A Case of Cerebral Paragonimiasis Combined with a Meningioma : A Case Report

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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.

Clinical Analysis of Repeated Lumbar Disc Surgery

Results from lumbar disc operation in general are favorable in 70% to 90% of patients. The rate of necessary reintervention of the primary discectomy, however, may be as high as one fifth of cases even though diagnostic and technical standards have been improved. The purpose of this study was to analyse the reasons for failure of primary discectomy and which factors might have influenced the outcome of revisions in 53 patients with failed back surgery syndrome from the years 1989 to 1993. Mean follow up duration was 11.4 months with range of 1 to 69 months. Before revisions, all patients had one or more lumbar disc operations in whom disabling pain, neurologic deficits, and/or lumbar instabilities have been persisted or newly developed. The most common intraoperative findings of patients with revision were recurrent or persistent disc material(35.9%) followed by incomplete decompression from previous operations(24.5%), and disc lesions at new level(11.3%). In overall, 77.3% of total patients showed satisfactor y results(fair, good, and excellent) but this figure drops to 39.6% when those with at least good or excellent outcomes are only considered as definitively improved. Moreover only 22.9% good results were obtained among 35 patients with those less than 6 months of symptom duration. As for the total number of operations undertaken, it can not be conclusively stated due to small numbers in each categories, but less favorable results have been observed in those with more than one revisions. The factors predicting good outcome from revisions in our series were:1) greater than 6 months of pain relief after primary operation, 2) sciatica more prominent than lower back pain, 3) fewer operations.

Thoracic Myelopathy Caused by Multiple Ossified Ligamentum flavum Combined with Ossification of the Posterior Longitudinal Ligament

The authors report a case of thoracic myelopathy caused by multiple ossification of the ligamentum flavum(OLF) combined with ossification of the posterior longitudinal ligament(OPLL). A 52-year-old man had progressive motor weakness and numbness in the lower extremities. Diagnosis was made from the MR imaging that provided useful information about the multiple lesions in the lower cervical and upper thoracic area and about the degree of spinal cord compression. The surgical approach consisted of two stages: Posterior decompression for OLF(first stage) and anterior decompression for OPLL, followed by interbody fusion(second stage). The patient had satisfactory improvement after surgical intervention.

A Case of Multiple Meningiomas: Case Report

The neurosurgical frequency of multiple intracranial meningioma is low. The authors report a case of multiple meningiomas of supratentorial region and posterior fossa. The patient was 57-year-old female and presented with severe headache and vomiting. Computerized tomography and magnetic resonance imaging revealed multiple meningiomas in right parasagittal region. right temporal region and posterior fossa. The patient was treated successfully by stage operation and all of these pathological types was meningotheliomatous meningioma.

Pain Relief from Dorsal Root Entry Zone(DREZ) Lesions Made with CO2 Laser in Brachial Plexus Injury Patients

Treatment of pain related to various types of deafferentation remains a neurosurgical challenge. Medical therapy and conventional surgical techniques for pain relief have not been effective due to this problem. Six patients with intractable pain following a brachial plexus injury were treated with dorsal root entry zone(DREZ) lesions. These lesions were made with CO2 laser. All patients were followed from 5 months to 5 years after surgery. Two-third of the patients were relieved of more than 50% of their preoperative pain. Post-operative neurosurgical complications were ipsilateral leg weakness and loss of proprioception in 2 cases. The laser technique is exact, makes uniform lesion, shortens the duration of the procedure, lessens cord manipulation and makes shalow penetration into the surrounding spinal cord. Dorsal root entry zone(DREZ) lesions made with CO2 laser appeared to be a satisfactory treatment for brachial plexus injury patients who have failed to respond to more conservative modes of therapy.

Three Cases of Ossification of Ligamentum Flavum Causing Thoracic Myelopathy

The authors report three cases of ossification of ligamentum flavum causing thoracic myelopathy. The symptoms of all cases were numbness in the legs and feet and motor weakness. Preoperative diagnosis were simple spine X-ray, metrizamide CT and magnetic resonance imaging. There was satisfactory improvement in all cases after total laminectomy and medial facetectomy.

Cirsoid Aneurysms of the Scalp: Report of Three Cases

The arteriovenous fistula and cirsoid aneurysm, characterised by abnormal arterial and venous connections with grossly dilated and expansile mass of vessels, may predispose to dramatic complications. Cirsoid aneurysms of the scalp have been reported to be difficult to remove. Multiple treatment schemes have been described and, as yet, no standard form of therapy exists. Three cases of cirsoid aneurysms of the scalp are presented. Each of them was treated with embolization and total excision after ligation of the feeding arteries. All of them were well cured.

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.

Sturge-Weber Syndrome: Report of an incomplete form

The Sturge Weber syndrome is an uncommon disorder characterized by port-wine nevus of the face with angiomatosis of the ipsilateral cerebral leptomeninges and extensive calcification in the underlying cerebral cortex. Associated with this syndrome are mental retardation, choroidal angioma, buphthalmus or glaucoma, seizure and hemiplegia. We studied a case of incomplete form of Sturage Weber syndrome in a 12 year-old boy, who had generalized seizure, a homonymous hemianopsia, intracranial calcification and leptomeningeal angiomatosis. There are no characteristic facial nevus, mental retardation, occular changes and hemiplegia.

The Study on Experimental Brain Herniation

Cerebral herniations were successfully produced in experimental animals during the expansion of intracranial balloon or laminaria. Visualizing structures deep in the brain, cat's heads were instantaneously frozen with liquid nitrogen and were sectioned in the midline longitudinally. The cerebral herniations were assessed by measureing the distance between parts of various anatomical structures on the brain in mid-sagittal sectional plane. Transtentorial rostrocaudal herniation of the brain stem was evident and more marked in the group of bilateral lesions than in the groups of frontal and temporal lesions. Infratentorial lesions produced transtentorial upward herniation of a part of anterior cerebellar vermis and downward herniation of the cerebellar tonsil through the foramen magnum. The risk of brain herniation was noted to be greater in rapid expanding lesions with balloon than the more slowly developing lesions with laminaria.