Papillary Endothelial Hyperplasia of the Sella, Cavernous Sinus, Ethmoid and Sphenoid Sinus

Papillary endothelial hyperplasia(PEH), usually originates in extracranial soft tissue, is considered a reactive proliferation of endothlium and an unusual form of thrombus organization. However the occurance of PEH in the cranial cavity is very rare. The authors report a case of a PEH involving intracranial sella, parasella, cavernous sius, ethmoid and sphenoid sinus in an 11-year-old boy. The patient was presented with sudden right visual disturbance. Magnetic resonance image showed a well-enhanced mass in the right cavernous sinus extending into the ethmoid and sphenoid sinus. The cerebral angiography demonstrated a vigorous tumor staining supplied by both internal and external carotid arteries. The right fronto-temporal craniotomy and subtotal resection of the tumor were performed. The mass was comprised in a highly vascular red-black nodular tissue associated with a mixture of fresh and organizing thrombi. The histopathological examination revealed papillary structures lined by endothelium within vascular space with organized thrombus. While the patient was waiting for second operation in order to remove remaining small tumor in the ethmoid and sphenoid sinues, the lesion exhibited rapid regrowth and the size became to the preoperative size at three months after operation. At reoperation, gross total removal was accomplished by a combination of trans-cranial and trans-sphenoidal approaches. Postoperative radiotherapy was given.

Management of Elderly Patients Older than 80 Years with Ruptured Intracranial Aneurysm / 대한뇌혈관학회지

OBJECTIVES: The aim of this investigation is to provide the strategy of management and to improve the outcomes of elderly patients older than 80 years with the ruptured intracranial aneurysm. METHODS: 18 patients over 80 years old with aneurysmal subarachnoid hemorrhage who are admitted to our institute between Jan. 1996 and Nov. 2001 were included. Mean age was 81.6 years and female was predominant (89%). Hunt and Hess grade (HHG) and Fisher grade (FG) on admission, specific management components, and clinical outcomes were recorded. RESULTS: HHG I to III on admission were in 11 patients (61.1%) and FG III to IV on admission were in 15 patients (83.3%). The 4-vessel angiography was performed in 13 patients and 18 aneurysms were detected with the highest percentage of posterior communicating artery aneurysm (22.8%). Aneurysm repair was performed in 12 patients; 7 patients underwent surgical repair, 5 patients underwent Guglielmi detachable coil (GDC) embolization but 1 patient failed because of tortuous vessel. Preexisting medical conditions, such as hypertension (33.8%), diabetes (16.7%), myocardial disease (11.1%), cerebrovascular disease (11.1%), bronchial asthma (5.6%), were related with poor outcomes. Overall Glasgow outcome scale (GOS) were death 6 (33.3%), vegetative state and severe disability 5 (27.8%), moderate disability 0 (0%), and good recovery 7 (38.9%). Favorable outcomes of active management were 6 (50%), and favorable outcomes of GDC embolization were 3 (60%). 3 patients who had favorable clinical grade refused treatment and discharged. CONCLUSION: Elderly patients with subarachnoid hemorrhage can be treated successfully and results are still improving. The development of GDC embolization may have contributed to the improved outcome. So we think that elderly patients of favorable clinical grade would have a chance of returning to an active, independent life, if treated actively.

Intracranial Endodermal Sinus Tumor

OBJECTIVE: Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors. RESULT: In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. CONCLUSION: Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.

Clinical Analysis of Cervical Spine Injury

The authors reviewed the cases of 95 patients with cervical spine injury, 28 patients underwent surgery and the others were managed with conservative treatment. The results were summarized as followings; 75 patients were 20-29 years old(78.9%). 2) There was no seasonal frequency variation(p<0.01). 3) The most frequent cause of injury was motor vehicle accident. 4) The common mechanisms of injury were flexion-extension, extension and flexion. 5) High cervical injuries were 32 cases(33.7%) and mid-low cervical injuries were 63 cases(66.3%). 6) C2 type II fracure was the most frequent type of high cervical injury(43.7%). 7) Associated injuries were found in 29.5% of the cases. 8) There was no statistical significance in the difference between the Frankel's classifications(A, D, E) of operated and those of non-operative cases(P<0.01) .