• Radiation Oncology Journal
• /
• v.21 no.1
• /
• pp.94-99
• /
• 2003

Purpose : To explore a 3D conformal radiotherapy technique for a posterior fossa boost, and the potential advantages of a prone position for such radiotherapy. Materials and Methods :A CT simulator and 3D conformal radiotherapy Planning system was used for the posterior fossa boost treatment on a 13-year-old medulloblastoma patient. He was placed In the prone position and Immobilized with an aquaplast mask and immobilization mold. CT scans were obtained of the brain from the top of the skull to the lower neck, with IV contrast enhancement. The target volume and normal structures were delineated on each slice, with treatment planning peformed using non-coplanar conformal beams. Results : The CT scans, and treatment In the prone position, were peformed successfully. In the prone position, the definition of the target volume was made easier due to the well enhanced tentorium, In audition, the posterior fossa was located anteriorly, and with the greater choice of beam arrangements, more accurate treatment planning was possible as the primary beams were not obstructed by the treatment table. Conclusion : .A posterior fossa boost, in the prone position, Is feasible in cooperating patients, but further evaluation is needed to define the optimal and most comfortable treatment positions.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.1
• /
• pp.118-125
• /
• 2000

Objective : Trigeminal neurinomas are rare tumors that may locate in the middle fossa or posterior fossa and straddled both the middle and posterior fossa, according to their origin in the nerve complex. The aim of this study was to analyze the clinical presentation, operative approaches employed and outcome in 15 patients who were treated surgically, with special emphasis on surgical approach. Method : Between 1994 and 1998, a total of fifteen patients were histopathologically identified as neurinomas originating from the trigeminal nerve complex at the tumor clinic in the neuroscience center of the our university. Results : The surgical approach to these tumors depends on their anatomical location and tumor size. Six patients had tumors confined to the middle fossa, five patients had tumors limited to the posterior fossa, and four patients both in middle and posterior fossa components of their tumors. Nine neurinomas were removed via the conventional approach(pterional, subtemporal, suboccipital) and six were excised using skull base approach(transzygomatic subtemporal, orbitozygomatic, transpetrosal). Total resection of the tumor was possible in 10 cases. Total resection of tumor was accomplished in 83% of patients following skull base approach compared with 56% of patients following conventional approach. The surgical outcome was excellent or good in 13 cases, fair in one and, poor in one. There was no operative death. In the immediate postoperative period, aggravation of preoperative facial hypesthesia and 6th cranial nerve palsy were common. Although, these deficits were generally transient, eight patients remained with some degree of trigeminal hypesthesia, two had facial weakness, one neurotrophic keratitis, one diplopia, and one mastication difficulty. Conclusion : Surgical approach to the trigeminal neurinoma depends on the tumor location and tumor size. Skull base approach provides more complete tumor excision without increased morbidity compared to conventional approach. Surgeons have to be meticulous in order to reduce postoperative complication.

• Journal of the Korean Arthroscopy Society
• /
• v.17 no.1
• /
• pp.84-87
• /
• 2013

At the posterior aspect of distal thigh, major nerves, vessels, muscles and tendons were located. So, if abscess occurs within deep muscular fascia of posterior aspect of distal thigh, it can be widely and deeply spread to proximal thigh, popliteal fossa, posterior proximal leg, surrounding areas of knee joint along deep fascia, muscles and tendons. In that case, it is difficult to eradicate the abscess using antibiotics without surgical drainage and debridement. But, it is often impossible to obtain satisfactory view of operative field with conventional technique and critical damage to major nerves and vessels in the popliteal fossa during operation may occur. We performed endoscopic treatment for extensive deep abscesses occurred in posterior aspect of distal thigh in 64-year-old man, and obtained satisfactory result without injury to the normal structures including major nerves and vessels. So we report this case with a review of relevant literatures.

• Imaging Science in Dentistry
• /
• v.46 no.1
• /
• pp.47-51
• /
• 2016

Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
• /
• v.21 no.2
• /
• pp.353-365
• /
• 1991

The author analyzed and compared tomographs with lateral oblique transcranial radiographs of 60 temporomandibular joints from 30 asymptomatic young adults. The results were as follows: 1. The mean height & width of condylar head were 6.82±1.99㎜, 11.98±1.28㎜ in tomographs and 5.41±0.79㎜, 10.67±1.28㎜ in transcranial radiographs. The mean height of articular fossa was 10.19±1.60㎜ in tomographs and 8.44±1.65㎜ in transcranial radiographs. 2. The mean width of articular fossa was 20.71 ±2.98㎜ in tomographs and 17.47±2.58㎜ in transcranial radiographs. There were significant differences in both the height and the width of articular fossa between two radiographic techniques (P<0.01). 3. In centric occlusion, the superior joint spaces were 4.28±1.09㎜, 4.18±1.28㎜, the anterior joint spaces were 2.84±1.02㎜, 2.53±0.72㎜, the posterior joint spaces were 3.11±1.19㎜, 2.66±0.89㎜ in tomographs and transcranial radiographs respectively. There were significant differences in right posterior joint spaces (P<0.05), and posterior joint spaces (P<0.05) between two radiographic techniques. 4. The condylar position in articular fossa was displaced posteroinferiorly (-0.35±4.40㎜ posteriorly, -1.55±1.24㎜ inferiorly) in tomographs and anteroinferiorly (0.45±3.77㎜ anteriorly, -1.29±1.26㎜ inferiorly) in transcranial radiographs with 1 inch opening. In maximum opening, it was displaced anteroinferiorly (5.39±3.63㎜ anteriorly, -1.22±1.67㎜ inferiorly) in tomographs and anteroinferiorly (6.35±4.00㎜ anteriorly, -0.55 ±1.98㎜ inferiorly) in transcranial radiographs. There was significant difference in superoinferior positions of both condyles with maximum opening between two radiographic techniques (P<0.05).

• Journal of Korean Neurosurgical Society
• /
• v.30 no.sup2
• /
• pp.340-343
• /
• 2001

Arachnoid cysts are defined as duplicated arachnoids and their splitting with congenital, intra-arachnoid, and leptomeningeal malformations. They are most commonly located in the middle cranial fossa followed by suprasellar and quadrigeminal cisterns, posterior fossa, and very rare in cerebral convexities. They are often ruptured by trauma or spontaneously and cause subdural hygroma or subdural hematoma. Authors report a case of a 32-year-old woman with a convexity arachnoid cyst mimicking subdural hygroma associated with a separate middle fossa arachnoid cyst. Preoperatively, the convexity arachnoid cyst was misinterpreted as subdural hygroma resulted from a ruptured middle fossa cyst. The patient underwent craniotomy and cyst fenestration into the basal cistern. Two separate arachnoid cysts were found in the cerebral convexity and middle cranial fossa during the operation. Finally, cysts were resolved and she was discharged without any complication.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
• /
• v.21 no.1
• /
• pp.65-72
• /
• 1991

For the enhancement of a comprehension in temporomandibular joint radiographs, the author has compared and analysed the roentgenographic images of the temporomandibular joint of human dry skull which was taken by submentovertex projection, panoramic radiography, oblique lateral transcranial projection, corrected anterio-posterior tomogram and corrected lateral tomogram. The obtained results were as follows. 1. The submentovertex projection represented in detail the both poles and the posterior surface of the condylar head of the mandible. 2. The oblique lateral transcranial projection represented the articular space, the outer contour of the condylar head and the position of the condylar head within the mandibular fossa, but the relationship of the temporomandibular joint was not revealed accurate, because of the oblique direction of a central ray in taking radiographs. 3. The corrected antero-posterior tomogram was superior method in representation of roent- genographic images of the superior surface and the both poles of the condylar head and the corrected lateral tomogram was considered as the most accurate method among some radiographic techniques for the interpretation of articular space and condyle-fossa relationship. 4. It was possible to observe three-dimensionally the head of condyle with the combinated use of submentovertex projection, corrected antero-posterior tomogram and corrected lateral tomogram.

• The Korean Journal of Pain
• /
• v.25 no.4
• /
• pp.275-277
• /
• 2012

The pain around the posterior knee, called 'popliteal fossa', has been known to be caused by a variety of disease entities. Venous malformation is a very rare cause of popliteal area pain, and its diagnosis is frequently delayed, missed, or given incorrectly. Here, we report a case of a patient with popliteal fossa pain for 2 years and was diagnosed as intramuscular venous malformation using ultrasound.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.4
• /
• pp.383-387
• /
• 2010

Complete removal of three-compartment trigeminal schwannomas is a challenge to neurosurgeons. To expand exposure of each compartment, the combination and modification of skull base approaches are necessary. The 61-year-old woman was admitted with chronic headache. Preoperative magnetic resonance imaging showed $47{\times}50{\times}40\;mm$-sized tumor originating primarily in the middle cranial fossa extended to the posterior and the infratemporal fossa. We performed operation in five stage; 1. Zygomatic osteotomy, 2. Inferior temporal fossa plate removal and foramen ovale opening, 3. Cavernous sinus opening, 4. Tailored anterior petrosectomy, 5. Meckel's cave opening. Combination of skull base surgery should be concerned according to the patient. In this study, extradural basal extension with zygomatic osteotomy, interdural posterior extension with tailored anterior petrosectomy, and intracavemous exploration are reasonable options for remodeling three-compartment lesion into a single compartment. Tailoring of bone resection and exploring through natural pathway between meningeal layers accomplish single-stage operation for complete removal of tumors.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.1
• /
• pp.53-57
• /
• 2011

We reported a unique case of posttraumatic giant infratentorial extradural intradiploic epidermoid cyst. A 54-year-old male, with a previous history of an open scalp injury and underlying linear skull fracture in the left occipital region in childhood, presented with a painful subcutaneous swelling, which had been developed gradually in the same region and moderate headache, nausea, vomiting and cerebellar ataxia. The duration of symptoms on admission was 3 months. Imaging studies revealed occipital bone destruction and giant extradural intradiploic lesion. The preoperative diagnosis was giant infratentorial extradural intradiploic epidermoid cyst. Surgery achieved total removal of the lesion, which was histologically confirmed and the postoperative course was uneventful. To our knowledge, this is the first case of giant infratentorial extradural intradiploic epidermoid cyst with a traumatic etiology described in the literature.