• Journal of Chest Surgery
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• 제57권1호
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• pp.92-95
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• 2024

Complete resection of an apicoposterior mediastinal mass is essential due to the mass effect, which exerts pressure on adjacent organs. Recently, the use of minimally invasive surgery has had many advantages. In this report, we describe a case in which a large apicoposterior mediastinal hypervascular mass was managed using a purse-string suture technique during robotic-assisted thoracoscopic surgery (RATS). The patient, a 77-year-old woman, was diagnosed with a 6.2-cm apicoposterior mediastinal hypervascular solid mass originating from the branches of the right subclavian artery. The patient underwent RATS for treatment. To obtain an adequate view of the apex of the thoracic cavity, a needle aspiration was performed, followed by the application of a purse-string suture technique. This was done to reduce the size of the tumor and to prevent catastrophic events such as seeding or spillage of the cystic mass. The mass was histopathologically diagnosed as a schwannoma. The patient was discharged on the first postoperative day without experiencing any complications.

• 대한정형외과학회지
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• 제55권6호
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• pp.511-519
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• 2020

목적: 신경초종은 말초신경에 주로 발생하는 양성종양이나 크기가 크거나 신경 이외의 부위에서 발견될 경우 악성 연부조직 종양으로 오인하기 쉽다. 저자들은 크기 5 cm 이상의 신경초종 50예의 1) 원발 위치의 분포 및 임상증상여부, 2) 술 전 방사선 및 병리학적 진단 결과와 진단적 정확도에 대해 알아보았다. 대상 및 방법: 신경초종으로 확진된 214예 중 자기공명영상(magnetic resonance imaging, MRI)상 종양의 최대직경이 5 cm 이상인 종양 50예를 추출하였다. 이를 주요신경 기원, 근육 내, 골 내의 원발위치에 따라 분류하였고 구체적인 해부학적 위치를 분석하였다. 결과: 전체 코호트에서 원발위치에 따라 분류하였을 때 주요 말초신경에 생긴 종양이 14예, 근육 내 발생이 31예, 골 내 발생이 5예였다. 신경초종의 평균크기는 7 cm였으며 근육내 신경초종이 평균 8 cm로 가장 컸다. MRI를 통한 영상학적 진단에서 전체 50예 중 33예(66.0%)는 양성 신경종양으로, 15예(30.0%)는 악성종양으로 판독하였으며, 나머지 2예(4.0%)는 각각 결핵 농양, 건활막 거대세포종으로 보고되었다. 골내 신경초종 5예 중 영상학적으로 신경초종으로 진단한 예는 없었다. 임상증상에서는 주요 신경기원의 경우는 Tinel sign이 78.6%로 많았고(11/14), 주요 신경 외 기원 종양에서는 종괴 촉지 증상이 93.5%로 가장 많았으며(29/31) 증상기간도 평균 66.6개월로 가장 길었다. 병리학적 진단을 위해 생검을 시행한 총 38예 중 86.8%에서는 신경초종으로 진단하였다. 합병증은 수술 후 합병증이 총 2예였으며 종양절제 후 출혈로 재수술이 필요했던 경우와 수술 후 경한 신경마비가 발생한 경우였다. 결론: 5 cm 이상의 근육 내 종양을 진단할 때 장기간의 종괴인지 소견이 있고, MRI상 비특이적인 소견일 경우에는 양상 신경종양일 가능성도 염두에 두고 조직학적 확진 후 치료를 시행하는 것이 과잉 치료 가능성을 줄이는 데 도움이 될 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제30권6호
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• pp.755-760
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• 2001

Objective : To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. Materials and Method : To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. Results : The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. Conclusion : Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.5019-5024
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• 2015

Background: The purpose of this study was to assess the dosimetric and clinical feasibility of volumetric modulated arc based hypofractionated stereotactic radiotherapy (RapidArc) treatment for large acoustic schwannoma (AS >10cc). Materials and Methods: Ten AS patients were immobilized using BrainLab mask. They were subject to multimodality imaging (magnetic resonance and computed tomography) to contour target and organs at risk (brainstem and cochlea). Volumetric modulated arc therapy (VMAT) based stereotactic plans were optimized in Eclipse (V11) treatment planning system (TPS) using progressive resolution optimizer-III and final dose calculations were performed using analytical anisotropic algorithm with 1.5 mm grid resolution. All AS presented in this study were treated with VMAT based HSRT to a total dose of 25Gy in 5 fractions (5fractions/week). VMAT plan contains 2-4 non-coplanar arcs. Treatment planning was performed to achieve at least 99% of PTV volume (D99) receives 100% of prescription dose (25Gy), while dose to OAR's were kept below the tolerance limits. Dose-volume histograms (DVH) were analyzed to assess plan quality. Treatments were delivered using upgraded 6 MV un-flattened photon beam (FFF) from Clinac-iX machine. Extensive pretreatment quality assurance measurements were carried out to report on quality of delivery. Point dosimetry was performed using three different detectors, which includes CC13 ion-chamber, Exradin A14 ion-chamber and Exradin W1 plastic scintillator detector (PSD) which have measuring volume of $0.13cm^3$, $0.009cm^3$ and $0.002cm^3$ respectively. Results: Average PTV volume of AS was 11.3cc (${\pm}4.8$), and located in eloquent areas. VMAT plans provided complete PTV coverage with average conformity index of 1.06 (${\pm}0.05$). OAR's dose were kept below tolerance limit recommend by American Association of Physicist in Medicine task group-101(brainstem $V_{0.5cc}$ < 23Gy, cochlea maximum < 25Gy and Optic pathway <25Gy). PSD resulted in superior dosimetric accuracy compared with other two detectors (p=0.021 for PSD.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.800-802
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• 2015

• Journal of Chest Surgery
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• 제38권3호
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• pp.249-252
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• 2005

상완 신경총에 발생하는 종양은 비교적 드물다 저자들은 상완 신경총의 하부 신경간에 발생한 신경초종을 미세현미경 수술로 치료하였기에 보고한다. 38세 남자 환자가 우측 쇄골상부 및 전완부의 6, 7번 경부신경 지배영역에 통증을 호소하였다. 고무탄력의 딱딱한 종괴가 우측 쇄골 상부에서 촉지되었고 자기공명영상소견 상 우측 상완 신경총 부위에 주위와 경계가 뚜렷하고 낭성 부위를 포함하며 조영제에 잘 조영되는 타원형의 종괴였다. 상완 신경총 종양은 전방 경흉부 접근법(Dartevelle 변형술식)을 통해 완전히 제거되었다. 수술 후 3개월째 아무런 신경 증상이 없이 외래 추적관찰 중이다.

• The Korean Journal of Pain
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• 제18권2호
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• pp.255-258
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• 2005

Many patients with intractable chest pain visit pain clinics, two of which, with rare cases of an intraspinal tumor and malignant mesothelioma were experiences at our clinic. A 37-year old female patient presented with exacerbating chest pain, but without neurological manifestations, of 15-months duration. Her laboratory findings, such as blood tests, chest X-ray, EKG, abdominal ultrasonography and chest CT, were normal. MRI revealed an intradural extramedullary schwannoma at the T 5 and 6 levels of the thoracic spine. She completely recovered following a laminectomy, with removal of the tumor. The other case was a 65-year old male patient, who presented with chest and back pain in the thoracic area of 6 months duration. He had no cough and dyspnea, and was initially misdiagnosed with intercostal neuralgia; therefore, pain control medication was administered, but all trials were ineffective. Finally, chest CT revealed a malignant mesothelioma, with multiple spine metastases. In conclusion, patients with intractable chest pain should be re-examined both clinically and radiographically.

• Journal of Korean Neurosurgical Society
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• 제42권6호
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• pp.450-454
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• 2007

Objective : The aim of this study was to identify the anatomical location and course of the facial nerve (FN) and their relationship to the tumor size in surgically treated vestibular schwannomas. Methods : A retrospective study was conducted on 163 patients who had been treated by the microsurgical resection for a newly diagnosed vestibular schwannoma between 1995 and 2005 (mean age of 46.1 years; 108 females and 55 males). Surgery was carried out via retrosigmoid approach in all patients with the electromyographic monitoring for the FN function. The anatomical location and course of the FN along the tumor surface were verified in each patient during the microsurgery, and were classified into 4 groups : 1) the FN displaced along the ventral and superior surface of the tumor (VS); 2) the ventral and central (VC); 3) the ventral and inferior (VI); and 4) the dorsal (Do). Results : The FN displacement was identified as the followings : VS in 91 patients (55.8%); VC in 57 (35.0%); VI in 14 (8.6%); and Do in 1 (0.6%). In the subgroup with tumors less than 2 cm in diameter (n=23), the FN was displaced along the ventral and central surface of the tumor in the majority (65.2%), whereas, in the patients with tumors larger than 2cm (n=140), it was displaced along the ventral and superior surface most frequently (59.3%). Conclusion : The FN can be displaced variably in vestibular schwannomas, and most frequently along the ventral and superior surface of the tumor, especially in large ones.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.159-167
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• 2007

Vestibular schwannoma (VS) is a benign tumor typically originated in the schwann cell of vestibular nerve and usually accompany hearing symptom. Microsurgical removal and radiosurgery have a great role for the treatment of VS. Recently radiosurgery has been considered as an alternative or primary treatment for VS with the tremendous increase of patients who were treated with gamma knife radiosurgery (GKS) though microsurgery still takes the premier. By many published results, it is proved that GKS is a effective and noninvasive technique for VS, especially small sized tumors with satisfactory tumor control rate. The authors assumed that GKS can be expected to achieve satisfactory tumor control rate for small VS under 5cc in volume. A major interest regarding radiosurgery nowadays is to determine the optimal radiation dose for hearing preservation to improve the quality of life of patients. The more high radiation dose are used for effective tumor growth control, the more radiation-related complications like as hearing deficit, the impairment of other cranial nerve function are increased. Since 1990's the mean radiation dose for tumor margin was more than 18 Gy, but there were high complication rate in spite of good tumor growth control. After the year of 2000, under the influence of advanced neuro-imaging techniques and radiosurgical planning system which enable clinicians to do more precise planning, marginal dose for VS has been decreased to 12-13 Gy and the radiation-related complications has been reduced. But because there may be a unexpected radiation induced complications as time goes by after the latency period, optimal radiation dose for VS should be established on the basis of more long term follow-up observation.

• 대한한방내과학회지
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• 제37권5호
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• pp.893-902
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• 2016

Objective: To describe the effects of traditional Korean medicine on dizziness and gait disturbance arising after removal of a vestibular schwannoma. Methods: The patient was treated using Korean medical treatments, such as herbal medicines (Jaeumkunbi-tang-gagambang and Yookmijihwang-Insamyangyoung-tang-gagambang), acupuncture, and moxibustion. We measured the state and progress of this case with the Korean Vestibular Disorder Activities of Daily Living Scale (K-VADL), Berg Balance Scale (BBS), and a visual analogue scale (VAS). Results: After treatment, the K-VADL score decreased from 167 to 74 and the VAS score decreased from 10 to 5.7, while the BBS score increased from 3 to 42. Conclusion: Jaeumkunbi-tang-gagambang (滋陰健脾湯) and Yookmijihwang-Insamyangyoung-tang-gagambang(六味地黃湯 合 人蔘養榮湯 加減方) appear to be effective for controlling dizziness and gait disturbances occurring after removal of vestibular schwannomas.