편측 시력 손실을 초래한 거대 안상 유피낭종의 수술적 치료

이성호(Sung-Ho Lee),고영초(Young-Cho Koh),조준(Joon Cho),오지영(Jee-Young Oh),노홍기(Hong Gee Roh),임소덕(So-Dug Lim) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1

Suprasellar epidermoid tumor presenting with visual loss is rare. A 50-year-old woman was referred for treatment of a large well demarcated cystic mass at the suprasellar region. She had a history of left visual loss for several years. To preserve the vision of right side, we underwent VEP (visual evoked potential) preoperatively and monitored VEP during the surgery. During surgery, the right optic nerve was severely compressed by the tumor, and was successfully decompressed without damage to the optic nerve. The left optic nerve was more severely compressed by the fibrotic and calcified tumor capsule around the optic canal. The 6 cm sized multilobulated tumor was subtotally resected while preserving the visual functions of the right side. We report a case of giant epidermoid tumor with unilateral visual loss, for which surgical removal was aided by VEP monitoring to save the only remaining vision.

경유양동 상미로접근법을 이용한 안면신경 감압술로 회복된 Ramsay Hunt syndrome 1례

이용우(Yong Woo Lee),장선오(Sun O Chang),김민범(Min-Beom Kim) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Ramsay Hunt syndrome (RHS) is a disease that shows a triad of facial palsy, vesicles on auricle, and hearing symptoms. This syndrome is characteristic of herpetic inflammation activation on the geniculate ganglion due to reactivation of varicella-zoster virus. Based on the pathogenesis of disease, high dose corticosteroids with antiviral agents are recommended as first line treatment. However, for those who are anticipated with unfavorable prognosis, surgical decompression of facial nerve is considered as an appropriate option. Currently, surgical treatment is recommended to be performed within 14 days, and electrophysiologic tests such as electroneurography, electromyography are used for selection of adequate subjects. A 56 year-old male diagnosed of RHS was treated with Facial nerve decompression via transmastoid/supra-labyrinthe approach and showed favorable prognosis. We reviewed this case with relevant publishings in medical literature.

거대 상상돌기 수막종에서의 미세수술 전략

송정원(Jung-Won Song),홍제범(Je-Beom Hong),오성한(Sung-Han Oh),김한규(Han-Kyu Kim) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Background : The giant clinoidal meningiomas (CLMs) inevitably engulf the neurovascular structures around the anterior clinoid process (ACP), which make the surgery in great danger of internal carotid artery (ICA) compromise, neuroendocrine disturbance, blindness and oculomotor nerve palsy. The aim of this study was to suggest the safe surgical strategy for these dreadful tumors. Materials and Methods : From March 2008 to April 2016, 12 patients underwent surgical removal for their giant CLMs. The clinical profile, radiological imaging, surgical records including surgical videos and postoperative neurologic outcomes were reviewed. Results : The mean age of patients was 51.9 years. Average size of the tumors was 6.3 cm ranging from 5.0 cm to 8.3 cm. Surgery was performed in supine position and head was rotated about 45°to the contralateral side. The extradural anterior clinoidectomy was applied with extended pterional craniotomy including zygomatic osteotomy or orbitozygomatic osteotomy. We removed the tumor with the concept of compartment dissection in which we divided the tumor into medial and lateral compartment with the reference of ICA-M1 (sphenoidal segment of middle cerebral artery) line. Total tumor removal was achieved in 8 patients (67%) and subtotal in 4 patients (33%). Postoperative complications were transient oculomotor nerve palsy in 3 patients and decreased visual acuity in one patient. The mean preoperative Karnofsky Performance Scale (KPS) score was 82.5 (range 60-90) and improved to 95.8 (range 80-100) in the last follow up period. Conclusion : The surgery of giant clinoidal meningiomas is difficult because of their giant size and multiple neurovascular and cisternal involvement. The most important factor for successful surgery is a three dimensional orientation of tumor with its surroundings. The concept of compartment dissection would help surgeons to be oriented in perception of neurovascular structure surrounding the tumor. The extended pterional craniotomy, extradural anterior clinoidectomy, extended durotomy, and compartmental dissection are recommended for the efficient removal of these dreadful tumors.

전정신경초종 및 측두골 골절로 인한 양측 심도 난청 환자에서 인공와우이식술 1례

김진웅(Jin Woong Kim),이영호(Young Ho Lee),이찬(Chan Lee),문인석(In Seok Moon) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Vestibular schwannoma often causes ipsilateral hearing loss due to its involvement of the 8th cranial nerve. Therefore hearing rehabilitation as well as tumor control should be considered simultaneously, especially when the patient also has hearing impairment in the contralateral side. Here, we report a 51-year-old patient who underwent contralateral cochlear implant due to temporal bone fracture in huge vestibular schwannoma patient.

비중격에서 발생한 다형성 선종 1례

신주현(Joo Hyun Shin),임은정(Eun Jung Lim),김태훈(Tae Hoon Kim) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Pleomorphic adenoma is a benign mixed tumor of the salivary gland. Although it most commonly occurs in the major salivary glands such as parotid glands and submandibular glands, it arising from minor salivary gland is uncommon. Especially, pleomorphic adenoma arising from nasal cavity is rare. We present a case of pleomorphic adenoma in a 28-year-old man, who was successfully treated with endoscopic surgery, with a review of the literature.

Modified Fisch class A와 B의 부신경절종의 치료 전략

신승호(Seung-Ho Shin) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Though paragangliomas are benign tumors which originate from the jugular bulb or tympanic cavity, it is not easy to remove them due to their vascularity. Because the treatment for tympanic paragangliomas is not well-established, their classification and treatment strategy will be described. Tympanic paragangliomas are classified as A1, A2, B1, B2 and B3 through modified Fisch classification. A transcanal approach is recommended for A1 tumor. A retroauricular transmastoid approach is preferred for A2 tumor. For B1 tumor, a canal wall up mastoidectomy and facial recess approach supplies a sufficient surgical field. For B2 tumor, an extended facial recess approach is required. For B3 tumor, subtotal petrosectomy is essential.

이개에 발생한 특발성 피부 석회증 1례

강윤진(Yun Jin Kang),박정미(Jung Mee Park),한정주(Jung Ju Han),박시내(Shi Nae Park) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Calcinosis cutis is a rare disease consisted of insoluble calcium salts in the skin and subcutaneous tissue. This can be categorized into 5 groups according to pathogenesis: dystrophic, metastatic, idiopathic, iatrogenic calcinosis cutis and calciphylaxis. Have been categorized into idiopathic one which occurs without any other external damage or underlying systemic disease. Here, we report one case of histologically confirmed congenital calcinosis cutis appeared as a growing mass on the right auricle with its interesting preoperative finding on magnetic resonance imaging scan which has never been reported before.

먼 측방 접근법

김주성(Ju-seong Kim),홍창기(Chang-Ki Hong) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

The surgical approach to anterolateral foramen magnum or lower clival lesion is still challenging procedure, except expert skull base neurosurgeon. The approach to the mentioned lesion can be accessed using far lateral approach. The Anatomical posterior lateral skull base structures (lateral suboccipital muscles, vessels, skull base bony structure, and intradural components) and their relationship are very important for far lateral approach. We summarized important surgical anatomy, anatomical relationship and surgical consideration to access foramen magnum lesion through far lateral approach and its variants.

빠른 종양 성장을 보인 청신경초종 환자: 증례보고

장일(Il Jang),이기택(Gi Taek Yee),김명진(Myeong Jin Kim),김은영(Eun Young Kim),유찬종(Chan Jong Yoo) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Vestibular schwannoma (VS) is a benign tumor which tends to grow slowly. In general, the growth rate of VS is about 1mm/year. We treated an unusual case of rapid growing VS associated with multiple cystic changes. Also, we review the natural history and factors influencing tumor growth of VS. A 75-year old female patient presented with gait disturbance and hearing loss. Brain magnetic resonance imaging (MRI) showed a mass of 4.0×4.0×3.5cm size with multiple cystic changes and heterogeneous enhancement in right cerebellopontine angle (CPA). Twelve six months ago, the patient had a brain MRI which revealed CPA mass less than 1.0cm in diameter. Small sized VSs should be followed up with MRI at least every two years and the VSs consisted with cystic component need to be more closed observation than the solid type.

Surgical experiences of anterior petrosal approach for skull base tumor resection in a single institution

Stephen Ahn,Seung Ho Yang,Jae Hoon Sung,Sang Won Lee 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

The middle fossa approach has undergone several modifications to expand its exposure along the cerebellopontine angle, petrous apex, tentorium and clivus. The middle fossa anterior transpetrosal approach, so called Kawase’s approach, is designed for the anterior cerebellopontine angle, the ventral surface of pons, and the upper clivus. The purpose of the study is to summarize the surgical experiences of anterior petrosal approach for the treatment of skull base tumor performed by a neurosurgeon. Eight patients (6 women and 2 men) underwent frontotemporal craniotomy and anterior petrosal approach for skull base tumor resection. They included 3 trigeminal schwannomas, 3 meningiomas, 1 chondroma, and 1 metastasis. The median age was 57.5 years (range, 43-72). Three patients with trigeminal schwannomas and 1 patient with chondroma achieved total resection using the classic anterior petrosectomy without dura opening. For petroclival meningioma, opening of posterior fossa dura and coagulation of petrosal sinus was additionally performed. However, surgical corridor was limited anteriorly by mandibular nerve, laterally by internal auditory canal, and posteriorly by tentorium. Neurological deterioration developed postoperatively in 2 patients with petroclival meningioma. It is suggested that anterior petrosal approach is suited for accessing middle fossa lesions with smaller petroclival components.