Fibrous Dysplasia Involving the Fronto-Orbital Bone: Surgical Experience

OBJECTIVE: To suggest early surgical treatment of fronto-orbital fibrous dysplasia, the authors present the surgical experiences of fronto-orbital fibrous dysplasia in 8 cases. METHODS: A total of 8 surgically treated patients with fronto-orbital fibrous dysplasia is included in this study. There were 4 males and 4 females with age range between 6 and 50(average 23.5 years). All presented with painless bulging mass in fronto-orbital region, and seven had varying degrees of proptosis with variable degrees of visual symptoms. Six cases were treated with radical resection and immediate orbital and cranial reconstruction using polymethylmethacrylate(PMMA) and miniplates. Two cases were treated with minimal resection and contouring using autogenous bone graft. RESULTS: No complications were seen except transient ptosis and wound infection in one case, respectively. There were no signs of recurrence during follow-up period(up to 4 years). Cosmetic results were acceptable in 7 seven patients but reoperation was required in remaining one patient 4 years after first operation. The patients who had visual symptoms showed improvement postoperatively. CONCLUSION: These results emphasize the importance of the early treatment with surgical approach in patients with fronto-orbital fibrous dysplasia who have visual sympotoms and cosmetinc problems. However, further study with larger population is warranted to validate early surgical correction in patients with varying degrees of symptomatologies.

Clinical Features and Prognostic Factors of Head Injury in Less Than Two-Year-Old Children

The brain and intracranial compartment undergo a multiplicity of physiologic and anatomical changes which influence the type of head injury and response to such injury, especially for those children in first two years of age in whom development of skull and brain is still undertaking. Thus, special attention to recognize and manage these children from such injury seems mandatory. Purpose of this study is to analyze the related causes for the head injury in this age group with various clinical parameters influencing the outcome. A total of 68 children less than two years of age who were admitted to our institution after head trauma were included in this retrospective study. The causes of head injury along with other clinical settings, such as type of pathologies, Pediatric Glassgow Coma Scale(PGCS), age, operation, hypoxia, shock, seizure, anemia, abnormal pupillary response, were reviewed and clinical outcome related with these parameters were analysed. The mean duration of admission period was 15 days and mean follow-up period was 29.4 months. Most common mode of injury was stairway injury(32.3%), followed by in-car accident(19.1%), with suspected child abuse being only 2.9%. Cerebral contusion was the most frequent diagnosis being 43 cases(63.2%), followed by skull fracture in 31(45.6%). For the outcome related to various categories, 5 cases of death were due to diffuse axonal injury or intracranial hemorrhage, but most simple linear fractures were not associated with underlying brain injury. Among those required the operation(18 cases), subdural and/or epidural hematoma were the most common pathology(50%), followed by subdural hygroma and depressed skull fracture. The outcome, however, was not related to type of pathology. Instead, it was rather closely related to the initial PGCS. The PGCS at admission was found out to be the major predicting factor to outcome. In overall, 34/36(94.4%) cases with normal PGCS in these age groups showed good recovery with deaths being 5/7(71.4%) cases of PGCS

A Case of Frontal Gliosarcoma

The authors report a case of frontal gliosarcoma. The characteristic of this tumor is that it is composed of mixed glial and sarcomatous elements. The sarcomatous elements are thought to derive from the neoplastic transformation of mesenchymal cells in or adjacent to the tumor. This transformation usually has the appearance of a fibrosarcoma or angiosarcoma. A 24-year-old man had a 1-month history of headache, dizziness followed by blurred vision. At admission, there was no focal neurological deficit except bilateral papilledema. Brain CT and MRI revealed a heterogeneously enhancing mass containing cystic portion in the right frontal lobe with considerable peritumoral edema and shift of the midline structures. A craniotomy was performed with gross total resection of the tumor. Postoperative course was uneventful with resolution of his symptoms. The histologic, immunohistochemical and electron microscopy studies revealed bimorphic pattern, a characteristic feature of gliosarcoma.

A Case of Thoracic Angiosarcoma

Angiosarcoma of spine is a rare neoplasm derived from vascular endothelium. Synonymous term include hemangiosarcoma and malignant hemangioendothelioma. The authors present the clinical, radiological and pathological features of a patient with angiosarcoma located in the thoracic spine. The treatment of this case is discussed.

Intramedullary Neurilemmoma in Conus Medullaris

A case of intramedullary neurilemmoma embedded within the conus medullaris of spinal cord and presumably extending over its surface, is reported. Published reports of these rare lesions and possible mechanisms of their origin are reviewed. The treatment of choice for these rare lesions is thought to be laminectomy and resection and intraoperative frozen section diagnosis is considered essential. Importance of operative removal is emphasized.

Effects of Intrathecal Baclofen on Spasticity

9 patients with spasticity of cerebral or spinal cord origin have been maintained for upto 2 months with intermittent bolus spinal intrathecal infusion of baclofen. Prior to treatment, all of patients had severe spastiuity in extremties & had frequent & extensive spontaneous spasms, all of which greatly interfered with their activities of daily living. Oral antispasmodic medications were ineffective. Within days of intrathecal baclofen infusion, the muscle tone was reduced remarkable & spasms were eliminated. The greatest benefit to the patients were improvement in activities of daily living & better sleep due to reduced spasms. Complications were not observed.

Liver Abscess Complicated With V-P Shunt

A 35-year-old male patient with hydrocephalus due to spontaneous subarachnoid hemorrhage secondary to brain tumor were treated with ventriculo-peritoneal shunt. Subsequently an unusual liver abscess developed at right lobe of liver which was drained successfully through the percutaneous puncture method. The liver abscess and ventriculitis was controlled with systemic, intrathecal and intraventricular antibiotics administrations. The authors have never seen a report of liver abscess after the ventriculoperitoneal shunt. The computed tomographic findings, managements of infection and a review of the literature is presented.

Sphenoid Sinus Mucocele Complicated With Spontaneous CSF Rhinorrhea: Case Report

Mucocele is commonly found in frontal sinus. Mucocele of sphenoid sinus is rare and only 100 cases have been reported since Burg's description in 1889. Their etiology is still conjectural. These lesions are potentially more serious and are often misdiagnosed as pituitary tumor. The author experienced a case of sphenoid sinus mucocele develped headache, fever and CSF rhinorrhea. Plain skull, cisternography brain CT scan help the diagnosis of sphenoid sinus mucocele. A transnasal approach is considered best for case with extensive sphenoid sinus mucocele with bone destruction in the floor of sella turcica. The headache, fever and CSF rhinorrhea improved after surgery.

Oligodendroglioma in the Fourth Ventricle: Case Report

The authors present a case of oligodendroglioma in the 4th ventricle which is extremely rare in occurrence. The patient is 11 year-old male whose complaints were severe headache and vomiting. In the brain computes tomogram, hyperdense mass seated in the 4th ventricle with marked hydrocephalus. The patient had operation for removal of the tumor. In the operating field, there are no relation of the choroid plexus and specific vesselas but the tumor attached firmly on the floor of the 4th ventricle. The tumor was removed totally. The pathologic specimens were verified oligodendroglioma.