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김상용(Sang Yong Kim),김승민(Seong Mim Kim),김한규(Han Kyu Kim),박문선(Moon Sun Park),정승영(Seong Young Chung),정성삼(Sung Sam Jung),박기석(Ki Suk Park) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.1
Epidermoid tumor rarely arises within the cavernous sinus and produce clinical symptoms. This 21-year old man presents with 6-year history of headache, diplopia, and ptosis. An evaluation revealed a mass located in the right cavernous sinus and he underwent gamma knife radiosurgery. But the symptoms did not improved, and there was slight increase in size of mass in follow-up evaluation. So, he underwent operation, the tumor was near-totally removed after surgery, and histologic finding revealed an epidermoid tumor. The patient was discharged with no newly developed neurologic deficits. In later three years follow-up, there was no evidence of recurrence. Magnetic resonance imaging, especially diffusion-weighted image, is a valuable tool in diagnosis of intracerebral epidermoid tumors. Radiotherapy is known to be ineffective for epidermoid tumors. Surgical removal should be attempted, but a less aggressive surgical strategy should be considered if there is strong adherence between the tumor capsule and the brain parenchyme particularly in eloquent areas. Regular long term follow-up is necessary for evaluation of recurrence.
뇌하수체 거대선종으로 오인된 안장가로막 뇌수막종과 뇌하수체 선종 1례
오정태(Jung Tae Oh),정승영(Seung Young Chung),김승민(Seong Min Kim),박문선(Moon Sun Park),정성삼(Sung Sam Jung),박기석(Ki Suk Park) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.1
The coexistence of a pituitary adenoma and another intracranial tumor is an uncommon finding. We report a rare case of diaphragm sellae meningioma and pituitary adenoma mimicking pituitary macroadenoma in a 41-year-old woman. The patient presented with bitemporal hemianopsia and was pregnant. Magnetic resonance imaging demonstrated a bright, homogeneously enhancing intra- and suprasellar mass, which was interpreted as a pituitary macroadenoma. Transsphenoidal extirpation was used on 1st operation and Orbitozygomatic craniotomy(transcavernous approach) was done on 2nd operarion because of a suspicion of nonsecreting pituitary macroadenoma. Histopathologically, the tumor was diagnosed as a pituitary adnoma and a meningothelial meningioma. Common carotid angiography before the second surgery revealed that the mass was supplied by the left opthalmic artery. The tumor was near-totally removed via a transcranial route, and she had lost her left vision after a second surgical procedure. It is difficult to make a differential diagnosis between nonsecreting pituitary macroadenomas with suprasellar extension and diaphragma sellae meningiomas preoperatively from the viewpoint of neuroimaging. Preoperative differentiation is essential, because the transsphenoidal approach is used for surgical removal of adenomas, while meningiomas are approached via a craniotomy.
임상 : 사대 척삭종의 수술 치료에 대한 비교 분석; 내시경을 이용한 경접형동 접근법의 유용성
정종철 ( Jong Chul Chung ),김승민 ( Seong Min Kim ),정성삼 ( Sung Sam Jung ),박기석 ( Ki Seok Park ),박문선 ( Moon Sun Park ),김한규 ( Han Kyu Kim ) 대한뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2
Objective:Chordomas, whether involving the clivus or simply situated anterior to the brainstem, present a technical challenge for adequate exposure and safe resection. Transsphenoidal approach is safer and easier than any other approaches, but it has some limitation of resectability in laterally extended tumor. The objective of this paper is to demonstrate the advantages of endoscope assisted transsphenoidal approach to remove paraclival lesion on the midline. Methods:Nine patients with clival chordomas underwent surgery in our institution from 2002 to 2009. There were two men and seven women who ranged in age between 4 and 59 years. Four patients underwent stage operation by both transsphenoidal surgery and transpetrosal or transcavernous surgery. Three patients underwent only transsphenoidal surgery and two underwent only transpetrosal surgery. For image guidance, both endoscope and neuronavigation system were used in all surgical procedures. Results:Gross total removal was achieved in 33.3% and subtotal removal was achieved in 55.5%. The mean follow-up period was 44.2 months. The mortality rate during the follow-up period was 11.1%. Conclusion:For accessing clival chordoma via an anterior route, visualization of the tumor with the endoscope and navigation system is readily achievable and have the advantages of confirmation the anatomy that cannot be seen in the conventional transsphenoidal approach. This study shows transsphenoidal approach become safer and easier if the tumor is located on upper two thirds of the clivus and located on the midline.
내시경을 이용하여 경접형동 접근술로 치료한 여포 자극 호르몬 분비 뇌하수체 샘종
정종철(Jong Chul Chung),김승민(Seong Min Kim),정성삼(Sung Sam Jung),정승영(Seung Young Chung),김병준(Byung Joon Kim) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.2
Follicle-stimulating hormone-secreting pituitary adenomas are rarley diagnosed and likely considered as a non-functioning pituitary tumor. Because they usually do not present until of sufficient size to cause neurologic deficits by mass effect or hypopituitarism, whereas other functioning tumors - acromegaly, prolactinoma, Cushing s disease - frequently present earlier with symptoms caused by physiologic effects of excess hormones that they secrete. 62-year-old man suffered from visual disturbance. Endocrinologic evaluation showed high serum FSH level. Suprasellar extended pituitary mass with compression to optic chiasm & cavernous sinus was imaged on MRI and removed by endoscope assisted endonasal transsphenoidal surgery. It was composed of gonadotroph showed strong immunohistochemical reactivity against FSH and LH. Uncommon pituitary tumors such as FSH-secreting adenomas can be defined early and accurately through correlation between their clinical, endocrionological, radiographic and immunohistochemical characteristics.
뇌종양으로 오인될 수 있는 단락관과 관련된 반응성 신경교증
위승복 ( Seung Bok Wee ),김승민 ( Seung Min Kim ),정성삼 ( Sung Sam Jung ),박기석 ( Ki Seok Park ),정승영 ( Seung Young Jung ),박문선 ( Moon Sun Park ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2
There are several pathologic conditions which can be around the shunt catheter. But, reactive gliosis related to shunt catheter is uncommon. We report a case of reactive gliosis which has been suggested to catheter-related tumorous condition such as glioblastoma. The authors report a 45-year-old man who had a history of ventriculoperitoneal shunt placement for hydrocephalus after traumatic intracranial hemorrhage 10 years ago. General weakness and dementic mentality developed recently. MRI revealed multi-lobulating contoured dark signal lesion on T2 weighted image and MR spectroscopy suggest tumorous condition such as meningioma or lymphoma. The stereotacxic biposy was performed under navigation guide. Histopathologically, the specimen showed strong positive reaction on glial cells. There was no remarkable results on microbiologic study. After steroid medication, patient`s condition was improved and enhancing mass was subsided. There are several diseases related to shunt catheter that to be ruled out, we must note the possibility of reactive gliosis mimicking brain tumor, like this case.
김승민(Seong-Min Kim),정승영(Seung-Young Chung),정성삼(Sung-Sam Jung),박문선(Moon-Sun Park) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2
Intraparenchymal cavernous hemangioma(CH) of central nervous system(CNS) was already well known to us, but the intradural and extra-axial CH was not and very rare. This case summarizes our surgical experience intradural-extramedullary CH on foramen magnum. A 44-year-old man complained occipital headache. Magnetic resonance imaging(MRI) showed a 15mm sized well enhancing mass that slightly displaced the medulla to the right side. An angiogram showed tumor staining with feeding artery from left posterior cerebellar artery(PICA). Our diagnosis with imaging studies was extra-axial tumor including meningioma, hemangiopericytoma. A suboccipital craniectomy and C1 laminectomy were performed. An encapsulated, highly vasculized mass was visualized and removed. Mass was purely extra-axial and pathological evaluation demonstrated a CH. So this case of CH reminds the neurosurgical community to consider CH in the differential diagnosis for extra-axial mass on foramen magnum.