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.

저척수 부신경 해면상 혈관종 -증례보고-

홍제범 ( Je Beom Hong ),홍창기 ( Chang Ki Hong ),이규성 ( Kyu Sung Lee ),윤선옥 ( Sun Och Yoon ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.2

We present a case of spinal accessory nerve cavernous hemangioma. A 44-year-old male patient visited our hospital because a mass at his foramen magnum had been found during a medical checkup. A magnetic resonance (MR) image revealed a well-enhanced mass in the foramen magnum, with displacement of the medulla oblongata to the left side by this mass. The lesion was resected using a far-lateral approach, and the pathological diagnosis was a cavernous hemangioma. Although cranial nerve cavernous hemangioma is a rare condition, it should be considered when making differential diagnoses of foramen magnum masses.

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.

감마나이프 방사선 수술로 조절되지 않은 두개저 수막종의 수술적 제거 : 증례보고

이재철(Jae Cheol Lee),정연구(Yeongu Chung),홍제범(Je Beom Hong),김한규(Han Kyu Kim) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.2

Because of their deep location, surrounded by many vital neurovascular structures, skull base meningiomas have been regarded as challenging lesions for surgical treatment. Stereotactic radiosurgery has been reported to be safe and effective to control skull base meningiomas. However, the use of radiosurgery must be considered very cautiously in treating skull base meningiomas, especially younger patients. In this study, we report a case with a huge skull base meningioma who had received radiosurgery prior to surgical removal.

거대 두개저 종양 절제술에 대한 단일 기관 수술 결과

김강현(Kang Hyeon Kim),이상민(Sang Min Lee),김한규(Han Kyu Kim),홍제범(Je Beom Hong),박세라(Sera Park) 대한두개저학회 2015 대한두개저학회지 Vol.10 No.2

Objectives : Giant tumors of the skull base are extremely rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after tumor resection. We report our experience of thirteen patients who had received surgical treatment successfully. Materials and Methods : Surgical approach is selectively perfomed based on the location of the tumor and surrounding anatomical structure. Twelve patients underwent extended translabyrinthectomy with combined anterior and posterior petrosectomy(ETLAPP) and one patient had received subtotal petrosectomy(SP). Tumor resection was achieved in all patients. Two patients underwent gross total removal(GTR) and eleven patients had received subtotal tumor resection(STR). Results : The mean age of the patients was 39 years (ranged from 7 to 60). The male to female ratio was 3:10. The average tumor size was 4.1×3.0×3.0cm. Of the thirteen patients, twelve patients had pre-operative cranial nerve deficits (CN II, III, V, VI, VII, VIII, XII) and another three patients had hemiparesis. Postoperative evaluation was performed for all patients after tumor resection. The new cranial nerve complications after surgery were found in five (38.5%) patient in the following order : facial palsy, hearing loss, extraocular paresis and double vision. The second most common morbidities were motor deficits (15.4%, n=2) in the early opstoperative period. In the pathological findings after surgery, schwannoma(n=5), meningioma(n=4), chondrosarcoma(n=1), pilocytic astrocytoma(n=1), embryonal carcinoma(n=1) and anaplastic oligodendroglioma(n=1) have been reported in excised tumors. Conclusion : Tumor resection is helpful to relatively young age of the patient with giant skull base tumor who do not have improvement in the conservative treatment. We found that the extended trans-labyrinthectomy combined with anterior and posterior petrosectomy are ways to minimize mortality and major morbidity. Further studies are needed to evaluate the effectiveness of the procedure in the future.

뇌간 해면상 혈관종의 수술적 치료

이주형(Ju-Hyung Lee),손선용(Sun-Yong Son),오성한(Sung-Han Oh),홍제범(Je-Beom Hong),김한규(Han-Kyu Kim) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.1

Purpose : The surgical excision is considered as the gold standard of cavernous malformation(CM) treatment. However, due to the high incidence of surgical morbidity, many surgeons feel very stressful for this disease. The authors reviewed their surgical cases of brainstem cavernous malformation in search of the safe surgical strategy for this dreadful disease. Materials and methods : From Sep. 2014 to Jul. 2016, total 14 cases of brainstem malformation were surgically resected using skull base technique with the use of intraoperative neuronavigation and neurophysiological monitoring. The clinical profile, radiological findings, surgical records were reviewed. The surgical videos were reviewed and the microsurgical findings were thoroughly investigated to identify the most efficient surgical techniques. Results : There were 6 women and 8 men aged 35.1 years old in average (11 - 58 years). And there are 1 case of midbrain CM, 11 cases of pontine CM, 2 cases of medulla oblongata CM. The surgical approaches were 8 telovelar approaches, 4 petrosal approaches, 1 far lateral approach and 1 midline suboccipital approach. The CMs were totally removed in all 14 cases and one case of them required the reoperation. The postoperative neurologic deficits include 5 cases of facial palsy, 6 cases of 6th n. palsy, 2 cases of motor deficit, 5 cases of sensory disturbance. Cerebrospinal fluid (CSF) leakage was developed in 2 cases. There was no mortality. Conclusion : The surgery of brainstem CM is difficult because of their critical location and surrounding neurovascular structures. However, brainstem CM can be surgically removed through the safe entry point using meticulous skull base technique.