• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• 제61권12호
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• pp.710-713
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• 2018

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children's anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.277-280
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• 2009

Posterior cranial fossa subdural hematomas and extension of the subdural hematoma to the cerebellopontine angle is rarely seen and the concurrent development of acute peripheral facial palsy and the management strategy have not previously been reported in this pathology because of its rarity. We present this case to emphasize that minor head trauma may lead to a posterior cranial fossa hematoma extending to the cerebellopontine angle and cause peripheral facial palsy in patients using aspirin (acetylsalicylic acid). In addition, partial evacuation and waiting for the resorption of the hematoma may help to prevent damage to the 7th and 8th cranial nerves.

• Journal of Korean Neurosurgical Society
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• 제54권5호
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• pp.405-410
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• 2013

Objective : The objective of this study was to investigate changes in the posterior cranial fossa in patients with symptomatic Chiari malformation type I (CMI) compared to a control group. Methods : We retrospectively reviewed clinical and radiological data from 12 symptomatic patients with CMI and 24 healthy control subjects. The structures of the brain and skull base were investigated using magnetic resonance imaging. Results : The length of the clivus had significantly decreased in the CMI group than in the control group (p=0.000). The angle between the clivus and the McRae line (p<0.024), as the angle between the supraocciput and the McRae line (p<0.021), and the angle between the tentorium and a line connecting the internal occipital protuberance to the opisthion (p<0.009) were significantly larger in the CMI group than in the control group. The mean vertical length of the cerebellar hemisphere (p<0.003) and the mean length of the coronal and sagittal superoinferior aspects of the cerebellum (p<0.05) were longer in the CMI group than in the control group, while the mean length of the axial anteroposterior aspect of the cerebellum (p<0.001) was significantly shorter in the CMI group relative to control subjects. Conclusion : We elucidate the transformation of the posterior cranial fossa into the narrow funnel shape. The sufficient cephalocaudal extension of the craniectomy of the posterior cranial fossa has more decompression effect than other type extension of the craniectomy in CMI patients.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.441-444
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• 2006

Objective : The goal of this study is to evaluate the clinical results in six patients who underwent surgical decompression for the acute subdural hematomas[ASDH] of posterior cranial fossa. Methods : Six patients [five males and one female] who had undergone surgery for ASDH of posterior cranial fossa between 2000 and 2005, were evaluated retrospectively with regard to clinicoradiological findings and surgical outcomes. The mean age was 45.8 years [range $9{\sim}67\;years$]. Results : Preoperative computed tomography showed ASDH on cerebellar hemisphere in four patients and on midline in two. All patients had the associated lesions such as subarachnoid hemorrhage, epidural or subdural hematoma, intraventricular hemorrhage, contusion or pneumocephalus in supratentorial area. Fracture of occipital bone was noted in two patients. Of the four patients who had 13 to 15 of Glasgow coma scale score at the time of admission, three were deteriorated within 24 hours after trauma. Of these three patients, delayed subdural hematoma developed 1 hour after initial normal CT finding in one patient and increased in thickness in another one. Postoperative outcome showed good recovery in three patients and moderate disability in one. Two patients were expired. Conclusion : This study supports that early diagnosis based on strict observation and prompt surgery in the patients with ASDH in posterior fossa will lead to the best results.

• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1079-1085
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• 2001

Objective : We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. Methods : In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. Results : Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. Conclusion : Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.

• 한국환경성돌연변이발암원학회지
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• 제25권1호
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• pp.25-31
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• 2005

The objective was to use MR imaging to provide a template of posterior fossa development during the late stages in the chick embryos. The MR findings were then correlated with histological data. Fourteen normal formalin-fixed embryonic specimens with a gestational age of 14 to 20 days were examined with 1.5 Tesla unit MRl using a conventional clinical magnet and pulse sequences. The MR findings were correlated with the whole-mount histological specimens. Resolution of the morphological features of posterior fossa development in embryos greater than 14 days gestational age was possible. Development of cerebellum, brain stem, 4th ventricle and bony posterior fossa was documented. In the 14-day-old embryos, a premordial cerebellum was visualized in the enlarged bony posterior fossa, and it covered the the roof of the primitive fourth ventricle. The bony posterior fossa grows at the same rate along the supratentorial skull. The supratentorial skull and the rostral part of the brain grows at the same rate. The cerebellum begins to grow later than the rostral part of the brain. In the 19- to 20-day-old embryos, MRl revealed the rapid development of the cerebellar hemispheres, along with an increase in volume manifested by the more typical mushroom-shaped configuration observed in the newly hatched. At this stage, the cerebellum almost completely filled the posterior fossa and covered the entire fourth ventricle. The brain stem grew steadily, but the volume change was too subtle to evaluate. Features of cerebellar histogeneis were beyond the resolution of MRl. However, there were lots of artifacts in the features of the bony posterior fossa. An MR template of normal posterior fossa development would be useful to avoid confusion of normal development with abnormal development and to identify the expected developmental features when provided the estimated gestational age of a embryo.

• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.125-127
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• 2006

Facial nerve schwannomas are uncommon tumors. A 40-year-old female presented with left-side facial weakness. Computed tomography[CT] imaging showed a $3\;{\times}\;2cm$ lesion on the posterior portion of the left middle cranial fossa. The mass abutted the anterior aspect of the left petrous bone with a wide erosive change involving the area of the left facial nerve ganglion [geniculate ganglion]. A well-circumscribed extra-axial mass was seen on magnetic resonance imaging[MRI]. The tumor was completely removed through subtemporal approach and the patient was discharged without additional neurological deficit. This rare case is discussed and a review of the relevant literature is presented.

• 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 Korean Neurosurgical Society
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• 제30권sup2호
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• pp.340-343
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• 2001

Arachnoid cysts are defined as duplicated arachnoids and their splitting with congenital, intra-arachnoid, and leptomeningeal malformations. They are most commonly located in the middle cranial fossa followed by suprasellar and quadrigeminal cisterns, posterior fossa, and very rare in cerebral convexities. They are often ruptured by trauma or spontaneously and cause subdural hygroma or subdural hematoma. Authors report a case of a 32-year-old woman with a convexity arachnoid cyst mimicking subdural hygroma associated with a separate middle fossa arachnoid cyst. Preoperatively, the convexity arachnoid cyst was misinterpreted as subdural hygroma resulted from a ruptured middle fossa cyst. The patient underwent craniotomy and cyst fenestration into the basal cistern. Two separate arachnoid cysts were found in the cerebral convexity and middle cranial fossa during the operation. Finally, cysts were resolved and she was discharged without any complication.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.310-312
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• 2005

We report a case of endodermal cyst of the posterior fossa. A 44-year-old man presented with headache for three months. Computed tomography and magnetic resonance imaging revealed a $6{\times}2.5{\times}2cm$ sized extra-axial non-enhancing cystic lesion on the ventral aspect to brain stem. To avoid retraction injury to brain stem, far lateral transcondylar approach was selected. Right suboccipital craniotomy and partial removal of occipital condyle with resection of C-1 and C-2 hemilaminae exposed the extra-axial cyst well. The cyst has a whitish thick membrane. It was not adherent to brain stem and lower cranial nerves. Total removal of the cyst was done without difficulty. Histological analysis disclosed a layer of pseudostratified columnar epithelium with basement membrane. The result of immunohistochemical study was consistent with endodermal cyst.