• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.98-102
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• 2014

Objective : The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery. Methods : Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status. Results : MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection. Conclusions : MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.

• 대한두경부종양학회지
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• 제36권1호
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• pp.27-31
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• 2020

The midline nasal dermoid cysts are rare congenital neoplasms, which are diagnosed frequently in childhood. Masses are often noticeable at birth gaining size over time with recurrent infections and usually arise from the nasal cavity or lower 1/3 of the nasal dorsum. CT scan as the primary investigation is helpful to determine accurately the size and extent of the lesion as well as the integrity of adjacent bony structures. MRI scan is recommended to rule out an intracranial extension or sinus tracts. Treatment of choice is the complete surgical excision preserving the cyst wall. Here in, we present an unusual case of nasofrontal dermoid cyst in a 19-year-old boy without radiographic evidence of transcranial extension. In this case, we surgically removed nasofrontal dermoid cyst via transcolumellar approach. We also corrected saddle nose deformity after mass removal. Therefore, in this case, we experienced a successful case in which the nasofrontal dermoid cyst was totally removed without facial scar and deformity.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.434-440
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• 2006

Objective : The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow[CBF] and cerebrovascular reserve capacity[CVRC], and to investigate the usefulness of single photon emission computed tomography [SPECT] as a prognostic factor for neurological improvement after cranioplasty. Methods : Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery[MCA] and internal carotid artery[ICA] were obtained by transcranial Doppler ultrasonography[TCD]. The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT [Group 1, n=7] and hypoactivity to acetazolamide-activated SPECT [Group 2, n=17]. These measurements were obtained two weeks prior to and two weeks after cranioplasty. Results : The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased [P<0.05]. Compared with Group 2, there was significant increase in CBF and neurological improvement after cranioplasty in Group 1. Conclusion : Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

• Journal of Korean Neurosurgical Society
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• 제37권1호
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• pp.25-28
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• 2005

Objective: Giant invasive pituitary adenoma looks histologically benign, but these tumors have an aggressive clinical course. The authors review 10 cases and discuss the results obtained and the strategy to use for the management of giant invasive pituitary adenoma. Methods: Out of a series of 155 pituitary adenomas treated surgically between 1994 and 2002, ten patients with giant invasive pituitary adenoma were selected and their clinical problems, radiologic findings, extent and invasiveness, hormonal and histologic findings and surgical results were analyzed retrospectively. Results: There were 4 male and 6 female patients, with an average age of 47 years and an average follow-up period of 42 months. The average size of tumor was 50.7mm. These tumors revealed severe invasions into surrounding structures. 8 patients underwent transsphenoidal approach(TSA) operations, 1 patient with transcranial operation and 1 patient with combined TSA and transcranial operation. In all cases, subtotal resection was performed. The histologic findings were 2 prolactinomas and 3 hormonal non-function adenomas. The therapies administered after surgical removal consisted of conventional fractionated radiotherapy (2 patients), treatment with dopamine agonists to control hyperprolactinemia (2 patients), and treatment with hormone replacement (2 patients). Conclusion: Giant invasive pituitary adenomas are characterized by different forms of expansion and invasiveness and variable clinical problems. Because of their aggressive expansion and invasiveness, there are many different strategies which can be considered for their management. The authors obtain good results by choosing conservative surgical removal and multidisciplinary treatments with serial radiological and hormonal follow-up.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.643-646
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• 2016

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.70-75
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• 1999

Trancranial Doppler(TCD) monitoring is a new application of ultrasonography which allows the nonivasive detection of blood flow velocity in the horizontal (M1) segment of the middle cerebral artery (MCA) and detects microembolic phenomena in the cerebral circulation. Recent studies emphasized the potential of using this technique in vascular surgery (carotid endarterectomy, cardiopulmonary bypass), interventional and intensive care setting. Although the disparity between CBF and blood flow velocity and number of microemboli could be used to prevent cerebral ischemic and embolism based on clinical studies. A reduction of more than 60% of MCA can reflex hemodynamic ischemic state and acoustic feedback of high intensity transient signals(HITS) from the TCD monitoring unit has a direct influence on surgical technique. TCD monitoring can immediately provide information about thromboembolism and hemodynamic changes, which may be a useful tool in the study and prevention of stroke.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.146-148
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• 2014

Benign triton tumor (BTT) or neuromuscular hamartoma is an uncommon tumor composed of mature neural and well-differentiated striated muscular elements. Its development is exceptionally rare in the adult and head region. This report describes a case of adulthood BTT that occurred in the orbit. The patient was a 53-year-old woman who presented with right periorbital swelling and pain in eyeball over 2 months. Magnetic resonance imaging revealed a well-enhancing mass surrounding optic nerve and ocular muscles in the right retrobulbar area. The tumor was subtotally removed via transcranial approach. Its pathological diagnosis was confirmed to be a neuromuscular hamartoma. She developed diplopia postoperatively. Adulthood BTT should be considered in the differential diagnosis of head and neck tumors. It is also important to make adequate therapeutic strategy to avoid postoperative neural dysfunction.

• Journal of Korean Neurosurgical Society
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• 제37권1호
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• pp.20-24
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• 2005

Objective: The purpose of this study is to assess the efficacy and advantages of an endoscopic endonasal approach for the treatment of pituitary tumors. Methods: We retrospectively analyzed the records of 31 patients with pituitary tumors having endoscopic endonasal surgery between March 1999 and August 2003. Results: Among 31 patients with pituitary adenomas, 25 (81%) patients exhibited gross total removal of tumor on postoperative MRI within 3 days after surgery. Among 6 patients removed subtotally, 2 had only radiosurgery, 3 have had periodic follow-up MRIs and one patient with large extended tumor (grade IV, Stage E) had secondary transcranial removal of tumor before radiosurgery. Postoperative complications included cerebrospinal fluid leak in 2 patients, sinusitis in 1 patient, and one patient died due to unexpected intracerebral hemorrhage on 5 days after surgery. Besides considerable experiences with this approach are needed because of narrow working channel to the sella turcica, the results of our study showed following advantages of this procedure: visualization of areas not seen with the operating microscope, elimination of oronasal complications, more functional and cosmetic outcome, and shortened operative time and hospital stay. Conclusion: The authors consider that endoscopic endonasal transsphenoidal approach provides good results with minimal invasion for patients with pituitary tumors.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.17-23
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• 2015

Background: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. Methods: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. Results: Two clivus tumor patients underwent transmaxillary approach; three tuberculum-sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. Conclusion: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.

• 대한임상검사과학회지
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• 제54권2호
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• pp.157-162
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• 2022

본 술기의 목적은 운동피질 주변에 발생한 뇌종양 환자의 수술에서 TceMEP로 인해 발생하는 위양성을 방지하고 수술 중 운동영역의 정확한 매핑과 피질척수로 보존하기 위함이다. 또한 검사과정에서 발생하는 시행착오를 줄이고 검사시간을 최소화하여 검사결과에 대한 빠른 피드백으로 수술하는 의사에게 정확한 정보를 전달함에 있다. 본 술기의 가장 중요한 요소는 첫번째로 일정 세기의 자극역치로 검사해야 하는 것과 두번째로는 일정 수준의 마취농도를 적정 수준으로 유지하는 것이 수술 중 발생하는 위양성을 막는 기본적이 요소이다. 세번째로는 수술하는 반대쪽 부위에 다중 채널을 이용한 기록전극의 설치로 최대한 많은 근육에서 TceMEP파형과 집접피질자극 및 직접피질하 자극에 대한 반응을 측정하는 것이다. 이런 조건들이 수술이 진행되는 동안 원활하게 유지된다면 검사에서 오는 위양성이 아닌 그 밖의 요인들에서 발생할 수 있는 원인들을 예측할 수 있다.