소아에서 발생한 삼차신경초종

김명훈,신형진,남도현,서연림,김종현,Kim, Myoung-Hoon,Shin, Hyung-Jin,Nam, Do-Hyun,Suh, Yeon-Lim,Kim, Jong Hyun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Trigeminal schwannoma is an uncommon intracranial tumor and constitutes less than 0.08-8% of all intracranial schwannoma. Trigeminal shchwannoma is even rarer in childhood and only 11 cases of trigeminal schwannoma under the age of 14 have been reported including our case. We experienced a case of trigeminal schwannoma in a 9 year-old girl without the stigmata of neurofibromatosis. She presented with a 2 week-history of right abducens nerve palsy. Magnetic resonance image demonstrated a dumbbell-shaped tumor extending into right middle and posterior fossas with a size of $60{\times}45{\times}35mm$. The tumor was successfully removed by right transzygomatic subtemporal extradural approach. Pathologic examination of the mass revealed typical features of schwannoma.

메니에르병으로 오인된 삼차신경초종

이철희,김창우,진재원,김창훈 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.2

Meniere’s disease is diagnosed by excluding other possible causes of symptoms characterized by relapsed vertigo, aural fullness, hearing loss and tinnitus. Several disease entities may mimic Meniere’s disease when the disease does not manifest its own characteristic findings. We present the case of a 40-year-old male patient who was suffering from the spontaneous and repeated onset of vertigo, and complaining of aural fullness, hearing loss and tinnitus in his left ear. A diagnosis of definite Meniere’s disease was made and medical treatment was applied with diuretics. One year later, he complained of a tingling sensation in his face, and MRI revealed an intracranial mass. Mass excision was performed with subtemporal approach and operative findings revealed trigeminal schwannoma. We supposed that the tumor might have compromised his vascularity and altered his CSF dynamics, leading to symptoms mimicking Meniere’s disease. Trigeminal schwannoma should be considered as an exclusion category of Meniere’s disease, and MRI is necessary to exclude the central lesion. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:178-82)

Temporomandibular Disorder and Disuse Atrophy of the Masticatory Muscles after Surgical Resection of a Schwannoma: A Case Report

이연희,박혜지,황미진,어규식 대한안면통증∙구강내과학회 2018 Journal of Oral Medicine and Pain Vol.43 No.4

Disuse atrophy involves gradual muscle weakening due to inadequate usage and can cause temporomandibular disorder (TMD). A 45-year old man with TMD symptoms on the left side, who had disuse atrophy of the masticatory muscles on the right side following surgical removal of a trigeminal schwannoma on the right side, first visited the Department of Orofacial Pain and Oral Medicine at Kyung Hee University Dental Hospital with left jaw pain and difficulty in opening mouth and chewing. He had been experiencing difficulties in cognitive function, decrease in visual acuity, impaired speech, and writing deficits after brain surgery. Furthermore, he complained of abnormal occlusion on the right side, which interfered with his ability to chew comfortably and open his mouth effectively. Herein, we describe a contralateral TMD case due to ipsilateral disuse atrophy after brain surgery for a trigeminal schwannoma and our successful treatment with medication, physical therapy, and stabilization splint.

Temporomandibular Disorder and Disuse Atrophy of the Masticatory Muscles after Surgical Resection of a Schwannoma: A Case Report

Lee, Yeon-Hee,Park, Hye-Ji,Hwang, Mi-Jin,Auh, Q-Schick Korean Academy of Orofacial Pain and Oral Medicine 2018 Journal of Oral Medicine and Pain Vol.43 No.4

Disuse atrophy involves gradual muscle weakening due to inadequate usage and can cause temporomandibular disorder (TMD). A 45-year old man with TMD symptoms on the left side, who had disuse atrophy of the masticatory muscles on the right side following surgical removal of a trigeminal schwannoma on the right side, first visited the Department of Orofacial Pain and Oral Medicine at Kyung Hee University Dental Hospital with left jaw pain and difficulty in opening mouth and chewing. He had been experiencing difficulties in cognitive function, decrease in visual acuity, impaired speech, and writing deficits after brain surgery. Furthermore, he complained of abnormal occlusion on the right side, which interfered with his ability to chew comfortably and open his mouth effectively. Herein, we describe a contralateral TMD case due to ipsilateral disuse atrophy after brain surgery for a trigeminal schwannoma and our successful treatment with medication, physical therapy, and stabilization splint.

변형 경관골접근법을 통한 두개외 삼차신경초종 절제술

한지혁(Ji Hyuk Han),이영우(Young Woo Lee),김정민(Jung Min Kim),정효진(Hyo Jin Chung),한수진(Su-Jin Han),윤주헌(Joo Heon Yoon),문인석(In Seok Moon) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Introduction : Surgical removal of extracranial trigeminal schwannoma has been challenging due to anatomic complexity and rarity of the disease. Transzygomatic approach can be a good option for extracranial trigeminal schwannoma, especially in cases extended to infratemporal fossa, pterygopalatine fossa and parapharyngeal space. Authors report several cases of extracranial trigeminal nerve schwannomas which were treated using modified or combined transzygomatic approaches. Materials and Methods : 3 patients were diagnosed as extracranial trigeminal schwannoma and underwent surgical removal via modified or combined transzygomatic approach from January 2013 to June 2016. Results : We analyzed the tumor control, complication rate, and origin of tumor. Among 3 patients, combined transzygomatic approach was applied to one patient. It was combined with transcervical approach for the patient. The huge extracranial trigeminal schwannomas were completely excised in all 3 cases. There were no significant complications. Conclusion : The modified transzygomatic approach is safe and useful for removal of huge extracranial trigeminal schwannoma without facial scar and is easily combined with transcervical approach.

신경섬유종증 II형 소아에서 발생한 거대 삼차신경초종

이문영,김태영,문성근,김종문,Lee, Mun Young,Kim, Tae Young,Moon, Seong Keun,Kim, Jong Moon 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

We report a case of huge trigeminal schwannoma in a 10-year-old boy with neurofibromatosis type II, extending into the three spaces of the left middle, posterior, and infratemporal fossa. Initially we thought the child had a solitary trigeminal schwannoma, and most of the mass was resected successfully through one-stage operation, cranio-orbito-zygomatic intradural approach. However during the follow-up of the patient we found radiographically other multiple intracranial tumors of bilateral acoustic schwannomas, right trigeminal schwannoma, and foramen magnum tumor. Eventually the patient was diagnosed as neurofibromatosis type II presenting multiple intracranial tumors. We think childhood trigeminal schwannoma, even though in the case of solitary tumor, should be considered as possible initial manifestation of neurofibromatosis type II and that careful follow-up for the possibility of occurrence of other brain tumors such as schwannomas or meningiomas is necessary.

삼차신경초종의 치료전략

김민수(Min-Su Kim),이정일(Jung-Il Lee),김종현(Jong-Hyun Kim),박관(Kwan Park) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.2

Objective : The objective is to clarify the role of multimodality treatment of trigeminal schwannomas and to suggest optimal treatment strategy for these tumors. Methods : From 1995 to April 2007 we had treated 52 patients with trigeminal schwannomas and the clinical data of these patients were analyzed retrospectively. There were 24 males and 28 females with mean age of 44.9 years (range 7-75 years). Surgical treatment was done in 43 patients and 8 patients of them were treated with a postoperative radiosurgery. 9 patients underwent radiosurgery on the basis of clinical findings and imaging criteria. Tumors that belong to type A (21 cases), which were predominantly in the middle cranial fossa; type B (9 cases), which presented predominantly in the cerebellopontine angle; type C (21 cases), which were dumbbellshaped extending into both the middle and posterior fossa; and type D (1 case), which was primarily extracranial with intracranial extension. Results : The mean follow-up period was 36.9 months (range 5-129 months). In surgical treatment group, total tumor resections were achieved in 33 of 43 patients (77%). Three patients underwent the second staged operation to remove a residual or recurrent mass and all of them were type C. In radiosurgical treatment group, the tumor growth controls were achieved in 16 of 17 patients (94%). Conclusion : Trigeminal schwannomas may be successfully removed with low morbidity in many patients, via an entirely subtemporal extradural approach. In patients with residual or newly diagnosed small sized trigeminal schwannomas, stereotactic radiosurgery may be a good adjuvant therapy.

하치조관을 침범한 두개외 삼차 신경초종 1예

윤여훈,김재진,서성태,구본석 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.1

Although trigeminal schwannomas (TS) are rare tumors that may involve any parts of the trigeminal nerve, most of these tumors are located in the intracranium. Extracranial TS are extremely rare. Management of extracranial TS is challenging because of the anatomic complexity around the tumor. Therefore, thorough surgical planning should be required preoperatively for complete tumor removal with the least morbidities. We presented a 64-year-old man with a trigeminal mandibular schwannoma in the left infratemporal, parapharyngeal, pterygomandibular space and inferior alveolar canal of mandible. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:41-3

내시경적 경비강 접근법을 통한 재발성 삼차신경초종의 제거

김성권(Sung Kwon Kim),김용휘(Yong Hwy Kim),김동규(Dong Gyu Kim),정희원(Hee-Won Jung) 대한두개저학회 2013 대한두개저학회지 Vol.8 No.2

Introduction : We report a case of repeatedly recurred trigeminal schwannoma after transcranial resection, operated via endoscopic endonasal approach. Case presentation : A 47-years-old female presented with intermittent headache, tinnitus, and hearing loss of right side. The magnetic resonance images showed the right cerebellopontine angle (CPA) mass consist of well enhancing solid and multiple cystic portions. The lesion was removed several times via transcranial approach. However, the residual lesion was consistently enlarged over the years and extended to prepontomedullary cistern, Meckel’s cave, and suprasellar area combined with related progression of symptoms. The recurred mass was removed via endoscopic endonasal combined transtubercular and trans-clival approach. We performed nearly total resection. There was no postoperative neurologic deficit and morbidity including the leakage of cerebrospinal fluid. Conclusion : The endoscopic endonasal combined trans-tubercular and trans-clival approach could be a safe and an alternative surgical option for the recurred trigeminal schwannoma extending to suprasellar area after repeatedly transcranial resection.

경관골접근법을 통한 거대삼차신경초종절제술 1례

김정민(Jung Min Kim),김현지(Hyun Ji Kim),김은경(Eun Kyung Kim),문인석(In Seok Moon) 대한두개저학회 2014 대한두개저학회지 Vol.9 No.2

Trigeminal nerve schwannomas are uncommon benign neoplasm of cranial based tumor. The goal of the treatment of trigeminal nerve schwannoma is to remove the primary tumor without complication. For example trigeminal nerve neuropathy, abducens nerve palsy, facial nerve palsy, etc. But in case of huge tumor it is very difficult to accomplish the goal. We have experienoed one case of huge trigeminal schwannoma which was completely removed using the Transzygomatic approach. The patient did not have problem of complication during the follow-up period. We would like to announce the feasibility of the Transzygomatic approach.