• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.464-466
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• 2010

A 59-year-old female presented with headache and dizziness for one year. Magnetic resonance imaging revealed a $52{\times}28$ mm, wellcircumscribed, homogenously enhancing mass lesion without dural attachment located in the left lateral cerebellomedullary cistern. The tumor was excised, and a histological diagnosis was a mixed pattern meningioma of meningothelial and fibroblastic type. A meningioma in the posterior fossa without dural attachment is quite rare. We report a rare case of lateral cerebellomedullary cistern meningioma without dural attachment with literature review.

• 대한안과학회지
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• 제59권11호
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• pp.1087-1090
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• 2018

목적: 중뇌(midbrain) 등쪽(dorsal)의 사구수조지방종(quadrigeminal cistern lipoma)에 의한 도르래신경마비를 경험하였기에 이를 보고하고자 한다. 증례요약: 65세 남자가 2년 전부터 간헐 양안 수직 복시가 있었으나 별다른 치료 없이 지내다가 2주 전부터 항상 증상이 생겨 내원하였다. 1달 전 진단받은 당뇨 이외에 다른 전신질환의 과거력은 없었다. 시력은 우안 20/25, 좌안 20/20이었고, 상대구심동공운동장애는 없었다. 안구운동검사에서 원거리 주시에서 4프리즘디옵터(prism diopters, PD)의 좌안 상사시와 근거리에서 4PD의 외사시를 보였다. 좌안은 내전시상전(elevation in adduction)이 있었다. 머리기울임검사에서 좌측 기울임에서 6PD의 좌안 상사시가 보였고, 우측 기울임에서는 정위를 보였다. 안저검사에서 우안 외회선과 좌안 내회선이 보였다. 뇌자기공명영상(brain magnetic resonance imaging)에서 중뇌 등쪽에서 나오는 도르래신경에 인접한 사구수조지방종을 확인하였다. 복시 증상의 완화를 위해 프리즘 안경을 처방하였고, 다른 신경 증상을 동반하지 않아 뇌 병변에 대한 경과관찰을 시행하기로 하였다. 결론: 중뇌 등쪽의 사구수조지방종으로 인해 도르래신경마비를 확인하였다. 종양의 압박에 의한 도르래신경마비는 드물지만, 본 증례와 같이 비특이적인 증상을 보인 도르래신경마비 환자에서는 빠른 뇌영상검사가 원인 감별에 도움을 줄 수 있다.

• The Korean Journal of Pain
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• 제4권2호
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• pp.191-195
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• 1991

Trigeminal neuralgia(tic douloureux) is a common clinical syndrome which is characterized by a painful facial condition. The clinician must be able to identify a patient with tic douloureux because this most severe pain syndrome can almost always be controlled. Gangliolysis is the most recent development in the long history of destructive procedures for tic douloureux. H$\ddot{a}$kason pioneered a technique of placing a needle for injecting glycerol into the trigeminal cistern which he found safe and effective for pain control. In August at 1991, I injected pure sterile glycerol three times into the cistern of trigeminal ganglion using the H$\ddot{a}$rtel approach to relieve a patient from pain. The results were as follows; 1) The response of pain relief to a glycerol gangliolysis was excellent. 2) As a complication, there were mild sensory deficit, transient headache and herpes simplex around the mouth angle.

• Journal of Korean Neurosurgical Society
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• 제52권2호
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• pp.152-155
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• 2012

A Rathke's cleft cyst (RCC) is a benign pituitary cyst derived from the remnant of Rathke's pouch, and usually presents as an intrasellar lesion with varying degrees of suprasellar extension. However, to date, a description of a primary prepontine RCC with no intrasellar component has not been reported. The author describes an exceptional case of a symptomatic RCC located behind the sella turcica in a 41-year-old woman who presented with severe headache. The author also provides an embryological hypothesis of the development of an ectopic RCC, with a special emphasis on radiologic characteristics.

• Journal of Korean Neurosurgical Society
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• 제51권1호
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• pp.62-65
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• 2012

Despite the remarkable developments in neurosurgical and neuro-interventional procedures, the optimal treatment for large or giant partially thrombosed aneurysms with a mass effect remains controversial. The authors report a case of a partially thrombosed aneurysm with a mass effect, which was successfully treated by stent-assisted coil embolization. A 41-year-old man presented with headache. Brain computed tomography depicted an $18{\times}18$ mm sized thrombosed aneurysm in the interpeducular cistern. More than 80% of the aneurysm volume was filled with thrombus and the canalized portion beyond its neck measured $6.8{\times}5.6$ mm by diagnostic cerebral angiography. Stent-assisted endovascular coiling was performed on the canalized sac and the aneurysm was completely obliterated. Furthermore, most of the thrombosed aneurysm disappeared in the interpeduncular cistern was clearly visualized follow-up brain magnetic resonance imaging conducted at 21 months. The authors report a case of selective coiling of a large, partially thrombosed basilar tip aneurysm.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.269-272
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• 2009

A rare case of hemifacial spasm caused by an ipsilateral tentorial meningioma is described. Magnetic resonance imaging showed a huge tumor in the right cerebellar hemisphere, distant to the cerebello-pontine cistern. The facial-vestibulocochlear nerve complex was stretched by the shift of the brainstem and the right cerebello-pontine cistern was effaced. After removing the tumor, the hemifacial spasm resolved completely. We review our case with the pertinent literature regarding the etiological mechanism.

• Journal of Korean Neurosurgical Society
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• 제53권6호
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• pp.374-376
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• 2013

The abducens nerve paresis generally can aid in the presumptive diagnosis of abducens schwannoma along with the typical radiological features of schwannomas. The authors present a case of a 76-year-old male patient with a abducens schwannoma without abducens nerve paresis. Peroperatively, abducens nerve located in the cerebellopontine cistern had normal in contour and diameter, despite the mass originated from this nerve. We hypothesize that anatomic location of abducens nerve may affect the vector of tumor growth to prevent destruction of its origin, the abducens nerve.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1476-1483
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• 2000

Objectives : The incidence of acute hydrocephalus(AHC) after aneurysmal subarachnoid hemorrhage reported as 13-31%. The AHC resolves spontaneously in some cases(simple AHC), but about 30% of the AHC progresses to shunt-dependent hydrocephalus(SDHC). The aim of this study was to understand clinical predisposing factors causing SDHC with performing differential clinical analyses between 2 subgroups, the simple AHC and the progresed SDHC. Methods : The 250 surgically treated patients with aneurysmal SAH over last two years were evaluated. Forty four patients(17.6%) of them showed the AHC. Of theses 37 cases were retrospectively analyzed, excluding 7 patients who died within 2 weeks after hemorrhage attack. Of the 37 AHC cases, 21 patient(56.8%) were complicated with the simple AHC, and 16 cases(43.2%) were progressed SDHC. Results : The older age(p<0.05), poor clinical grade(p＝0.03), larger amount of SAH in perimesencephalic cistern on CT scan(p＝0.005) were significantly related to the SDHC. No significant difference was noted in aneurysm location, multiplicity, rebleeding, hypertension and Fisher grade between 2 subgroups. Conclusion : Of the total 37 AHC, the simple AHC was 56.8% and the progressed SDHC 43.2%. The older age, poor clinical grade, large amount of SAH in perimesencephalic cistern were significant predisposing factors causing the SDHC. The large amount of SAH in perimesencephalic cistern is the single most important predisposing factor developing the progressed SDHC.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1019-1023
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• 2000

Objective : Endoscopic third ventriculostomy is gaining popularity as a minimally invasive surgical option for certain types of hydrocephalus as an alternative to shunting. The authors have tried to fenestrate down to the subdural space passing through the prepontine cistern to lessen or avoid the chance of redoing due to healing. Materials and Method : A 48-year-old male patient with several years of intractable headache was presented. Magnetic Resonance Image(MRI) of the brain revealed marked ventricular dilatation with stenotic cerebral aqueduct. A 2.3mm flexible steerable endoscope($Neuroview^{(R)}$) was introduced via precoronal route and accessed to the third ventricular floor. Using 3-French Fogarty balloon catheter, thin third ventricular floor and the arachnoid membrane of the prepontine cistern were fenestrated, so called "double fenestration". To confirm the fenestration, subdural compa-rtment of the left abducens nerve was identified during the procedure. Forceful pulsating flow through the orifice convinced the patency of the opening. Results : The patient was discharged on the third postoperative day without any postoperative complications. The postoperative follow-up MRI of the brain, at second and sixth months, clearly demonstrated the flow void through the third ventricular floor. Conclusions : Endoscopic third ventriculostomy was successfully performed on an adult hydrocephalus patient with aqueduct stenosis. The third ventricular floor and arachnoid membrane of the prepontine cistern were fenestrated to achieve double fenestration to minimize the chance for failure. The details of this procedure and results are described.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.169-173
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• 2010

Objective : The normal anatomic relationships characteristic of the pituitary stalk area were previously thought to involve only one location. The purpose of this study was to re-evaluate the anatomic location of the pituitary stalk and possible varying locations in relation to the tuberculum sellae and dorsum sellae using morphometric evaluation and anatomic dissection of human cadaveric specimens. The surgical implications of the variations are discussed. Methods : The calvaria were removed via routine autopsy dissections, and the brains were removed from the skull while preserving the pituitary stalk. The diaphragma sellae, tuberculum sellae, and the location of the pituitary stalk were examined in 60 human cadaveric heads obtained from fresh adult cadavers. Empty sellae were excluded. Results : The openings of the diaphragma sellae averaged $6.62{\pm}1.606mm$ (range, 3-9 mm). The distance between the tuberculum sellae and the posterior part of the pituitary stalk was 1 to 8 mm. The upper face of the diaphragma sellae appeared flat in 26 (43%), concave in 24 (40%), and convex in 6 cases (10%), with a prominent tuberculum sellae in 4 cases (7%). The location of the chiasm was normal in 47 cases (78%), with a prefixed chiasm in 3 cases (5%) and a postfixed chiasm (17%) in the 10 cases. Four cadaver specimens had prominent tuberculum sellae and other parameters were not evaluated. Conclusion : When opening the chiasmatic cistern, neurosurgeons should be aware about the relationship between the pituitary stalk and the surrounding structures to prevent inadvertent injury to the pituitary stalk.