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W Leem

Publications and source records attributed to W Leem.

8 recordsLinked to original sources
PubMed1999

Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: A case report.

Cranial irradiation may lead to accelerated atherosclerotic changes to small or medium sized arteries, but stroke associated with pituitary irradiation is not frequent. A patient treated with Gamma Knife radio-surgery (GKRS) for a pituitary adenoma suffered a cerebral infarction with internal carotid artery occlusion 4 years after radiosurgery. The patient was a 35-year-old male presenting with a visual disturbance. Endocrinological tests were normal. MRI revealed a 4.3 by 4.3 cm diameter invasive macroadenoma of the pituitary, projecting toward the suprasellar region and with cavernous sinus involvement with encasement of both internal carotid arteries (ICAs). GKRS was performed for residual tumor after a transcranial resection. The maximum dose was 40 Gy and the dose to the right carotid artery was below 20 Gy. The delayed hemiparesis was accompanied by a right capsular lacunar infarct shown on MRI. The images also showed a marked reduction in tumor size. Total, right ICA occlusion was confirmed by Doppler ultrasound. The patient had no history or signs of heart disease or metabolic disorder which could predispose to cerebrovascular

Adenoma↗
PubMed1998

Four years' experiences in the treatment of pituitary adenomas with gamma knife radiosurgery.

To determine the tumor control rates and endocrinological responses after stereotactic radiosurgery for pituitary adenomas, we reviewed our experience in 65 patients (40 men, 25 women) treated in the Gamma Knife during the last 4 years. The mean age was 41.6 years (range 19-69 years). 43 patients had endocrinologically active tumors (20 growth hormone-secreting, 19 prolactin-secreting and 4 ACTH-secreting adenomas). 22 had nonfunctioning adenomas. 39 patients had a macroadenoma and 26 patients had a microadenoma. 33 patients underwent Gamma Knife radiosurgery for recurrent or residual tumors after microsurgery. 50 patients have had follow-up neuroimaging studies and/or hormonal evaluation. The follow-up period was 25.5 months (range 3 to 54 months). The margin of the tumor was incorporated within the 50 to 90% isodose. The mean number of isocenters was 3.8 and the mean marginal dose was 25.4 Gy (range 15 to 36 Gy). 27 out of 40 patients (65.7%) showed decreased tumor volume to less than 50% of the initial volume. In 17 out of 38 patients (44.7%) with endocrinologically active tumors, the hormonal level fell to within the normal range. Two patients had delayed complications: in one case there was pituitary insufficiency and in the other a visual disturbance. Gamma Knife radiosurgery seems to be effective adjuvant therapy for pituitary adenoma in selected cases. More long-term follow-up is required to evaluate the efficacy and side effects further.

Acromegaly↗
PubMed1996

Two cases of Gamma Knife radiosurgery for low-grade optic chiasm glioma.

The effect of radiosurgery on optic gliomas is uncertain. We report two cases of low-grade glioma of the optic nerve and chiasm treated by transcranial subtotal removal and Gamma Knife radiosurgery. The first case was a 2-year-old boy, admitted with visual disturbance and nystagmus. Histopathological examination showed a pilocytic astrocytoma. The tumor volume was 14.4 cm3. Dose planning was performed using axial and coronal T1-weighted enhanced images. The marginal dose was 12 Gy at the 40% isodose line. The dose to the optic apparatus was less than 9 Gy. The second case was a 47-year-old woman, admitted to our hospital with headache and visual disturbance. The histopathological findings showed a fibrillary astrocytoma. The tumor volume was 12.3 cm3. The marginal dose was 14.4 Gy at the 40% isodose curve. The follow-up periods for the two cases were 24 and 43 months, respectively. In both cases the most recent follow-up magnetic resonance scan showed a marked decrease in tumor size, and visual symptoms were improved. No postradiosurgical complications have developed to date. Gamma Knife radiosurgery could be an effective adjuvant therapy for low-grade optic glioma. However, long-term follow-up is required for further evaluation of the efficacy and potential side effects.

Child, Preschool↗
PubMed1990

Symptomatic subependymoma--a case report.

Subependymoma is a rare, slow-growing, benign noninvasive tumor of the central nervous system that may be located in the fourth ventricle, the septum pellucidum, the third and the lateral ventricles, the aqueduct, and the proximal spinal cord. Symptoms, if any, usually result either from direct compression of the brain stem or from acute hydrocephalus due to occlusion of the foramen of Monro or aqueduct of Sylvius. In this report, we describe a case of subependymoma of the lateral ventricle with headache in a young female patient. This is the first reported case subependymoma in Korea that was documented along with Magnetic resonance image.

Adult↗
PubMed1980

[Circulatory changes in neurosurgical patients with intracerebral angiomas in neuroleptanaesthesia (author's transl)].

In 10 neurosurgical patients with intracerebral angiomas circulatory and respiratory functions were studied. After induction of anesthesia the cardiac output declined from an average value of 7.63 +/- 2.13 1.min-1 to 3.99 +/- 0.43 1.min-1 (-48%) in consequence to the decline of the heart rate by 24% and the stroke volume by 32%. In the same time increased the calculated peripheral resistance in reverse proportion to the decline of the cardiac output by 47%. The oxygen transport decreased after induction of anaesthesia by 48% while the oxygen uptake decreased by 28.6%. The oxygen utilization coefficient increased by 48% (0.33) and documented a satisfactory relation between oxygen-uptake and oxygen utilization in neuroleptanaesthesia.

Adolescent↗