Coincidental Aneurysms with Pituitary Adenoma: Case Report

The occurrence of coincidental intracranial aneurysms with tumors of pituitary origin is very rare. Silent intracranial aneurysms located distant from the lesion to treated have little relevance to surgical management of most patients. However, aneurysms of the major arteries adjacent to pituitary and suprasellar mass are an additional hazard to surgical treatment. We experienced silent multiple aneurysms located just below the bifurcation of both internal carotid arteries associated with symptomatic pituitary adenoma(acromegaly). Transfrontal removal of the pituitary eosinophillic adenoma was carried out without treatment of the aneurysms. The angiographic data considered significant to the safety of the procedure. So the necessity of the cerebral angiography is stressed to show the precise relationships of vessels to masses in the pituitary region. Also the possible reasons for the occurrence of aneurysms in association with these tumors were discussed.

Epidermoid Cyst in the Middle Cranial Fossa Associated with Trigeminal Neuralgia: Case Report

We have recently experienced a rare case of extradural epidermoid cyst in the left middle cranial fossa associated with trigeminal neuralgia. A 22-year old female has intermittently developed lancinating pain in the left of face and dark reddish rhinorrhea for 5 years. Plain skull films showed an elevation of lesser wing of sphenoid bone and protrusion of left zygomatic arch with deepening of left middle cranial fossa. Carotid angiograms and brain scan with technetium 99m revealed a large cystic mass in left middle cranial fossa. A left temporal craniotomy was done and a large cystic mass filled with dark bluish colored fluid was removed at the left middle cranial fossa. Postoperatively the trigeminal neuralgia subsided completely. We have discussed the pathogensis and clinical symptoms with the review of the literatures.

A Case of Primary Rhabdomyosarcoma in the Left Cerebello-Pontine Angle

The primary rhabdomyosarcoma of the brain is very rare. There are only 14 cases reported in the literatures till 1975, and the majority of them were arised in the cerebellum. The intracranial rhabdomyosarcomas may be originated from the multipotent mesenchymal cells of aberrent muscle tissue in the leptomeninges. The histological 3 types are adult pleomorphic, alveolar and embryonal type. The demonstration of cross-striation is confirmed for diagnosis of this tumor. All of these tumors tend to have a short clinical course, but the survival time seems to be slightly improved by surgical excision followed by radiotherapy. We have recently experienced one case of primary rhabdomyosarcoma in the left cerebellopontine angle of 9 year-old girl, which was confirmed by operation and complete autopsy.

A Case of Intraventricular Oligodendroglioma Associated with Arterio-Venous Malformation

Bailey and Cushing described the oligodendroglioma firstly in 1926. The oligodendroglioma is rare tumor and involves the ventricular system in 7% to 10% of all cases. The authors present a case of intraventricular oligodendroglioma associated with arterio venous malformations in a 34 year old male who had the history of visual disturbance and mental deterioration, for one month. The diagnosis was confirmed by operation and autopsy.

Cerebral Paragonimiasis: An Analysis of 7 Cases

Pagonimus Westmani, occuring as an important human infestation of the lung, is widely distributed in the Far East ; Korea, Japan, China and the Philippines. Since Otani found the parasites for the first time in the human brain in 1887, it has been established that cerebral infestation occurs with the highest frequency among extrapulmonary involvement. In 0.8 to 25 percent of patients infested with the lung flukes cerebral paragonimiasis may be developed. The larvae may procedure arachnoiditis, abscess, fibrous cystic lesions and granulomas in the brain. Based on a review of the literatures and upon the 7 cases of cerebral paragonimiasis which have been observed by the authors at the National Medical Center, Seoul, Korea, the following points are stressed. 1) Males had a significantly higher prevalence than females. Cerebral paragonimiasis was most commonly found in young adults(16 to 25yrs). 2) Clinically the patients with cerebral involvement were characterized by Jacksonian type of epilepsy, headache and visual disturbance. Mental deterioration, hemiplegia, hemihypesthesia, homonymous hemianopsia and optic atrophy were the five major signs. 3) The patients having symptoms for less than 6 months developed mild leukocytosis in many cases. All the cases of cerebral paragonimiasis revealed positive reaction in the intradermal tests with purified antigens of P. Westermani. 4) On skull films multiple round or oval cystic calcification was diagnostic value for cerebral paragonimiasis. On angiogram vascular staining and abnormal vessels were not disclosed. On pneumoencephalogram subcortical atrophy or filling defect of the ventricle may be showed. 5) The predilection area of the granuloma and fibrous cystic mass were the occipital, posterior parietal and posterior temporal lobes. 6) The patients with chronic stabilized cerebral paragonimiasis. having intractable symptoms and signs, could not be improved with Bithionol treatment. But headache, vomiting, visual disturbance, facial weakness and especially intractable seizure were improved in our cases treated with surgical operation.

Analysis of 6 Cases of Brain Stem Glioma

An analysis of recent experiences for the brain stem glioma with surgery and autopsy established confirmation of the characteristic symptoms and signs, and of diagnostic criterias of Conray-ventriculogram and vertebral-angiogram. The cases consisted of 2 cases of exophytic brain stem glioma and 4 cases of pontomedullary glioma, and 5 of 6 patients had the signs of the increased intracranial pressure in this cases. A resurgence of interest in the Conray ventriculogram has been produced by cut-off sign of aqueduct of Sylvius in 2 cases of the exophytic brain stem glioma. The survival period in adults (1-3 years) were longer than that in children (less than 3 months) in this series.

No title available

A case of ectopic pinealoma in the region of the sellar trucica, which not enlarged reaiologically, so-called the intrasellar germinoma is described with its clinical manifestions, roentgenographic pictures, pathological findings and therapeutic points of view.

No title available

A case of ectopic pinealoma in the region of the sellar trucica, which not enlarged reaiologically, so-called the intrasellar germinoma is described with its clinical manifestions, roentgenographic pictures, pathological findings and therapeutic points of view.

Clinical Analysis of Brain Scans Using Technetium-99M

Technetium 99 M pertechnetate has become a valuable for the radioisotopic brain scan. This was introduced by Haper in 1963 and is now widely used in the medical field. The advantages are easy administration, high count rate with potential for high speed scanning, absence of beta radiation and decreasing time for test. We used Siemens Scintimat 2 Scanner with a 3x2 inch Na(T1) crystal and 151-hole collimator in our study. 10 mci Technetium 99 M was injected intravenously and obtained both lateral, anterior and posterior view in 80 cases of brain lesion from Mar. 75 to Sep. 76. The scans were classified as positive, negative and suspicious. The overall detection rate in 40 cases of brain tumors was 60%, especially high uptake in mengioma, malignant pituitary tumor, astrocytoma, metastatic brain tumor and acoustic neuroma. But in nontumors diseases of the brain including CVA, head injury and hydrocephalus the uptake rate was a little value.

Malignant Pituitary Adenoma

The authors present 2 cases of malignant pituitary adenoma. One case has remote metastases to the right frontal lobe, and the other case has invasion into the adjacent temporal lobe and malignant features histologically. Malignant pituitary adenoma constitute less than 1% of the large reported series of pituitary adenoma, which defined as (1) it burst its capsule to invade the adjacent nervous structures or bone, (2) it shows malignant features histologically, such as frequent mitoses, anaplasia with hyperchromatic pleomorphic cells, loss of alveolar arrangement, and (3) presence of distant metastases.

A Case Report of Meningioma "en plaque"

Meningioma en plaque are extremely rare, not only dose it form a thin layer on the inside of the dura but also infiltrates it an invades the adjacent bone. Painless, slowly developing exophthalmos with palpable swelling in the ipsilateral temporal region, and later impairment of vision and ocular motility indicate menigioma "en plaque" in the temporal region. The authors report a case of meningioma "en plaque" arisen from the outer third of sphenoid ridge.

A Case of Oligodendroglioma

Since oligodendroglioma was first described by Bailey & Cushing in 1926, there have been numerous studies reporting detailed description of the clinical and pathological characteristics of the tumor. It is a slow growing tumor usually in adults, with the highest frequency between 30 and 50 years, and affect the cerebral hemispheres, particularly the frontal lobes. Of all brain tumors the oligodendroglioma is the most likely to contain calcareous deposits which can be demonstrated radiologically in 40% to 50%. It consists of a continous sheet of uniformed small, round & densely packed cells interruptedly only by remarkably regular network of small blood vessels in histology. We have been recently experienced of a case of typical oligodendroglioma and reviewed the literatures.

Malignant Schwannoma Associated with Von Recklinghausen' Disease

Malignant peripheral nerve tumors are very rare and derived from the neurofibromatosis in about 13%. There are two classes of malignant tumors in the peripheral nerve, one those of mesoblastic origin, is far most common and made up of malignant neurofibroma and much common fibrosarcoma, and metastasis in 20% of fibrosarcoma, and the other is neuroepithelial origin. These are characterized by increased cellularity, atypical form of cells, mitoses and invasiveness. The choice treatment is radical removal of the tumor, and not affected the prognosis by radiation or chemotherapy. We have been recently experienced of one case of malignant schwannoma on the cervical roots in a case of von Recklinhausen's disease.

A Case of Brain Stem Glioma

Intracranial gliomas were found more commonly in childhood(70 to 80%) than in adulthood(40 to 45%). The common infratentorial tumors in children were cerebellar astrocytoma(26.9%), medulloblastoma(18.5%) and brain stem glioma(10.5%). Brain stem gliomas were infiltrating type of tumor and frequently involved the pons and medulla. An almost pathognomic syndrome of the brain stem gliomas consists in the presences of multiple bilateral cranial nerve abnormalities in combination with involving signs of pyramidal tract and cerebro-dentato-rubro-thalamic tract in the absence signs of increased ICP, especially in the early stage. These tumors take grave course because of clinical malignancy and lack of definite therapy. Once diagnosed, radiation therapy was at best palliative treatment. Sometimes surgical therapy could be attempted to find out curable cysts. We have been experienced in a case of brain stem glioma recently that was confirmed with an autopsy;astrocytoma grade II to III, microscopically.

Vascular Tumor of the Spine

Although a vascular tumor of the spinal cord is a fairly common lesion, and is often asymptomatic, it was recently found more frequently by contrast myelography and selective spinal angiography. The first report on an angioma of the spinal cord was made by Hebold in 1885. They may be classified as malformation composed of masses of tortuous interlacing vessels. A benign vascular tumor of the spinal cord may occur at any level and within the structures of the spinal canal. The cord involved directly by portions of the varix, foci of infarction of the involved cord may be thrombosis of the vessels of the angioma. Vascular tumors of the cord are difficult to treatment. An attempt can be made to reduce the size of the angioma by ligation or resection, but it is imperative that the blood supply to the spinal cord or nerve roots should not be injured. Roentgen therapy may be of value. We have experienced in 3 patients with vascular tumor involving the spinal epidural space. They had paraparesis or paraplegia with sensory level and urinary difficulity. Roentgenograms show perpendicular striations in the vertebral body owing to coarse trabeculations surrounding the dilated vascular spaces. Myelogram shows subarachnoid blockade in the epidural space by a tumor mass. Total laminectomy was performed, and the vascular tumor mass was removed, thereafter the neurological signs were some improved.

Acute Subdural Hematomas Review of 100 Cases

The authors reported 100 cases of acute subdural hematomas confirmed by operation from Jan. 1972 to Sept. 1975. We discussed the relationship of the type of operation to mortality in acute subdural hematomas. The types of surgical operations were divided in 4 groups. The surgical mortality rate was 19% for frontotemporoparietal craniotomy, 29% for multiple burr holes technique, 42% for craniectomy and 48% for subtemporal decompression with burr holes and total over-all mortality was 36% in our cases. The authors reviewed the literatures described the surgical operative method and it's mortality and so we thought large frontotemporoparietal craniotomy is more valuable method for operation of the acute subdural hematomas.

Cloward's Technique for Lumbar Disc Lesion

The surgical technique for removal of ruptured lumbar intervertebral disc has changed very little since it was introduced by Mixter and Barr in 1934. The technique of the interlaminar operation used by most neurosurgeons was used successfully in early cases to relieve the sciatica, but many patients were unable to return to heavy work because of low back pain. Cloward described a different surgical technique for removal of a ruptured lumbar intervertebral disc. The operation utilizes a transverse skin incision and a wide bilateral stlipping and retraction of fascia and muscles. The ligamentum flavum is not removed but detached and reflected medially in a flap. Only the bone margins of the adjacent facets are removed. A complete laminectomy is never done except for spondylolisthesis when the separate neural arch is disarticulated and removed. Using a "Vertebral Spreader", and interlaminar exposure is developed two to three times larger than that obtained y the "standard" technique. The advantages are obvious: 1. Both operations were done through a single transverse incision. A wider lateral exposure for the skin wound, being made parallel to the lumbar operation was possible and the normal skin lines, heals better with less scar. 2. The entire ligament is preserved, by separating its attachments from the lamina and reflecting in a flap, a larger opening into the spinal canal is obtained and the replaced flap protects the dura and prevents scarring. 3. Cloward recommends the use of a narrow, sharp chisel and hammer, but we used the spinal rongeurs including the Kerrison punch to remove part of the laminal edge. We leave the articular facets of the lumbar disc surgery because the articular facets are considered important major elements in the articulation of the vertebral joints, and as an essential bony surface to be used in posterior spinal fusion operation. 4. The routine use of intrathecal cortisone after lumbar disc operation has not been used in our cases because of increased pressure of the cerebrospinal fluid in modified prone position of the patient.

Intramedullary Dermoid Cyst Associated with a Congenital Dermal Sinus: Case Report

Congenital dermal sinuses result from a failure of separation of the cutaneous epithelial ectoderm from the neuroepithelial ectoderm along the dorsum of the embroy during the first month of intra-uterine life. These sinus tracts can occur at any level of the cerebro-spinal axis, but are located predominantly in the occipital and lumbosacral regions and occasional cases involving the cervical and thoracic regions. The dermal sinus tract is lined by stratified squamous epithelium and extends from the surface through the deeper tissues into the cranial or spinal cavity, usually ending on the dura or within the dura in conjunction with a terminal epidermoid or dermoid cyst. An intra-medullary epidermoid or dermoid with a dermal sinus is an unusual association. We have been able to find a previously reported coincidence of these malformations although there are many definitive papers on these uncommon entities. We are experienced in one case who are 14 months old boy with a intra-medullary dermoid cyst associated with a congenital dermal sinus at the T4 level, and reviewed related reports.

A Case of Bilateral Cerebellar Tuberculomas

Hematogenous spread from tuberculous lesions of other parts of the body represent the origin of intracranial tuberculomas. In most series of the literature, the cerebellum has about two thirds and the cerebral hemispheres about one third of the intracranial tuberculomas. It may occurs as a single lesion, but multiple intracranial tuberculomas varies from 10% to 33% of the cases due to the hematogenous spread. Calcium deposits are rare, occurring in about 6% of cases. Ramamurthi and Varadarajan described the two types of the intracranial tuberculoma; 1. Superficial and vascular type, produces early focal signs of increased intracranial pressure. 2. deep and avascular type, accompanied by signs of increased intracranial pressure. We have been experienced in one case of symmetrical and bilateral cerebellar tuberculomas probably originated from the pulmonary lesion.

Brain Abscess, A Study of Eight Consecutive Cases

Eight patients, with brain abscess or localized cerebritis proved histologically, were seen at The National Medical Center from 1971 to 1972, and 3 died, which is 37.5% mortality. Evidence of infection was often minimal in patients with brain abscess. The presence of increased erythrocyte sedimentation rate, highly suggestive of a cerebral abscess when an intracranial space-occupying lesion is suspected. The cerebral angiography and EEG were the best diagnostic tests. Early accurate diagnosis and early intracranial relieving with surgical procedure were most important factor in management of brain abscess. Primary excision of the abscess was considered to be the most satisfactory therapy.