KISEP Case Reports Korean J Otolaryngol 1999;42:232-6 경미로접근법으로제거한거대소뇌교각종양 4 예 박찬민 황보철 신종헌 손수준 Four Cases of Large Cerebellopontine ngle Tumors Removed by Translabyrinthine pproach Chan Min Park, MD, Cheul Hwangbo, MD, Jong Heon Shin, MD and Soo Joon Sohn, MD Department of Otolaryngology, Fatima Hospital, Taegu, Korea BSTRCT Several approaches to the cerebellopontine angle and internal auditory canal have been described for the removal of large acoustic tumors. Of these, the translabyrinthine removal of the large cerebellopontine angle tumors requires extensive removal of bones in order to manage the low-lying tegmen, the anterior sigmoid sinus, and the high jugular bulb. We removed 4 large cerebellopontine angle tumors by the translabyrinthine approach alone. ll tumors were totally removed with acceptable facial nerve function. There was a case of CSF leak which was repaired at the revision surgery. Korean J Otolaryngol 1999;42:232-6 KEY WORDSLarge cerebellopontine angle tumor Translabyrinthine approach. 232
Table 1. Summary of 4 large cerebellopontine angle tumors removed by translabyrinthine approach Case number Sex / age Side Size cm Symptoms 1 F/60 Left 5 2 F/65 Right 4.2 3 F/39 Left 5 4 F/56 Right 3.8 Hearing loss Dizziness Preop. PTdB CT SR Total deafness Canal paresis bsent Tumor excision Total Facial nerve* Hearing loss Total deafness Facial numbness Dead labyrinth Dizziness taxia bsent Total V/III 60 Hearing loss Facial numbness bsent Total V/III Facial weakness Vomiting Headache Hearing loss 65 Dead labyrinth bsent Total I/I I/I Pathology Meningioma coustic neurinoma coustic neurinoma Meningioma Complication CSF leakage *Facial motor function in House-Brackmann grade checked at postoperative 1 day/11 monthsaverage of 4 cases. PTPure Tone verage CTCaloric test SRStapedial reflex 233
거대 소뇌교각종양 로 호전되었다. 병리조직검사상 청신경초종으로 확진되었다. 의 조영증강이 잘 되는 종양이 좌측 소뇌교각부에서 관찰 되었다(Fig. 1). 수술소견상 상전정신경에서 기시한 종양은 증 례 3 내이도에서 안면신경과 유착되어 있었고 소뇌교각을 벗어 39세의 여자환자로 3년간의 좌측 청력소실과 이명 그리 나 천막, 삼차신경, 그리고 높게 위치한 경정맥구와도 유착 고 약 1년간의 좌측 안면의 마비와 감각둔마 등을 주소로 을 보였다. 종양이 거대하고 유양동이 좁아서 S상정맥동의 하여 내원하였다. 이학적 검사상 양측 고막은 정상이었으 후방 및 측두골 인부의 골을 광범위하게 제거하여 수술시 며 좌측은 Hitselberger검사가 양성이었고 grade II의 안 야를 확장하였다. 경정맥구를 덮고 있는 골판을 제거한 후 면마비가 관찰되었다. 우측의 청력은 정상이었으나 좌측은 Surgicel 과 bone wax를 이용하여 경정맥구를 하방으로 순음청력검사상 60 db의 감각신경성 난청을 나타내었고 압박하고 이어서 내이도 하방의 골을 제거하여 종양의 하 등골근반사는 음성이었다(Table 1). 뇌 MRI상 5 cm 크기 부를 노출시켰다. 후두개 경막을 크게 열자 유양동으로 밀 B C D Fig. 1. Preoperative postgadolinium T1 weighted axial image. case 1. There is a 5 cm-sized mass in left cerebellopontine angle. B case 2. There is a 4.2 cm-sized cystic mass in right cerebellopontine angle. C case 3. There is a 5 cm-sized mass in left cerebellopontine angle. D case 4. There is a 3.8 cm-sized mass in right cerebellopontine angle. 234 Korean J Otolaryngol 1999;42:232-6
B Fig. 2. Postoperative postgadolinium T1 weighted axial images of case 3 and 4B. The tumors were totally removed. 235
REFERENCES 1) Cushing H. Further concerning acoustic neuromas. Laryngoscope 192131209-28. 2) House WF. coustic neuroma monograph. rch Otolaryngol Head Neck Surg 196480598-757. 3) House WF. Surgical exposure of the internal auditory canal and its contents through the middle cranial fossa. Laryngoscope 19611363-85. 4) House WF, Hitselberger WE. The transcochlear approach to the skull base. rch Otolaryngol 1976102334-42. 5) Jackler RK, Pitts LH. Selection of surgical approach to acoustic neuroma. Otolaryngol Clin North m 199225361-87. 6) Brackmann DE, Green JD. Translabyrinthine approach for acoustic tumor removal. Otolaryngol Clin North m 199225311-29. 7) DiTullio MV, Malkasian D, Rand R. critical comparison of the neurosurgical and otolaryngological approaches to acoustic neuromas. J Neurosurg 1978481-12. 8) Tator CH, Nedzelski JM. Facial nerve preservation in patients with large acoustic neuromas treated by a combined middle fossa ranstentorial translabyrinthine approach. J Neurosurg 1982571-7. 9) House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 198593184-93. 10) Jackler RK. coustic neuroma. InJackler RK, Brackmann DE, editors. Neurotology. St. LouisMosby year book1994. p.729-85. 11) Friedman R, Brackmann DE, van Loveren HR, Hitselberger WE. Management of the contracted mastoid in the translabyrinthine removal of acoustic neuroma. rch Otolaryngol Head Neck Surg 1997123342-44. 12) Tos M, Thomsen J, Harmsen. Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size. cta Otolaryngol Stockh 1988;suppl. 45238-51. 13) Fagan P, Sheehy JP, Chang P, Doust BD, Coakley D, tlas MD. The cerebellopontine angledoes the translabyrinthine approach give adequate access? Laryngoscope 1998108:679-82. 14) Suh JS, Lee SH, Bae SH, Park JK, Yang MK. Combined approach for large tumor of cerebellopontine angle. Korean J Otolaryngol 199235709-15. 15) Thedinger B, Glasscock ME, Cueva R. Transcochlear transtentorial approach for removal of large cerebellopontine angle meningiomas. m J Otol 199213408-15. 236 Korean J Otolaryngol 1999;42:232-6