경미로 접근법

조양선(Yang-Sun Cho),이낙준(Nak Joon Lee),최지은(Ji Eun Choi) 대한두개저학회 2014 대한두개저학회지 Vol.9 No.1

두개저에 발생한 염증성 가성종양의 치료 결과

조양선(Yang-Sun Cho),이동경(Dong-Kyung Lee),소윤경(Yoon-Kyoung So),홍성화(Sung Hwa Hong),정원호(Won-Ho Chung),박계훈(Kye Hoon Park) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1

This study was performed to evaluate the response to steroid and radiation therapy in inflammatory pseudotumors (IPT) involving the skull base. Eight patients with inflammatory pseudotumor of the skull base were retrospectively evaluated. Of these, six patients were diabetic. All patients underwent an initial high dose of steroid therapy. Seven out of eight patients underwent subsequent low doses of steroid maintenance. Additional low dose radiation therapy was performed on six patients. We reviewed the medical records and radiological findings of the patients to evaluate their responses to the steroid and radiation therapy. In all patients, the initial response to steroid therapy was satisfactory. However, seven patients showed recurring symptoms after the cessation of steroid therapy. In five out of six patients, low dose radiation therapy resulted in recurrences. On follow-up MR imaging, none of the patients showed complete remissions of the disease. This observation demonstrates aggressive clinical characteristics of IPT involving the skull base and its poor response to steroid therapy and low dose radiation therapy. For improving control, more aggressive initial efforts including high dose radiation therapy with or without concurrent steroid therapy may play a causative role.

The Clinical Applicability of Transoral Transpharyngeal Approach to the Craniovertebral Junction Lesions

조태구,박관,조양선,백정환,남도현,김종수,홍승철,신형진,어환,김종현,Cho, Tae Goo,Park, Kwan,Cho, Yang-Sun,Baek, Chung-Hwan,Nam, Do Hyun,Kim, Jong Soo,Hong, Seung-Chyul,Shin, Hyung Jin,Eoh, Whan,Kim, Jong Hyun The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.3

목 적 : 경구적 접근법은 두개 경추이행부의 병소에 대한 유용한 접근방법이나 신경외과 의사에게는 비교적 친숙하지 않은 해부학적 구조물과 뇌척수액 누출로 인한 뇌막염의 위험성으로 인하여 많이 사용되지 않고 있다. 본원 신경외과에서는 다양한 두개 경추이행부의 병변에 대한 경구적 접근법을 시행하였으며, 수술 방법에 따른 결과 및 이의 적응증에 대해 발표하고자 한다. 방 법 : 1996년 9월부터 1999년 4월까지 총 8예의 환자에서 경구적 접근법을 시행하였다. 3명의 환자에서 선천성 기형에 의한 두개저 함입이 있었고, 2명에서는 외상성 치상돌기 골절, 2명에서는 외상성 환축추탈구, 1명에서는 비인두부위 가양성 종양을 동반하였다. 5명의 환자에서 전방 접근법 시행후 후방 골유합술을 시행하였다. 결 과 : 환자 전 예에서 양호한 결과를 보였으며 수술전 사지의 부진마비가 있었던 환자에서는 시간이 경과 함에 따라 신경학적 호전을 보였으며, 골유합술을 시행하였던 5예에서 성공적인 골유합이 관찰되었고, 연구개를 절개하였던 환자 4명중 1명이 창상 열개를 보여 재수술로 상처 치유가 가능하였다. 뇌척수액 누수는 한 예에서도 발생하지 않았다. 결 론 : 경구적 접근법은 두개 경추 이행부의 병소에 대한 유용한 접근법으로 사용될 수 있을 것으로 생각된다. Objective : Although transoral transpharyngeal approach is a very useful method for the lesions of craniovertebral junction, it is not frequently used because of anatomical unfamilarity, risk of cerebrospinal fluid(CSF) leakage, and resultant postoperative meningitis. To evaluate the usefulness of transoral transpharyngeal approach for various lesions of craniovertebral junction, clinical characteristics and the results of this approach are investigated. Methods : Transoral transpharyngeal approaches were performed in eight cases between 1996 and 1999. Among them, there were three basilar invaginations due to congenital anomalies, two odontoid type I fractures, two atlantoaxial dislocations, and one pseudotumor. Surgical methods included five cases of anterior decompression and posterior fusion, two anterior approaches for decompression and one transoral approach for biopsy. Results : This procedure allowed immediate clinical improvement in all cases. In seven patients with preoperative motor deficit showed a progressive neurological improvement. The follow-up plain x-rays demonstrated successful bony fusion in all patients. Only one patient suffered from postoperative wound dehiscence, but she completely recovered after wound revision. There was no complication of postoperative CSF leakages. Conclusions : Transoral transpharyngeal approach for the ventral lesions of craniovertebral junction, can be used as a relatively simple and effective method.

외이도 악성 종양 21례의 치료 경험

정종인(Jong In Jeong),조양선(Yang Sun Cho),추호석(Ho Suk Chu),홍성화(Sung Hwa Hong),정원호(Won Ho Chung),백정환(Chung Hwan Baek),정한신(Han Sin Jeong),정만기(Man Ki Chung) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.1

Background and Objectives:The malignances of external auditory canal(EAC) are very rare diseases and have very poor prognosis. Numerous staging systems have been proposed to classify patients before treatment. To treat the diseases, multimodal therapy is performed. The aim of this study was to review our experiences of the treatments for the malignances of EAC, and to propose most effective treatments according to the stage. Subjects and Method:Twenty-one patients with the malignances of EAC diagnosed between November 1994 and December 2009 were analyzed. The patients were analyzed according to the Pittsburgh staging system and histopathological findings. Results:The number of patients staged as T1, T2, T3, and T4 were 4, 2, 2, and 13, respectively. Surgical treatments were performed in 13 patients using lateral temporal bone resection, subtotal temporal bone resection. Initial or postoperative radiotherapies were performed in 13 patients. After the treatment, the mean disease free survival periods of 5 patients (23.8%) who are still alive without the disease was 27.8 months, and 4 patients (19%) expired within the mean periods of 11.8 months. Conclusion:We suggest that en-bloc resection with or without radiation therapy is the best treatment for the malignancies of the external auditory canal. A positive resection margin or residual tumor should be considered as worst prognostic factor.

안면신경 전방전위를 이용한 경정맥공 종양 제거 수술에서 술 후 안면신경 기능의 예후인자 분석

장영수(Young-Soo Chang),조양선(Yang-Sun Cho),장규선(Kyu-Sun Jang),최나연(Nayeon Choi),박준오(Jun Oh Park) 대한두개저학회 2011 대한두개저학회지 Vol.6 No.1

Objectives : Resection of jugular foramen tumors is limited by the intratemporal course of the facial nerve. Facial nerve rerouting techniques were developed to facilitate resection of extensive tumors occupying the skull base. Although facial nerve rerouting technique can maximize the surgical view, it may result in some degree of facial nerve paresis. We have therefore analyzed factors associated with post-operative facial nerve outcome in patients with jugular foramen tumor who were undergone surgical management including anterior facial nerve rerouting. Study design : Retrospective study Methods : We retrospectively enrolled 21 patients with jugular foramen tumor who underwent anterior rerouting of the facial nerve. Rerouting technique, type of mastoidectomy, operation time, completeness of tumor resection and change of facial expression were obtained from the medical records. Facial nerve function was evaluated using House-Brackmann grading system. Results : Shorter rerouting resulted in a better outcome without statistical significance. Operation time lesser then 12 hours had a better facial nerve outcome at immediately postoperative evaluation. However, facial nerve outcome within 6-12 months did not show the difference. Conclusion : The facial nerve function at 12 months after operation could be preserved in 90.5 % of patients who underwent surgical management of the jugular foramen tumor including anterior rerouting of the facial nerve. We can expect better facial nerve outcome with short rerouting and after operation with short duration. The facial nerve should be minimally manipulated during even in the rerouting procedure.

경정맥 사구종 2예

소윤경(Yoon-Kyoung So),조양선(Yang-Sun Cho),정한신(Han-Sin Jeong),정수찬(Soo-Chan Jung) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2

Glomus jugulotympanicum is a slow growing tumor originating at the dome of jugular bulb. It is histologically benign, but can have an aggressive clinical course with involving neurovascular structures at the skull base and extending through dural barrier. The primary treatment of glomus jugulotympanicum is total surgical extirpation. However, it can cause injury of cranial nerves and major vessels at the cranial base. We present two cases of glomus jugulotympanicum and reviewed the surgical techniques with special emphasis on the manipulation of facial nerve and postoperative cranial nerve palsy.

작은 전정신경 종양의 수술 및 감마나이프 치료의 치료성적 및 삶의 질 평가

박신홍(Shin Hong Park),조양선(Yang-Sun Cho),정규환(Kyu Whan Jeong),장전엽(Jeon Yeob Jang),류남규(Nam Kyu Ryu),정원호(Won-Ho Chung),홍성화(Sung Hwa Hong) 대한두개저학회 2007 대한두개저학회지 Vol.2 No.2

Objective : The aim of this study was to evaluate the treatment result and quality of life (QOL) in patients with intracanalicular to small-sized vestibular schwannoma (VS), who were managed with microsurgery or gamma knife radiosurgery (GKS). Methods : Medical records of 40 patients who were available on the telephone interview and were followed up more than 6 months after treatment for VS of Koss grade 2 or less from 1997 to 2007 were reviewed. Eighteen patients were treated with microsurgery via translabyrinthine approach and 22 patients were treated with GKS. We evaluated tumor control rate, complications and QOL. To evaluate the QOL, we used the Glasgow Benefit Inventory questionnaires with telephone interview. Result : The mean observation time was 26.85 months. Sixteen patients (88.89%) in microsurgery group did not develop recurrence of tumor. Twenty patients (90.91%) in GKS group were controlled with less than 140% volume increase. One patient in microsurgery group had facial nerve palsy (FNP) worse than House-Brackmann (H-B) Grade III at last follow-up, while no patient developed FNP worse than H-B grade III in GKS group. Although GKS group had higher score in GBI questionnaires, the difference was not significant in comparison with microsurgery group. Conclusion : In small VS, microsurgey and GKS showed similar tumor control and complication rate. Microsurgery group did not have worse QOL than GKS group.

경미로 접근법을 통한 전정신경초종 수술에서 술 후 안면신경 기능의 분석 : 난외표제 : 전정초종에 대한 경미로 접근법의 안면신경 기능결과

서민영(Min Young Seo),조양선(Yang-Sun Cho),박가영(Ga Young Park),홍성화(Sung Hwa Hong),정원호(Won-Ho Chung),박관(Kwan Park),공두식(Doo-Sik Kong),설호준(Ho Jun Seol) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.1

Introduction : One of the therapeutic goals for vestibular schwannoma (VS) is to preserve the function of cranial nerves, especially the facial nerve (FN). The purpose of this study was to determine the relationship between tumor origin, size and outcomes of FN function in VS surgery via translabyrinthine approach. Methods : To determine the characteristics of tumor and FN outcomes, medical records and MRI were reviewed retrospectively in a series of 39 patients who underwent gross total removal of VS via translabyrinthine approach. FN function was graded according to the House-Brackmann (H-B) grading immediately after surgery and at 1 year postoperatively. Results : The tumor originated from inferior vestibular nerve (IVN) was 38.5 % (n=15) and that of superior vestibular nerve (SVN) was 30.8% (n=12). Twelve out of 15 (80%) patients with IVN tumors and 10 (83.3%) out of 12 patients with SVN tumors achieved HB grade I-II facial nerve function at immediate and 1-year after the surgery. (p=0.825, p=0.396) In comparison between tumor size and FN function, immediate postoperative satisfactory FN outcome of HB I-III were achieved in 4 (80%), 8 (80%), 12 (70.6%) and 3 (42.9%) patients with intracanalicular tumor, tumor less than 1cm, 1.1-2.5cm and 2.6-4cm, respectively. One-year postoperatively, HB grade I-II could be observed in 4 (80%), 9 (90%), 13 (76.5%) and 4 (57.1%) patients. In overall, FN function of HB grade I-III was achieved in 71.8% immediately and 76.9% 1-year after surgery. Conclusions : The result of the facial nerve preservation did not differ significantly according to tumor location. The preservation of facial nerve function seems to be correlated with size of the tumor. More than 3/4 of VS patients could maintain their FN function of HB grade I-II after translabyrinthine approach at 1 year follow-up.

청신경 초종 수술에서 골미로를 통한 접근법의 유용성

김종현,조태구,박관,박익성,남도현,이정일,조양선,홍성화,홍승철,신형진,어환,Kim, Jong Hyun,Cho, Tae Goo,Park, Kwan,Park, Ik Seong,Nam, Do-Hyun,Lee, Jung-Il,Cho, Yang-Sun,Hong, Sung Hwa,Hong, Seung-Chyul,Shin, Hyung-Jin,Eoh, Whan 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objective : To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. Materials and Method : To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. Results : The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. Conclusion : Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.

양측 내이도를 침범한 전이성 종양으로 추정되는 1례

조양선,권중근,홍성화,노종렬 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.5