• Investigative Magnetic Resonance Imaging
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• 제24권1호
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• pp.51-54
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• 2020

Superficial siderosis is attributed to hemosiderin deposition in the subpial layers of the nervous system. The clinical features of infratentorial superficial siderosis (ISS) are hearing loss, cerebellar ataxia, and corticospinal tract signs and the most common cause of idiopathic ISS is a dural defect. As magnetic resonance imaging (MRI) has advanced, the diagnosis of infratentorial superficial siderosis can be confirmed by unique radiological findings in MRI. Here, we report on a female patient diagnosed with idiopathic ISS by means of clinical symptoms and radiological findings.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.53-57
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• 2011

We reported a unique case of posttraumatic giant infratentorial extradural intradiploic epidermoid cyst. A 54-year-old male, with a previous history of an open scalp injury and underlying linear skull fracture in the left occipital region in childhood, presented with a painful subcutaneous swelling, which had been developed gradually in the same region and moderate headache, nausea, vomiting and cerebellar ataxia. The duration of symptoms on admission was 3 months. Imaging studies revealed occipital bone destruction and giant extradural intradiploic lesion. The preoperative diagnosis was giant infratentorial extradural intradiploic epidermoid cyst. Surgery achieved total removal of the lesion, which was histologically confirmed and the postoperative course was uneventful. To our knowledge, this is the first case of giant infratentorial extradural intradiploic epidermoid cyst with a traumatic etiology described in the literature.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.188-191
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• 2010

A postoperative contralateral supra- and infratentorial epidural hematoma after decompressive surgery is an extremely rare event. We describe a 38-year-old male with a contralateral supra- and infratentorial acute epidural hematoma just after decompressive surgery for an acute subdural hematoma. A contralateral skull fracture involving a lambdoidal suture and an intraoperative brain protrusion may be warning signs. The mechanisms, along with relevant literature, are discussed.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.89-93
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• 2017

Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.321-330
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• 2014

Objective : Based on surgical outcomes of patients with infratentorial meningiomas surgically treated at our institution, we analyzed the predictors for surgical resection, recurrence, complication, and survival. Methods : Of surgically treated 782 patients with intracranial meningioma, 158 (20.2%) consecutive cases of infratentorial location operated on between April 1993 and May 2013 at out institute were reviewed retrospectively. The patients had a median age of 57.1 years (range, 16-77 years), a female predominance of 79.7%, and a mean follow-up duration of 48.4 months (range, 0.8-242.2 months). Results : Gross total resection (Simpson's grade I & II) was achieved in 81.6% (129/158) of patients. Non-skull base location was an independent factor for complete resection. The recurrence rate was 13.3% (21/158) and the 5-, 10-, and 15-year recurrence rates were 8.2%, 12.0%, and 13.3%, respectively. Benign pathology, postoperative KPS over than 90, low peritumoral edema, and complete resection were significantly associated with longer recurrence-free survival rate. The 5-, 10-, and 15-year survival rates were 96.2%, 94.9%, and 94.9%, respectively. Benign pathology, postoperative KPS over than 90 and complete resection were significantly associated with a longer survival rate. The permanent complication rate was 13% (21/158). Skull base location and postoperative KPS less than 90 were independent factors for the occurrence of permanent complication. Conclusion : Our experience shows that infratentorial meningiomas represent a continuing challenge for contemporary neurosurgeons. Various factors are related with resection degree, complications, recurrence and survival.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.217-220
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• 2001

A rare case of multiple supratentorial and infratentorial hemangioblastomas in a 50-year old man is presented. There were neither manifestations of visceral tumors nor familial history. The two tumors were totally removed in two sessions and the diagnosis in both tumors were hemangioblastomas.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.399-403
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• 2023

Supratentorial and infratentorial epidural hematoma (SIEDH) is a rare but life-threatening complication following traumatic brain injury. However, the literature on SIEDH is sparse, consisting only of a few small series. Prompt diagnosis and the application of appropriate surgical techniques are crucial for the rapid and safe management of SIEDH. Herein, we present three cases of SIEDH treated at our institution, employing a range of surgical approaches.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.640-643
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• 2000

Objective : In neurosurgical practice, it has been generally accepted that when the dura is opened, it should be watertightly closed, and traditionally non-watertight closure has not been performed. We clinically tried non-watertight closure, analyzed the frequency of CSF leakage and evaluated the possible clinical application of non-watertight closure. Methods : After classifying our cases with supratentorial and infratentorial approach, we tried non-watertight and watertight closures and compared the results. We also analyzed the cases with or without dural graft. Results : In supratentorial approach, the rate of cerebrospinal fluid leakage noted in non-watertight closure was similar to that of watertight closure. In infratentorial approach, except microvascular decompression(MVD), the rate of cerebrospinal fluid leakage in non-watertight closure was higher than that of watertight closure. Dura graft application did not seemed to influence the cerebrospinal fluid leakage. Conclusion : Since the frequency of cerebrospinal fluid leakage was not higher in non-watertight closure than that of watertight closure, non-watertight closure can be applied in supratentorial approach. In infratentorial approach, non-watertight closure may be applied in surgery with relatively short dural incision, such as MVD. However, non-watertight closure doesn't seem to be appropriate in surgery that requires wide dural incision, such as skull base surgery.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.249-256
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• 2024

The Leksell frame-based transcerebellar approach was proposed with the arc support frame attached upside down to the Z coordinate. This study presented practical tips and considerations for obtaining adequate tissue samples for deep-seated cerebellar lesions or lower brainstem lesions specifically those accessible via the cerebellar peduncle. For practical insights, the Leksell coordinate frame G was fixed to prevent the anterior screw implantation within the temporalis muscle, to avoid interference with the magnetic resonance (MR)-adapter, and taking into account the magnetic field of MR in close proximity to the tentorium. After mounting of indicator box, the MR imaging evaluation should cover both the indicator box and the infratentorial region that deviated from it. The coordinates [X, Y, Za, Arc⁰, Ringa⁰] obtained from Leksell SurgiPlan^® software (Elekta, Stockholm, Sweden) with arc 0⁰ located on the patient's right side were converted to [X, Y, Zb=360-Za, Arc⁰, Ringb⁰=Ringa⁰-180⁰]. The operation was performed in the prone position under general anesthesia in four patients with deep cerebellar (n=3) and brainstem (n=1) tumors. The biopsy results showed two cases of diffuse large B-cell lymphoma, one metastatic braintumor and one glioblastoma. One patient required frame repositioning as a complication. Drawing upon the methodology outlined in existing literature, we anticipate that imparting supplementary expertise could render the stereotactic biopsy of infratentorial tumors more consistent and manageable for the practitioner, thereby facilitating adequate tissue samples and minimizing patient complications.

• Clinical and Experimental Pediatrics
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• 제49권1호
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• pp.76-81
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• 2006

목 적 : 뇌종양에 의한 임상증상은 뇌종양 발생의 발생위치와 밀접한 관계를 가지는 것으로 알려져 있다. 본 연구에서는 소아 뇌종양 환자에서 발생위치에 따라 증상의 차이와 증상 발현시부터 보호자와 의료진이 종양을 의심하고 진단하기까지 걸리는 시간의 차이에 대해 조사하였다. 방 법 : 1996년 7월부터 2004년 6월까지 인하대학교병원 소아과에서 뇌종양으로 진단받은 15세 이하의 환아를 대상으로 종양의 위치와 증상, 보호자와 의료진이 증상이 나타나기부터 진단을 하기까지 얼마의 시간이 경과했는지에 관해 후향적 고찰을 시행하였다. 발생위치는 방사선검사상(자기공명영상)에서 나타난 위치에 따른 진단을 근거로 분류하였다. 결 과 : 뇌종양으로 진단 받은 환아는 모두 45명이었고 남아가 27명, 여아가 18명이었다. 대상 환아에서 발병연령의 중앙값은 천막상부는 6.0세, 천막하부는 7.0세로 두 군간의 유의한 차이는 없었다. 발생위치는 천막상부에 24명(53.3%), 천막하부에 21명(46.6%) 발생하였고 천막상부 종양에서는 대뇌반구 및 측뇌실 종양이 14명(58.3%), 터키안 상부 종양이 7명(29.1%), 송과체 및 제3 뇌실 후반부종양이 3명(12.5%)을 각각 차지하였으며 천막하부 종양에서는 소뇌충부 및 제4 뇌실종양이 12명(57.1%), 소뇌 반구종양이 4명(19.1%), 뇌간 종양이 5명(23.8%)을 차지하였다. 종양으로 진단시 환아들의 주증상은 천막상부 종양에서는 경련이 9명(37.5%)으로 가장 많았고 두통은 3명(12.5%)을 차지한 반면 천막하부 종양에서는 두통이 8명(38.0%)으로 가장 많았고 경련이 1명(4.8%)으로 조사되어 천막상부 종양에서는 경련이 천막하부에 비하여 많이 나타났고(P=0.012) 천막하부 종양에서는 두통이 천막상부에 비하여 많은 것으로 나타났다(P=0.046). 이밖에도 천막상부 종양에서는 성장지연(2명), 성조숙증(2명) 등이, 천막하부 종양에서는 운동실조(3명), 구토(3명) 등이 우세하게 나타났으나 통계학적으로 유의성은 없었다. 보호자가 증상 인식 후 병원을 내원하기까지 기간은 천막상부는 중앙값이 6일(즉시-8개월), 천막 하부는 중앙값이 30일(즉시-2개월)로 나타났으나 두 군간의 유의한 차이는 없었다(P=0.088). 병원에 내원 후 의료진이 진단하기까지 기간은 천막상부와 하부에서 모두 내원 즉시 의심을 하여 방사선검사로 확진된 경우가 대부분 이었으나 천막상부의 경우 6년, 하부의 경우 7개월까지 지연된 예가 있었다. 결 론 : 소아에서 뇌종양이 진단될 때 천막상부 종양에서는 경련이 천막하부 종양에서는 두통이 각각 가장 많은 비중을 차지하였다. 보호자가 증상을 발견하고 내원하는 기간과 병원에 내원 후 종양이 진단되기까지 기간은 오래 걸리지 않는 경향을 보였지만, 두통이나 경련으로 내원하는 소아환자에서 자세한 병력청취와 신경학적 검사 및 두개 방사선 영상검사를 통해 뇌종양을 의심하는 것이 중요하다.