• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.117-121
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• 2017

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권3호
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• pp.214-216
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• 1998

Midfacial degloving approach의 장점으로는 비강, 비중격, 상악동, 사골동, 접형골동, 비인두 부위 병소의 접근에 좋은 시야를 제공하며, 수술방법이 기존의 방법에 비해 수월하고, 두피관상 절개법, 측두부 절개법, 구개부 절개법과 함께 사용하여 수술시야를 넓힐 수 있으며, 안면부에 나타나는 흉터가 없어 심미적으로 만족스러우며 특히, Keloid 체질에서 유용하다는 것을 들 수 있다. 이에 저자 들은 구강악안면외과 영역에서도 중안면부 외상, 두개안면부 기형 처치, 상악골 절제술을 요하는 경우, 상악골과 비골의 동시 수술을 요하는 경우 등에 midfacial degloving approach가 유용한 수술 접근 방법으로 사료되었다.

• 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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• 제30권sup1호
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• pp.128-132
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• 2001

뇌기저동맥 체간부에 존재하는 동맥류는 매우 희귀하며 그 수술적 치료는 복잡한 해부학적 구조와 근접해있는 중요한 신경혈관 구조때문에 수술적 접근이 매우 어려운 부위이다. 산화 단층촬영과 자기공명영상의 발달은 두개저 병변을 정확히 진단할 수 있게 하였고 두개저 부위의 수술적 접근에 많은 발전을 가져오게 하였다. 뇌기저동맥 체간부에 존재하는 동맥류의 수술 방법중의 하나로 저자들은 소뇌와 측두엽의 견인이 적어 소뇌 부종을 극소화 할 수 있고 와우, 미로, 안면신경등의 구조물을 보존하여 청력손실, 안면신경마비등의 합병증이 없고 횡정맥동, S상정맥동의 보존뿐만 아니라 Labbe's 정맥을 보존할 수 있으며 수술시야가 비교적 좋은 장점들이 있는 후미로 전S상정맥동 경천막을 통한 추체로접근법을 이용하여 뇌기저동맥 체간부에 발생한 동맥류의 직접 결찰수술을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• 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.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.503-506
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• 2011

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

• 대한두경부종양학회지
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• 제9권2호
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• pp.200-209
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• 1993

The primary treatment of the nasopharyngeal carcinoma is, at this time, mainly based on radiotherapy. In most studies for patient treated with radiotherapy, overall 5-year survival rate is in the range of 35 to 55%. Obviously, these therapeutic results may be influenced by various factors such as clinical stages, histopathological types and radiation techniques, etc. Though the radiotherapy had a good therapeutic result, there is a limitation to apply the radiotherapy only in cases of the advanced nasopharyngeal carcinoma. Anatomical complexity of the skull base and difficulties in complete surgical intervention were the trouble of the surgery but in the case of radiation failure, there is no adequate cholice of other curative modalities. So it is appropriate to investigate whether surgical resection may improve the results of treatment of nasopharyngeal carcinoma. The purpose of this paper is to report the surgical experience with nasopharyngeal carcinoma, then to take into consideration of the new model of treatment strategy of nasopharyngeal carcinoma.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.156-160
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• 2009

Solitary extramedullary plasmacytomas are isolated plasma cell tumors of soft tissue that typically do not metastasize. They are rare and account for 4% of all plasma cell tumors. To our knowledge, only 14 cases of solitary extramedullary plasmacytomas in the sphenoid sinus have been reported. A 32-year-old man presented to our department with complaint of ocular pain in the right eyeball and diplopia. Physical and neurological examinations revealed intact and prompt direct and indirect light reflexes in both pupils and limitation of extraocular muscle movement seen with the lateral gaze of the right eyeball. Magnetic resonance imaging suggested the presence of mucocele or mycetoma, therefore surgical resection was performed with endoscopic endonasal transsphenoidal approach. Histopathology was consistent with plasmacytoma. Systemic work-up did not show any evidence of metastasis and the sphenoid sinus was the sole tumor site, and therefore the diagnosis of solitary extramedullary plasmacytoma was confirmed. We report a rare case of solitary extramedullary plasmacytoma in the sphenoid sinus with successful treatment using the endoscopic endonasal transsphenoidal resection and adjuvant radiotherapy.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권2호
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• pp.180-184
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• 2011

The mucocele is a mucus extravasation cyst arising from the salivary gland. Although it is a common?lesion of the minor salivary gland, it is uncommon when it originated from the submandibular gland. The ranula is a form of mucocele which specifically occurs in the floor of the mouth and the sublingual gland is generally accepted as the origin of ranula. They can be classified into two types based on extent: simple ranula are confined to the sublingual space and plunging ranula extend into the adjacent space. It is difficult to differentiate the submandibular gland mucocele from the plunging ranula because both of them can occupy the submandibular space. A 37-year old male visited our clinic with the chief complaint of left facial swelling. The patient's history revealed that he had suffered from a cystic lesion on the left side of the floor of the mouth 10 months previously. He supposed the cystic lesion had come from trauma at other dental clinics. Using CT and MRI, we diagnosed a simple ranula on the sublingual space and a submandibular gland mucocele. We then excised the mucocele with the submandibular gland by an extraoral approach and the sublingual gland by an intraoral approach under general anesthesia. We report a rare case of an enormous submandibular gland mucocele which extended into the pterygoid plate and parapharyngeal space with good surgical results.

• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.407-414
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• 2018

Objective : The purpose of the present study was to describe an OrBitoZygomatic (OBZ) surgical variant that implies the drilling of the orbital roof and lateral wall of the orbit without orbitotomy. Methods : Design : cross-sectional study. Between January 2010 and December 2014, 18 patients with middle fossa lesions underwent the previously mentioned OBZ surgical variant. Gender, age, histopathological diagnosis, complications, and percentage of resection were registered. The detailed surgical technique is described. Results : Of the 18 cases listed in the study, nine were males and nine females. Seventeen cases (94.5%) were diagnosed as primary tumoral lesions, one case (5.5%) presented with metastasis of a carcinoma, and an additional one had a fibrous dysplasia. Age ranged between 27 and 73 years. Early complications were developed in four cases, but all of these were completely resolved. None developed enophthalmos. Conclusion : The present study illustrates a novel surgical OBZ approach that allows for the performance of a simpler and faster procedure with fewer complications, and without increasing surgical time or cerebral manipulation, for reaching lesions of the middle fossa. Thorough knowledge of the anatomy and surgical technique is essential for successful completion of the procedure.