperative period were achieved in 94.7% of cases (36/38). Sixteen patients showed visual function after fractionated GKRS, twenty cases were stationary, and two patients showed visual function deterioration after GKRS. CONCLUSION GKRS is a safe and effective alternative to either surgery or fractionated radiotherapy for selected benign lesions that are adjacent to the optic apparatus.
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Affiliation(s)
- Tae Keun Jee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Seok Im
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim SJ, Son TO, Kim KH, Jeon P, Hyun SH, Lee KH, Yeon JY, Kim JS, Hong SC, Shin HJ, Bang OY. Neovascularization precedes occlusion in moyamoya disease: angiographic findings in 172 pediatric patients. Eur Neurol 2014; 72:299-305. [PMID: 25323466 DOI: 10.1159/000365286] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 06/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both basal collaterals (BC) and cortical microvascularization (CM) on angiography have been suggested as moyamoya disease (MMD)-specific findings; however, it is unknown whether the vascular network represents compensatory mechanisms for vascular occlusion or aberrant active neovascularization. METHODS We investigated the grade of antegrade MCA flow, the degree of BC, and the presence of CM on conventional angiography in relation to disease severity in pediatric MMD. CM was defined as enlarged and winding distal cortical arteries and categorized into anterior or posterior CM depending on their sources. Findings from basal and acetazolamide stress brain perfusion SPECT studies were also evaluated. RESULTS A total of 172 pediatric patients with MMD were enrolled in this study. As the severity of MMD increased, the grade of antegrade MCA flow gradually diminished. While the degree of BC peaked at Suzuki stage 3-4, CM was frequently observed at early MMD stages. About two-thirds of hemispheres with normal antegrade MCA flow on angiography and normal perfusion status on SPECT had anterior and/or posterior CM. Both anterior and posterior CM gradually decreased with the advancement of MMD. CONCLUSION Our findings from a large cohort of angiographically confirmed pediatric MMD patients indicate that neovascularization may occur before significant hemodynamic impairment in MMD.
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Affiliation(s)
- Suk Jae Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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