Pleomorphic Xanthoastrocytomas: Report of Three Cases

We report three cases of patient with pleomorphic xanthoastrocytoma(PXA). PXA is a clinicopathologically distinct variant of cerebral astrocytoma which is a low-grade leptomeningeal glioma affecting under the age of 30 years. This tumor has a favorable prognosis, but histological and neuroradiological findings suggest malignant brain tumor. Occasionally these may be confused with malignant gliomas. Clinical features from our three patients were manifestation of increased intracranial pressure and all cases were under the age of 30 years and females. Two patients had superficial location in the right frontal and left temporal respectively, but remaining one(case 2) which was associated with arteriovenous malformation in the left frontal region was in the right lateral ventricle. The intraoperative histological evidence by frozen biopsy suggested glioblastoma or anaplastic astrocytoma in all cases which confirmed to be PXA by postoperative histological examination. Two cases which had been resected subtotally were followed by cranial irradiation without therapeutic efficacy. Optimal management of PXA is primary surgical resection to reduce recurrence of tumor and to secure long-term survival. Therefore, differentiation of PXA from malignant brain tumors and intraoperative diagnosis of PXA is imperative to treat PXA effectively.

Acute Panspinal Epidural Abscess

Epidural abscess of the spine is an uncommon disorder. However, this condition can cause irriversible neurologic injury or death if it is not recognized and treated early. The constellation of presenting symptoms is frequently nondiagnostic and may be especially confusing in patients with chronic neck or back pain. The most important source of infection is, via hematogenous spread, the furuncle and abscess of the skin. The most frequent site of infection is thoracolumbar region(50%), and the most common cause of pathogen is Staphylococcus The pathogenesis o f the associated spinal cord dysfunction remains unresolved, but histopathological data from a previous study suggested that a mechanical mass effect rather than vascular thrombosis or vasculitis was responsible for the initial neurological deficit. MRI offered the advantage of noninvasive early recognition and anatomical localization, which made it the imaging modality of choice. Rim enhancement indicates abscess and diffuse enhancement indicates granulation tissue and fibrosis. Tuberculous epidural abscess usually spreads to ventral epidural space whereas pyogenic epidural abscess encircles entire epidural space. The treatment of choice of the spinal epidural abscess is early surgical decompression and drainage. Rapid diagnosis and treatment of this disease is essential for neurologic recovery and even for preservation of life. The author report a case of spinal epidu ral abscess, which involved continuously from the second cervical vertebra to the forth lumbar vertebra. The patients neurological conditions were improved following emergent decompression.

Endoscope Assisted Anterior Cervical Foraminotomy

A new technique of endoscope assisted anterior cervical foraminotomy was developed to improve the conventional microsurgical anterior cervical foraminotomy. Microsurgical anterior cervical foraminotomy provides direct anatomical decompression of the compressed nerve root by removing the spondylotic spur or disc fragment while preserving the functioning segment of the disc. The authors modified the anterior cervical foraminotomy using the MED TM(Microendoscopic discectomy) system to minimize the skin incision, and to achieve safe drilling and easy retraction. The uncinate process was drilled under endoscopic visualization through a tubular retractor. This technique has been applied to 13 patients with single level radiculopathy due to posterolateral osteophyte or soft disc herniation. The nerve roots were decompressed successfully under endoscopic control as in conventional microsurgical foraminotomy through a 2cm skin incision. Postoperatively, all patients showed improvements in their radiculopathic symptomatologies. Corresponding CT scans confirmed satisfactory anatomical decompression in all patients. This surgical technique has shown good clinical outcomes with fast recovery.