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.

양쪽에 두 개씩 존재하는 접형동 소공의 증례

한승우(Sungwoo Han),한정주(Jung Ju Han),김도현(Do Hyun Kim),김성원(Sung Won Kim) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Trans-sphenoid approach is useful surgical technique for sellar tumors. Sphenoid ostium is good for orientation in trans-sphenoid approach. Therefore it is important understanding anatomical variation of sphenoid ostium. There was one patient who had a mass in the clivus. We did trans-sphenoid approach and found double ostium of spenoid sinus on both side. It is an unprecedented case. For contribution of understanding the variation of sphenoid sinus, we report this case.

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.

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.

비중격 피판 거상을 동반한 경접형동 접근법 시행 후 후각 기능의 단기 회복 양상

김지룡(Ji Ryong Kim),김엘(El Kim),정종인(Jong In Jeong) 대한두개저학회 2017 대한두개저학회지 Vol.12 No.2

Background: The cases of endoscopic skull base surgery applied in more aggressive lesions have increased recently, raising interests about nasoseptal flap (NSF) for reconstruction. However, transient or permanent olfactory dysfunction may occur after NSF elevation, it have great influence on the quality of life of the patient. The aim of this study was to identify proper intervention time by comparing the recovery patterns of olfactory function after NSF elevation with conventional trans-septal approach. Methods: All subject were administered self-reporting olfaction score (Visual Analogue Scale [VAS], 0-10) and the threshold, discrimination, and identification (TDI) score of Korean Version of Sniffin Stick Test II (KVSS II) preoperatively. The trans-sphenoidal approach (TSA) was performed with conventional trans-septal approach or NSF elevation. VAS and TDI were followed-up by 12weeks after surgery. Results: Fifteen patients who underwent TSA were enrolled. Baseline VAS and TDI score were 9.2 and 28.3 in TSA group, and 7.7 and 24.6 in NSF elevation group. VAS of trans-septal approach group was recovered to the preoperative level from 8weeks after surgery, whereas NSF elevation group was 12weeks. TDI scores of trans-septal approach group were 12.1, 25.4, and 24.8 at 4, 8, and 12 weeks after surgery, whereas NSF elevation group were 10.6, 19.7, and 22.1. Conclusions: After TSA with NSF elevation, olfactory function is more gradually recovered than conventional trans-septal approach, and the intervention about permanent olfactory dysfunction may need to be considered for the poorly-improved olfactory dysfunction until 8weeks after surgery.

나노기둥구조 크기가 섬유아세포의 증식 및 alpha-smooth muscle actin (α-SMA)의 발현에 미치는 영향

강은혜(Eun Hye Kang),이상수(Sang Soo Lee),윤영식(Young Sik Yun),이원재(Won Jai Lee),여종석(Jong Souk Yeo),노태석(Tai Suk Roh),윤인식(In Sik Yun) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.2

Backgound : With advances in medicine and materials engineering, biomaterials, such as silicone and titanium are used in many tissue regeneration cases. Many studies are being conducted to confirm the reactivity of cells to various biomaterials. Among these studies, fibroblast proliferation and differentiation are known as important factors related to capsulation. In this study, we attempted to determine how various sized polyurethane acrylate (PUA) nanopillar structures act on fibroblast proliferation and differentiation. Methods : The scaffolds were prepared in four groups: flat and nanopillar (350 nm, 500 nm, 1,000 nm). Flat group was used as a control. To evaluate the effect of scaffolds of nanopillar structures on fibroblasts, quantitatively analyzed for the degree of adhesion, proliferation and alpha-smooth muscle actin (α-SMA) expression of cells. Results : As a result of the MTT assay, the proliferation was lower than that of the flat group in the nanopillar group. As a result of staining, the intensity of F-actin was significantly different from that of the flat group. And the intensity of α-SMA was different from that of the flat group but not significantly. Conclusions : The nanopillar structure of PUA material seems to play a role in inhibiting the proliferation and differentiation of fibroblasts regardless of the size of the structure. This suggests that the use of PUA nanopillar implants may be effective in suppressing fibrosis due to fibroblast proliferation and differentiation.

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.

약물스크리닝을 통해 청신경종양 세포를 억제하는 유효물질의 발굴

이세아(Se A Lee),이종대(Jong Dae Lee),이호균(Ho Kyun Lee),남궁완(Wan Namkung) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Objectives : Our knowledge of the molecular biology of vestibular schwannomas (VS) and the development of novel medical therapies for their treatment are increasing. Although several anticancer drugs have been tested in VS, new medical therapies without toxicity are needed. Therefore, we investigated to identify novel hit compounds for potential inhibitors of VS growth using a cell-based screening assay. Method : HEI-193 cells and Nf2 knockout SC4 cells were used to investigate the inhibitory effects on VS cells. We investigated 2,300 FDA-approved / investigational drugs and natural compounds using a cell-based screening assay. Briefly, HEI-193 cells were plated in 96-well plates at 30% confluence and then the test compounds were added to each well at final concentration of 10μM with fresh growth medium. After 24 hour incubation, MTS assays were done to assess cell proliferation. Results : In primary screening, twenty three hit compounds were identified as potential inhibitors of VS growth from 2,320 compounds of FDA approved/ investigational drugs at a concentration of 10μM. The hit compounds were defined by > 50% reduction in VS growth. Conclusion : We identified several schwannoma growth inhibitory compounds for VS from a cellbased screening with 2,320 compounds. These kinds of pharmacologically well-characterized molecules can be readily translated to further preclinical studies for VS.

측두엽 내 종괴로 발견된 콜레스테롤 육아종 1예

이재혁(Jae Hyuk Lee),김민범(Min-Beom Kim) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.2

Cholesterol granulomas are unusual, expansile benign lesions, which may produce symptoms from localized mass effect. It can develop in any portion of air cells within the temporal bone as a result of a lack of aeration and inadequate drainage, especially in the middle ear cavity followed by the mastoid process and the petrous apex. But huge cholesterol granulomas with extensive temporal bone destruction and intracranial extension are rarely reported. Recently we experienced a case of huge cholesterol granuloma with intracranial extension misdiagnosed as a intracranial tumor, such as schwannoma or meningioma in a 52-year-old female. After tumor removal, destroyed tegmen tympani was reconstructed with artificial dural materials and plates. We reviewed this case with relevant publishings in medical literature.

터키안결절 수막종의 치료 결과 분석

김주평(Joo Pyung Kim),박봉진(Bong Jin Park),임영진(Young Jin Lim) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.2

Instruction : The most important factors for treatment of tuberculum sellae meningioma is complete resection of the tumor without provoking symptoms such as decreased visual acuity and visual field defect. We retrospectively analyzed patients with tuberculum sellae meningioma with regard to postoperative tumor control and visual outcomes. Material and Method : From 1994 to 2008, 17 patients with tuberculum sellae meningioma underwent surgical treatment. Mean age was 49.8 years, mean symptom duration was 12.5 months. The mean follow up period was 67.2 months. 13 patients underwent surgery through extradural anterior clinoidectomy with optic nerve decompression. Subfrontal approach was performed in 2 patients and orbitozygomatic approach in 2 patients. Result : Twelve patients presented with symptoms of optic nerve compression, and hypopituitarism symptoms in 1 patient. Four patients were found incidentally as tuberculum sellae meningioma. Ten patients who presented with visual acuity disturbance before operation, 6 with visual field defect and optic nerve atropy in 5 patient. Gross total resection was achieved in 13 patients. Simpson grade I in 1 case, grade II in 8 cases, grade III in 4 cases and subtotal resectionl in 4 cases. Of the 12 patients with preoperative optic nerve compression symptoms pre-operatively, 8 patients(66.7%) were improved and 4 were unchanged(33.3%). There were no further visual deteriorations for the patients with no visual disturbances before operations. Conclusion : We obtained good outcome via the extradural anterior clinoidectomy with optic nerve decompression. We think that this approach was suitable access to patients with visual deterioration and reduces the risk of intraoperative optic nerve injury.