課程資訊

台灣顱底外科醫學會第四屆第一次會員大會暨學術研討會地點:台北榮總致德樓第一會議室 (台北市石牌路二段 201 號)

Scientific Program ( 97 年 11 月 15 日星期六 )

時間議程08:00~08:45 會員報到08:45~09:00 潘宏基理事長 Opening remark

學術演講座長演講者題目9:00~9:20 曾漢民

魏志鵬鄭澄懋 Modified Orbitozygomatic Craniotomy for Medial Wing

Meningiomas: cadaver dissection and report of five

consecutive cases

9:20~10:00 杜永光顏玉樹

Professor

Hongo

Surgery for the Foramen Magnum Meningioma

09:50~10:00 discussion

10:00~10:30 施養性邱仲慶

杜永光 Surgical approaches to cavernous sinus lesions

10:30~10:4

5

Coffee break

10:45~11:15 高明見陳敏雄

潘宏基 Gamma Knife Surgery for the treatment of cavernous sinus

hemangioma and AV fistulas involving cavernous sinus

11:15~11:35 張承能關皚麗

侯勝博 Changing Paradigm in Skull Base Surgery- from open to

endoscopic

11:35~11:55 洪純隆陳幸鴻

沈炯祺 Neuroendoscopic history and future development

11:55~12:3

0台灣顱底外科醫學會第四屆第一次會員大會暨理監事選舉

12:30~14:0

0Lunch (中正一樓誠品生活廣場) (第三屆理監事:中正一樓蘇杭餐廳)

14:00-14:25 何青吟張凱評 Identification of Macrophage Inflammatory Protein 3 as a

Novel Serum Marker for Nasopharyngeal Carcinoma from

cDNA microarray

14:25~14:50 邵國寧許永信

李明陽 Skull base reconstruction with free ALP flap

14:50~15:15 黃勝雄陳明德

顏玉樹 Endoscopic transnasal transclival odontoidectomy

15:15~15:40 陳翰容劉安祥 Meningiomas of the craniovertebral junction

15:40~16:1

0

Coffee break(第四屆第一次理監事會議:選舉常務理監事及理事長 )

16:10~16:30 蘇泉發劉康渡

梁正隆 Gamma Knife Radiosurgery for skull base tumors

16:30~16:50 郭萬祐駱子文 Gamma Knife Radiosurgery for Head and Neck Malignancy

1

任森利 Invading Base of Skull – The Tzu-chi Experience

16:50~17:05 陳冠助黃文成

張軒凱 Multiple meningiomas of different pathologic types in a

patient—a case report

17:05~17:20 蔣永孝楊懷哲 Trigeminal Neuralgia: Review of current treatment and our

experience

17:20~17:35 鍾文裕李政家 Vestibular evoked myogenic potential (VEMP) in

radiosurgery-treated patients with acoustic neuromas

17:35~18:00 Shuttle bus to 僑園餐廳18:00~ 晚宴

Modified Orbitozygomatic Craniotomy for Medial Wing Meningiomas: cadaver dissection and report of five consecutive cases

鄭澄懋

三軍總醫院

Abstract

Medial wing meningiomas reside on the medial sphenoid ridge, which is a one-centimeter cliff-like

bony structure where content of cavernous sinus, optic nerve, and cranial internal ceratoid artery are

closely bounded to each other. Historically, these cranial base meningiomas were treated with

traditional frontotemporal craniotomy and the outcome had not been promising largely because of the

excessive brain retraction. Cranial base approaches with modern microneurosurgical techniques yield

better results. However, these kind of cranial base approaches often cope with some extension of

zygomatic arch, which associated with somewhat morbidity. We report the methods and results of

using MOZC, without any resection of zygomatic arch, to access five consecutive large medial

sphenoid wing meningiomas.

The modified orbitozygomatic craniotomy (MORC) is a reform of skull base approach with the

characteristics of its simplicity and wide exposure. Since this approach was newly introduced to the

neurosurgical society lately in 2003, its clinical reports are few. The goal of this presentation is to

advocate its clinical feasibility. In the following five years, five consecutive patients harboring large

(> 4 cm) sphenoid wing meningiomas were treated with MORC. Total brain tumor removal was

achieved in all patients. There is no mortality in this series of follow-up. One patient was complicated

with the postoperative epidural hematoma and evacuated on the same operative day. All patients

returned to their own daily activity without neurological sequella. The MORC is the option of choice

in treating large upper-third clival lesion while the standard frontotemporal craniotomy is considered

to give less surgical rooms. To our knowledge, this is the first report of treating sphenoid wing

meningiomas with MOZC.

2

Surgery for the foramen magnum meningioma

Kazuhiro Hongo, Tetsuya Goto, Keiichi Sakai

Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan

Even with the recent advancement of the skull base approaches and techniques, surgery for the

ventral foramen magnum remains challenging. To accomplish safe resection, microsurgical anatomy

of this region should be fully understood. To achieve a satisfactory result for removing the ventral

foramen magnum meningioma, adequate exposure with applying a skull base approach taken from the

inferolateral side, and gentle manipulation to dissect the tumor from the surrounding critical structures

without compressing the medulla oblongata are essential. The intraoperative electrophysiological

monitoring is also quite helpful.

In the presentation, key points for the surgical approach to this lesion as well as the anatomy of the

foramen magnum are shown. Representative cases of meningioma surgery will be presented.

3

杜永光尚缺

4

Gamma Knife Surgery for the Treatment of Cavernous Sinus Hemangiomas and AV Fistulas Involving the Cavernous Sinus

潘宏基David Hung-Chi Pan, M.D.

台北榮總神經外科Department of Neurosurgery, Taipei Veterans General Hospital

Introduction: Surgery for tumors or vascular lesions involving the cavernous sinus poses difficulty

due to the risks of excessive bleeding. This report presents our 15-year experience in Gamma Knife

surgery (GKS) for the treatment of cavernous sinus cavernous hemangiomas (CHs) and dural

arteriovenous fistulas (DAVFs). The characteristic imaging findings of CHs, differential diagnosis

from other benign tumors, radiosurgical methods, results and patients’ outcome are described.

Material and methods: A total of 444 patients with cavernous sinus lesions were treated by GKS at

the Taipei VGH between 1993 and 2008. Among them 265 were neoplasms and 179 were DAVFs.

Cavernous sinus hemangiomas account for 2% (6 patients) of all tumors in the cavernous sinus. These

rare but difficult tumors can be distinguished from more commom meningiomas based on the

characteristic MR finding that T2-weighted images show marked hyperintensity. The median age of

CH patients was 49y/o. Female was predominant with a male/female ratio of 2/4. Pre-treatment

manifestations included headache, visual loss, oculomotor and abducence palsies. Tumor volume

ranged 2.9-23.1ml. During radiosurgery, precise stereotactic targeting and irradiation using multiple

small shots to obtain a conformal, high-dose treatment were achieved. Average marginal / maximum

dose were 13/23 Gy respectively.

For the 179 DAVF patients, GKS was applied to treat AV shunts involving the wall of the

cavernous sinus. Feeders on the dural wall both from ICA and ECA were irradiated while optic nerves

were carefully protected. After treatment, patients were regularly followed by MRI/MRA and doppler

ultrasound to assess flow of the superior ophthalmic veins. Cerebral angiography was performed 2

years post-treatment to verify complete obliteration.

Results: Five of six cases with CHs had received regular MRI follow-up study (FU range 6-156,

mean 40 months). Clinically, all patients showed remarkable symptomatic improvement with

resolution of headache, diplopia or visual impairment. There was no complication or mortality. Tumor

volume measurement in follow-up MRI showed 80% reduction of the volume, with rapid regression

of the tumor within 3-6 months. For comparison, the average volume change of our 84 meningiomas

only showed 29% reduction. The statistical difference of volume changes between CHs and

meningiomas was significant (p=0.0023).

For the DAVF patients, 90% showed clinical improvement with disappearance of red eyes,

chemosis, or double vision. Follow-up in 105 patients based on Kaplan-Meier study showed 70% cure

rate in the first year and 90% in the second year. There was 6% with persisted symptoms or recurrence

2 years post-treatment.

Conclusion: GKS is a safe and effective alternative treatment for cavernous sinus hemangiomas and

dural AV fistulas. The characteristic MRI findings of CH before and after GKS allow us to select

proper cases for the treatment.

5

Changing Paradigm in Skull Base Surgery- from open to endoscopic

Sheng-Po Hao MD, FACS, FICS

Professor & Chairmen, Department of Otolaryngology Head and Neck

Chang Gung Memorial Hospital

Chang Gung University

Surgical approach is the cornerstone of a successful skull base surgery. For the anterior cranial base

lesions, craniofacial resection is the standard approach.

However, with the modern development of endoscope and vast advance of technology in navigation

system, an open wide field approach which usually carries unavoidable morbidity is no longer always

considered feasible. Rather, endoscopic approach, endoscopic resection and encoscopic reconstruction

seems justified if the oncological results is not inferior to open method. However, we have to keep in

mind that the only thing changed in endoscopic resection is the way to remove the tumor,

nevertheless, the extent of resection and the control of surgical margin remain exactly the same with

the open method. Thus, we may reach the same oncological results but having fewer surgical

morbidity. The future trend is to change the paradigm in skull base surgery from open to endoscopic.

6

沈炯祺尚缺

7

Identification of Macrophage Inflammatory Protein 3 as a Novel Serum Marker for

Nasopharyngeal Carcinoma from cDNA microarray

Kai-Ping Chang, M.D., Ph.D.; Ku-Hao, Fang, M.D.; Sheng-Po Hao, M.D., FACS

張凱評, 方谷豪, 侯勝博Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou

Medical Center, Tao-Yuan, Taiwan

長庚紀念醫院林口醫學中心耳鼻喉部頭頸外科

Introduction: From differential expression profiles analyzed using cDNA microarray between paired

nasopharyngeal carcinoma (NPC) and pericancerous normal epithelium, we identified two sets of

genes which were up-regulated/ down-regulated in NPC tumors and associated with immune

response. Among these genes, we found the most up-regulated gene, macrophage inflammatory

protein (MIP)-3 might be a potentially novel tumor marker. We herein examine whether MIP-3 is a

biomarker for NPC, and whether it is involved in modulating NPC cell functions.

Materials & Methods: The study population comprises 275 NPC patients and 250 controls. MIP-3 levels in tissues and sera were examined by immunohistochemistry and ELISA, respectively. EBV

DNA load and EBV VCA IgA were measured by qRT-PCR and immunofluorescent assay,

respectively. MTT assays were done to investigate the role of MIP-3 on NPC cell proliferation.

Effects of MIP-3 on NPC cell motility were investigated by trans-well migration/invasion assays and

RNA interference.

Results: MIP-3 was over-expressed in NPC tumor cells. Serum MIP-3 levels were significantly

higher in untreated patients, recurrent patients and patients with distant metastases versus non-NPC

controls, patients with complete remission, and long-term disease-free patients. In the prospective

cohort, serum MIP-3 levels were significantly higher in untreated NPC patients with advanced TNM

stage versus early stage, and also correlated with EBV DNA load. Measurement of MIP-3, EBV

DNA and VCA IgA levels in serial serum/plasma samples from treated patients at 6-month intervals

revealed a high association between MIP-3 level, EBV DNA load and disease status. Among 155

consecutive NPC patients, subjects with pre-treated MIP-3 serum levels over 65 pg/ml had worse

prognoses for overall survival and distant metastasis-free survival in univariate and multivariate

analysis. Additionally, cell functional assays showed that MIP-3 had no obvious effect in the NPC

cell proliferation but contributed to migration and invasion of NPC cells, which could be effectively

inhibited by MIP-3 knock-down.

Conclusions: From the analysis derived from the results of cDNA microarray, we discovered the up-

regulation of MIP-3 and found that MIP-3 may be a novel biomarker and prognosticator for NPC

and is involved in migration and invasion of NPC cells.

Anterior Skull Base Reconstruction with Free Anterolateral Thigh Flap – NCKUH Experience

前側大腿皮瓣重建顱底缺損：成大醫院之經驗

Ming-Yang Lee E-Jian Lee8

Division of Neurosurgery, Department of Surgery, National Cheng- Kung University Hospital

李明陽李宜堅成大醫院神經外科

Summary

Defects at the anterior skull base were not commonly found after head trauma and skull base tumor

resection. Reconstruction of the anterior skull base defect is paramount to prevent postoperative

complications such as cerebrospinal fluid (CSF) leakage and meningitis ascending infection from

underlying aerodigestive tract. Several reconstructive methods of the anterior skull base have been

reported .

From February 2004 to July 2008 the anterior skull base reconstructions were performed in 17

patients. In 9 patients the defects were related to the head and neck tumors and 8 patients related to the

severe head trauma with comminuted fractures in the anterior cranial base. Reconstructions with

galeopericranial flaps were used in fifteen patients and free anterolateral thigh (ALT) flap were

performed in two patients due to large head and neck defect and reoperation. There were no CSF

leakage and postoperative meningitis.

By a multidisciplinary surgical team approach, there is an increasing role for reconstruction of

complex anterior cranial base resection defects using microvascular surgical techniques.

9

Endoscopic Trans-nasal Trans-clival Odontoidectomy: A New Approach to Decompression

Jau-Ching Wu, M.D.1,2,3,4, Wen-Cheng Huang, M.D.1,2,3, Henrich Cheng, M.D., Ph.D.1,2,3,4 , Mu-Li Liang, M.D.1,3, Ching-Yin Ho, M.D., Ph.D.3,5, Yang-Hsin Shih, M.D.1,3, Yu-Shu Yen M.D.1,3

Objectives:

Endoscopic trans-nasal trans-clival resection of the odontoid process is less invasive than the standard

trans-oral odontoidectomy. We describe here our techniques that are less invasive but provided

successful decompression.

Presentations:

From September 2004 to April 2007, three consecutive patients with basilar invagination and

instability in the cranio-vertebral junction were enrolled in this report. The etiologies included

rheumatoid arthritis in two and trauma in one, and all presented with myelopathy and quadriparesis

prior to the interventions.

Interventions:

All of the three patients underwent an endoscopic trans-nasal trans-clival approach for anterior

decompression and resection of the displaced odontoid process and pannus, in order to decompress the

underlying medulla. Subsequently, they received occipital-cervical fixation by lateral mass screws and

bone fusion to ensure stability. Remarkable neurologic recovery was observed after surgery in all and

no adverse effects were noted.

Conclusions:

Compared to the standard trans-oral approach, the trans-nasal trans-clival endoscopic approach for

decompressing basilar invagination is a feasible and effective alternative that avoids common

disadvantages like prolonged intubation, excessive tongue retraction, and need for palatal incision.

10

Meningiomas of the craniovertebral junction

Ann-Shung Lieu, Shiuh-Lin Hwang and Shen-Long Howng

顱脊椎處腦膜瘤

劉安祥黃旭霖洪純隆Department of Neurosurgery, Kaohsiung Medical University Hospital

高雄醫學大學附設醫院神經外科

Tumors of the foramen magnum are found infrequently and, due to their insidious onset, they resemble degeneration diseases of the central nervous system. Meningiomas are the most common benign tumors of the foramen magnum. They represent about 1.8% of all meningiomas. Most of these lesions can be resected using traditional posterior approaches, but some anterior and anterolateral lesions are difficult to be resected via traditional methods due to inadequate exposure. Therefore, management of lesions situated in the anterior foramen magnum, lower livus, and anterior aspect of the upper cervical area is a challenging issue for neurosurgeon. Mehtods of treating these lesion includes transoral, transuncodiscal, and lateral suboccipital approaches, the last of which has undergone several modifications including the for-lateral suboccipital, dorsolateral suboccipital transcondylar, and extreme lateral transcondylar variations. Lateral suboccipital approaches and modificational exposure can be satisfactory with minimal or no retraction of important neurovascular structures in the region.

11

Gamma Knife Radiosurgery for Skull Base Tumors

Cheng-Loong Liang, Kang Lu, Han-Jung Chen

Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung

Tumors located at the skull base are among the most difficult problems that neurosurgeons

encounter. Management of patients with skull base tumors must take into account that complete tumor

removal is not possible with acceptable morbidity in many patients. Therefore, radiation therapy and

stereotactic radiosurgery (SRS) are commonly performed. The use of radiosurgery for patients with

skull base tumors has increased significantly over the past two decades. The goal of radiosurgery is

cessation of tumor growth and preservation of neurological function. The technique of radiosurgery

has evolved due to improved imaging, better radiosurgical devices and software, and the continued

analysis of results. In this report, the authors discuss technical concepts and present the preliminary

results of skull base radiosurgery treated by Gamma knife in E-Da hospital.

At our center we used Gamma Knife SRS for a variety of benign, extraaxial basal tumors. These

included schwannomas, meningiomas, hemangiomas, pituitary adenomas, craniopharyngiomas. For

properly selected patients with benign tumors (meningiomas, schwannomas, glomus tumors), tumor

control rates between 90 and 100% have been reported. Radiosurgery is also commonly performed for

patients with malignant skull base tumors as a palliative treatment and symptom relief is common,

especially for patients with cranial nerve involvement related to their tumor.

12

Gamma Knife Radiosurgery for Head and Neck Malignancy Invading Base of Skull – The Tzu-chi Experience

Tzu-wen Loh 1 , Tsung-lang Chiou1, Pao-sheng Yen2, Dai-wei Liu3, Peir-rong Chen4, Chain-fa Su1

駱子文 1 , 邱琮朗 1, 嚴寶勝 2, 劉岱瑋 3, 陳培榕 4, 蘇泉發 1

Department of Neurosurgery1, Department of Radiology2, Department of Radiation-Oncology3,

Department of Otolaryngology4, Buddhist Tzu-Chi Medical Center, Hualien, Taiwan, R.O.C.

花蓮慈濟醫學中心神經外科 1, 影像醫學科 2, 放射腫瘤科 3, 耳鼻喉科 4

Introduction: Although less common, local invasion of head and neck malignancy into skull base

might be disclosed. This kind of extension remains challenging to skull base surgeons because of

vulnerability of nearby vital neurological strutures. Fortunately, lots of head and neck malignancy are

radio-sensitive. Thus, Gamma knife radiosurgery might hold an evolving position in treatment of

extensive skull base invasion of head and neck malignancy.

Materials & Methods: From November 2003 to August 2008, 10 patients with local skull base

invasion of head and neck malignancy were referred from our otolaryngology department. Before

referral, operations for radical excision were all applied to these patients. There were 3 women and 7

men in this group, and the mean age was 46.7 years old. The entities of disease diagnosis included

NPC in 3, buccal cancer in 2, hypopharyngeal cancer in 2, parotid gland tumor in 1, and salivary gland

neoplasm in 1 patient, and another patient suffered from olfactory neuroblastoma. The mean tumor

volume of skull base extension was 12.8 c.c. (range: 8.8 to 36.8 c.c.). Gamma knife radiosurgery was

arranged to these patients and the mean prescription dosage was 18.6 Gy (range: 18 to 20 Gy). Some

extensive tumor masses were so close to optic apparatus that dosage of 8 Gy was adapted as safe

upper limit of irradiation within the optic apparatus.

Results: The follow-up periods in these patients were 11 to 28 months. 5 patients encountered

mortality during follow-up due to primary disease progression. No marked neurological deficits were

noted within these patients.

Conclusions: From our preliminary experiences, Gamma knife radiosurgery might be a safe and

useful tool when dealing with local skull base invasion of head and neck malignancy. It might also be

put into consideration of co-operation between otolaryngologists and neurosurgeons, especially when

the skull base extension was around cavernous sinus, optic apparatus, or other important but

vulnerable structures. The long-term follow-up and evaluation is, nevertheless, still in necessity.

13

Multiple meningiomas of different pathologic types in a patient: a case report

Hsuan-Kan Chang, MD Li-Yu Fay, MD Chun-Fu Lin, MD Min-Hsiung Chen, MD, PhD

張軒侃, 費立宇, 林俊甫, 陳敏雄

Department of Neurosurgery, Neurological Institute,

Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

台北榮總神經醫學中心神經外科

Abstract:

Multiple meningiomas(MM) are considered rare disease entity, which accounts for 5.9-10.9% of all

meningiomas from literature review. Most MM removed from the same person showed identical

pathological subtype. The authors report a case of multiple meningiomas with different pathologic

subtypes. The patient is a 67-years-old female with the initial presentation of right eye ptosis. MRI

revealed four spatially separated meningiomas located at right parasagittal, bilateral cavernous

sinuses, and left planum sphenoidale, respectively. The surgeons removed three of them in one

operation and pathology showed three different subtypes of meningiomas, namely meningothelial,

fibrous, and secretory types. Special immunohistochemistry such as progesterone receptor(PR), p53,

and MIB-1 LI were performed and compared with literature results.

14

Trigeminal Neuralgia: Review of current treatment and our experience

楊懷哲劉康渡鐘文裕潘宏基

台北榮總神經外科

Trigeminal neuralgia (TN) is the most common facial neuralgia, and is considered to be one of the

most painful conditions to affect patients. TN is generally characterized by lancinating, unilateral,

paroxysmal pain occurring in the distribution of the fifth cranial nerve. Generally, TN can be diagnosed

by the typical patient history, a negative neurologic exam, and response to a trial of carbamazepine.

Imaging studies should be considered if the diagnosis is uncertain or neurologic abnormalities are

noted. Most cases are caused by compression of the trigeminal nerve root, usually within a few

millimeters of entry into the pons. The treatment modalities for the management of TN may be divided

into medical, surgical, and gamma-knife radiosurgery. Generally, response to drug therapy is good,

with over 80% of patients responding to some of the anticonvulsants. Percutaneous approaches to

trigeminal gangliolysis are considered to have less associated risk and less cost than open surgical

procedures. Open surgical procedures used in the treatment of TN include microvascular

decompression of the trigeminal root and retrogasserian rhizotomy. Additionally, because both of

these procedures have greater associated risks, morbidity, and mortality, they are customarily applied

only to younger patients in good health. Stereotactic radiosurgery has been established as an

alternative treatment for patients who do not respond to optimal medical management.

We began use of this technique at our center in 1995 and have evaluated outcomes serially.

Independently acquired data from 207 patients with idiopathic TN that had Gamma Knife radiosurgery

was reviewed. 29 patients received twice Gamma-kinfe treatment and 2 patients received three times

due to recurrent pain.The maximal radiosurgery dose was 80 Gy with a range of 70 to 90 Gy. One

hundred patients (48.3%) had prior surgery or radiofrequency treatment. Patients were followed to a

maximum of 10.5 years (mean, 28 months). Complete or partial pain relief was achieved in 58.5% of

patients at 1 year. The absence of prior surgery correlated with an increased proportion of patients in

complete or partial pain relief over time (65.4%). 5.8% of patients developed new or increased

subjective facial paresthesia or facial numbness. Radiosurgery for idiopathic TN was safe and effective

and is an important addition to the surgical armamentarium for TN.

15

Vestibular evoked myogenic potential (VEMP) in acoustic neuromas treated by Gamma-knife radiosurgery --- preliminary study

聽神經瘤經伽馬刀治療後之前庭誘發肌性電位---初步研究

李政家楊懷哲劉康渡鍾文裕潘宏基王懋哲蕭安穗台北榮民總醫院神經外科耳鼻喉科

Introduction The ventricular evoked myogenic potential (VEMP) test showed abnormal results in

80% of acoustic neuroma (AN). Although the sensitivity of VEMP was lower than that of ABR test, it

is useful in neurophysiology to classify the origin of ANs. Besides, pure tone audiogram (PTA) and

Calori test give us additional information to differentiate the nature of ANs. In this preliminary study,

we hope to study the VEMP in ANs treated by Gamma-knife radiosurgery.

Patients and methods Ten AN patients was recruited, and we performed PTA, Calori test, and

VEMP. We defined 30dB loss as abnormal PTA finding, canal paralysis (Jonkees’ formula) > 20% as

abnormal Calori test, and evoked potential ratio (EPr) >30% as abnormal VEMP results. We also

calculate the volume of tumors, to correlate the results of PTA, Calori, and VEMP test. Finally,

compare pre-GKS and post-GKS VEMP (EPr) results.

Results The PTA, Calori test , and VEMP test showed abnormal results in 80%, 60% and 60% ANs,

respectively. Hearing impairment, tinnitus, and dizziness were happened in 90%, 70%, 60% ANs,

respectively. PTA, Calori test, and VEMP results were not correlated each other. The larger tumor, the

more severe results in PTA, Calori test, and EPr were found. The tumor volume can be calculated = -

0.875 + 1.040*(PTA) + 2.350*(Calori test) + 2.175*EPr. Finally, all tests (PTA, Calori test, and

VEMP) are progressing in first month followed-up after Gamma knife radiosurgery.

Discussion All three tests can help use to differentiate the nature of tumors. The three tests are

independent in the small volume of tumor, although all tests are abnormal in large volume of tumor.

Our followed-up post radiosurgery still in proceed, and need more time to observe the outcome of the

ventricular functional recover.

*********************************************************************************

16

9:00~9:20

Name: 鄭澄懋 Cheng-Mao Cheng

(Also known as: Robert C.M. Cheng)

Professional Address: Division of Neurological Surgery

Tri-Service General Hospital,

e-mail: [email protected]

Date of Birth: 18 August, 1964

Education:

1990 Bachelor of Medicine

National Defense Medical Center, Taipei, Taiwan

Speical Training:

1988- 1990 Medical Internship

Tri-Service General Hospital, Taipei, Taiwan

1992- 1994 General Surgery


1994-1997 Neurological Surgery Residency


1997-1998 Neurological Surgery Chief Resident


1998-1999 Visiting doctor of Neurological Surgery,

Pen-Hoo Army Hospital, Pen-Hoo, Taiwan

1999-2000 Attending doctor of Neurological Surgery,


2001-2002 Reaserch fellowsip in skull base surgery and neuroradiology in Oregon Health &

Science University

2002-2007 Attending doctor of Neurological Surgery,


Activity:

Member of Surgical Association, Republic of China

Member of Neurosurgical society, Taiwan

Interests: Mountain climbing, fishing, photography.

17

mailto:[email protected]

Research Experience:

1. Skull base Surgery

2. Spinal cord repair on rat

Division of Neurological Surgery

Tri-Service General Hospital

Advisor: Shinn-Zong Lin, Ph.D.

Presentation:

1. Cheng-Mao Cheng, Shinn-Zong Lin, Yung-Hsiao Chiang, Ming-Ying Liu:

Correlation of monitoring of laser Doppler flowmetry and intracranial pressure in severe head-

injuried patients: a preliminary result in Tri-Service General Hospital

Annual meeting of Surgical Society,R.O.C., 1998

Presented by Cheng-Mao Cheng


Intracranial pressure monitoring in severe head-injured patients: a practical method

in delineation of adequate cerebral perfusion pressure and the preliminary result in Tri-Service

General Hospital.

11th Internaional Congress of Neurological Surgery, July 1997



The application of the stereotactiv craniotomy with removal of tumor under laser guide

Annual meeting of Surgical Society,R.O.C., 1997


4 Cheng-Mao Cheng, Rochey Chao, Shinn-Zong Lin, Ming-Ying Liu:

Posterior atlantoaxial interarticular screw fixation as an alternative option for treatment of

type II Odontoid Fracture complicated by failure of anterior odontoid screw fixation—a case

report

Annual meeting of Surgical Society, R.O.C., 1996


5. Cheng-Mao Cheng, Gregory J Anderson, Frank Hsu, Akio Noguchi, Aclan Dogan, Sean O

McMenomey:

Quantitative comparison of the supraorbital keyhole, pterional and supraorbital subfrontal

approaches to the parasellar region

Annual Meeting of North America Skull Base Society, California, USA, 2002


6. Cheng-Mao Cheng, Frank Hsu, Akio Noguchi, Aclan Dogan, Sean O McMenomey, Johnny

B Delashaw:

Topography of skull base in relation to fisher’s segmental nomenclature of intracerebral

18

artery

Annual Meeting of North America Skull Base Society, California, USA, 2002


Publication:

1. Cheng-Mao Cheng , Ming-Ying Liu, Bao-Chiien Chang, Cheng-Ti Cheng. Detection of radiation necrosis with Thallium-201 and

Technetium-99m DTPA single-photon emission computed tomography in a patient with irradiated malignant glioma. Annal of

Nuclear Medicine and Sciences.Vol. 10, No. 1, 5-8, 1997

2. Cheng CM , Chiang YH, Fan YM, Huang WS, Cheng CY. Localization of Abscess in Dural Graft with Fusion Image of Gallium-67

CT-SPECT. 核子醫誌 17:225-228, 2004

3. Cheng CM , Alpha fetoprotein producing immature teratoma of the pinel region without components of endodermal sinus tumour. J

of Clin Neuroscience 13: 257-259, 2006

4. Vijayabalan Balasingam , Gregory J Anderson , Neil D Gross , Cheng-Mao Cheng , Akio

Noguchi , Aclan Dogan , Sean O McMenomey , Johnny B Delashaw Jr , Peter E

Andersen. Anatomical analysis of transoral surgical approaches to the clivus.

J Neurosurg. 2006 Aug ;105 (2):301-8

19

9:20~10:00

Name: Kazuhiro Hongo, M.D., Ph.D.Address (office): Professor and Chairman

Department of Neurosurgery

Shinshu University School of Medicine

3-1-1 Asahi, Matsumoto 390-8621, Japan

Tel : +81-263-37-2690, Fax: +81-263-37-0480

E-mail: [email protected]

Date of Birth: December 10, 1953

Citizenship: Japanese

Medical School: Shinshu University School of Medicine

(April, 1974 - March, 1978)

Postgraduate Training & Professional Career:

1978 Junior Resident, Dept. of Neurosurgery, Shinshu Univ. School of Medicine

1979 Rotating Intern, Anesthesiology, Shinshu Univ. School of Medicine

1980 Fellow in Pharmacology, Shinshu Univ. School of Medicine

1981 Chief, Dept. of Neurosurgery, Matsumoto National Hospital

1982 Chief, Dept. of Neurosurgery, Shinonoi General Hospital

1984 Staff, Dept. of Neurosurgery, Shinshu Univ. School of Medicine

1986 Research Fellow, Dr. Kassell’s Cerebrovascular Research Laboratory, Dept. of Neurosurgery,

University of Virginia, USA

1988 Chief, Dept. of Neurosurgery, Showa-Inan General Hospital

1992 Assistant Professor, Dept. of Neurosurgery, Shinshu Univ. School of Medicine

1994 Associate Professor, Dept. of Neurological Surgery, Aichi Medical University

2001 Associate Professor, Dept. of Neurosurgery, Shinshu Univ. School of Medicine

2003 Professor and Chairman, Dept. of Neurosurgery, Shinshu Univ. School of Medicine

Fields of Research and Academic Interest:

Microsurgery of cerebrovascular diseases (AVM, aneurysm),

Skull base surgery (meningioma, neurinoma, etc.)

Microvascular decompression

Robotics surgery

Pharmacological research on cerebral vasospasm

20

10:00~10:30

Yong-Kwang Tu, M.D.,Ph.D.Birth Date:

April 9, 1948

Marital Status:

Married with 2 children (Spouse: Tso-Hsien Tu)

Current position:

Professor and Chairman, Department of Neurosurgery,

College of Medicine and Hospitals, National Taiwan University, Taipei, Taiwan

Medical education:

1976 M.D. School of Medicine, National Taiwan University, Taipei

1984 Ph.D. Institute of Clinical Medicine, National Taiwan University, Taipei

Postdoctoral training:

1976-1977 Resident in Internal Medicine

National Taiwan University Hospital, Taipei

1977-1980 Resident in Surgery (Neurosurgery)


1980-1981 Chief Resident in Neurosurgery


1984-1988 Fellow in Neurosurgery, Massachusetts General Hospital and

Harvard Medical School, Boston, U.S.A.

Academic Appointments

1987-1988 Instructor in Surgery (Neurosurgery), Harvard Medical School,

Boston, U.S.A.

1989-1991 Associate Professor in Neurosurgery (Non-tenure), National

Taiwan University

1991-1998 Associate Professor in Neurosurgery (Tenure), National Taiwan

University

1998- Present Professor in Neurosurgery (Tenure), National Taiwan University

2004- Present Chairman, Department of Neurosurgery, National Taiwan University

Other Appointments:

1982-1983 Chief, Department of Neurosurgery, King Fahd Hospital (Jeddah General

Hospital), Kingdom of Saudi Arabia21

1998-1999 Vice-President, Provincial Taoyuan Hospital, Taoyuan, Taiwan

1999-2000 President, Municipal Chung-Hsin Hospital of Taipei

2000-2001 Director, Taipei Stroke Center

Academic Societies:

2000-2002 Secretary General, International College of Surgeons

2001-2003 President, Taiwan Stroke Society

2001-2004 President, Asian-Oceanian Society for Skull Base Surgery

2003-2005 President, Taiwan Society for Skull Base Surgery

2005-2007 President, Taiwan Neurosurgical Society

2006-2009 President, International Congress on Cerebrovascular Surgery

2007-2011 President, Asian-Australasian Society of Neurological Surgeons

2009-2012 Second Vice President, World Federation of Neurosurgical Societies

22

10:45~11:15

Name: David Hung-Chi Pan, M.D.

Birth Date: Nov. 9, 1947, Male, Birth Place: Taiwan

Present Position:

(1) Director, Gamma Knife Center, Neurological Institute,

Taipei Veterans General Hospital, 1993 till now

(2) Chief, Division of Functional Neurosurgery, Neurological Institute, Taipei Veterans General

Hospital, 1989 till now

(3) Professor of Surgery, Faculty of Medicine, National Yang-Ming University, 2003 till now

(4) Delegate, Radiosurgery Committee, World Federation of Neurological Surgery (WFNS).

(5) President, Taiwan Society for Skull Base Surgery, 2007-2008

Experience:

(1) Resident, Department of Surgery, Taipei Veterans General Hospital, 1974-1977

(2) Attending Neurosurgeon, Neurological Institute, Taipei Veterans General Hospital,

1979-1989

(3) Clinical Fellow, Department of Neurosurgery, Karolinska Hospital, Sweden, 1981-1982

(4) Associate Professor, Faculty of Medicine, National Yang-Ming University, 1985 – 2003

Education: (1) Taipei Medical University, Taipei, Taiwan, 1966-1973

(2) Karolinska Institute, Stockholm, Sweden, 1981-1982

Society Membership:

(1) World Society for Stereotactic and Functional Neurosurgery since 1989

(2) International Stereotactic Radiosurgery Society since 1992

(3) Leksell Gamma Knife Society since 1992

(4) World Federation of Neurological Surgery, Radiosurgical Committee since 1995

(5) Taiwan Neurosurgical Society since 1993

(6) Chinese Medical Association (Taipei) since 1974

(7) Surgical Association, Taiwan since 1974

23

11:15~11:35

一、基本資料　　　　　　　　　　　　　　　　簽名：　　　　　　

中文姓名侯勝博英文姓名HAO SHENG-PO

(Last Name) (First Name) (Middle Name)

國籍中華民國性別男 □ 女出生日期 1959 年 06 月 30 日聯絡電話 (公).03-3281200 EXT 3966 (宅).02-27602407

傳真號碼 03-3979361 E-MAIL [email protected]

二、主要學歷請填學士級以上之學歷或其他最高學歷均可，若仍在學者，請在學位欄填「肄業」。

畢／肄業學校國別主修學門系所學位起訖年月(西元年/月)

台北醫學院中華民國醫學系醫學士 1978/ 09 至 1985/ 07

　 / 至　 /　

　 / 至　 /　

三、現職及與專長相關之經歷指與研究相關之專任職務，請依任職之時間先後順序由最近者

往前追溯。服務機關服務部門／系所職稱起訖年月(西元年/月)

現職：　 /

財團法人長庚紀念醫院耳鼻喉部副教授部長

2005/07至今

經歷：　 / 至　 /　

孫逸仙癌症中心耳鼻喉科、頭頸外科主任 1995/ 07 至 1997/07

財團法人長庚紀念醫院耳鼻喉科主治醫師 1989/ 07 至 1995/06

美國 Cornell University Memorial Sloan-Kettering

Cancer center

研究員 1993/ 06 至 1993/06

美國匹茲堡大學耳鼻喉、頭頸外科及顱底醫學中心

研究員 1992/ 09 至 1993/06

四、專長請自行填寫與研究方向有關之學門及次領域名稱。

鼻咽癌口腔癌顱底手術頭頸部腫瘤

24

11:35~11:55

姓名 : 沈炯祺 Chiung-Chyi Shen

性別 : 男

出生日期 : 1961年2月18日

學歷 : 國防醫學院80期畢業（76年班）

職稱 : 台中榮總神經外科主任

國立陽明醫學大學專任助理教授

國立國防醫學大學兼任助理教授

教師資歷 : 助教授字第007871號 (教育部)

求學及經歷

76年畢業(大字第027214號)後分發至台中榮總擔任住院醫師，接受神

經外科專科醫師訓練，並通過醫師執照考試(醫字第015879號)

80年升任神經外科住院總醫師

80年通過外科專科醫師考試 (外專醫字第2709號)

81年升任神經外科主治醫師

81年獲選為台中榮民總醫院臨床教學績優醫師

82年通過神經外科專科醫師考試 (神外專字第000257號)

82年轉任台中空軍總醫院神經外科主任醫師

83年借調嘉義榮民醫院神經外科主治醫師

84年通過公務人員高等考試(全高字第3293號)

87年獲選台中市優良醫師特殊貢獻獎25

87年於中國醫藥學院醫學系授課

88年上學期於中國醫藥學院醫學系授課

88.08 ~ 89.07赴美國哈佛大學附設醫院麻省總醫院神經外科進修

89年回國擔任神經外科主治醫師

90年至今於弘光科技大學授課

92年於中山醫科大學醫學系授課

92年於國立暨南大學生命科學研究所授課

93年台中榮總神經外科主任

26

14:00-14:25

張凱評醫師 Kai-Ping Chang, MD, PhD

學歷:

長庚大學醫學系醫學士長庚大學醫學博士美國醫師資格 ECFMG證書

經歷:

長庚醫院林口醫學中心耳鼻喉部總醫師台灣耳鼻喉專科醫師台灣臨床腫瘤專科醫師台灣顱底外科醫學會創始會員

現任:

長庚醫院耳鼻喉部頭頸腫瘤外科主治醫師　　　長庚大學醫學系助理教授台灣頭頸部腫瘤醫學會理事美國耳鼻喉頭頸外科學會會員美國癌症研究協會會員　　　

專長:

口腔癌手術　　鼻咽癌治療　喉癌,下咽癌外科治療　　　頭頸部腫瘤外科頭頸癌分子醫學研究一般耳鼻喉科

27

14:25~14:50

姓名：(中文) 李明陽Name：(英文) Ming-Yang Lee

(個人照片)職稱：□ Professor □ Associate professor ■ Assistant professor

□ Lecturer ■醫師 _□Others________

單位：(中文) 國立成功大學醫學院附設醫院外科部神經外科(英文): Department of Surgery, National Cheng-Kung University

Hospital

Appointments(現職)：Clinical Assistant Professor in Surgery (Neurosurgery),

National Cheng Kung University Medical School.

Address ： Neurosurgical Service, Department of Surgery (Neurosurgery),

National Cheng Kung University Medical Center and Medical School.

138 Shen-Li Road, Tainan, Taiwan.

E-mail： [email protected]

TEL：06- 235-3535 ext 5181 FAX：06- 276-6676

Education (學位)：Ph.D. candidate: Biomedical Engineering, National Cheng Kung

University, Tainan, Taiwan.

Professional activities (經歷)

Fellowship in Neurological & Neurosurgical Departments, University of

Massachusetts Medical School, Worcester, MA, USA

Fellowship in Neurosurgical Departments, Brigham & Women Hospital, Boston,

MA, USA

Research Interest (研究興趣)：

1. Biomechanics of Spine 2. Neurooncology 3. Cerebral blood flow and metabolism

28

14:50~15:15

Name: Yu-Shu Yen ( 顏玉樹 )

Date of Birth: October 10, 1962

Sex: Male

Birthplace: Chya-Yi, Taiwan, R.O.C. (中華民國,台灣,嘉義縣)

Citizenship: Taiwan, Republic of China

Family: Married, one son and one daughter

Office Address: Department of Neurosurgery,

Neurological Institute,

Veterans General Hospital-Taipei

No. 201, Sec 2, Shih-Pai Road,

Shih-Pai, Taipei, Taiwan 112

Republic of China

Telephone: (O) 886-2-8757491 ext. 9, 886-2-8712121 ext. 3147

Fax No.: (O) 886-2-8757588

Education:

7/1981 - 6/1988 Medical Department of China Medical College, Taichung, Taiwan

Internship: Chang-Gung Memorial Hospital, Lin-Cou, Taipei, Taiwan (July

1986 - June 1988)

Postgraduate Training:

7/1988 - 6/1990 Rotating Surgical Resident

Department of Surgery, Chang-Gung Memorial Hospital, Lin-Cou,

Tao-Yuan

7/1990 -6/1993 Neurosurgical Resident

Department of Neurosurgery, Neurological Institute, Taipei Veterans

General Hospital

7/1993 -6/1994 Chief Resident in Neurosurgery

Department of Neurpsurgery, Neurological Institute, Taipei Veterans

General Hospital

7/1996 – 6/1997 Research fellow in Neurosurgical and Pharmacology Departments, Shinshu

University School of Medicine,

Matsumoto, Japan

29

Hospital Appointments:

Since Feb. 1995 Attending Neurosurgeon

Department of Neurosurgery, Neurological Institute, Taipei

Veterans General Hospital

Academic Appointments:

Since July 1993 Lecturer of Neurology and Neurosurgery

National Defense Medical College, Taipei, Taiwan, R.O.C.

Since July 1993 Lecturer of Surgery

National Yang-Ming Medical College, Taipei, Taiwan,R.O.C.

Present Clinical Assistant Professor of Neurosurgery

National Defense Medical College, Taipei, Taiwan, R.O.C.

Present Clinical Assistant Professor of Neurosurgery

National Yang-Ming University, School of Medicine

Membership in Academic and Professional Organization:

Member of Surgical Association, Republic of China

Member of Neurological Society, Republic of China (Taiwan)

Member of Neurosurgical Association, R.O.C. (Taiwan)

Member of Taiwan Neurospinal Society

Member of Taiwan Neurooncology Society

Member of Taiwan Skull Base Society

Member of Taiwan Endoscope Society

Member of Taiwan Stroke Society

Organization of National Academic Society

July 2001 ~ June 2003 Vice Secretary General of Taiwan Neurospinal Society

Dec 2001 ~ Nov 2003 Vice Secretary General of

Neurosurgical Association, R.O.C. (Taiwan)

March 2003 ~ Feb 2005 Secretary General of Taiwan Stroke Society

Dec 2003 ~ Nov 2005 Secretary General of Taiwan Neurooncology Society

March 2005 ~ Board of directors of Taiwan Stroke Society

Organization of International Conferences/Symposia

Secretary General of the 4th Meeting of the Asian Society for Neuro-Oncology, Taipei (Grand Hotel),

Taiwan, November 4 ~ 6, 2005

Secretary General of 34th Annual Meeting of the International Society for Pediatric Neurosurgery (ISPN),

Taipei(Grand Hotel), Taiwan, September 10 ~ 14, 2006

30

15:15~15:40

一、基本資料

中文姓名劉安祥英文姓名Lieu Ann Shung

性別男出生年月日 51 年 8 月 21 日

E-mail [email protected]二、主要學歷

畢業學校國別主修學們系所學位起訖年月

高雄學大學中華民國醫學系學士1981/09~1988/06

三、現職及專長

服務機關服務部門職稱起訖年月

現職：

高雄醫學大學附設醫院神經外科

加護病房

主任 2006~迄今

高雄醫學大學附設醫院神經外科主治醫師 1998~迄今

高雄醫學大學外科學助理教授 2006/01~迄今

經歷：

美國維吉尼亞大學神經外科研究員2003/08~2005/07

高雄醫學大學附設醫院外科住院醫師1988/08~1994/07

高雄醫學大學附設醫院神經外科總醫師1994/08~1996/07

高雄醫學大學外科學講師2000/08~2005/12

31

16:10~16:30

Name: Cheng-Loong Liang 梁正隆Office Address: Department of Neurosurgery, E-DA Hospital, #1 E-DA Road, Yan-Chau Shiang,

Kaohsiung County, 824, TAIWAN. Tel No: 886-7-6150011

Education:

(2004 APR. ~ OCT.) Fellowship, Center for Imagine-Guided Neurosurgery, Department of

Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, USA

(1998~2002) Master of Medical Sciences, Institute of Clinical Medicine, Chang Gung

University, Taiwan

(1984~1991) Doctor of Medicine, Chung Shan Medical University, Taiwan

Academic Appointment:

Lecturer, I-Shou University

Employment Record:

(2004~ ) Director, Gamma Knife Center, E-DA Hospital, I-Shou University

(2004~ ) Attending Neurosurgeon, Department of Neurosurgery, E-DA Hospital, I-Shou University

(1999~2004) Attending Neurosurgeon, Department of Neurosurgery, Chang Gung Memorial Hospital,

Kaohsiung Medical Center

(1993~1999) Resident, Department of Surgery and Neurosurgery, Chang Gung Memorial Hospital,

Kaohsiung Medical Center

Board Certification: 1998, Board of Surgery (Taiwan)

Board Certification: 1999, Board of Neurosurgery (Taiwan)

Professional Affiliations:

American Association of Neurological Surgeon (AANS) USA

Surgical Association of R.O.C. (Taiwan)

Medical Association of R.O.C. (Taiwan)

Neurological Association of R.O.C. (Taiwan)

Taiwan Neurosurgical Society

Taiwan Stroke Society

Honor and awards:

2001 Award of Professor Lee T.K., Taiwan Stroke Society

2003 Award of Professor Du S.B., Taiwan Stroke Society

32

16:30~16:50

駱子文慈濟大學醫學系畢花蓮慈濟醫學中心神經外科總醫師花蓮慈濟醫學中心神經外科專科醫師(今年考取)

16:50~17:05

張軒凱陽明大學醫學系畢業台北榮總神經外科住院醫師

17:05~17:20

楊懷哲台北醫學大學醫學系畢業台北榮總神經外科總醫師台北榮總神經外科專科醫師(今年考取)

17:20~17:35

李政家陽明大學醫學系畢業台北榮總神經外科住院醫師

33

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