• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.38-38
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• 1991

콜레스테롤 육아종은 콜레스테롤 결정이 주위조직에 이물질로 작용하여 육아성 반응 및 골파괴 반응을 유발시키는 질환으로 병리조직학적으로 많은 콜레스테롤 결정이 거대세포를 가진 만성적인 염증성 침윤속에 나타나는것을 특징으로 한다. 이 병변은 아주 드물지만 특징적인 방사선적소견, 병리조직학적 소견과 임상양상으로 쉽게 진단이 된다. 두부에서는 다양한 위치에서 발견되는데 특히 함기화가 잘 된 측두골, 유양동, 고실강에서 많이 보이며 전두골, 상악골, 협골, 인상측두골 및 후두개와에서도 보고되고 있으나 부비동에 발생하는것은 특히 드물다. 부비동에서 발생한 콜레스테롤 육아종의 발생기전은 환기장애설, 배출장애설 및 출혈설 등으로 보고되고 있다. 저자들은 최근 복시와 측두통을 호소하는 50세 여자환자에서 접형동에 발생한 콜레스테롤 육아종이 우측 상안와열 (superior orbital fissure)과 경사대(clivus)를 파괴하며 전교조 (Prepontine cistern)로 확장된 1례를 경험하였기에 임상 증세, 특징적인 전산화단층 및 핵자기공명소견과 병리조직학적인 소견을 문헌 고찰과 함께 보고하는 바이다.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.28-32
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• 2010

Purpose: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. Methods: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients (0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of $Medpor^{(R)}$. Clinical symptoms and signs were a little different from each other. Results: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP (visual evoked potential), visual field test, electromyogram. With ophthalmologic test and followup CT, we can rule out the orbital apex syndrome. We gave $Salon^{(R)}$ (methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with $Methylon^{(R)}$ (methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. Conclusion: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.18 no.2
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• pp.86-92
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• 2005

Painful ophthalmoplegia due to idiopathic granulomatous inflammation of the cavernous sinus/superior orbital fissure has been termed Tolosa-Hunt syndrome(THS). The syndrome is characterized by pain behind, above or around the eye, involvement of the cranial nerves which pass through the cavernous sinus, spontaneous remissions and exacerbations, and a favourable response to steroid therapy. There was the 56 years old man who suffered from painful ophthalmoplegia and facial palsy. The oriental medical treatment without steroids and analgesics reduced the symptoms of the patient remarkably during 5 weeks. There is few report that treat THS with oriental medical method. If more clinical trials like this are proved to be effective, we can expect that oriental medical treatment will be a good method in THS.

• 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.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.391-395
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• 2012

Objective : Removal of the anterior clinoid process (ACP) is an essential process in the surgery of giant or complex aneurysms located near the proximal internal carotid artery or the distal basilar artery. An extradural clinoidectomy must be performed within the limits of the meningeal layers surrounding the ACP to prevent morbid complications. To identify the safest method of extradural exposure of the ACP, anatomical studies were done on cadaver heads. Methods : Anatomical dissections for extradural exposure of the ACP were performed on both sides of seven cadavers. Before dividing the frontotemporal dural fold (FTDF), we measured its length from the superomedial apex attached to the periorbita to the posterolateral apex which connects to the anterosuperior end of the cavernous sinus. Results : The average length of the FTDF on cadaver dissections was 7 mm on the right side and 7.14 mm on the left side. Cranial nerves were usually exposed when cutting FTDF more than 7 mm of the FTDF. Conclusion : The most delicate area in an extradural anterior clinoidectomy is the junction of the FTDF and the anterior triangular apex of the cavernous sinus. The FTDF must be cut from the anterior side of the triangle at the periorbital side rather than from the dural side. The length of the FTDF incision must not exceed 7 mm to avoid cranial nerve injury.