• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.295-306
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• 2001

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

• Archives of Craniofacial Surgery
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• v.21 no.2
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• pp.137-140
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• 2020

Epidermoid cysts are benign tumors that account for approximately 1% of intracranial tumors. In very rare cases, temporally located extradural intradiploic epidermoid cysts can cause neurological symptoms and skull perforation. Herein, we report the case of a 34-year-old woman who underwent successful treatment of an epidermoid cyst in the temporal region accompanied by neurological symptoms. Accurate radiological evaluation and complete removal of the tumor and capsule play a vital role in ensuring favorable long-term outcomes. Computed tomography and magnetic resonance imaging scans can provide an accurate assessment of the extent of intracranial expansion and invasion of the cerebral parenchyma, as well as enabling the precise localization and characterization of the bone defect and mass. In addition, collaborative surgery with a neurosurgeon is required for cases involving intracranial expansion and dural invasion.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.24 no.1
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• pp.7-21
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• 1994

Fifty-two cases of traumatic bone cysts in 50 patients were analysed clinically and radiologically. The obtained results were as follows; 1. Women showed a slightly higher incidence than did men (56% of patients) and the average age proved to be 18.6 years. 2. The majority of the cases were asymptomatic. being detected incidentally. and over the half of the cases occurred in the mandibular symphyseal region. 3. All cases were unilocular and the largest diameter of the lesions varied from 1 to 10㎝, mean 3㎝. 4. Some degree of marginal condensation was present in 28 cases and 23 cases presented pencil-sketch appearance. 5. Many anatomical cortical plates (especially, mandibular inferior cortex and lamina durae) consisted of the margin of the lesions partly. 6. Erosive change of the mandibular inferior cortex was caused by 12 cysts, but cortical expansion only by 3 cysts including 2 cases of buccal expansion. 7. The lesion enveloped the roots of the adjacent teeth in 27 cases and scalloping was present between roots in 17 cases. 8. Lamina dura of the teeth was destroyed by only 1 cyst, and in 1 case root resorption was noticed. But there was no divergence of the roots of teeth.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.29 no.1
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• pp.55-63
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• 1999

The author observed and compared the radiographic features of 49 cases of the fibrous dysplasia and 14 cases of the ossifying fibroma in the osteoblastic or mature stage radiologically and histopathologically. The obtained results were as follows: 1. Fibrous dysplasia occurred most frequently in the 2nd decade, but ossifying fibroma in the 3rd and 4th decades, and both lesions occurred with slight predilection in females. 2. In most cases, chief complaints were painless facial swelling. And 61.1％ of fibrous dysplasia occurred in the maxilla, 92.9％ of ossifying fibroma in the mandible, and most of these lesions occurred in the premolar-molar region. 3. In the mandibular lesions, ossifying fibroma was shown more oval and round shape. but fibrous dysplasia was shown fusiform shape. 4. Fibrous dysplasia was shown homogeneously distributed. complete radiopaque shadow at 63％, and ossifying fibroma was shown concentric. mixed appearance of radiolucent and radiopaque shadow at 92.9％. 5. Fibrous dysplasia was entirely shown poorly outlined and blended to normal surrounding bone, but ossifying fibroma was shown well-defined border. 6. Cortical thinning and expansion were observed in these lesions. but degree of cortical expansion was more severe in ossifying fibroma than fibrous dysplasia. 7. Loss of lamina dura. tooth displacement. and displacement of mandibular canal were observed in both lesions. but root resorption was observed in ossifying fibroma only.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.16 no.1
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• pp.113-126
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• 1986

This study was undertaken to document and better define this condition to help clarify this clinical and radiographic appearances by the analysis of clinical and radiographic features of cementoma. A study was made of a series of 104 cases with cementoma. This investigation of cementoma revealed the following features: 1. The female occurred in 73% of periapical cemental dysplasia and benign cementoblastoma, and 80% of cementifying fibroma. 2. 40% of periapical cemental dysplasia occurred in the fifth decades, and 73% of benign cementoblastoma during the second and third decades, while there was no age predilection in the cementifying fibroma. 3. 63% of periapical cemental dysplasia occurred in the mandibular anterior region. 91% of benign cementoblastoma and 80% of cementifying fibroma occurred in the mandibular premolar and/or molar region. 4. There were no cases complaining the associated clinical signs and subjective symptoms in the periapical cemental dysplasia, however the patient complained the pain in 36% of benign cementoblastoma and 40% of cementifying fibroma. 5. There were no cases expanding the cortical plates in the periapical cemental dysplasia, however 73% of benign cementoblastoma and all of 5 cases of cementifying fibroma showed the expansion of cortical plates. 6. Several radiographic features of the periapical cemental dysplasia were shown: a. 29% of the cases had multiple lesions. b. 53% of the cases were in the mature stage. c. During the osteolytic stage, the alveolar lamina dura was lost in 89% of the cases.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.46-48
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• 2013

Chondrosarcoma is a very uncommon malignant primary bone tumor, especially, it occurs extremely rare in the spine. A 52-year-old man was admitted to the emergency room with sudden paraplegia. Twelve hours prior to a paraplegic event, he visited an outpatient clinic with discomfort and tenderness around the medial border of the right scapular, and his neurologic status was absolutely intact. Magnetic resonance imaging showed a lobulated soft tissue mass from T3 to T5, which extended to the epidural space. Computed tomography scans showed soft tissue mass on the spinal posterior arch and osteolytic change of the adjacent bony structures. Emergent surgery was performed and the lesion was removed. Dark reddish blood and gel-like material were encountered around the dura and posterior arch during the operation. Multiple pulmonary nodules were found on a chest CT scan and a biopsy of one of them had been proven to be a metastasis of chondrosarcoma. The histologic examination showed dedifferentiated chondrosarcoma. The patient's neurologic deficit was improved slowly from ASIA A to ASIA D. Chondrosarcoma in the spine is extremely rare, even more with acute hemorrhage and sudden expansion into the epidural space. We named it chondrosarcoma apoplexy. We should consider the possibility of a hemorrhagic event when the patient's neurologic deficit worsens suddenly with spinal bone tumor.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.24 no.1
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• pp.47-55
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• 1994

Post operative maxillary cyst may arise after the surgical treatment for maxillary sinusitis with the symtoms of swelling, pain, and pus discharge in the buccal region. It is examined by Waters' view, panoramic view and other intraoral radiographs, but quite variable radiologically. Most of the cyst is seen round or ovoid shape radiolucency, destruction, expansion and thinning of the lateral wall or posterior wall, and roots of the adjacent teeth may be resorbed. We studied about 117 cases of the post operative maxillary cysts which diagnosed in department of oral and maxillofacial radiology, Seoul National University Hospital. We analyzed and obtained following results. 1. These cysts occured more frequently in male than in female and the incidence is highest in the 4th and 5th decade. 2. Initial radical operation of maxillary sinus were performed mainly between the age of 10 and 45 years, and about 60% of the patients were 15 to 25 years. 3. Pain and swelling on buccal area, pus discharge, and toothache are most chief compaints, seven cases were found at routine examination without symtoms. 4. Most of these cysts were unilocular with smooth and well-defined border. 5. The majority of the cysts occurred in the anterolateral wall of maxillary sinus. 6. Dental changes of the lesional area were loss of lamina dura and root resorption, but about 55% were not changed.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.25 no.1
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• pp.17-25
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• 1995

The purpose of this study was to obtain some informations for the radiographic differential diagnosis between odontogenic keratocyst and unicystic ameloblastoma in the mandible. The author compared and analysed the clinico-radiographic features of 48 cases of odontogenic keratocyst and 32 cases of unicystic ameloblastoma. The obtained results were as follows : 1. Odontogenic keratocyst and unicystic ameloblastoma occurred the most frequently in the 2nd and 3rd decades, and both lesions occurred with slight predilection in males. The most frequent lesional site was molar area in odontogenic keratocyst(50.0％) and mandibular angle and ramus area in unicystic amelobla-stoma(71.9％). 2. Cortical thinning and expansion were observed with similar occurrences in odontogenic keratocyst(77.l％) and in unicystic ameloblastoma(72.9％). 3. Typical undulating lesional border was observed more frequently in odontogenic keratocyst(79.2％) than in unicystic ameloblastoma(46.9％). 4. Well-defined lesional outline occurred more frequently in odontogenic keratocyst(97.9％) than in unicystic ameloblastoma(53.1％). 5. Root resorption of adjacent teeth occurred more frequently in unicystic ameloblastoma(65.2％) than in odontogenic keratocyst(18.8％) respectively, but loss of lamina dura was frequently observed in odontogenic keratocyst(79.2％). And tooth displacement occurred more frequently in odontogenic keratocyst(50.0％) than in unicystic ameloblastoma(17.4％). 6. Displacement of mandibular canal occurred more frequently in odontogenic keratocyst(75.0％) than in unicystic ameloblastoma(61.5％). 7. Inhomogeneous lesional radiolucency occurred more frequently in unicystic ameloblastoma(53.l％) than in odontogenic keratocyst(39.6％).

• Archives of Craniofacial Surgery
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• v.20 no.2
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• pp.139-143
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• 2019

Here we report a case of a focal atypical proliferative nodule (PN) arising from a congenital melanocytic nevus (CMN). Diagnosis was challenging because it had both benign and malignant clinical features. Unusual histopathology, immunohistochemistry, and intraoperative findings of this atypical PN are discussed. A 5-year-old girl was admitted for a congenital $5{\times}5cm$ sized scalp mass. This hemangioma-like soft mass showed biphasic characteristics such as a slow, gradual, and benign increase in size but worrisome dural invasion with cranial bone defect. We removed the scalp mass with clear resection margins. Interoperatively, we found that the cranial bone defect had already filled. Histopathologic examination showed CMN with focal atypical PN. The nodule showed sharp demarcation and cellular pleomorphism. However, in immunohistochemical study, Ki-67 proliferation index and expression levels of protein S-100 and Melan-A were very low. These were unusual findings of atypical PNs. Despite her worrisome preoperative radiologic features, she showed an indolent clinical course compatible with previously reported biologic behavior. The patient underwent follow-up inspection with magnetic resonance imaging every 6 months for up to 3 years. The nodule appeared to be stationary at the last visit.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.22 no.2
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• pp.367-373
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• 1992

The author observed a 35-year-old male patient who came to the Dental Infirmary of Kyungpook National University Hospital who had complained of gradual swelling on both side of the mandible for 15 years. As a result of careful analysis of clinical, radiological and histopathological findings, the authors diagnosed it as cementifying fibroma and obtained the results as follows: 1. In clinical examination, main clinical symptom was facial deformity due to gradual swelling on both side of the mandible. 2. In radiographic examination, radiolucent lesions with central radiopaque foci were seen on both mandibular body areas bilaterally, and cortical thinning and expansion of the mandibular body were seen buccolingually. And loss of lamina dura and root resortption of adjacent teeth were also seen. In histopathological examination, this lesion was composed of delicate interlacing collagen fibers interspersed by the fibroblasts and cementoblasts. And round or oval shaped basophilic masses of cementum-like tissue were observed in the connective tissue.