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.

중이공간에서 확인된 이소성 타액선 조직 1예

이준욱(Junuk Lee),한재상(Jae Sang Han),서재현(Jae Hyun Seo),박시내(Shi Nae Park) 대한두개저학회 2020 대한두개저학회지 Vol.15 No.2

Heterotopic salivary gland tissue (HSGT) or salivary gland choristoma is defined as the histologically normal salivary gland tissue found in organs other than salivary glands. HSGT in middle ear is an extremely rare entity. It is considered as a result of developmental abnormality and may be associated with abnormalities of adjacent structures. A 59-year-old male patient, who suffered from the left side hearing impairment after a head trauma 40 years ago, visited our outpatient clinic. The audiogram showed severe conductive hearing loss on the left side and small soft tissue density filling in the middle ear cavity was observed. Explotympanotomy was done for diagnosis as well as treatment. The stapes was surrounded by yellowish soft tissue and adhered to exposed tympanic segment of the facial nerve. After removing the soft tissue, ossiculoplasty was followed. The final pathological diagnosis was HSGT and the patient is under observation without any complications.

뇌하수체 선종에 대한 경접형동 수술적 제거 후 발생한 두통 : 뇌하수체 종양과 관련된 두통에 대한 병태생리학적 가설

조용학(Yong Hag Cho),이승환(Seung Hwan Lee),고학철(Hak Cheol Ko),신희섭(Hee Sup Shin),고준석(Jun Seok Koh) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.2

There have been numerous reports of headache associated with pituitary tumors. Most of them were described based on the evaluation of pre-operative degree of headache, the anatomic distortion around the sellar area, and chemical changes. Herein, the authors report a unique experience that headache developed after the second transsphenoidal approach (TSA), in which not occurred after the first TSA. A-47-year-old female with a visual disturbance, having a pituitary tumor which expanded superiorly beyond optic chiasm admitted. The surgery underwent via TSA with the aid of an endoscope. On post-operative magnetic resonance imaging, there left half reduced tumor around the suprasellar region, without achieving satisfactory visual improvement. Additional surgery for the removal of the remaining tumor underwent using the same corridor in a week. In the second surgery, a thin membrane was descended enough to reach the sellar floor following total removal of the suprasellar mass. After the second surgery, her recovery was uneventful except complaining of severe headache that had not been after the first surgery. This phenomenon of exposing and stretching of basal arachnoid membrane seems to be a certain explanation for headache development in the patients with a pituitary tumor.

궁륭부 수막종으로 오인된 원발성 중추신경계 림프종

최재훈(Jae Hoon Choi),윤원기(Won Ki Yoon),김종현(Jong Hyun Kim),권택현(Taek Hyun Kwon),변준호(Joonho Byun) 대한두개저학회 2023 대한두개저학회지 Vol.18 No.1

We are reporting the case of a 56-year-old female patient who presented with headache, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a homogeneous enhancing mass on the left frontal lobe. Based on the impression of a convexity meningioma, surgical treatment was planned, and intravenous (IV) steroids were administered to alleviate brain edema. Additional brain MRI was performed just before surgery for intraoperative navigation, which showed a significant reduction in tumor size. Due to the good response to IV steroids, we suspected that the tumor might be a differ-ent lesion rather than a meningioma, and thus, we proceeded with surgery for histologic diagnosis. Intraoperative findings revealed a whitish-gray, rubbery tumor adhering to the dura and arachnoid membrane, which was removed, and intraoperative frozen biopsy reported lymphoma. Finally, the patient was diagnosed with diffuse large B-cell lymphoma. This case report highlights the impor-tance of considering lesions that may be responsive to steroids and the imaging characteristics of lymphoma, which can be distinguished from other lesions.

안면신경수술의 역사

박시영(Si young Park),김진(Jin Kim) 대한두개저학회 2016 대한두개저학회지 Vol.11 No.1

Facial paralysis has long been investigated from ancient times of human beings. Although there was a sculpture of an Italian general with facial paralysis on BC 1 century, the first report about the presence of facial weakness could be founded on the paper of Conelis Stalpart Van der Wiel(1620-1702). From the time of the first report, some reports about the anatomical and functional studies of facial nerve had been performed by many scholars. Among them, a Scottich neuroscientist Sir Charles Bell(1774-1842) had announced the importance of facial asymmetry or altered facial expression induced by the disease of facial nerve . Since vascular insufficiency, viral reactivation, autoimmuine disease had been thought of the pathophysiology of facial palsy, James Ramsay Hunt introduced the herpetic inflammation on geniculate ganglion as an ganglionitis as the main mechanism of herpetic facial palsy. Ugo Fisch had pointed out the facial nerve decompression for acute severe facial palsy. KK Adour had dispute the surgical consideration and emphasized the medical treatment of steroid. Mark May had complied the facial nerve surgery of reanimation and rejuvenation for facial palsy. The facial nerve study is actually performed by the Korean otologic society group and in the future, there could be many reports about the new diagnostic tool, or surgical consensus for the facial palsy, or facial rejuvenation for chronic facial palsy.

청각신경종양 제거술 후 발생한 일측 청력저하 환자들에서 Ba ha Attract를 이용한 청각재활 효과

이정금(Jeong Gum Lee),문인석(In Seok Moon) 대한두개저학회 2021 대한두개저학회지 Vol.16 No.2

Background : Single-sided deafness (SSD) is defined as a unilateral sensorineural deafness in the poorer ear, and vestibular schwannoma itself, or treatment of it can cause patients SSD. So there were many treatments for SSD, such as hearing aids, bone-anchored hearing devices, but which had many disadvantages. Now newly developed system, Baha Attract have some advantages. Methods : As a case series study, retrospective chart review was conducted for 4 patients who had undergone Baha Attract implantation after removal of vestibular schwannoma for rehabilitation of SSD by one senior surgeon (M.I.S.) at a single tertiary hospital in 2021. We analyzed the clinical features, radiologic findings (computed tomography [CT], magnetic resonance imaging [MRI]), hearing tests (pure tone audiogram), and surgical outcomes of the patients. Results : All patient took postoperative temporal MRI of schwannoma removal, temporal bone CT, pure tone audiogram. During 2-5 months outpatient follow-up, of course there should be further long period observation, we concluded there were some advantages of patient’s hearing level. Conclusions : There should be a lot of further studies in Baha Attract implant model, it can be one of useful treatments for SSD patients to improve hearing levels

안와를 포함한 관자놀이 두개골절개술에서 두 개의 골편을 이용한 수술기법 : 미용적 측면의 개선방법

황선철(Sun-Chul Hwang),김범태(Bum-Tae Kim),임수빈(Soo-Bin Im),신원한(Won-Han Shin) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.1

Cosmetic problems after the orbitopterional craniotomy are big concerns caused by the injury to the temporalis muscle and more destructive resection of the orbit. This report describes the techniques to dissect the physiologic plane of the temporalis muscle and fascia and to preserve the contour of orbit. Subfascial dissection of the temporalis muscle for the scalp reflection was applied to preserve the frontal branch of the facial nerve. The temporalis muscle was detached from the temporal fossa with anterior to posterior and proximal to distal manner. The muscle was not incised vertically or cauterized. A usual pterional craniotomy was performed and then an orbital craniotomy was followed. The passing drill (#8TA11, Midas Rex) was used to cut the orbital rim. The first cut was made on the lateral to the supraorbital notch. The second cut was proximal to the frontozygomatic suture. Following, the orbital roof was thinned to 3 to 4 cm posteriorly with cutting drills. The drilling was connected to the cutting edges of the orbital rim and the superior orbital fissure. After dural closure, the bone flaps were fixed with a Neuroclip??. This technique has been used for the 21 adult patients (11 male and 10 female patients) to clip anterior communicating artery aneurysms. The thickness of the temporalis muscle was measured at 3 points before surgery and in 3 months after surgery. As a result, it provided a wide basal exposure for clipping aneurysms. There were no injuries to the frontal branch of facial nerve. The most vulnerable area of periorbital injuries was just distal to frontozygomatic suture. All the patients suffered from the periorbital swelling after operation, which was subsided around 5 days. The bulk of the temporalis muscle was not significantly reduced and the reduction of the muscle thickness was less than 10%. The rigid fixation of the orbital and pterional bone flaps could be achieved. Although orbitopterional craniotomy requires extensive works, cosmetic results may be optimal if the physiologic dissection of the temporalis muscle and fascia and appropriate resection and fixation of orbital roof were performed.

Bilateral facial palsy by injury of intracranial portion of facial nerve

Jin-Bu Ha,Sung-Woo Han,Yu-Pyo Hong,Dong-Kee Kim 대한두개저학회 2018 대한두개저학회지 Vol.13 No.1

Injuries of the intracranial portion of the facial nerve may lead to facial palsy. A 42-year-old man with a non-contributory medical history arrived at our emergency department following a traffic accident. After a craniotomy to treat an epidural hemorrhage at the occipital lobe, he became conscious and then bilateral facial palsy was identified. Brain magnetic resonance imaging showed some hemorrhage in the right internal auditory canal (IAC), but temporal bone computed tomography showed no fracture or dislocation. We postulated that the paralysis was due to an IAC shear injury caused by concussion. We started conservative care, including steroid treatment. After 7 months, the right facial palsy had improved to House-Brackmann Grade II. No left facial palsy was observed.

편평세포상피암으로 오인한 비인두의 다형성 선종 2례

류광희(Gwanghui Ryu),홍상덕(Sang Duk Hong),정승규(Seung-Kyu Chung) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.1

Pleomorphic adenoma (PA) of nasopharynx is very rare. Squamous metaplasia of PA is an unusual finding and has the possibility for misdiagnosis as squamous cell carcinoma (SCC). This study presents two cases of nasopharyngeal PA diagnosed as SCC from frozen sections, whereas permanent pathology was PA with squamous metaplasia. Preoperative endoscopy, radiographic images, and histopathological findings were reviewed. Two male patients underwent complete en-bloc resection of tumors with adequate margins because of the possibility of SCC from frozen section. The pathologic results were PA with squamous metaplasia and there was no recurrence during one year follow-up period. Nasopharyngeal PA can mimic SCC, surgeons should consider the clinical and radiological characteristics of tumors. We do not recommend deciding treatment modalities for nasopharyngeal tumors with only the frozen section.

정중선 전두개저수막종에 대한 전두엽하 겸상막후각신경로 접근법

류한승(Han-Seung Ryu),김상덕(Sang-Deok Kim),김주휘(Ju-Hwi Kim),장우열(Woo-Youl Jang),정태영(Tae-Young Jung),문경섭(Kyung-Sub Moon),김인영(In-Young Kim),정신(Shin Jung) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.1

Anterior skull base meningiomas (ASMs) such as planum sphenoidale meningioma (PSM) and olfactory groove meningioma (OGM) may be symmetric around the midline. Bifrontal frontobasal approach and its variations have long been recommended as standard approach to remove these tumors. In the present report, we describe a subfrontal Falco-olfactory approach to treat these ASMs. The subfrontal Falco-olfactory approach was used to treat nine patients with anterior skull base tumor, including six patients who were diagnosed as PSM and three patients with OGM. Subfrontal craniotomy was performed with minimal dissection of temporalis muscle. In all nine cases, ipsilateral olfactory nerve and tumor base could be visualized in the initial stage of the procedure after retraction of frontal lobe carefully. This allowed for olfactory nerve preservation and early tumors devascularization. Between falx and olfactory nerve (above olfactory nerve), we gained excellent visualization of the tumor. After removal of ipsilateral side tumor, incision of the falx, other side tumor could be exposed easily. Preservation of other side olfactory nerve was also done. All patients had no postoperative complications. Thus, subfrontal transfalcial olfactory approach could be considered as a safe and versatile surgical route for ASMs.