경접형골동접근법에 의한 뇌하수체종양의 재수술

고영초,유헌,김창현,황도윤,장진순,박효일,Koh, Young-Cho,Yoo, Heon,Kim, Chang-Hyun,Whang, Do-Yun,Jang, Jin-Soon,Park, Hyo-Il 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Objective : The results of secondary transsphenoidal surgery(TSS) for either residual or recurring pituitary adenomas have been reported to be unfavorable. To evaluate the effectiveness of secondary TSS, we analyzed the surgical results of residual or recurred pituitary adenomas in patients who underwent secondary TSS from 1992 to 1998. Material and Methods : Among the 95 patients who underwent TSS during this period, 14(15%) received repeated TSS. Two of the 14 patients underwent three TSS. Among the 11 patients with pituitary adenomas, three had nonfunctioning tumors ; six prolachnomas ; two GH-secreting adenomas. The remaining three patieats had craniopharyngioma, pituitary abscess and hemangioendothelioma respectively. The interval between the two surgical procedures ranged from one week to 33 months(mean ; 12 months). Causes of the secondary TSS were tumor recurrence in 11 patients, intentional staged operation in three, persistent disease despite medical therapy and CSF leak after initial operation in one respectively. Treatments prior to secondary TSS were medical treatment only in eight patients. Results : During the repeated operationtss some adhesion was noted in septal mucous membrane. The sphenoid cavity was filled with fibrous tissue which correlated with the methods of reconstruction of the sellar floor at the previous operation. There was no statistically significant difference in success rate of surgery between the initial and the second TSS(86% vs 81%). The complication rate was similar between the two procedures. There was no statistically significant factors affecting the results of second TSS. Conclusion : Transsphenoidal reoperation was regarded as a suitable approach for treating recurrent pituitary adenomas in spite of some degree of operative difficulties. In patients with transsphenoidally resectable tumor residuals or recurrences confirmed by magnetic resonance imaging, remissions can be obtained with high probability, especially in secondary surgery after an staged decompression.

종양내 출혈로 진단된 청신경 초종 -증례보고-

고영초 ( Young Cho Koh ),유헌 ( Heon Yoo ),권오기 ( O Ki Kwon ),김용만 ( Yong Man Kim ),주미 ( Mee Joo ),이기재 ( Ghi Jai Lee ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1

The authors report unusual presentation of a vestibular schwannoma in a 53-year-old man, who presented with sudden onset of severe headache and, vomiting followed by left peripheral type facial palsy two weeks prior to admission. He had been well except for a longstanding left hearing difficulty, which had been considered as an aging process. In addition, he had mitral valve replacement surgery two years prior to admission , for which he had taken anticoagulant(Warfarin 2mg) everyday with regular monitoring of coagulability. Plain CT scan on admission demonstrated a 3×4×3cm sized high density mass at the left cerebellopontine angle with erosion and widening of the left internal auditory meatus. Brain MRI showed a heterogenous signaled mass with high signal on T1WI with little contrast enhancement and low signal on T2WI suggestive of multistaged hematomas within the peripherally enhancing tumor. Under the impression of intratumoral repeated bleeding in a patient with preexisting vestibular schwannoma, left suboccipital craniectomy was undergone to remove a large extraaxial tumor, mixed with large amount of hemorrhages. Postoperative course was uneventful except for persistent left facial palsy and hearing loss. Postoperative anticoagulation was started on the 5th postoperative day.

두개골 유아 근섬유증 - 증례보고 -

박병준,고영초,유헌,이채혁,박효일,Park, Byoung Jun,Koh, Young Cho,Yoo, Heon Yoo,Lee, Chea Heuck,Park, Hyo Il 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Infantile myofibromatosis is a rare and benign myofibroblastic tumor that may occur in either solitary or multicentric form in the soft tissue of infants. A 13-month-old girl presented with a painless firm mass, measuring $2.5{\times}2.5cm$ in the right temporal area. Skull X-ray and CT scan revealed a well enhancing soft tissue tumor with a round skull defect and sclerotic margin. The tumor was totally excised with curettage of the skull defect followed by cranioplasty. Pathology was confirmed to be a solitary infantile myofibromatosis. We report this rare solitary infantile myofibromatosis of the temporal bone with review of the pertinent literature.

양측성 외전신경 마비를 보인 파열성 후교통동맥 동맥류 - 증례보고 -

이채혁,고영초,Lee, Chea Heuck,Koh, Young Cho The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.3

뇌 지주막하출혈에서 흔치않은 임상양상인 양측성 외전신경마비와 두통을 주소로 내원한 46세 여자환자에서 혈관조영술을 시행하여 좌측 후교통동맥 동맥류, 전맥락동맥 동맥류, 그리고 우측 후교통동맥 동맥류등 다발성 뇌동맥류가 발견되어 수술시행 하였다. 양측성 외전신경마비 이외에 시력 및 시야장애는 보이지 않았다. 수술시 상당한 뇌압증가의 양상을 보였고, 좌측 후교통동맥 동맥류 출혈흔적과 기저조에 소량의 혈종이 있었으며, 첫번의 좌측 수술 후 2주 정도에 안구운동장애가 서서히 회복되어 정상화되었다. 저자들은 뇌동맥류 출혈에서 드물게 보는 양측성 외전신경마비 환자를 경험하였기에 문헌고찰과 함께 증례보고 한다. Arare case of bilateral abducens nerve paralyses after rupture of a left posterior communicating artery(PcomA) aneurysm with multiple unruptured aneurysms in a 46-year-old female is presented. Sudden left abducens nerve paralysis followed by progressive right abducens nerve paralysis were present without additional neuroophthalmological signs. Postoperatively, bilateral abducens nerve paralyses gradually recovered and disappeared in 2 weeks. The authors reviewed and discussed the possible mechanisms involved in this uncommon neuro-ophthalmological manifestation.

하후두부 접근법과 후경추체 접근법에 의한 거대 경정맥공 신경초종의 제거술과 동반된 합병증 - 증례보고 -

고성범,고영초,유헌,박시영,박효일,Koh, Sung-Bum,Koh, Young-Cho,Yoo, Heon,Park, Si-Young,Park, Hyo-IL 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9

Schwannomas of the jugular foramen, originating from the glossopharyngeal nerve, vagus and accessory nerve represent approximately 0.17-0.72% of all intracranial tumor, and consists of 1.4-2.9% of all intracranial schwannomas. The clinical presentation of these tumors varies significantly according to originated nerve and it's growth pattern. Magnetic resonance(MR) image and temporal bone computed tomography(CT) scan have a major role for diagnosis of such tumor. The treatment of choice is total resection whenever possible. Generally, suboccipital approach is sufficient for the removal of the tumor, but in case with large size, combination of resection of petrous part of temporal bone with or without transection of sigmoid sinus is may be necessory. We have recently experienced one case of giant jugular foramen schwannoma and postoperative fatal complication in a 34-year-old male who was treated with combined posterior petrous and suboccipital approach with transection of sigmoid sinus

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.

두개골에 발생한 Idiopathic Massive Osteolysis of the Skull -증례보고-

김용만 ( Yong Man Kim ),고영초 ( Young Cho Koh ),이채혁 ( Chae Heuk Lee ),최우진 ( Woo Jin Choe ),박효일 ( Hyo Il Park ) 대한뇌종양학회 2003 대한뇌종양학회지 Vol.2 No.2

The authors report a case of idiopathic massive osteolysis of the parietal bone. A 37-year-old male was admitted with the complaints of headache. The depression of the skull was palpable. Plain skull X-ray and brain computed tomography(CT) revealed a diffuse massive osteolytic lesion at the left parietal bone without any evidence of new bone formation or skull tumor. Cranioplasty was performed and through biopsy idiopathic massive oeteolysis was confirmed. The authors report this case with the literature review, and discuss clinical, radiological features, and management methods of this rare case.

원발성 중추신경계 림프종의 과거력을 가진 환자에서의 후각신경모세포종

이주용(Joo-Yong Lee),고영초(Young-Cho Koh),조준(Joon Cho),최우진(Woo Jin Choe),임소덕(So-Dug Lim),박호권(Ho-Kwon Park),김진국(Jin-Kook Kim) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1

Olfactory neuroblastoma is a rare malignant tumor arising from the olfactory neuroepithelium. A 48-year-old male patient with a prior medical history of primary Central Nervous System (CNS) lymphoma presented with severe epistaxis of sudden onset. Radiologic study revealed a left ethmoidal tumor. A biopsy done at a local ENT clinic revealed a highly malignant tumor. Minimally invasive craniofacial resection was undergone for this malignant tumor with anterior skull base invasion. Pathology confirmed the diagnosis of olfactory neuroblastoma with no evidence of primary CNS lymphoma. We report a case of olfactory neuroblastoma in a patient with a history of primary CNS lymphoma.

임상 : 역형성 핍지교종 환자의 치료 결과에 관한 연구

이성호 ( Sung Ho Lee ),고영초 ( Young Cho Koh ),최우진 ( Jin Woo Choe ),조요한 ( Yo Han Cho ),노홍기 ( Hong Gee Roh ),홍세미 ( Se Mi Hong ),임소덕 ( So Duck Lim ),이채혁 ( Chae Heuck Lee ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Objects:To evaluate prognostic impacts of surgical extent, postoperative Karnofsky performance status(KPS), and chemotherapy( CTx) in patients with anaplastic oligodendroglioma(AO), the authors analyzed the overall survival(OS) and progression free survival(PFS) in these patients according to those factors. Methods:Twenty nine patients with AO, who had undergone surgery by a single surgeon at the three university hospitals where the senior author had been active staff during the last 20 years, were enrolled in this retrospective analysis. Maximal safe resection was tried in all cases with or without neuronavigation techniue. The extent of removal was evaluated by immediate postoperative MRI. Impact of surgical extent, CTx, and postoperative KPS were evaluated on the OS and PFS in these patients. Results:Thirteen men and 16 women patients with the mean age at the diagnosis of 42.9 years(7-71 yrs) were included in this study. The mean follow-up duration was 61.8 months(3-237 months) and 12 patients died of tumor progression during the follow-up. There was no operative mortality. Gross total resection(GTR) was done in 15 patients, and either subtotal resection(STR) or partial resection(PR) was done in 14 patients. Of the 29 patients 26 were subjected to conventional radiotherapy(RT). The three remaining patients in poor KPS, less than 60, didn`t undergo RT. Twenty patients were subjected to CTx either with PCV(procarbazine, CCNU, vincristine) or Temozolomide(TMZ). Nineteen patients tolerated well the CTx with mild to moderate hematological or other toxicities and could finish the 6 or 7 cycles of PCV or TMZ. During the follow-up, tumor recurrences had been observed in 13 patients, for whom additional operations and /or salvage CTx were tried. GTR affects significantly on OS and PFS(p<0.01). Good postoperative KPS was also favorable for OS and PFS(p<0.05). Adjuvant CTx either with PCV or TMZ in addition to RT in patients with AO was not statistically significant prognostic impact for OS and PFS in this study(p>0.05). Conclusion:From this single-surgeon-operated series, the authors could confirm significant prognostic impacts of radical surgery, and good postoperative KPS in patients with AO on PFS and OS.

뇌에서 발생한 원발성 섬유조직구종 -증례보고-

김동천 ( Dong Cheon Kim ),조준 ( Joon Cho ),조요한 ( Yo Han Cho ),노홍기 ( Hong Gee Roh ),임소덕 ( So Dug Lim ),고영초 ( Young Cho Koh ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

Malignant fibrous histiocytoma(MFH) is a soft tissue sarcoma arising from the extremities and retroperitoneum in older adults. Primary intracranial MFH is extremely rare. A 29-year-old woman presented with headache showing three large masses on brain magnetic resonance image(MRI). She had undergone extended total gastrectomy with splenectomy under the diagnosis of advanced gastric cancer three years previously. Systemic positron extension tomography(PET) computed tomography(CT) scan on routine follow-up study before the first brain surgery revealed no hot spots. Three masses were totally removed at a single session. The pathology was confirmed to be typical MFH. Two months after the first brain surgery, she underwent tonsillectomy due to a rapidly growing tonsillar mass and the pathology was found out to be MFH. Postoperative neck CT with angiography for the evaluation of hypotension showed no significant finding. Except for the tonsillar mass, she had been symptom free during 10 months after the first brain surgery. Between 11th and 18th months postoperatively, multiple intracranial recurrences including metastatic lesions of the mediastinum and the spine were noticed. She died of pneumonia 20 months after the first brain surgery during salvage chemotherapy. We report a rare case of primary MFH of the brain with a past medical history of advanced gastric cancer.