Young Seok Han, Joo Yeon Kim, Chang Hoi Kim, Jae Hwan Kwon
Lipoma is the most common benign tumor in adults, but it is rare in the nasal cavity, paranasal si-nus, and nasal septum. A 44-year-old woman who had a fat autograft during pituitary surgery two months ago visited with a headache and a fetid odor. Although there were no specific findings on her nasal endoscopy, 2.0 cm × 1.5 cm homogenous low-density mass was persisted in the posterior septum and sphenoid sinus on non-contrast computed tomography. Under general anesthesia, we completely removed the mass through endoscopic sinus surgery and postoperative histopathology confirmed it as a fibrolipoma. We report a case of nasal septal fibrolipoma resulting from autologous fat grafted during surgical removal of a pituitary tumor.
脂肪瘤是成人最常见的良性肿瘤，但在鼻腔、鼻窦和鼻中隔是罕见的。一位44岁的女性，在两个月前的垂体手术中接受了自体脂肪移植手术，她出现头痛和恶臭。虽然鼻内窥镜检查未见特异性发现，但非对比ct显示后鼻中隔及蝶窦内持续存在2.0 cm × 1.5 cm均匀低密度肿块。在全身麻醉下，我们通过内窥镜鼻窦手术完全切除了肿块，术后组织病理学证实为纤维脂肪瘤。我们报告一例鼻中隔纤维脂肪瘤由自体脂肪移植在手术切除垂体瘤。
{"title":"A case of iatrogenic septal lipoma after transsphenoidal approach of a pituitary surgery","authors":"Young Seok Han, Joo Yeon Kim, Chang Hoi Kim, Jae Hwan Kwon","doi":"10.55911/jksbs.23.0007","DOIUrl":"https://doi.org/10.55911/jksbs.23.0007","url":null,"abstract":"Lipoma is the most common benign tumor in adults, but it is rare in the nasal cavity, paranasal si-nus, and nasal septum. A 44-year-old woman who had a fat autograft during pituitary surgery two months ago visited with a headache and a fetid odor. Although there were no specific findings on her nasal endoscopy, 2.0 cm × 1.5 cm homogenous low-density mass was persisted in the posterior septum and sphenoid sinus on non-contrast computed tomography. Under general anesthesia, we completely removed the mass through endoscopic sinus surgery and postoperative histopathology confirmed it as a fibrolipoma. We report a case of nasal septal fibrolipoma resulting from autologous fat grafted during surgical removal of a pituitary tumor.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"201 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135928914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ju Yeob Lee, Bo Young Kim, Jung Yeon Kim, Young-Soo Chang
A dermoid cyst is an unusual congenital anomaly that is lined by squamous epithelium and contains skin adnexal structures, such as sebaceous glands and hair follicles. Only a few cases of dermoid cysts have been reported to occur around the auricle and several benign tumors should be considered in the differential diagnosis. In this article, the authors have experienced a 12-year-old female with the congenital painless mass at the left auriculotemporal area. The computed tomography showed a low-contrast enhancing mass similar to adipose tissue. The lesion was considered as a lipoma until we observed the skin adnexal structures when it ruptured intraoperatively. Although benign tumors are rarely involved in the auriculotemporal area, presenting without symptoms, it is recommended of complete excision to prevent the possibility of malignancy, recurrence, or infection. Thus, we report a very rare case of a dermoid cyst of the auriculotemporal area with the literature review.
{"title":"A dermoid cyst misdiagnosed as a lipoma in the auriculotemporal area","authors":"Ju Yeob Lee, Bo Young Kim, Jung Yeon Kim, Young-Soo Chang","doi":"10.55911/jksbs.23.0011","DOIUrl":"https://doi.org/10.55911/jksbs.23.0011","url":null,"abstract":"A dermoid cyst is an unusual congenital anomaly that is lined by squamous epithelium and contains skin adnexal structures, such as sebaceous glands and hair follicles. Only a few cases of dermoid cysts have been reported to occur around the auricle and several benign tumors should be considered in the differential diagnosis. In this article, the authors have experienced a 12-year-old female with the congenital painless mass at the left auriculotemporal area. The computed tomography showed a low-contrast enhancing mass similar to adipose tissue. The lesion was considered as a lipoma until we observed the skin adnexal structures when it ruptured intraoperatively. Although benign tumors are rarely involved in the auriculotemporal area, presenting without symptoms, it is recommended of complete excision to prevent the possibility of malignancy, recurrence, or infection. Thus, we report a very rare case of a dermoid cyst of the auriculotemporal area with the literature review.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"104 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135928925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inseo Hong, Kyung Hwan Kim, Huyk-Jin Oh, Sae Min Kwon, Hee-Won Jeong, Eun-Oh Jung, Han-Joo Lee, Hyon-Jo Kwon, Seung-Won Choi, Seon-Hwan Kim, Hyeon-Song Koh, Jin-Young Youm
Background: Brainstem cavernous malformations (CMs) are characterized by dilated sinusoidal channels related to capillary telangiectasia and developmental venous anomalies. Brainstem CM hemorrhages present with focal neurological symptoms, according to their invasive lesions. Surgical removal should be considered for symptomatic and recurrent bleeding of brainstem CMs. Despite the risk of surgery with highly eloquent tissue, surgical removal should be performed to protect patients from stepwise decline due to recurrent hemorrhage. The approaches for treating brainstem CMs are retrosigmoid, far lateral, midline suboccipital with or without telovelar, orbitozygomatic, and supracerebellar-infratentorial. Pontine and medullary CMs are approached via retrosigmoid, far lateral, and suboccipital craniotomies, with or without the telovelar approach.
Materials and Methods: The telovelar approach is the standard approach used for pontine brain-stem CMs. Patients with brainstem CMs treated using the telovelar approach were enrolled from three institutions.
Results: All three patients had no further neurological deficits after surgery.
Conclusions: The surgical results suggest that the telovelar approach for pons and pontomedul-lary junction brainstem CMs is safe and effective.
{"title":"The surgical outcomes and nuances of the telovelar approach for pontine and medullary cavernous malformations: A multi-institutional case series","authors":"Inseo Hong, Kyung Hwan Kim, Huyk-Jin Oh, Sae Min Kwon, Hee-Won Jeong, Eun-Oh Jung, Han-Joo Lee, Hyon-Jo Kwon, Seung-Won Choi, Seon-Hwan Kim, Hyeon-Song Koh, Jin-Young Youm","doi":"10.55911/jksbs.23.0010","DOIUrl":"https://doi.org/10.55911/jksbs.23.0010","url":null,"abstract":"Background: Brainstem cavernous malformations (CMs) are characterized by dilated sinusoidal channels related to capillary telangiectasia and developmental venous anomalies. Brainstem CM hemorrhages present with focal neurological symptoms, according to their invasive lesions. Surgical removal should be considered for symptomatic and recurrent bleeding of brainstem CMs. Despite the risk of surgery with highly eloquent tissue, surgical removal should be performed to protect patients from stepwise decline due to recurrent hemorrhage. The approaches for treating brainstem CMs are retrosigmoid, far lateral, midline suboccipital with or without telovelar, orbitozygomatic, and supracerebellar-infratentorial. Pontine and medullary CMs are approached via retrosigmoid, far lateral, and suboccipital craniotomies, with or without the telovelar approach. 
 Materials and Methods: The telovelar approach is the standard approach used for pontine brain-stem CMs. Patients with brainstem CMs treated using the telovelar approach were enrolled from three institutions. 
 Results: All three patients had no further neurological deficits after surgery. 
 Conclusions: The surgical results suggest that the telovelar approach for pons and pontomedul-lary junction brainstem CMs is safe and effective.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"158 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ho Che Jung, Hyun Seok Lee, Kyung Rae Cho, Kwan Park
Background: Cerebrospinal fluid (CSF) leakage is one of major complication following cranial surgery. Many studies have been introducing surgical methods to prevent CSF leakage. Technique applying dural substitutes are being studied for its efficacy for preventing CSF leakage. We introduce four layer onlay stacking repair (FLOSR), effective dural closing technique for preventing CSF leak-age, while avoiding application of foreign material intradural space.
Materials and Methods: Retrospective analysis of patients undergone microvascular decompres-sion (MVD) surgery for hemifacial spasm (HFS) and trigeminal neuralgia (TN) by a single surgeon in single center between September 2020 and September 2022 was done. MVD was done by retro-mastoid suboccipital approach. Number of patients who had CSF leakage, symptoms occurred by CSF leakage and treatment done for the patients were collected.
Results: In this study, 355 patients underwent MVD for HFS and TN and 4 were excluded. Three patients of selected 351 patients who underwent MVD for HFS were suspected for CSF leakage which counts for approximately 0.9% of patients. All patients suspected for CSF leakage underwent MVD for HFS (3 of 3, 100%). Continuous lumbar drainage of 180-240 cc per day for 5 days was done and every patient had symptom improvement.
Conclusions: FLOSR provided an effective method intra-operatively in preventing and lowering risk of severe CSF leakage after craniotomy by RMSOC (retromastoid suboccipital craniotomy) ap-proach without the risk of placing foreign materials inside dura.
{"title":"Four layer onlay stacking repair of dura preventing cerebrospinal fluid leakage in microvascular decompression","authors":"Ho Che Jung, Hyun Seok Lee, Kyung Rae Cho, Kwan Park","doi":"10.55911/jksbs.23.0018","DOIUrl":"https://doi.org/10.55911/jksbs.23.0018","url":null,"abstract":"Background: Cerebrospinal fluid (CSF) leakage is one of major complication following cranial surgery. Many studies have been introducing surgical methods to prevent CSF leakage. Technique applying dural substitutes are being studied for its efficacy for preventing CSF leakage. We introduce four layer onlay stacking repair (FLOSR), effective dural closing technique for preventing CSF leak-age, while avoiding application of foreign material intradural space.
 Materials and Methods: Retrospective analysis of patients undergone microvascular decompres-sion (MVD) surgery for hemifacial spasm (HFS) and trigeminal neuralgia (TN) by a single surgeon in single center between September 2020 and September 2022 was done. MVD was done by retro-mastoid suboccipital approach. Number of patients who had CSF leakage, symptoms occurred by CSF leakage and treatment done for the patients were collected.
 Results: In this study, 355 patients underwent MVD for HFS and TN and 4 were excluded. Three patients of selected 351 patients who underwent MVD for HFS were suspected for CSF leakage which counts for approximately 0.9% of patients. All patients suspected for CSF leakage underwent MVD for HFS (3 of 3, 100%). Continuous lumbar drainage of 180-240 cc per day for 5 days was done and every patient had symptom improvement.
 Conclusions: FLOSR provided an effective method intra-operatively in preventing and lowering risk of severe CSF leakage after craniotomy by RMSOC (retromastoid suboccipital craniotomy) ap-proach without the risk of placing foreign materials inside dura.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Young Jun Seo, Jeong Hae Park, Suk-Ho Moon, Shi Nae Park
Cochlear implant (CI) is an effective surgical option for managing severe sensorineural hearing loss. Among the postoperative complications, implant exposure has been considered as one of the most threatening and serious complications. Conventionally, replacing a new device after a removal of the exposed one has been well known to be performed. Salvaging the exposed implant without explanta-tion can be challenging and beneficial and recently has been reported as an alternative management option. Here, we report our experience salvaging two cases of exposed cochlear implants using a rotational scalp flap reconstruction combined with implant coverage with a galeal flap.
{"title":"Management of exposed cochlear implants: Two cases of salvaging implants using rotational scalp flap and galeal flap","authors":"Young Jun Seo, Jeong Hae Park, Suk-Ho Moon, Shi Nae Park","doi":"10.55911/jksbs.23.0015","DOIUrl":"https://doi.org/10.55911/jksbs.23.0015","url":null,"abstract":"Cochlear implant (CI) is an effective surgical option for managing severe sensorineural hearing loss. Among the postoperative complications, implant exposure has been considered as one of the most threatening and serious complications. Conventionally, replacing a new device after a removal of the exposed one has been well known to be performed. Salvaging the exposed implant without explanta-tion can be challenging and beneficial and recently has been reported as an alternative management option. Here, we report our experience salvaging two cases of exposed cochlear implants using a rotational scalp flap reconstruction combined with implant coverage with a galeal flap.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"70 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chondrosarcoma is a slow-growing tumor, a rare lesion in the skull base. The mainstay of treatment for chondrosarcoma is surgical resection, with or without adjuvant radiation therapy. We report a case of skull base chondrosarcoma in a 35-year-old man, which was successfully treated by surgical resection via a modified infratemporal fossa type A approach.
{"title":"A case of skull base chondrosarcoma treated by modified infratemporal fossa type A approach","authors":"Jae Ha Lee, Se A Lee, Ki Nam Park, Jong Dae Lee","doi":"10.55911/jksbs.23.0008","DOIUrl":"https://doi.org/10.55911/jksbs.23.0008","url":null,"abstract":"Chondrosarcoma is a slow-growing tumor, a rare lesion in the skull base. The mainstay of treatment for chondrosarcoma is surgical resection, with or without adjuvant radiation therapy. We report a case of skull base chondrosarcoma in a 35-year-old man, which was successfully treated by surgical resection via a modified infratemporal fossa type A approach.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This study aims to evaluate retrospectively the surgical outcomes and associated complications of vestibular schwannoma in a low-volume, single-center institution. We intend to discuss strategies that may improve clinical outcomes in the surgical treatment of vestibular schwan-noma in low-volume medical centers and the correlation between the case volume of medical center and clinical outcomes.
Materials and Methods: From January 2018 to December 2022, 13 patients (5 males and 8 fe-males; median age, 66 years) underwent surgery for vestibular schwannoma. The surgeries were performed by a single surgeon who initiated the clinical practice. The median length of tumors was 35 mm (range, 13-55 mm).
Results: Among 13 patients, 10 patients (76.9%) underwent retromastoid suboccipital craniotomy, 3 patients (23.1%) underwent translabyrinthine approach, 4 patients (30.8%) underwent subtotal resection, 6 patients (46.2%) underwent near-total resection, and 3 patients (23.1%) underwent gross total resection. The facial nerve preservation rate was 84.6% (n = 11). Hearing preservation rate was 30.7% (n = 4).
Conclusions: The surgical outcomes of vestibular schwannoma are not directly influenced by the volume of the medical institution. Instead, they are dependent on factors such as proper surgical planning, appropriate selection of surgical approaches and using intraoperative monitoring.
{"title":"Surgical outcomes of vestibular schwannoma in the low-volume center","authors":"Jae-Woong Lee, Hyuk-Jin Oh, Jong-Hyun Park, Gi-Yong Yoon, Jae-Min Ahn, Seok-Mann Yoon","doi":"10.55911/jksbs.23.0013","DOIUrl":"https://doi.org/10.55911/jksbs.23.0013","url":null,"abstract":"Background: This study aims to evaluate retrospectively the surgical outcomes and associated complications of vestibular schwannoma in a low-volume, single-center institution. We intend to discuss strategies that may improve clinical outcomes in the surgical treatment of vestibular schwan-noma in low-volume medical centers and the correlation between the case volume of medical center and clinical outcomes.
 Materials and Methods: From January 2018 to December 2022, 13 patients (5 males and 8 fe-males; median age, 66 years) underwent surgery for vestibular schwannoma. The surgeries were performed by a single surgeon who initiated the clinical practice. The median length of tumors was 35 mm (range, 13-55 mm).
 Results: Among 13 patients, 10 patients (76.9%) underwent retromastoid suboccipital craniotomy, 3 patients (23.1%) underwent translabyrinthine approach, 4 patients (30.8%) underwent subtotal resection, 6 patients (46.2%) underwent near-total resection, and 3 patients (23.1%) underwent gross total resection. The facial nerve preservation rate was 84.6% (n = 11). Hearing preservation rate was 30.7% (n = 4).
 Conclusions: The surgical outcomes of vestibular schwannoma are not directly influenced by the volume of the medical institution. Instead, they are dependent on factors such as proper surgical planning, appropriate selection of surgical approaches and using intraoperative monitoring.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyeon Gyu Yang, Joonho Byun, Sang Woo Song, Young-Hoon Kim, Chang Ki Hong, Jeong Hoon Kim
In this case report, we present a rare case of a suspicious central nervous system (CNS) high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR). A 29-year-old woman ini-tially presented with an incidental ventricular tumor detected on computed tomography. The brain magnetic resonance imaging revealed a 6 × 5 cm heterogeneously enhancing solid cystic mass with coarse calcifications in the right lateral ventricle. Preoperative radiological diagnosis suggested a cen-tral neurocytoma, and subsequent surgery was done in gross total resection with satisfactory recov-ery. However, after three years, tumor recurrence was observed, leading to revision surgery. Based on the histopathological evaluation according to the 2021 World Health Organization classification, the tumor was suggested as CNS HGNET-BCOR. Adjuvant radiotherapy was planned as part of the treatment strategy. This case report contributes to the limited knowledge about intraventricular CNS HGNET-BCOR tumors, offering insights into diagnosis and treatment approaches for this rare en-tity.
{"title":"Surgical experience of a rare ventricular tumor: A case report","authors":"Hyeon Gyu Yang, Joonho Byun, Sang Woo Song, Young-Hoon Kim, Chang Ki Hong, Jeong Hoon Kim","doi":"10.55911/jksbs.23.0021","DOIUrl":"https://doi.org/10.55911/jksbs.23.0021","url":null,"abstract":"In this case report, we present a rare case of a suspicious central nervous system (CNS) high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR). A 29-year-old woman ini-tially presented with an incidental ventricular tumor detected on computed tomography. The brain magnetic resonance imaging revealed a 6 × 5 cm heterogeneously enhancing solid cystic mass with coarse calcifications in the right lateral ventricle. Preoperative radiological diagnosis suggested a cen-tral neurocytoma, and subsequent surgery was done in gross total resection with satisfactory recov-ery. However, after three years, tumor recurrence was observed, leading to revision surgery. Based on the histopathological evaluation according to the 2021 World Health Organization classification, the tumor was suggested as CNS HGNET-BCOR. Adjuvant radiotherapy was planned as part of the treatment strategy. This case report contributes to the limited knowledge about intraventricular CNS HGNET-BCOR tumors, offering insights into diagnosis and treatment approaches for this rare en-tity.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"115 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Giant pituitary adenoma is a challenging disease in the neurosurgical field. Several therapeutic strategies have been performed depending on tumor characteristics and the surgeon’s experience during the last decades, but it is still difficult to achieve the gross total resection with good clinical outcome. Here, we present our clinical experience with giant pituitary adenomas (PAs) focusing on factors related to surgical outcome.
Materials and Methods: A total of 26 patients with giant PAs were collected. All clinical data, including preoperative symptom, visual and hormonal function, operation record, and radiologic imaging, were reviewed. Statistical analysis was used to identify the factors related with the extent of resection.
Results: The median age of patients was 53 years, and all patients showed impaired vision. Endo-scopic transsphenoidal surgery, staged operation, and open craniotomy were performed in 19, 5, and 2 patients, respectively. Fifteen patients received gross total resection, 14 patients received subtotal resection and 1 patient received partial resection. Postoperatively, visual function was improved in 14 patients, not changed in 6, and deteriorated in 4. Gross total resection was significantly related with the tumor size (45 mm), Knosp grade, ICA (internal carotid artery) encasement, and middle cranial fossa extension in the statistical analysis.
Conclusions: Despite of the limited experience for giant PAs, it still hard to achieve the gross total resection and good clinical outcome. We recommend identifying the tumor characteristics that make it difficult to complete total resection before surgery and consider other strategies, such as staged op-eration or adjuvant radiotherapy.
{"title":"Hurdle of giant pituitary adenoma in achieving total resection","authors":"Hyuk Jang, Yeon Hee Im, Dong-Hyun Kim, Dong-Sup Chung, Wan-Soo Yoon","doi":"10.55911/jksbs.23.0020","DOIUrl":"https://doi.org/10.55911/jksbs.23.0020","url":null,"abstract":"Background: Giant pituitary adenoma is a challenging disease in the neurosurgical field. Several therapeutic strategies have been performed depending on tumor characteristics and the surgeon’s experience during the last decades, but it is still difficult to achieve the gross total resection with good clinical outcome. Here, we present our clinical experience with giant pituitary adenomas (PAs) focusing on factors related to surgical outcome.
 Materials and Methods: A total of 26 patients with giant PAs were collected. All clinical data, including preoperative symptom, visual and hormonal function, operation record, and radiologic imaging, were reviewed. Statistical analysis was used to identify the factors related with the extent of resection.
 Results: The median age of patients was 53 years, and all patients showed impaired vision. Endo-scopic transsphenoidal surgery, staged operation, and open craniotomy were performed in 19, 5, and 2 patients, respectively. Fifteen patients received gross total resection, 14 patients received subtotal resection and 1 patient received partial resection. Postoperatively, visual function was improved in 14 patients, not changed in 6, and deteriorated in 4. Gross total resection was significantly related with the tumor size (45 mm), Knosp grade, ICA (internal carotid artery) encasement, and middle cranial fossa extension in the statistical analysis.
 Conclusions: Despite of the limited experience for giant PAs, it still hard to achieve the gross total resection and good clinical outcome. We recommend identifying the tumor characteristics that make it difficult to complete total resection before surgery and consider other strategies, such as staged op-eration or adjuvant radiotherapy.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"194 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135928926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Da-Hee Park, Un-Kyoung Ryu, Hyo Beom Jang, Hwan-Jung Roh, Dong Jo Kim, Chi Hyung Lee, Soon-Ki Sung, Sue Jean Mun
Background: There are controversies on whether endoscopic transsphenoidal approach (TSA) affects postoperative olfaction. This study aimed to compare olfactory function in regard of partial resection status of middle turbinate (MT) and analyze the amount of resection in images.
Materials and Methods: This study retrospectively reviewed 46 patients who had undergone endoscopic TSA due to pituitary adenoma or Rathke’s cleft cyst from 2015 to 2019. MT preserva-tion (MTP) group was defined as the group of patients whose MTs were preserved. MT resection (MTR) group was defined as the group of patients whose MTs were partially resected unilaterally or bilaterally. Olfactory function was compared with pre- and postoperative 3-month Korean version of sniffing sticks test-II which was composed of threshold, discrimination, identification (TDI) scores each making 16 with correct answers. Pre- and postoperative images including paranasal computed tomography and sellar magnetic resonance imaging were analyzed using Picture Archiving and Communication System.
Results: There were 41 pituitary adenomas and 5 Rathke’s cleft cysts. Male patients were 39.1% (n = 18) and mean age was 42.6. About 1/3 (31%) of MT was resected in MTR group (n = 13), which had the effect of increasing the cross-sectional area of the nasal cavity by 19%. Post-septectomy area was 6% of total septum. Preoperative TDI score was 27.34 and postoperative TDI score was 25.42. There were no significant differences of olfactory score in total, MTR and MTP groups 3 months after endoscopic TSA.
Conclusions: Resection of lower third of MT may produce low morbidity in respect of olfactory function after endoscopic TSA.
{"title":"Effect of middle turbinate partial resection in olfactory function in endoscopic transsphenoidal approach: A retrospective study","authors":"Da-Hee Park, Un-Kyoung Ryu, Hyo Beom Jang, Hwan-Jung Roh, Dong Jo Kim, Chi Hyung Lee, Soon-Ki Sung, Sue Jean Mun","doi":"10.55911/jksbs.23.0022","DOIUrl":"https://doi.org/10.55911/jksbs.23.0022","url":null,"abstract":"Background: There are controversies on whether endoscopic transsphenoidal approach (TSA) affects postoperative olfaction. This study aimed to compare olfactory function in regard of partial resection status of middle turbinate (MT) and analyze the amount of resection in images.
 Materials and Methods: This study retrospectively reviewed 46 patients who had undergone endoscopic TSA due to pituitary adenoma or Rathke’s cleft cyst from 2015 to 2019. MT preserva-tion (MTP) group was defined as the group of patients whose MTs were preserved. MT resection (MTR) group was defined as the group of patients whose MTs were partially resected unilaterally or bilaterally. Olfactory function was compared with pre- and postoperative 3-month Korean version of sniffing sticks test-II which was composed of threshold, discrimination, identification (TDI) scores each making 16 with correct answers. Pre- and postoperative images including paranasal computed tomography and sellar magnetic resonance imaging were analyzed using Picture Archiving and Communication System.
 Results: There were 41 pituitary adenomas and 5 Rathke’s cleft cysts. Male patients were 39.1% (n = 18) and mean age was 42.6. About 1/3 (31%) of MT was resected in MTR group (n = 13), which had the effect of increasing the cross-sectional area of the nasal cavity by 19%. Post-septectomy area was 6% of total septum. Preoperative TDI score was 27.34 and postoperative TDI score was 25.42. There were no significant differences of olfactory score in total, MTR and MTP groups 3 months after endoscopic TSA.
 Conclusions: Resection of lower third of MT may produce low morbidity in respect of olfactory function after endoscopic TSA.","PeriodicalId":49515,"journal":{"name":"Skull Base-An Interdisciplinary Approach","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135929068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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