• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.17-23
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• 2015

Background: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. Methods: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. Results: Two clivus tumor patients underwent transmaxillary approach; three tuberculum-sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. Conclusion: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.44-50
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• 2000

Objective : A few anecdotal cases of mesenchyme-derived tumors which grow into a cranial cavity have been reported that disclosed a dismal prognosis, due to their critical location, aggressive biological behavior, and high rate of surgical morbidity. The aim of this study is to search clinical factors related to these tumors. Methods : Eight patients who underwent surgical removal of intracranial mesenchymal tumors between January 1993 and December 1997 were studied retrospectively. The tumors included are three chordomas, two chondrosarcomas, two rhabdomyosarcomas, and one hemangiopericytoma. Authors compared clinical features, treatment, and results of our cases with reported cases. The mean follow-up period was 20.5 months. Results : All cases showed nonspecific, location-related clinical findings and arose from sphenopetroclival region. Single stage operation was performed in 4 cases, and skull base approaches in 3 cases. Adjuvant therapies were done in 2 cases. Recurrence was seen in 3 cases(37.5%), and 3 patients died. Interdisciplinary approach with otologic surgeon was done in 2 cases. Conclusion : Recent advancement of refined tactics has made these tumors amenable and provides prolongation of progression-free survival. These are modified skull base approaches, multi-modality treatment options, and inter-disciplinary team approaches. Good results may be expected for these mesenchymal tumors by aggressive resection and adjuvant therapies according to their biological nature.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.175-182
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• 2005

Skull base tumors have been determined inoperable because it is difficult to accurately diagnose the extent of the involvement and to approach and excise the tumor safely. However, recently, the advent of sophisticated diagnostic tools such as computed tomography and magnetic resonance imaging as well as the craniofacial and neurosurgical advanced techniques enabled an accurate determination of operative plans and safe approach for tumor excision. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amenable to local tissue closure. The purpose of this study is to analyze experiences of skull base reconstruction and to evaluate long term survival rate and complications. All cranial base reconstructions performed from July 1993 to September 2000 at Department of Plastic and Reconstructive Surgery of the Seoul National University Hospital were observed. The medical records were reviewed and analysed to assess the location of defects, reconstruction method, existence of the dural repair, history of preoperative radiotherapy and chemotherapy, complications and causes of death of the expired patients. There were 12 cases in region II, 8 cases in region I and 1 case in region III according to the Irish classification of skull base. Cranioplasty was performed in 4 patients with a bone graft and microvascular free tissue transfer was selected in 17 patients to reconstruct the cranial base and/or mid-facial defects. Among them, 11 cases were reconstructed with a rectus abdominis musculocutaneous free flap, 2 with a latissimus dorsi muscluocutaneous free flap, 1 with a fibular osteocutaneous free flap, 2 with a scapular osteocutaneous free flap, and 1 with a forearm fasciocutaneous free flap, respectively. During over 3 years follow-up, 5 patients were expired and 8 lesions were relapsed. Infection(3 cases) and partial flap loss(2 cases) were the main complications and multiorgan failure(3 cases) by cancer metastasis and sepsis(2 cases) were causes of death. Statistically 4-years survival rate was 68%. A large complex defects were successfully reconstructed by one-stage operation and, the functional results were also satisfactory with acceptable survival rates.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.910-917
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• 2000

Introduction : The management of chordomas and chondrosarcomas in the skull base is difficult due to the critical location, locally aggressive nature, and high recurrence rate. The authors present the effectiveness of surgical removal and radiation therapy on survival and tumor recurrence. Material and Methods : Thirty cranial base chordomas and chondrosarcomas from 23 patients(14 patients with chordomas and 9 patients with chondrosarcomas) were operated in our institution between 1985 and 1998. There were 15 men and 8 women, with a mean age of 40.7 years. The largest diameter of tumors ranged from 15 to 70mm (mean 41.5). The extent of surgical removal was subtotal or total in a half(15 operations). In nineteen operations, tumors were removed by conventional approaches and skull base approaches were applied in 11 operations. Postoperative radiation therapy was performed in 16(70%) patients. The mean duration of follow up is 50 months(1- 156 months). Results : The 3- and 5-year survival rates(YSR) of overall patient are 75% and 67%, respectively. The analysis showed that 1) skull base approach to chordomas and chondrosarcomas showed a tendency to remove more portion of the tumors(p＝0.058) but leave more frequent incidence of new deficits(p＝0.047) : 2) larger tumor diameter af-fected the extent of removal(p＝0.028) : 3) the extent of removal seemed to be the determining factor for overall survival and recurrence-free survival(the 5-YSR and RFSR of subtotal or total removal group are 92% and 80% vs. 40% of partial removal or biopsy group) : 4) conventional radiation therapy improved patient survival(5-YSR of patients who received RT is 76% whereas 5-YSR of those who didn't receive RT is 43%) but failed to prolong long-term recurrence-free survival. Conclusion : The extent of removal and postoperative radiation therapy are determining factors of patients' survival in skull base chordomas and chondrosarcomas. However, none of these factors significantly influenced the survival in multivariate analysis. Aggressive surgical removal of more than subtotal resection combined with postoperative radiation therapy seems to be the choice of therapy in the management of these tumors.

• 대한두경부종양학회:학술대회논문집
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• 대한두경부종양학회 2004년도 제21차 학술대회
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• pp.208-208
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• 2004

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.281-285
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• 2015

Myxomas are rare benign tumors that originate from mesenchymal tissue. They usually develop in the atrium of the heart, the skin, subcutaneous tissue, or bone. Involvement of the skull base with an intracranial extension is very rare and not well-described in the literature. We report a rare case of primary intracranial ossifying myxoma arising from the anterior skull base and mimicking a huge chondrosarcoma, and we review the relevant literature.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.118-125
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• 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.

• Investigative Magnetic Resonance Imaging
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• 제21권2호
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• pp.114-118
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• 2017

Dermoid cysts are benign congenital tumors composed of keratinizing squamous epithelium and dermal derivatives. They account for less than 1% of all intracranial tumors and are rarely exhibited at the base of the skull. To the best of our knowledge, only one case report has presented computed tomography and conventional T1-weighted magnetic resonance (MR) findings that revealed an infratemporal dermoid cyst. In the present study, we report an unusual case of a dermoid cyst in the right infratemporal fossa, which was incidentally detected by MR imaging with the Dixon technique. This article also highlights the importance of meticulous radiological review and the usefulness of the Dixon technique in everyday clinical practice.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1437-1444
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• 2000

저자들은 10년동안 수술을 시행받았던 212례의 수막종 환자중 뇌기저부에 위치한 61례에 대한 임상 분석을 시행한 결과 다음과 같은 결과를 얻었다. 1) 본 연구기간중 뇌기저부 수막종 환자는 61례로 전체의 29%를 차지하였으며, 평균 추적기간은 약 52개월이었다. 2) 성비는 여성이 남성보다 약 2배 많았으며, 평균연령은 52세였다. 3) 위치별로는 후두개와가 가장 많았으며, 전체적으로는 접형골연부, 천막부 및 소뇌교각부가 대부분을 차지하였다. 4) 호발증상 및 징후로는 두통, 뇌신경마비 및 소뇌징후 순으로 나타났다. 5) 종양제거정도는 심슨등급 I, II로 전적출한 경우가 82%이었으며, 심슨등급 III로 아전적출한 경우가 18%이었다. 6) 병리조직결과는 양성이 85%로 대부분을 차지하였으며, 비정형성과 악성은 각각 10%, 5%를 차지하였다. 7) 술후 보조적 치료는 악성, 부분적출 및 재발한 경우에 사용하였다. 8) 술후 합병증으로는 뇌척수액누출, 뇌신경마비 및 간질 발작 순이었다. 9) 술후 사망한 경우는 수술후 사망한 1례와 종양 재발에 의한 사망 2례이었다. 10) 재발은 약 15%로 심슨등급 III와 악성인 경우에 높았으며, 재발 위치는 천막부, 접형골연 및 소뇌교각부 순이었다. 결론적으로 뇌기저부 수막종의 수술은 종양 주변부의 중요한 구조물이 위치함에 따라 낮은 사망률 및 합병증 발생률을 가지고 수술적 적출이 어렵지만, 술전 방사선학적 소견의 정확한 이해와 적절한 접근법의 선택, 뇌기저부 재건술이 술후 합병증의 감소 및 종양적출을 위해 필수라고 생각한다.

• Investigative Magnetic Resonance Imaging
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• 제9권1호
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• pp.57-61
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• 2005

골육종은 주로 장골의 골간단 (metaphysic) 에 생기는 악성도가 매우 높은 종양으로 두개골에는 매우 드물게 생긴다. 저자들은 두개기저부에 생겨 접형골을 파괴시키면서 약 2개월 만에 재발한 골육종 1예를 보고하고자 한다. 두통과 어지러움증 그리고 오른족 볼쪽의 감각이 저하된 28세 남자의 전산화단층촬영과 자기공명영상소견에서 이 종양은 약 3cm 의 크기로 균일하게 조영증강이 잘 되면서 내부에 낭성변화가 동반된 소견을 보였다. 종양은 완전히 절제되었고 한달간의 항암요법을 시행하였다. 약 두 달후에 다시 시행한 자기공명영상 소견에서 처음 수술한 같은 부위에 다시 처음보다 크기가 더 큰 종양이 발견되었고 제 2차 수술후 병리소견에서 처음과 같은 골육종으로 확진되었다.