• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.237-248
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• 2024

Objective : Postoperative data on Cushing's disease (CD) are equivocal in the literature. These discrepancies may be attributed to different series with different criteria for remission and variable follow-up durations. Additional data from experienced centers may address these discrepancies. In this study, we present the results obtained from 96 endoscopic transsphenoidal surgeries (ETSSs) for CD conducted in a well-experienced center. Methods : Pre- and postoperative data of 96 ETSS in 87 patients with CD were included. All cases were handled by the same neurosurgical team between 2014 and 2022. We obtained data on remission status 3-6 months postoperatively (medium-term) and during the latest follow-up (long-term). Additionally, magnetic resonance imaging (MRI) and pathology results were obtained for each case. Results : The mean follow-up duration was 39.5±3.2 months. Medium and long-term remission rates were 77% and 82%, respectively. When only first-time operations were considered, the medium- and long-term remission rates were 78% and 82%, respectively. The recurrence rate in this series was 2.5%. Patients who showed remission between 3-6 months had higher long-term remission rates than did those without initial remission. Tumors >2 cm and extended tumor invasion of the cavernous sinus (Knosp 4) were associated with lower postoperative remission rates. Conclusion : Adenoma size and the presence/absence of cavernous sinus invasion on preopera-tive MRI may predict long-term postoperative remission. A tumor size of 2 cm may be a supporting criterion for predicting remission in Knosp 4 tumors. Further studies with larger patient populations are necessary to support this finding.

• Journal of Korean Neurosurgical Society
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• v.37 no.4
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• pp.275-281
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• 2005

Objective: The prolactinoma is the most common pituitary tumor and sometimes shows severe invasiveness to the adjacent cavernous sinus, especially in the male patient. The dopamine agonist can be used as an alternative treatment modality to surgery. But, the transsphenoidal or transcranial approach for tumor removal has been more preferred treatment option of neurosurgeons in invasive prolactinoma. Especially rapid decompression of mass effect and resolution of the neurologic deficit is demanded. The prospective study is done in order to identify the therapeutic efficacy of bromocriptine as an initial treatment option for the invasive prolactionomas. Methods: Twenty patients with invasive prolactinoma were studied. Preoperative neurological and endocrinological evaluations were done, and size and invasiveness of the tumor was estimated on MRI. Bromocriptine was administrated by increasing dose planning reaching maximum dose at 1 month of treatment, with close neurological and endocrinological monitoring. At 3months after treatment, MRI was taken and decision was made whether to continue bromocriptine or to have surgical intervention. Results: Thirteen patients showed excellent result with only bromocriptine treatment. These patients showed not only marked reduction of tumor volume and prolactin level, but also, improving clinical symptoms and other hormonal deficits. 13patients who had visual field defect and decreased visual acuity had all improved visual symptoms. But, the remaining 4patients required surgical treatment due to insufficient reduction of tumor size inspite of normalized prolactin level within 3months. Remaining 2patients had $20{\sim}30%$ of tumor size reduction, but prolactin level was not normalized. One patient required radiation therapy. Conclusion: Bromociptine can be used as initial treatment for the invasive prolactinomas with careful monitoring of the neurological and endocrinological status. It should be carefully followed up for tumor size reduction within 3 months after initiation of treatment.

• Radiation Oncology Journal
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• v.17 no.4
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• pp.293-298
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• 1999

Intracranial involvement by adenoid cystic carcinoma (ACC) is very rare and there is no report of intracranial extension from the palate ACC in Korea. Intracranial involvement can occur in one of three ways: direct extension, perineural spread, and hematogenous spread. A case report of a 35-year-old woman with intracranial ACC is presented. Initially she had ACC of the right palate and was treated by surgery and postoperative radiation therapy. Three years and 10 months later, the paresthesia in the distribution of ophthalmic and maxillary branch of right trigeminal none developed without evidence of recurrence in CT scan. Ptosis and total ophthalmoplegia developed sequentially and the second operation was peformed. It was suggested that the tumor was spread perineurally along the trigeminal news into the Gasserian ganglion and then cavernous sinus and orbit. Seven years and 6 months after the first operation, direct intracranial extension into the right temporal lobe developed via sphenoid bone, sphenoid sinus and temporal bone and the third operation was done. And then lung metastasis was diagnosed. She is alive for 9 years 5 months after first operation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.1
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• pp.20-26
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• 2010

This type of neuropathic pain(atypical odontalgia) is seen most often in middle-aged women or men after dentoalveolar operation. Atypical odontalgia probably is caused by deafferentation leading to intraneural changes in the medullary dorsal horn. Treatment of this problem is difficult, but some success has been reported in uncontrolled, open-labeled studies using high doses of tricyclic antidepressants. This is the management report of a patient case, that had a neuropathic atypical odontalgia recognized with the right maxillary lateral incisor. The patient was consulted to the Department of Pain Clinics, ENT & Neurology and diagnosed the adenoid cystic carcinoma on left cerebellum and right paranasal sinus with extension to the cavernous sinus. In spite of the osteoplastic craniotomy, neurosurgical mass removal and radiation therapy were done with chemotherapy, atypical odontalgia was continued. In addition to the consultation to Psychology, stress management and antidepressant medication were done and improved slowly.

• Anatomy and Cell Biology
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• v.56 no.2
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• pp.200-204
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• 2023

Although in counterpart, the sphenopalatine artery (SPA), has been well described in the medical literature, the sphenopalatine vein (SPV) has received scant attention. Therefore, the present anatomical study was performed. Additionally, we discuss the variations, embryology, and clinical significance of the SPV. Adult cadaveric specimens underwent dissection of the SPV. In addition, some specimens were submitted for histological analysis of this structure. The SPV was found to drain from the sphenoidal sinus and nasal septum. Small tributaries traveled through the nasal septum with the posterior septal branches of the SPA and nasopalatine nerve. The SPA and SPV were found to travel through the sphenopalatine foramen and another tributary was found to perforate the medial plate of the pterygoid process and to connect to the pterygoid venous plexus which traveled lateral to the medial plate of the pterygoid process. The vein traveled through the posterior part of the lateral wall of the nasal cavity with the posterior lateral nasal branches of the SPA and the lateral superior posterior nasal branches of the maxillary nerve. To our knowledge, this is the first anatomical study on the SPV in humans. Data on the SPV provides an improved anatomical understanding of the vascular network of the nasal cavity. Developing a more complete picture of the nasal cavity and its venous supply might help surgeons and clinicians better manage clinical entities such as posterior epistaxis, cavernous sinus infections, and perform endoscopic surgery with fewer complications.

• The Journal of Internal Korean Medicine
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• v.30 no.2
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• pp.431-437
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• 2009

Tolosa-Hunt syndrome is an idiopathic syndrome characterized by the formation of granulation tissue in the anterior cavernous sinus or superior orbital fissure, producing a painful ophthalmoplegia. We experienced a 66-year-old woman whose conditions improved through oriental medical treatment. We treated the patient with herbal medicine Liqiqufeng-san (理氣祛風散) and electro-acupuncture at Cuanzhu (瓚竹, BL2) and Yuyao (魚腰, Extra) acupuncture points with 1${\sim}$50Hz for 15min. After treatment, the patient's symptoms improved considerably. This result suggests that oriental medical treatment has good effect on Tolosa-Hunt syndrome.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.420-422
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• 2012

Cerebral aspergillosis is rare and usually misdiagnosed because its presentation is similar to that of a tumor. The correct diagnosis is usually made intra-operatively. Cerebral abscess with fungal infection is extremely rare and few cases have been reported, but it carries a poor prognosis. A 73 year-old man presented with decreased visual acuity and paresis of the right cranial nerve III. Magnetic resonance imaging (MRI) revealed a mass in the right cavernous sinus, extened to the anterior crainial fossa and the superior orbital fissure. During surgery, a well encapsulated pus pocket was found, and histopathological examination of the mass resulted in the diagnosis of aspergillosis. Despite appropriate anti-fungal treatment, the patient eventually died from fatal cerebral ischemic change and severe brain swelling. The correct diagnosis of cerebral aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific. Surgical intervention and antifungal therapy should be considered the optimal treatment. Early diagnosis and aggressive antifungal treatment provide good results.

• Clinical and Experimental Pediatrics
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• v.49 no.6
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• pp.696-699
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• 2006

Tolosa-Hunt syndrome is a rare disease in children characterized by dull, persistent pain around the affected eye and ophthalmoplegia caused by granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbit. Although spontaneous remission can occur, corticosteroids frequently have a dramatic response; however, recurrence can transpire after complete remission. We report an 11-year-old girl with Tolosa-Hunt syndrome who responded to corticosteroid promptly, without complications, but suffered three recurrences of headache and retro-orbital pain and required maintenance on a low dose of steroid.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.104-106
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• 2006

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.110-113
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• 2006

Surgery and radiotherapy are mainly used for plasma cell neoplasm which constitutes about $1{\sim}2%$ of human malignancy. The authors carried out Fractionated Stereotactic Radiotherapy[FSRT] on the residual tumor after the subtotal removal of Intracranial plasmacytoma. A huge mass lesion was observed on MRI [magnetic resonance image] in the left anterior and middle cranial fossa of a 63-year-old man with left exophthalmus which lasted for a month, and was suspected as a meningioma with strong contrast enhancement. Extramedullary plasmacytoma was diagnosed on histopathological examination. After the surgery, FSRT was also carried out on the residual tumor which invaded the skull base. One-year follow up after FSRT showed contrast enhancement only in the left sphenoid bone on MRI, which indicated significant decrease in the size of the tumor without any abnormal neurologic deficits. We treated intracranial plasmacytoma which invaded left anterior and middle cranial fossa and surrounded cavernous sinus without cranial nerve deficit through subtotal tumor removal and FSRT.