The Role of Surgery in the Treatment of Spinal Myeloma

OBJECTIVE: Spinal myeloma has been treated with radiation therapy and chemotherapy. However, the role of surgery was not fully evaluated. This study is performed to evaluate the efficacy of surgery in the treatment of spinal myeloma. METHODS: 22 patients who were treated with surgery for spinal myeloma from August 1999 to April 2003 were analyzed. Radiological finding, surgical methods and result were reviewed in retrospective study. For compression fracture due to myeloma infiltration, percutaneous vertebroplasy(PVP) was done. Decompression surgery with or without fixation was performed for patients with neurologic deficit. The modalities of surgery consist of PVP (14 cases), corpectomy and fixation (7 cases), and laminectomy and epidural mass removal (3 cases). To evaluate clinical outcome, visual analogue pain score and Frankel neurological scale were used. RESULTS: In 14 cases of PVP, total 57 vertebral segments were treated including 21 thoracic vertebral bodies and 36 lumbar vertebral bodies. Pain relief was achieved in all cases. The pain score changed from 7.7 (preoperatively) to 2.5 (postoperatively). And pain relief effect was maintained over than one year. Frankel grade improved in decompression cases. CONCLUSION: Surgical treatment can alleviate pain and improve neurologic deficit immediately in spinal myeloma patients.

A Case of Pituitary Fossa Chondrosarcoma Mimicking Sellar and Suprasellar Mass

We report a rare case of chondrosarcoma arising from the dorsum sellae as it mimicked sellar and suprasellar mass. A 36 year-old man visited our hospital for his decreasing visual acuity. Brain magnetic resonance(MR) image revealed round a sellar and suprasellar mass showing mottled enhancement with internal cystic material. The MR image favored the diagnosis of craniopharyngioma, most likely, while plain skull X-ray showed sellar floor erosion and widening, which favored pituitary adenoma. The patient underwent trans-sphenoidal approach less than a week of admission and evaluation because his visual acuity was at a risk of blindness. In the operation, sellar mass was totally removed but some of suprasellar mass was inevitably remained due to limited surgical field. The pathologic diagnosis was chondrosarcoma. Six months from the first operation, pterional approach was performed to remove the remaining suprasellar mass, which didn't come down to sellar area. Intraoperative findings confirmed that the mass was originated from dorsum sellae.

Postoperative Brain Abscess Caused by Co-Infection of Aspergillus and Staphylococcus: Case Report

A staphylococcal brain abscess admixed with aspergillosis occurred after operation for the olfactory groove meningioma at remote site. We report the rare case and consider the clinical pathogenesis. Bifrontal craniotomy for the olfactory groove meningioma was done in a 61-year-old female. She was bedridden for one month after craniotomy. During that period, panhypopituitarism occurred and was corrected with hormonal replacement. Sore in the occipital scalp which had occurred during the bedridden state was cared by dressing. After 60 days of treatment, he was discharged with ambulatory status. During postoperative period, we found left parieto-occipital brain abscess in the brain computed tomography(CT) at 3 months. And then craniotomy and abscess resection was performed. Vancomycin and itraconazole antibiotic therapy was instituted after the identification of staphylococcus and aspergillus in the cystic fluid, and aspergillus hyphae in the solid wall portion of the abscess. After the confirmation of resolution of brain abscess on the postoperative 3 weeks' brain CT, the patient was discharged with oral itraconazole medication.