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중간 크기 이상의 전정신경초종에서의 적절한 수술적 접근법
설호준(Ho Jun Seol) 대한두개저학회 2019 대한두개저학회지 Vol.14 No.1
Traditional surgical approaches to larger than medium-sized vestibular schwannomas (VSs) were retrosigmoid suboccipital craniotomy in neurosurgical area. The approach has plenty of advantages for these tumors, however, several disadvantages such as cerebellar retraction injury, postoperative headache, hydrocephalus, etc. Therefore, most of otolaryngologists and some neurosurgeons have used posterior transpetrosal approaches like translabyrinthine one to diminish the above complications. The selection of the surgical approaches is not the issue of the department, but the experience as well as rational basis. Thus, I reviewed these approaches for the medium- or larger VSs to understand how to choose the appropriate approaches.
설호준 ( Ho Jun Seol ),황승균 ( Sung Kyun Hwang ),최윤라 ( Yoon La Choi ),지제근 ( Je G Chi ),정희원 ( Hee Won Jung ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2
Subependymoma is a rare, slow growing, rarely recurrent tumor. We report a case of recurrent subependymoma with subependymal seeding. An intraventricular tumor in the left temporal horn was detected in a 48-year-old female who presented with a 4-year history of dizziness and memory disturbance. Following near total surgical resection, a tumor diagnosis of subependymoma was confirmed by scattered clusters of isomorphic nuclei embedded in a dense fibrillary matrix of glial cell processes. Twenty six months after surgery, follow-up(F/U) magnetic resonance(MR) imaging revealed tumor recurrence in the previous site which necessitated linear accelerator radiosurgery(LINAC). A further 21 months later, F/U MR imaging showed recurrent, multiple, enhanced, nodular lesions in the enlarged left lateral ventricle for which the patient underwent reoperation. Radiological and operative findings revealed local relapse with subependymal seeding. The pathological finding was similar to that of the previous tumor and compatible with subependymoma. Immunohistochemical studies revealed that glial fibrillary acidic protein(GFAP) was positive and CD-99 was negative. The patient underwent radiation therapy for the residual tumor. This case history suggests that symptomatic residual tumors require close observation even though the clinical course of subependymoma is usually benign.
설호준 ( Ho Jun Seol ),박승우 ( Seoung Woo Park ),김광기 ( Kwang Ki Kim ),박성혜 ( Sung Hye Park ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.1
The incidence of primary central nervous system lymphoma(PCNSL) is increasing, however, primary ventricular involvement is very rare. We report a rare case of intraventricular PCNSL in a 76 year-old male who presented with cognitive dysfunction. Brain magnetic resonance imaging showed enhancing nodular lesions in both frontal horns and right temporal horn of lateral ventricle. Diffuse large B-cell lymphoma was confirmed by endoscopic biopsy. No evidence of parenchymal central nervous system or systemic lymphoma was identified throughout the course of disease.
김용휘 ( Young Hwy Kim ),설호준 ( Ho Jun Seol ),정희원 ( Hee Won Jung ),한대희 ( Dae Hee Han ),김민아 ( Min A Kim ),지제근 ( Je G Chi ) 대한뇌종양학회 2003 대한뇌종양학회지 Vol.2 No.1
Astrocytoma or pitiictytoma in sellar region is rare tumor and most of reported cases were pilocytic astrocytoma pathologically. The authors experienced a case of pathologicaly proven fibrillary astrocytoma which might originate from neurohypophysis. It may be the first reported case in the literarure. A 16-year-old woman presented with the primary amenorrhea. Magnetic resonance(MR) ima-gings showed heterogeneously enhanced mass with cystic portion, which compressed and eleveated the pituitary stalk. The hormonal assay showed the panhypopituitarism. Subtotal removal was performed via a pterional approach. On pathologic examination including immumohis-tochemical staning, the fibrillary astrocytoma was revealed. Follow-up MR images showed the small enhanced mass on the sella. The patient remains stable and still on hormone replacement 12 months after surgery without other adjuvant therapies. Fibrillary astrocytoma should be included in the differential diagnosis of tumors arising in the posterior hypophysis although it was very rare tumor in this region.
신덕철(Duk Chul Shin),설호준(Ho Jun Seol),왕규창(Kyu-Chang Wang),조병규(Byung-Kyu Cho),김승기(Seung-Ki Kim),심은보(Eun bo Shim) 대한기계학회 2006 대한기계학회 춘추학술대회 Vol.2006 No.6
Moyamoya disease (MMD) is characterized by bilateral intimal thickening of distal internal carotid arteries (ICA's) and development of many collateral vessels in the base of the brain. Although the origin of MMD and the reason why it is limited to the major vessels remain unclear, flow dynamics such as shear stress may be related to its smooth muscle cell migration. Therefore, this study was performed to find out the local hemodynamic factor which concerns predominance of specific anatomic site such as distal internal carotid artery(ICA) and posterior cerebral artery (PCA) in progressed stages. We simulated the hemodynamics in cerebral arteries in circle of Willis using the computational models of two dimensional geometries of distal ICA and PCA. A finite element package, ADINA was used to simulate the blood flow in these arteries. Numerical results showed that shear stress is relatively low at the ICA region. It was seen that the shear stress distribution was related to the moyamoya disease.
3차원 모델을 이용한 모야모야병과 연관된 뇌동맥 혈류역학 해석
신덕철(Duk Chul Shin),설호준(Ho Jun Seol),왕규창(Kyu-Chang Wang),조병규(Byung-Kyu Cho),김승기(Seung-Ki Kim),심은보(Eun bo Shim) 대한기계학회 2006 대한기계학회 춘추학술대회 Vol.2006 No.11
Moyamoya disease (MMD) is characterized by bilateral intimal thickening of distal internal carotid arteries (ICA's) and development of many collateral vessels in the base of the brain. Although the origin of MMD and the reason why it is limited to the major vessels remain unclear, flow dynamics such as shear stress may be related to its smooth muscle cell migration. Therefore, this study was performed to find out the local hemodynamic factor which concerns predominance of specific anatomic site such as distal internal carotid artery(ICA) in progressed stages. We simulated the hemodynamics in cerebral arteries in circle of Willis using the computational models of three dimensional geometries of distal ICA. A finite element package, ADINA was used to simulate the undteady non-Newtonian blood flow in ICA. Numerical results showed that shear stress is relatively low at the ICA region. It was seen that the shear stress distribution was related to the moyamoya disease.
후각 기능을 보존한 내시경적 후각 신경모세포종 제거술 1례
김한결(Hankyeol Kim),최지은(Ji-Eun Choi),설호준(Ho Jun Seol),홍상덕(Sang Duk Hong) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2
Olfactory neuroblastoma is malignant tumors, which is rare to the sinonasal tract. This tumor is challenging to surgeon because it is difficult to achieve negative resection margin without causing facial disfigurement and loss of olfaction. There were few cases of craniofacial resection of this tumor with preservation of the olfaction. Therefore, we report a case of 34-year-old male who underwent endoscopic craniofacial resection for olfactory neuroblastoma with preserving olfactory function.
두개저 병변에 대한 내시경적 경비강 혹은 경안와 접근술에서 로봇 팔의 활용에 대한 초기 경험
하창민(Chang-Min Ha),김민수(Minsoo Kim),홍상덕(Sang Duk Hong),우경인(Kyung In Woo),설호준(Ho Jun Seol),남도현(Do-Hyun Nam),이정일(Jung-Il Lee),공두식(Doo-Sik Kong) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.1
Background : Endoscope has improved dramatically and is currently utilized in all fields of neurosurgery. In particular, endoscope is widely used in skull base surgery. However, endoscope possesses innate limitation in which it should be operated manually. To overcome this problem, robotic holding system has been developed and its use is gradually expanding. Methods : Fifty cases in single institution from October to November, 2019 that underwent surgery with assistance by ENDOFIXexo (AKTORmed, Barbing, Germany) were analyzed to evaluate the effectiveness of robotic holding system. All operations were performed by the corresponding author. Results : Total 47 patients underwent operation and 50 cases, including 3 revisions due to cerebrospinal fluid leakage, were reviewed. The histological diagnoses included 35 pituitary adenomas, 7 meningiomas, 2 Rathke’s cleft cysts, 2 craniopharyngiomas, and 1 cavernous hemangioma. No severe or unexpected events such as swaying or fall down of robotic holding system were reported. Conclusions : ENDOFIXexo can be manipulated easily without any discomfort and no significant complications were found. From the study, we showed the effectiveness of the robotic holding system. Growing experience in using the robotic holding system will eventually accelerate the advance of the system and treatment outcome.
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.