경정맥공 종양의 수술적 접근법

홍제범(Je Beom Hong),김한규(Han Kyu Kim),김주평(Joo Pyung Kim),장종희(Jong Hee Chang),문인석(In Seok Moon) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Background: The infratemporal fossa approach type A (ITFA-A) is a good approach for small jugular foramen tumors with a small extraforaminal cervical extension. On the other hand, the posterolateral approach to jugular foramen has been adopted to see the posterior aspect of the jugular foramen. For large tumors, we combined posterolateral approach with various otologic operations including ITFA-A, transcochlear approach and fallopian bridge technique. The purpose of this study is to evaluate the surgical adequacy of our approaches including postoperative complications and outcomes. Methods: From January 2014 to January 2017, we operated total 14 cases of jugular foramen tumors. We chose the surgical approach to these tumors based on their location and extent. And the facial nerve manipulation was added in combined approach in which facial nerve was dissected and transpositioned (3 cases) or remained in fallopian canal (fallopian bridge technique, 3 cases). Results: Grossly total resection was achieved in 12 patients (85.7%). Immediate postoperative lower cranial nerve deficit occurred in 10 patients (71.4%). Postoperative facial nerve paralysis and hearing impairment occurred in 4 patients (28.6%) and 6 patients (42.9%) respectively. Two-thirds of the jugular foramen could be exposed in the combined approach which enabled the complete removal of tumors regardless of the size at this area. Conclusion: Using skull base technique with thorough understanding of surrounding anatomic structures followed in wider exposure, gross total removal can be achieved by multidirectional approach under relative safety.

안면 마비의 치료를 위한 안면신경감압술

문인석(In Seok Moon) 대한두개저학회 2014 대한두개저학회지 Vol.9 No.2

무선 통신과 영상인식을 활용한 지능형 자율주행 자동차 개발에 관한 연구

문인석(In-Seok Moon),정태광(Tae-Kwang Jeong),홍원기(Wonkee Hong) 한국산업정보학회 2009 한국산업정보학회 학술대회논문집 Vol.2009 No.5

논문은 지능형 자동차 개발을 위한 마이크로마우스를 활용한 차량-도로 간 통신, 모터제어, 영상처리와 물체감지 센서들을 활용한 도로 상황정보 인식 시스템 등을 활용하여 지능형 자동차의 운행을 구현하고 테스트 할 수 있다. 이를 활용하여 검증된 기술들을 실제 차량에 적용하기 위해서 다양한 실험과 테스트를 실시한다. 또한 누구나 쉽게 간단한 마이크로 컨트롤러를 통한 지능형 자동차를 위한 다양한 아이디어를 접목할 수 있도록 시스템을 설계한다. 이를 활용하여 영상처리를 통한 차선인식과, 직전 좌회전 및 도로의 교통표시마크를 읽어 들여 차체를 컨트롤하고 차량-도로간 통신을 이용해서 신호등의 정보를 입력받아 교차로를 안전하게 통과하게 된다. 또한 앞 차량을 인식하여 자동으로 속도조절과 차량 간 거리를 유지하는 시스템을 구현한다.

내이, 중이, 외이 및 경정맥구를 침범한 전정신경초종

문인석(In Seok Moon),김진(Jin Kim),심대보(Dae Bo Shim),이원상(Won-Sang Lee) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.2

Intralabyrinthine schwannoma is rare and vestibular schwannoma extended into intralabyrinthine area is rarer. Until now, there have been no reports of schwannomas extending simultaneously in the inner ear, middle ear, and jugular foramen. We report the first experience of a vestibular schwannoma simultaneously involving the IAC, cochlea, vestibule, middle ear, external ear, and jugular foramen which removed via modified surgical technique called as‘ Rope-skipping’

귀수술에서 드릴의 소음이 비수술측 귀에 미치는 영향

장승현(Seung Hyun Jang),정연수(Yeonsu Jeong),허영균(Young Kyun Hur),문인석(In Seok Moon),배성훈(Seong Hoon Bae) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.1

Background : Many studies have suggested that mastoidectomy possibly induces hearing loss in the contralateral non-operated ear through excessive noise or vibration energy from drilling. The aim of this study was to compare long-term postoperative hearing threshold change in the non-operated ear following three different types of otologic surgery requiring different drilling times. Methods : Medical charts of 108 patients who underwent tympanoplasty, mastoidectomy, and translabyrinthine-approached (TLA) tumor excision were retrospectively reviewed. Results of hearing function tests were collected at 9 to 15 months postoperatively. The threshold shift between pre- and postoperative values in each group was analyzed, and an inter-group analysis was conducted. Results : There was no significant permanent threshold shift after surgery, regardless of the required drilling time. The inter-group analysis also showed no significant difference compared to the control group (tympanoplasty). Conclusions : Drilling in otologic surgery does not induce a permanent threshold shift in the non-operated ear, even in TLA tumor excision.

청각신경종양 제거술 후 발생한 일측 청력저하 환자들에서 Ba ha Attract를 이용한 청각재활 효과

이정금(Jeong Gum Lee),문인석(In Seok Moon) 대한두개저학회 2021 대한두개저학회지 Vol.16 No.2

Background : Single-sided deafness (SSD) is defined as a unilateral sensorineural deafness in the poorer ear, and vestibular schwannoma itself, or treatment of it can cause patients SSD. So there were many treatments for SSD, such as hearing aids, bone-anchored hearing devices, but which had many disadvantages. Now newly developed system, Baha Attract have some advantages. Methods : As a case series study, retrospective chart review was conducted for 4 patients who had undergone Baha Attract implantation after removal of vestibular schwannoma for rehabilitation of SSD by one senior surgeon (M.I.S.) at a single tertiary hospital in 2021. We analyzed the clinical features, radiologic findings (computed tomography [CT], magnetic resonance imaging [MRI]), hearing tests (pure tone audiogram), and surgical outcomes of the patients. Results : All patient took postoperative temporal MRI of schwannoma removal, temporal bone CT, pure tone audiogram. During 2-5 months outpatient follow-up, of course there should be further long period observation, we concluded there were some advantages of patient’s hearing level. Conclusions : There should be a lot of further studies in Baha Attract implant model, it can be one of useful treatments for SSD patients to improve hearing levels

Rat 모델에서 MOSFET 선량계를 이용한 와우내 방사선량 측정

정준희(Junhui Jeong),한수진(Su-Jin Han),서진영(Jin Young Seo),문인석(In Seok Moon) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.1

Objectives : To measure the actual dosages of radiation being delivered to the cochlea is important for hearing preservation in stereotactic radiosurgery for vestibular schwannoma. It is very difficult to quantify because the cochlea is embedded deep within the temporal bone. The objective of this study is to compare cochlear irradiation dosages as measured by small-sized metal-oxide semiconductor-field-effect transistor(MOSFET) probes placed directly on the cochlear promontory through a myringotomy incision to larger standard ion chamber dosimeter (gold standard) probes positioned at the level of the cochlea or on the mastoid surface in an adult rat. Methods : A Norway Brown adult rat was euthanized and placed in a custom restrainer with rigid head fixation; the vertex was located 8cm from the X-ray irradiation source. One ear was exposed to radiation, while the contralateral ear and remainder of the body were shielded by 6 mm of lead. MOSFET probes were then placed on bilateral cochlear promontories(via myringotomies) and the standard dosimeter probe was placed alongside the mastoid at the level of the cochlea. Various dosages of radiation(160 kV, 25 mA; 0 to 20 Gy) were delivered to the cochlea at 5.35 Gy/minute, and dosages of cochlear radiation were measured by the MOSFET and standard dosimeter probes. Results : There were linear dose-dependent relationships between the total time of delivered radiation and total Gy measured by the standard ion chamber dosimetry(Gy = 6.39×Min-0.12, R2=1) and MOSFET probes placed in the radiated and non-radiated ears(Gy = 5.80×Min+0.01, R2=0.9999; Gy = 0.08×Min+0.35, R2=0.06, respectively). MOSFET probes placed on the cochlear promontory in the radiated ear shielded with lead measured from 0.35 to 0.60 Gy of radiation. Standard ion chamber dosimetry probes overestimate cochlear radiation dosages in rats by 10%, when compared to MOSFET probes placed on the cochlear promontory in radiated ears. Conclusion : MOSFET with small dosimeter probes that can be placed on the cochlear promontory can more accurately measure the amount of radiation received by the cochlea compared to large standard ion chamber dosimeter probes that are positioned at the approximate height of the cochlea or mastoid surface. When performing stereotactic radiosurgery for vestibular schwannoma, MOSFET may give information of actual radiation dosages received by the cochlea.

내이도와 소뇌교각에 국한되어 발생한 동정맥기형 1례

배성훈(Seong Hoon Bae),문인석(In Seok Moon) 대한두개저학회 2012 대한두개저학회지 Vol.7 No.1

We report a case of an arteriovenous malformation within the internal auditory meatus and cerebellopontine angle. A 46-year-old woman presented with a five-year history of unilateral hearing loss and recent aggravation. Initially she misdiagnosed as sudden hearing loss and treated with systemic steroid. 6 months later, her hearing worsened and vertigo was developed. Magnetic resonance imaging and magnetic resonance angiography demonstrated a lesion consisting of multiple high flow vessels within the left internal auditory canal and cerebellopontine angle. Patient was recommended to receive transarterial embolisation, but refused and was just followed up. Arteriovenous malformations of the internal auditory canal and cerebellopontine angle are exceedingly rare. It is important that a pre-treatment diagnosis is made, as the management of arteriovenous malformation differs from that of other, more common lesions at this site.

유양동 삭개술 없이 내시경적 갑각하 접근법을 통한 청신경초종 제거와 인공와우 이식을 동시에 시행하여 청력을 회복한 증례

김정기(Jungghi Kim),문인석(In Seok Moon) 대한두개저학회 2021 대한두개저학회지 Vol.16 No.2

Various approaches have been applied to surgery of vestibular schwannomas (VSs) and preservation of hearing, when possible, has been one of important goals of VS surgery. In recent years, several attempts have been made to restore damaged hearing with implants, going beyond simple preservation of hearing, in addition to tumor removal. We present a case of a 40-year-old male who had a 7-mm intracanalicular VS with profound ipsilateral hearing loss. The patient underwent nonmastoidectomy endoscopic transcanal infrapromontorial tumor removal with concurrent cochlear implantation on the ipsilateral side, without any complication during or after surgery. Postoperative pure-tone audiometry showed notable improvement to 21 dB HL. With this approach, the infrapromontorial corridor provided space to remove the tumor and most of the normal cochlear structure was preserved, allowing stable insertion of a cochlear implant electrode. This case suggests that nonmastoidectomy infrapromontorial approach and concurrent cochlear implantation can achieve both minimally invasive tumor removal and restoration of hearing simultaneously.

내시경 두개저 수술의 최신 지견

나지나(Gina Na),문인석(In Seok Moon) 대한두개저학회 2019 대한두개저학회지 Vol.14 No.1

The start of neurotologic surgery using endoscope dates back to the 1960s, but there has been much debates as to whether or not to replace operative microscope. Therefore, endoscope has been mainly used for diagnostic purposes for a while. Recently, with the increasing interest in minimally invasive surgery, various surgical procedures have been tried in the field of neurotology and their success has been reported. In this review, cases of vestibular schwannoma, facial nerve decompression, glomus tumor, petrous apex cholesterol granuloma, venous malformations of the facial nerve, and perilymph fistula are summarized.