• Journal of Korean Neurosurgical Society
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• 제44권2호
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• pp.88-90
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• 2008

Cavernous malformations (CMs) arising from the optic nerve and chiasm are extremely rare. The authors present a case of 39-year-old woman with CMs of the optic chiasm. She was referred due to sudden onset of bitemporal hemianopsia and headache, the so-called 'chiasmal apoplexy'. MRI findings suggested a diagnosis of hemorrhage and vascular malformation of the optic chiasm. Pterional craniotomy revealed an intrachiasmatic cavemous malformation with hemorrhage. The malformation was totally excised, but field deficits remained unchanged after surgery.

• Annals of Clinical Neurophysiology
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• 제8권2호
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• pp.199-202
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• 2006

We report a case of chiasmal optic neuritis in a patient who had been diagnosed as multiple sclerosis, and was presented with bitemporal hemianopsia. The brain MRI revealed a high signal lesion with focal enhancement in optic chiasm, and the visual evoked potential functionally supported it. This is the first case of chiasmal optic neuritis in multiple sclerosis with temporally and spatially disseminated lesions.

• Journal of Korean Neurosurgical Society
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• 제47권1호
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• pp.71-73
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• 2010

A 28-year-old woman was referred to our hospital with a sudden, very severe headache. Brain computed tomographic angiography showed a saccular cerebral aneurysm at the bifurcation of the left middle cerebral artery and infraoptic courses of both anterior cerebral arteries. The anterior cerebral arteries were seen to arise from the ipsilateral internal cerebral arteries at the level of the origin of the ophthalmic artery, passed underneath the ipsilateral optic nerve, and turned upward at ventral portion of the optic chiasm. Infraoptic course of the proximal anterior cerebral artery is an extremely rare anomaly and is often associated with cerebral aneurysms. We report the clinical features, radiological findings, and possible genesis of this anomaly with a literature review.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.291-293
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• 2015

Anterior communicating artery (ACoA) aneurysms sometimes present with visual symptoms when they rupture or directly compress the optic nerve. Giant or large ACoA aneurysms producing bitemporal hemianopsia are extremely rare. Here we present an unusual case of bitemporal hemianopsia caused by a large intracranial aneurysm of the ACoA. A 41-year-old woman was admitted to our neurosurgical department with a sudden-onset bursting headache and visual impairment. On admission, her vision was decreased to finger counting at 30 cm in the left eye and 50 cm in the right eye, and a severe bitemporal hemianopsia was demonstrated on visual field testing. A brain computed tomography scan revealed a subarachnoid hemorrhage at the basal cistern, and conventional cerebral catheter angiography of the left internal carotid artery demonstrated an $18{\times}8mm$ dumbbell-shaped aneurysm at the ACoA. Microscopic aneurysmal clipping was performed. An ACoA aneurysm can produce visual field defects by compressing the optic chiasm or nerves. We emphasize that it is important to diagnose an aneurysm through cerebrovascular study to prevent confusing it with pituitary apoplexy.

• 한국의학물리학회지:의학물리
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• 제18권1호
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• pp.42-47
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• 2007

목적: 망간 조영증강 자기공명영상을 이용하여 시신경경로의 활성화를 추적해 보고자 하였다. 대상 및 방법: 뉴질랜드 암컷 흰색 토끼의 망막에 $30{\mu}l$의 $MnSl_2(1mol)$ 용액을 주입한 후 고성능 경사자계 시스템이 장착된 임상용 1.5 기기에서 3D FSPGR 펄스열을 사용하여 고해상도 T1-강조영상을 망간 주입 후 12시간, 24시간, 48시간에 각각 획득한 후 시신경경로의 주요 해부학적 구조물에서의 조영증강을 관찰하였다. 또한 정량적 평가를 위하여 해부학적 위치에 동일한 원형의 관심영역을 정하여 신호강도를 측정 한 후 배경 잡음의 신호강도와의 신호대 잡음비(signal-to-noise ratio)를 구하였다. 결과: 망간 주입 후 시신경 경로상의 주요 구조물들이 조영증강 되었다 조영 증강된 주요 구조물로는 오른쪽 시신경(optic nerve), 시각교차(optic chiasm), 왼쪽 시신경 경로(optic tract), 왼쪽 가쪽 무릎핵(lateral geniculate nucleus), 왼쪽 상구(superior colliculus) 등 오른쪽 망막의 대측(contralateral) 시신경 경로상의 구조물이었으며 동측(ipsilateral) 시신경 경로는 조영증강을 보이지 않았다. 결론: 시신경계의 말단부위인 망막에 $MnCl_2$를 주입한 후 시신경계의 축삭을 통한 망간이온의 전파를 비침습적으로 관찰 할 수 있었다. 이러한 망간이온의 전파는 전압 개폐성 칼슘채널을 통하여 일어나는 것으로 여겨지며 특히 망막에 직접 주입하는 경우 전압 개폐성 칼슘채널의 빠른 이동 경로를 이용하는 것으로 추측된다.

• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.23-31
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• 2015

Objective : The aims of this study were to investigate the quantitative relationship between pituitary macroadenoma size and degree of visual impairment, and assess visual improvement after surgical resection of the tumor. Methods : The medical records of patients with pituitary adenoma, who had undergone trans-sphenoidal adenectomy between January 2009 and January 2011, were reviewed. Patients underwent an ocular examination and brain MRI before and after surgery. The visual impairment score (VIS) was derived by combining the scores of best-corrected visual acuity and visual field. The relationship between VIS and tumor size/tumor type/position of the optic chiasm was assessed. Results : Seventy-eight patients were included (41 male, 37 female). Thirty-two (41%) patients experienced blurred vision or visual field defect as an initial symptom. Receiver operating characteristic curve analysis showed that tumors <2.2 cm tended to cause minimal or no visual impairment. Statistical analysis showed that 1) poor preoperative vision is related to tumor size, displacement of the optic chiasm in the sagittal view on MRI and optic atrophy, and 2) poorer visual prognosis is associated with greater preoperative VIS. In multivariate analysis the only factor significantly related to VIS improvement was increasing pituitary adenoma size, which predicted decreased improvement. Conclusion : Results from this study show that pituitary adenomas larger than 2 cm cause defects in vision while adenomas 2 cm or smaller do not cause significant visual impairment. Patients with a large macroadenoma or giant adenoma should undergo surgical resection as soon as possible to prevent permanent visual loss.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.61-64
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• 2002

As intensity modulated radiation therapy compared with conventional radiation therapy, tumor target dose increased and normal tissues and critical organs dose reduced. In brain tumor, treatment planning of intensity modulated radiation therapy was practiced in 4MV, 6MV, 15MV X-ray energy. In these X-ray energy, was considered the dose distribution and dose volume histogram. As 4MV X-ray compared with 6MV and 15MV, maximum dose of right optic-nerve increased 10.1 %, 8.4%. Right eye increased 5.2%, 2.7%. And left optic-nerve, left eye, optic chiasm and brainstem incrased 1.7% - 5.2%. Even though maximum dose of PTV and these critical organs show different from 1.7% - 10.1% according to X-ray energies, these are a piont dose. Therefore in brain tumor, treatment planning of intensity modulated radiation therapy in 9 treatment field showed no relation with energy dependency.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.20-25
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• 2001

Objectives : A substantial number of craniopharyngiomas recur despite gross total excision. The purpose of our study was to investigate pattern of recurrence and to verify prognostic factors for recurrence after gross total excision of craniopharyngiomas in children. Methods : A series of 36 patients with craniopharyngiomas were reviewed. All patients had undergone gross total excision and none of them received radiotherapy after initial surgery. Fifteen were girls and twenty-one were boys, with a mean age of 7.3 years(range, one to 15 years). The mean follow-up period was 52 months(range, one to 149 months). Recurrence was noted in 14 patients within 83 months(mean 31.4 months). Results : The overall three-year recurrence free survival rate was 65%, and the five-year recurrence-free survival rate was 55%. Regular neuroimaging follow-up at six to 12-month intervals detected tumor recurrence of a smaller size before symptoms developed(p<0.05). At the first surgical procedure, the optic nerve/chiasm(n=23) was the most common adhesion site. The most frequent sites of recurrence were the optic nerve/chiasm(n=6) and the pitiutary fossa(n=6). Tumor location was the single significant clinical predictor of recurrence. The five-year recurrence-free survival rate was 39% for those who had an intrasellar tumor component and 81% for those who did not (p<0.05). Conclusion : Craniopharyngiomas with intrasellar components should be followed cautiously and regular followup of patients should be emphasized, even when the tumors are totally resected.

• 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.

• Journal of Korean Neurosurgical Society
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• 제51권2호
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• pp.94-97
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• 2012

Tumors that metastasize to the pituitary gland are unusual, and are typically seen in elderly patients with diffuse malignant disease. The most common metastases to the pituitary are from primary breast and lung cancers. We report a 65-year-old woman with pituitary metastasis from breast cancer who presented with recent-onset left progressive deterioration of visual acuity and visual field. The clinical diagnosis was made after brain and sellar magnetic resonance imaging showed a large sellar mass compressing the optic chiasm and invading the pituitary stalk. An otorhinolaryngology and neurosurgery team removed the tumor via a transsphenoidal approach, and this procedure obtained symptomatic relief. Postoperatively, metastasis from breast invasive ductal adenocarcinoma was confirmed histologically. We report this unusual case with a review of the relevant literature.