Publications by authors named "Youngbeom Seo"

24 Publications

  • Page 1 of 1

Giant Intradiploic Epidermoid Cyst in the Occipital Bone: A Case Report.

Brain Tumor Res Treat 2021 Apr;9(1):21-25

Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.

Epidermoid cysts are uncommon intracranial tumors. As one of the extradural types of epidermoid cysts, intradiploic epidermoid cysts are even rarer tumors and occur in any part of the skull. We herein report a rare case of a giant intradiploic epidermoid cyst of the occipital bone. A 57-year-old woman presented with a 1-year history of localized headache in the occipital area. CT and MRI showed an extradural mass measuring 50×70 mm in the occipital bone with bony destruction. The patient underwent surgical resection. The tumor was completely removed with its capsule. There was no extension to the intradural space. The pathological report confirmed that the tumor was an epidermoid cyst. Follow-up MRI 24 months after the operation showed no recurrence. The headache was well controlled without any medications. We report a rare case of intradiploic epidermoid cyst with clinical and radiologic features and surgical treatment. It is important to consider this diagnosis for a patient with persistent regional headache with or without a growing scalp mass.
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http://dx.doi.org/10.14791/btrt.2021.9.e3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082287PMC
April 2021

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

Brain Tumor Res Treat 2021 Apr;9(1):9-15

Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Background: To date, there has been no practical guidelines for the prescription of antiepileptic drugs (AEDs) in brain tumor patients in Korea. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for AED usage in brain tumors since 2019.

Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of the keywords.

Results: The core contents are as follows. Prophylactic AED administration is not recommended in newly diagnosed brain tumor patients without previous seizure history. When AEDs are administered during peri/postoperative period, it may be tapered off according to the following recommendations. In seizure-naïve patients with no postoperative seizure, it is recommended to stop or reduce AED 1 week after surgery. In seizure-naïve patients with one early postoperative seizure (<1 week after surgery), it is advisable to maintain AED for at least 3 months before tapering. In seizure-naïve patients with ≥2 postoperative seizures or in patients with preoperative seizure history, it is recommended to maintain AEDs for more than 1 year. The possibility of drug interactions should be considered when selecting AEDs in brain tumor patients. Driving can be allowed in brain tumor patients when proven to be seizure-free for more than 1 year.

Conclusion: The KSNO suggests prescribing AEDs in patients with brain tumor based on the current guideline. This guideline will contribute to spreading evidence-based prescription of AEDs in brain tumor patients in Korea.
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http://dx.doi.org/10.14791/btrt.2021.9.e7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082286PMC
April 2021

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

Brain Tumor Res Treat 2021 Apr;9(1):1-8

Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Background: There have been no guidelines for the management of adult patients with diffuse midline glioma (DMG), H3K27M-mutant in Korea since the 2016 revised WHO classification newly defined this disease entity. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for DMG since 2019.

Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. As 'diffuse midline glioma' was recently defined, and there was no international guideline, trials and guidelines of 'diffuse intrinsic pontine glioma' or 'brain stem glioma' were thoroughly reviewed first.

Results: The core contents are as follows. The DMG can be diagnosed when all of the following three criteria are satisfied: the presence of the H3K27M mutation, midline location, and infiltrating feature. Without identification of H3K27M mutation by diagnostic biopsy, DMG cannot be diagnosed. For the primary treatment, maximal safe resection should be considered for tumors when feasible. Radiotherapy is the primary option for tumors in case the total resection is not possible. A total dose of 54 Gy to 60 Gy with conventional fractionation prescribed at 1-2 cm plus gross tumor volume is recommended. Although no chemotherapy has proven to be effective in DMG, concurrent chemoradiotherapy (± maintenance chemotherapy) with temozolomide following WHO grade IV glioblastoma's protocol is recommended.

Conclusion: The detection of H3K27M mutation is the most important diagnostic criteria for DMG. Combination of surgery (if amenable to surgery), radiotherapy, and chemotherapy based on comprehensive multidisciplinary discussion can be considered as the treatment options for DMG.
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http://dx.doi.org/10.14791/btrt.2021.9.e8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082289PMC
April 2021

Extremely delayed solitary cerebral metastasis in patient with T1N0M0 renal cell carcinoma after radical nephrectomy: Case report and literature review.

Medicine (Baltimore) 2021 Apr;100(15):e25586

Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine Daegu, Republic of Korea.

Rationale: Although renal cell carcinoma (RCC) is one of the common origins of brain metastasis, few cases of extremely delayed brain metastasis from RCC, more than 10 years after nephrectomy, have been reported. We present a rare case of extremely delayed brain metastasis from RCC, also performed a literature review to increase knowledge of the characteristics for extremely delayed brain metastasis from RCC.

Patient Concerns: A 72-year-old man presented with right-sided hemiplegia and dysarthria. The patient had a history of radical nephrectomy for RCC with stage T1N0M0 15 years earlier.

Diagnosis: Magnetic resonance imaging with contrast revealed a 2-cm sized non-homogenous enhanced mass in the left frontal lobe with peritumoral edema. The pathological examination after surgery reported metastatic clear cell RCC.

Interventions: A craniotomy for removal of the mass was performed at the time of diagnosis. Stereotactic radiosurgery was performed for the tumor bed 3 weeks after craniotomy, and then, chemotherapy was started 2 months after the SRS.

Outcomes: Metastasis progressed to multiple organs 6 months after the craniotomy. The patient chose a hospice and no longer visited the hospital.

Lessons: In cases with a history of nephrectomy for RCC, long period follow-up is necessary for monitoring RCC brain metastasis and pathologic diagnosis should be confirmed.
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http://dx.doi.org/10.1097/MD.0000000000025586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052049PMC
April 2021

Safety and Efficacy of Endoscopic Dorsum Sellar Resection for Access to Retroinfundibular or Upper Clival Tumors (Korean Society of Endoscopic Neurosurgery-008).

World Neurosurg 2021 Mar 23. Epub 2021 Mar 23.

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Pituitary Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address:

Objective: The retroinfundibular and upper clival regions are challenging to access using the endoscopic endonasal approach because these regions are obstructed by the dorsum sellae and posterior clinoid processes. We evaluated the safety and clinical efficacy of endoscopic dorsum sellar resection (DSR) and identified the optimal indications for endoscopic DSR in patients with craniopharyngioma.

Methods: A retrospective study was conducted of patients who had undergone treatment with an endoscopic endonasal approach from January 2014 to January 2019. We identified a total of 50 patients who had undergone DSR. The indications for DSR included the following: 1) a tumor involving the upper clivus; 2) a tumor located behind the dorsum sellae; and 3) a tumor involving the interpeduncular or prepontine cistern. We evaluated the clinical outcomes, postoperative endocrinological status, and surgical morbidities.

Results: Of the 50 patients, 16 had been treated for craniopharyngioma, 30 for chordoma, 2 for pituitary adenoma, 1 for schwannoma, and 1 for chondrosarcoma. An extradural approach for DSR with posterior clinoidectomy was performed in 33 patients (66.0%) and an interdural transcavernous approach in 17 patients (34.0%). The overall gross total tumor resection rate was 92.0% (46 of 50 patients). Postoperatively, 28 of 33 patients (84.8%) with normal pituitary function preoperatively showed preservation of hormonal function postoperatively.

Conclusions: DSR with or without posterior clinoidectomy is a challenging procedure that requires considerable effort and advanced surgical techniques. However, it can be safely performed with accumulating experience and a thorough knowledge of the surrounding anatomical structures.
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http://dx.doi.org/10.1016/j.wneu.2021.03.085DOI Listing
March 2021

Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis.

Radiat Oncol 2021 Feb 17;16(1):34. Epub 2021 Feb 17.

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.

Background: The impact of adjuvant radiotherapy (RT) on atypical meningioma (AM) underwent a gross total resection (GTR) remains unclear, showing conflicting results from various studies. The objective of this study was to perform an updated meta-analysis for observational studies to determine the effect of adjuvant RT after GTR on local recurrence and survival outcomes compared to observation after GTR.

Methods: PubMed, Embase, and Web of Science were searched to identify comparative studies that reported outcomes of adjuvant RT versus observation for AM patients after GTR. Local recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicities related to RT were considered as outcomes of interest. Differences between two cohorts were estimated by calculating odds ratios (OR) for LR rate and hazard ratios (HR) for survival outcomes with 95% confidence intervals (CIs) for meta-analysis, using R version 4.0.3 software. Included studies were appraised with the Risk of Bias Assessment tool for Non-Randomized Studies. Outcome ratios were combined with the Mantel-Haenszel method and the inverse variance-weighted method, appropriately.

Results: Data from 30 studies involving 2904 patients (adjuvant RT: n = 737; observation: n = 2167) were eventually included. Significant reduction of local recurrence rate was seen in the adjuvant RT cohort compare to that in the observation cohort (OR 0.50; 95% CI 0.36-0.68; p < 0.0001). Pooled HRs of PFS at 1-year, 3-year, 5-year, and > 5-year revealed that adjuvant RT was superior to observation. There was no significant difference in OS between the two cohorts during any period. Most toxicities were tolerable with grade 1 or 2. There was no documented grade 5 toxicity.

Conclusions: For AM patients who underwent GTR, evidence suggested that adjuvant RT could potentially decrease local recurrence and improve PFS better than observation.
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http://dx.doi.org/10.1186/s13014-021-01759-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890913PMC
February 2021

Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy.

Acta Neurochir (Wien) 2021 May 6;163(5):1371-1381. Epub 2021 Jan 6.

Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea.

Background: Primary decompressive craniectomy (DC) is considered for traumatic brain injury (TBI) patients with clinical deterioration, presenting large amounts of high-density lesions on computed tomography (CT). Postoperative CT findings may be suitable for prognostic evaluation. This study evaluated the radiographic predictors of clinical outcome and survival using pre- and postoperative CT scans of such patients.

Methods: We enrolled 150 patients with moderate to severe TBI who underwent primary DC. They were divided into two groups based on the 6-month postoperative Glasgow Outcome Scale Extended scores (1-4, unfavorable; 5-8, favorable). Radiographic parameters, including hemorrhage type, location, presence of skull fracture, midline shifting, hemispheric diameter, effacement of cisterns, parenchymal hypodensity, and craniectomy size, were reviewed. Stepwise logistic regression analysis was used to identify the prognostic factors of clinical outcome and 6-month mortality.

Results: Multivariable logistic regression analysis revealed that age (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.032-1.151; p = 0.002), postoperative low density (OR = 12.58; 95% CI 1.247-126.829; p = 0.032), and postoperative effacement of the ambient cistern (OR = 14.52; 95% CI 2.234-94.351; p = 0.005) and the crural cistern (OR = 4.90; 95% CI 1.359-17.678; p = 0.015) were associated with unfavorable outcomes. Postoperative effacement of the crural cistern was the strongest predictor of 6-month mortality (OR = 8.93; 95% CI 2.747-29.054; p = 0.000).

Conclusions: Hemispheric hypodensity and effacement of the crural and ambient cisterns on postoperative CT after primary DC seems to associate with poor outcome in patients with TBI.
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http://dx.doi.org/10.1007/s00701-020-04679-xDOI Listing
May 2021

Inhibition of MUC1 exerts cell-cycle arrest and telomerase suppression in glioblastoma cells.

Sci Rep 2020 10 26;10(1):18238. Epub 2020 Oct 26.

Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.

Mucin 1 (MUC1) is a transmembrane glycoprotein involved in tumorigenesis of diverse cancers. However, the role of MUC1 in glioblastoma (GBM) has not yet been fully explored. In this study, the anticancer mechanism of MUC1 suppression in GBM was investigated. The expression level of MUC1 was analyzed in human glioma and paired normal brain tissues. MUC1 was overexpressed in GBM and was negatively associated with overall survival. Moreover, we silenced MUC1 to investigate its effect in GBM cell lines and found that knockdown of MUC1 inhibited cell proliferation and resulted in cell cycle arrest at G1 phase. MUC1 silencing decreased the phosphorylation of RB1 and increased the expression of CDKN1B. Gene set enrichment analysis showed that a series of genes related to cell cycle, telomere maintenance and transforming growth factor Beta (TGF-β) signaling in epithelial mesenchymal transition (EMT) were influenced by MUC1 knockdown. Notably, the reduced TERT expression levels combined with impaired telomerase activity and the switching of telomere maintenance mechanism to alternative lengthening of telomeres (ALT) were observed after MUC1 knockdown. Our results support the role of MUC1 in oncological process in GBM which can be developed as a therapeutic target for cell cycle control and telomere maintenance mechanism.
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http://dx.doi.org/10.1038/s41598-020-75457-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589558PMC
October 2020

Calvarial Tuberculosis Presenting with Skin Defect in an Elderly Patient.

World Neurosurg 2020 08 16;140:267-270. Epub 2020 May 16.

Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea.

Background: Tuberculosis is a common disease; however, the prevalence of calvarial tuberculosis is very rare. Most cases of calvarial tuberculosis occur in young patients. We report a rare case of calvarial tuberculosis in an elderly patient.

Case Description: An 89-year-old woman presented with a forehead skin defect. Radiologic imaging showed bony erosion 20 × 10 mm in size with adjacent dural enhancement in the left frontal bone. The patient underwent surgical treatment. Pathology revealed chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. Antituberculous medications were prescribed for 6 months.

Conclusions: A careful assessment should be performed to obtain an appropriate diagnosis in cases of osteolytic lesions of the skull.
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http://dx.doi.org/10.1016/j.wneu.2020.05.076DOI Listing
August 2020

A National Consensus Survey for Current Practice in Brain Tumor Management III: Brain Metastasis and Primary Central Nervous System Lymphoma.

Brain Tumor Res Treat 2020 Apr;8(1):20-28

Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Background: The Guideline Working Group of the Korean Society for Neuro-Oncology (KSNO) conducted the nationwide questionnaire survey for diverse queries facing to treat patients with brain tumor. As part III of the survey, the aim of this study is to evaluate the national patterns of clinical practice for patients with brain metastasis and primary central nervous system lymphoma (PCNSL).

Methods: A web-based survey was sent to all members of the KSNO by email. The survey included 7 questions of brain metastasis and 5 questions of PCNSL, focused on the management strategies in specific situations. All questions were developed by consensus of the Guideline Working Group.

Results: In the survey about brain metastasis, respondents preferred surgical resection with adjuvant treatment for patients with a surgically accessible single brain metastatic lesion less than 3 cm in size without extracranial systemic lesions. However, most respondents considered radiosurgery for surgically inaccessible lesions. As the preferred treatment of multiple brain metastases according to the number of brain lesions, respondents tended to choose radiotherapy with increasing number of lesions. Radiosurgery was mostly chosen for the brain metastases of less than or equal to 4. In the survey about PCNSL, a half of respondents choose high-dose methotrexate-based polychemotherapy as the first-line induction therapy for PCNSL. The consolidation and salvage therapy showed a little variation among respondents. For PCNSL patients with cerebrospinal fluid dissemination, intrathecal chemotherapy was most preferred.

Conclusion: The survey demonstrates the prevailing clinical practice patterns for patients with brain metastasis and PCNSL among members of the KSNO. This information provides a point of reference for establishing a practical guideline in the management of brain metastasis and PCNSL.
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http://dx.doi.org/10.14791/btrt.2020.8.e7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221464PMC
April 2020

A National Consensus Survey for Current Practice in Brain Tumor Management II: Diffuse Midline Glioma and Meningioma.

Brain Tumor Res Treat 2020 04;8(1):11-19

Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Background: The Guideline Working Group of the Korean Society for Neuro-Oncology (KSNO) conducted a nationwide questionnaire survey for diverse queries faced in the treatment of brain tumors. As part II of the survey, the aim of this study is to evaluate the national patterns of clinical practice for patients with diffuse midline glioma and meningioma.

Methods: A web-based survey was sent to all members of the KSNO by email. The survey included 4 questions of diffuse midline glioma and 6 questions of meningioma (including 2 case scenarios). All questions were developed by consensus of the Guideline Working Group.

Results: In the survey about diffuse midline glioma, 76% respondents performed histologic confirmation to identify H3K27M mutation on immunohistochemical staining or sequencing methods. For treatment of diffuse midline glioma, respondents preferred concurrent chemoradiotherapy with temozolomide (TMZ) and adjuvant TMZ (63.8%) than radiotherapy alone (34.0%). In the survey about meningioma, respondents prefer wait-and-see policy for the asymptomatic small meningioma without peritumoral edema. However, a greater number of respondents had chosen surgical resection as the first choice for all large size meningiomas without exception, and small size meningiomas with either peritumoral edema or eloquent location. There was no single opinion with major consensus on long-term follow-up plans for asymptomatic meningioma with observation policy. As many as 68.1% of respondents answered that they would not add any adjuvant therapies for World Health Organization grade II meningiomas if the tumor was totally resected including dura.

Conclusion: The survey demonstrates the prevailing clinical practice patterns for patients with diffuse midline glioma and meningioma among members of the KSNO. This information provides a point of reference for establishing a practical guideline in the management of diffuse midline glioma and meningioma.
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http://dx.doi.org/10.14791/btrt.2020.8.e6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221470PMC
April 2020

A National Consensus Survey for Current Practice in Brain Tumor Management I: Antiepileptic Drug and Steroid Usage.

Brain Tumor Res Treat 2020 Apr;8(1):1-10

Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Background: The Guideline Working Group of the Korean Society for Neuro-Oncology (KSNO) conducted a nationwide questionnaire survey for diverse queries faced in the treatment of brain tumors. As part I of the survey, the aim of this study is to evaluate national patterns of clinical practice about antiepileptic drug (AED) and steroid usage for management of brain tumors.

Methods: A web-based survey was sent to all members of the KSNO by email. The survey included 9 questions of AED usage and 5 questions of steroid usage for brain tumor patients. All questions were developed by consensus of the Guideline Working Group.

Results: The overall response rate was 12.8% (54/423). Regarding AED usage, the majority of respondents (95.2%) routinely prescribed prophylactic AEDs for patients with seizure at the peri/postoperative period. However, as many as 72.8% of respondents prescribed AED routinely for seizure-naïve patients, and others prescribed AED as the case may be. The duration of AED prophylaxis showed wide variance according to the epilepsy status and the location of tumor. Levetiracetam (82.9%) was the most preferred AED for epilepsy prophylaxis. Regarding steroid usage, 90.5% of respondents use steroids in perioperative period, including 34.2% of them as a routine manner. Presence of peritumoral edema (90.9%) was considered as the most important factor determining steroid usage followed by degree of clinical symptoms (60.6%). More than half of respondents (51.2%) replied to discontinue the steroids within a week after surgery if there are no specific medical conditions, while 7.3% preferred slow tapering up to a month after surgery.

Conclusion: The survey demonstrated the prevailing practice patterns on AED and steroid usage in neuro-oncologic field among members of the KSNO. This information provides a point of reference for establishing a practical guideline in the management of brain tumor patients.
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http://dx.doi.org/10.14791/btrt.2020.8.e5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221462PMC
April 2020

Evaluation of the safety and effectiveness of an alternative dural substitute using porcine pericardium for duraplasty in a large animal model.

J Clin Neurosci 2018 Dec 24;58:187-191. Epub 2018 Oct 24.

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

This study aimed to evaluate the safety and effectiveness of an alternative dural substitute using a porcine pericardial graft for duraplasty in a large animal model. Six pigs underwent bilateral craniectomy followed by bilateral duraplasty using either a porcine pericardium patch or a Biodesign® Dural Repair Graft. Intraoperative workability was evaluated for each type of graft. Pigs were euthanized after 1 and 3 months (n = 3 per group). Histological analysis was performed for each case. The Biodesign® Dural Repair Graft showed better workability than the porcine pericardial patch, which was more transparent (p = 0.002). Histological analyses at 1 and 3 months showed no differences between the types of graft. There was no postoperative leakage of cerebrospinal fluid in any case. No grafts showed any adverse reactions in the underlying brain tissues. The porcine pericardial patch as a dural substitute seems to be an acceptable alternative graft to duraplasty using a small intestinal submucosal graft (Biodesign®). Further studies are needed to determine whether porcine pericardial patches provide workable alternatives in clinical practice.
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http://dx.doi.org/10.1016/j.jocn.2018.10.071DOI Listing
December 2018

The Outcomes of Pituitary Apoplexy with Conservative Treatment: Experiences at a Single Institution.

World Neurosurg 2018 Jul 27;115:e703-e710. Epub 2018 Apr 27.

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Objective: Pituitary apoplexy is an unpredictable complication caused by hemorrhage or infarction in a pituitary adenoma. We retrospectively analyzed the radiologic and clinical outcomes of patients with conservatively managed pituitary apoplexy.

Methods: A total of 32 patients who had undergone conservative treatment with high-dose corticosteroid replacement were enrolled in this study. This cohort study consisted of 20 male and 12 female patients. The median patient age was 60 years. Five patients had a previously diagnosed pituitary tumor, and one third of the patients had a history of hypertension.

Results: The median follow-up duration was 50 months. The median tumor volumes at the initial and final assessments were 2.75 cm (range, 0.32-10.7 cm) and 0.64 cm (range, 0-8.74 cm), respectively. Complete radiographic regression occurred in 9 of the 32 patients, partial regression occurred in 14 patients, and no change in size or progression occurred in 9 patients. Eighteen of the 32 patients had visual disturbances at the initial presentation; in this subgroup, 17 patients showed improvement over the course of the study. One patient had newly developed diplopia related to tumor progression. Nineteen of the 32 patients had ≥1 hormonal deficiency at the initial assessment, 8 of whom recovered to normal endocrine status. Three patients developed a new hormonal deficiency during the follow-up, and 3 patients experienced tumor recurrence.

Conclusions: This study showed the regression of tumors related to pituitary apoplexy, with favorable ophthalmologic and endocrinologic recovery. Conservative management should be considered in patients without severe or progressive neuro-ophthalmic deficits.
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http://dx.doi.org/10.1016/j.wneu.2018.04.139DOI Listing
July 2018

A Retrospective Analysis of the Outcomes of Dural Arteriovenous Fistulas Treated with Gamma Knife Radiosurgery: A Single-Institution Experience.

Stereotact Funct Neurosurg 2018 14;96(1):46-53. Epub 2018 Mar 14.

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: Gamma knife radiosurgery (GKRS) has recently been used as a treatment modality for dural arteriovenous fistula (DAVF).

Objective: To retrospectively analyze the outcomes of GKRS for DAVF at a single institute.

Methods: Between 1998 and 2016, a total of 20 patients underwent GKRS for DAVF. After excluding 4 patients with > 12 months of follow-up, 16 patients were enrolled in this study. Twelve patients had undergone embolization prior to GKRS. The most common location was the cavernous sinus (CS). The median clinical and radiological follow-up durations were 87.5 (range 24-186) months and 44.5 (range 14-174) months.

Results: Ten (62.5%) of the 16 DAVFs were obliterated; 8 were confirmed on angiography. Five cases resulted in small, residual DAVFs, and one case remained unchanged. The obliteration rate of GKRS for CS DAVF was significantly higher than that for non-CS DAVF (100 vs. 40%; p = 0.034). Fifteen out of 16 patients (94%) had a favorable outcome, and the remaining patient had an unfavorable outcome. Hemorrhage after GKRS occurred in only 1 patient, who presented with seizure.

Conclusions: GKRS is a safe and effective treatment modality for DAVF in combination with a traditional treatment option such as endovascular embolization or microsurgery.
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http://dx.doi.org/10.1159/000486685DOI Listing
December 2018

Long-Term Outcomes After Gamma Knife Radiosurgery for Benign Meningioma: A Single Institution's Experience With 424 Patients.

Neurosurgery 2018 11;83(5):1040-1049

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Background: Gamma knife radiosurgery (GKRS) is recognized as an important treatment modality for meningioma.

Objective: To analyze the long-term outcomes in meningioma patients treated with GKRS to determine the risk factors related to treatment failure and peritumoral edema (PTE) development.

Methods: Between 1998 and 2010, 770 consecutive patients were treated with GKRS for intracranial meningioma. After the exclusion of patients with follow-up periods of less than 5 yr and those with neurofibromatosis, multiple meningiomas, nonbenign meningioma, or radiotherapy, a total of 424 patients were enrolled in this study. The median follow-up duration was 92 mo. The median tumor volume was 4.35 cm3, and the median marginal dose was 14 Gy.

Results: The overall local tumor control rate was 84%. The actuarial tumor control rates were 91.7% and 78.9% at 5 and 10 yr, respectively. The tumor control rate of a radiologically diagnosed tumor was higher than that of a grade I tumor (82% vs 70.1% at 10 yr, P = .001). In multivariate analysis, factors associated with tumor progression were female sex (hazard ratio: 0.5, P = .025) and a previous history of craniotomy (hazard ratio: 1.9, P = .009). Symptomatic PTE was identified in 36 (8.5%) patients, and the factor associated with poor PTE was the presence of PTE before GKRS (odds ratio: 4.6, P < .001). Permanent complication rate was 4%.

Conclusion: GKRS appears to be an effective treatment modality for meningioma with long-term follow-up. However, the identification of delayed tumor progression in our study suggests that extended follow-up data should be collected after GKRS.
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http://dx.doi.org/10.1093/neuros/nyx585DOI Listing
November 2018

Genomic analysis of synchronous intracranial meningiomas with different histological grades.

J Neurooncol 2018 May 8;138(1):41-48. Epub 2018 Feb 8.

Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro (Yeongeon-dong), Jongno-gu, Seoul, South Korea.

Although meningioma is the most common primary tumor of the central nervous system, the mechanism of progression from benign to atypical or anaplastic grade remains elusive. The present case reports the genomic evaluation of two synchronous meningiomas with different histological grades (benign and atypical) in the same patient. Under the assumption that the atypical tumor may have progressed from the benign tumor, the clonal origin of the lesions was investigated to identify genomic events responsible for the oncogenic process of evolution to higher grades in meningioma. A 59 year-old female patient was diagnosed with two synchronous meningiomas with different histological grades, benign and atypical. Whole-exome sequencing (WES) and RNA sequencing (RNA-seq) analysis of both tumors were done. WES analysis showed that each meningioma harbored distinct mutation profiles, and RNA-seq analysis revealed distinct gene expression profiles between the two tumors. The only apparent common genetic abnormality found in both tumors was the loss of heterozygosity of chromosome 22, raising the possibility that this event is the initial step in tumor formation, after which distinct subsequent mutations lead to the evolvement of two separate tumors of different grades. The result provides additional evidence on previous reports suggesting separate, independent mechanism of progression into higher grades in meningioma.
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http://dx.doi.org/10.1007/s11060-018-2772-1DOI Listing
May 2018

Contralateral trigeminal neuralgia in a rapidly growing vestibular schwannoma: A case report.

J Clin Neurosci 2018 Jan 6;47:132-134. Epub 2017 Nov 6.

Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

We present a rare case of vestibular schwannoma (VS) with contralateral trigeminal neuralgia. A 59 year-old woman presented with right-sided trigeminal neuralgia and a small VS in the left cerebellopontine angle (CPA) that was found via magnetic resonance imaging. The patient was administered medication; however, her symptoms gradually aggravated, and the size of the tumor increased. Two years after the initial diagnosis, the patient underwent surgical resection. After surgical resection, the patient's facial pain was improved. The trigeminal neuralgia appeared to be related to brainstem displacement caused by the contralateral VS. For VS with contralateral trigeminal neuralgia, surgical resection of the tumor should be considered as a possible treatment strategy.
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http://dx.doi.org/10.1016/j.jocn.2017.10.018DOI Listing
January 2018

Glutaminase 2 expression is associated with regional heterogeneity of 5-aminolevulinic acid fluorescence in glioblastoma.

Sci Rep 2017 09 22;7(1):12221. Epub 2017 Sep 22.

Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) is now a widely-used modality for glioblastoma (GBM) treatment. However, intratumoral heterogeneity of fluorescence intensity may reflect different onco-metabolic programs. Here, we investigated the metabolic mechanism underlying the heterogeneity of 5-ALA fluorescence in GBM. Using an in-house developed fluorescence quantification system for tumor tissues, we collected 3 types of GBM tissues on the basis of their fluorescence intensity, which was characterized as strong, weak, and none. Expression profiling by RNA-sequencing revealed 77 genes with a proportional relationship and 509 genes with an inverse relationship between gene expression and fluorescence intensity. Functional analysis and in vitro experiments confirmed glutaminase 2 (GLS2) as a key gene associated with the fluorescence heterogeneity. Subsequent metabolite profiling discovered that insufficient NADPH due to GLS2 underexpression was responsible for the delayed metabolism of 5-ALA and accumulation of protoporphyrin IX (PpIX) in the high fluorescence area. The expression level of GLS2 and related NADPH production capacity is associated with the regional heterogeneity of 5-ALA fluorescence in GBM.
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http://dx.doi.org/10.1038/s41598-017-12557-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610329PMC
September 2017

Erratum to: Loss of Pericytes in Radiation Necrosis after Glioblastoma Treatments.

Mol Neurobiol 2018 Jun;55(6):4927

Department of Neurosurgery, Seoul National University Hosptial, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1007/s12035-017-0765-2DOI Listing
June 2018

Loss of Pericytes in Radiation Necrosis after Glioblastoma Treatments.

Mol Neurobiol 2018 Jun 2;55(6):4918-4926. Epub 2017 Aug 2.

Department of Neurosurgery, Seoul National University Hosptial, Seoul National University College of Medicine, Seoul, Korea.

Radiation necrosis (RN) in brain tumor patients is often symptomatic, persistent without immediate resolution, and confused with tumor recurrence. Cerebral vascular pericytes are essential for endothelial function, vascular integrity, and angiogenesis. In this study, we showed that the loss of pericytes is involved in the pathogenesis of RN. From a brain tumor tissue repository, we identified three patients since 2011 with pathologically confirmed RN after the standard treatment for glioblastoma (GBM). The RN and their preradiation GBM tissues were serially processed for Western blotting using cell-type-specific antibodies against endothelial (CD31, active RhoA), pericyte [platelet-derived growth factor receptor-beta (PDGFR-β)], alpha-smooth muscle actin (α-SMA), astrocyte (GFAP), myelin sheath protein (MBP), and microglial markers (Iba1). Normal brain tissues from a brain bank were used as normal controls. The expressions of PDGFR-β and α-SMA were remarkably reduced in the RN, compared to those of GBM. However, the levels of CD31 or RhoA were not different between the two groups, which suggest that there was no change in the number of endothelial cells or their cytoskeletal assembly. The RN tissues showed a decreased ratio of pericyte/endothelial markers and an increased level of Iba1 compared to the GBM and even to the normal brain. The levels of GFAP and MBP were not changed in the RN. In the histopathology, the RN tissues showed a loss of markers (PDGFR-β), whereas the GBM tissues had abundant expression of the markers. The loss of pericytes and vascular smooth muscle cells, and the unsupported endothelial cells might be the cause of the leaky blood-brain barrier and tissue necrosis.
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http://dx.doi.org/10.1007/s12035-017-0695-zDOI Listing
June 2018

An Updated Nationwide Epidemiology of Primary Brain Tumors in Republic of Korea, 2013.

Brain Tumor Res Treat 2017 Apr 30;5(1):16-23. Epub 2017 Apr 30.

Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea.

Background: This report aims to provide accurate nationwide epidemiologic data on primary brain and central nervous system (CNS) tumors in the Republic of Korea. We updated the data by analyzing primary brain and CNS tumors diagnosed in 2013 using the data from the national cancer incidence database.

Methods: Data on primary brain and CNS tumors diagnosed in 2013 were collected from the Korean Central Cancer Registry. Crude and age-standardized rates were calculated in terms of gender, age, and histological type.

Results: A total of 11,827 patients were diagnosed with primary brain and CNS tumors in 2013. Brain and CNS tumors occurred in females more often than in males (female:male, 1.70:1). The most common tumor was meningioma (37.3%). Pituitary tumors (18.0%), gliomas (12.7%), and nerve sheath tumors (12.3%) followed in incidence. Glioblastomas accounted for 41.8% of all gliomas. In children (<19 years), sellar region tumors (pituitary and craniopharyngioma), embryonal/primitive/medulloblastoma, and germ cell tumors were the most common tumors.

Conclusion: This study should provide valuable information regarding the primary brain tumor epidemiology in Republic of Korea.
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http://dx.doi.org/10.14791/btrt.2017.5.1.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433946PMC
April 2017

Acute physical stress induces the alteration of the serotonin 1A receptor density in the hippocampus.

Synapse 2014 Aug 10;68(8):363-8. Epub 2014 May 10.

Department of Nuclear Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.

Stress affects the serotonergic system, which is associated with depression. Previous research has showed that chronic stress causes the deactivation of the limbic system. However, the influence of the acute physical stress on the serotonergic system in vivo was primarily unclear. The purpose of this research is to elucidate the effects of the acute physical stress in vivo using PET. For quantification of the 5-HT1A receptors in the brain, we measured [(18)F]Mefway uptake in the two experiment groups (control and despair rats). The despair group was subjected to the external stressful situation (i.e., forced swimming) and total duration time of immobility, refers to the despair severity, and was analyzed. In the intercomparison experiment, the resulting PET images of [(18)F]Mefway in the despair rat displayed a significant reduction of radioactivity in the hippocampus (HP) compared with the control. The nondisplaceable binding potential (BPND ) refers to the ratio of the concentration of radioligand in the receptor-rich region (i.e., HP) to the concentration of that in the receptor-free region (i.e., cerebellum). The hippocampal uptake and the BPND in the despair group were respectively about 25 and 18% lower than those of the control group. The ratio of specific binding to nonspecific binding in the despair group was 18% lower than that of the control. In the intracomparison experiments, the BPND and immobility in the despair group showed a strong negative correlation. Taken together, the data illustrates that an acute physical stress induces the change in the serotonergic system that correlates with the behavioral despair.
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http://dx.doi.org/10.1002/syn.21748DOI Listing
August 2014

Evaluation of dopamine transporters and D2 receptors in hemiparkinsonian rat brains in vivo using consecutive PET scans of [18F]FPCIT and [18F]fallypride.

Appl Radiat Isot 2012 Dec 19;70(12):2689-94. Epub 2012 Aug 19.

Department of Pharmacology, Brain Research Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.

The aim of this study was to investigate dopaminergic function in unilaterally lesioned 6-OHDA rats by dual PET radioligands: [(18)F]FPCIT (a dopamine transporter imaging radioligand) and [(18)F]fallypride (a dopamine D2 receptors imaging radioligand). As a result, the brain uptake of [(18)F]FPCIT was significantly reduced and that of [(18)F]fallypride was increased in the ipsilateral striatum (lesion side) of the 6-OHDA rats. These findings implicated that dopamine transporter is down-regulated and dopamine D2 receptor is up-regulated in this hemiparkinsonian rat model.
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http://dx.doi.org/10.1016/j.apradiso.2012.08.005DOI Listing
December 2012