Glioblastoma Following Surgery of Cavernous Malformation: Case Report

The authors report a case of left parietal glioblastoma developed five years after surgical removal of the frontal cavernous malformation. A 36-year-old woman presented with history of seizure for 13 years and left frontal parasagittal mass on MRI. The mass was removed uneventfully, and the histopathologic examination revealed a cavernous malformation. Her seizure disappeared after the surgery. Five years later, the patient developed new symptoms of right leg weakness and paresthesia. Imaging studies followed by pathological study revealed left parietal, parasagittal glioblastoma, which was located posterior to the previous surgical field. Following surgery, she is now on regular follow up with radiation therapy and chemotherapy. The authors report this rare occurence of the glioblastoma following surgical removal of cavernous malformation with review of pertinent literatures.

Anterolateral Intrumentation and Spinal Stabilzation of Thoracolumbar Burst Fracture

Between March 1994 and March 1995, 10 patients with thoracolumbar burst fractures underwent a one-stage operation consisting of anterior decompression, reduction, bony fusion with iliac bone and stabilization with Kaneda device. The mean follow-up was 6.4 Months. Most patients with incomplete neurologic lesions showed postoperative improvement and were upgraded one or two steps in the Frankel scale. No patient showed neurological deterioration after surgery. Loss of reduction was 5.5 degree during follow-up period. Anterior decompression and strut fusion was used to effectively recover the neurological deficit and reduce the pain in a thoraco-lumbar burst fracture.

Clinical Experiences in the Treatment of Far Lateral Lumbar Disc Herni

The authors present 12 cases of far lateral disc herniation(FLDH) diagnosed and treated in our institution from march, 1992 to February, 1994. In the author's series the incidence of far lateral disc herniation was 5% of all lumbar disc herniations. The average age of the patients was 4 years and there were 7 men and 5 women. The L4-5 intervertebral disc level was the most commonly involved level. All patients initially presented with symptoms of radiculopathy. Cases with double herniations at the same level and on the same side seemed to have the most potential source of misdiagnosis and mismanagement, and a careful surgical consideration was needed for such cases. In 4 cases, a combined intraspinal and extraforaminal approach was performed with preservation of facet joints and in 2 cases, paramedian muscle splitting approach was performed. Chemonucleolysis and the usual partial hemilaminectomy were undertaken in 5 cases and in 1 case, respectively. The combined approaches proved to be an effective means of treatment for cases with double herniations, but misdiagnosis of such lesion can lead to an inappropriate and an ineffective treatment and poor surgical results. Furthermore, in the diagnosis of far lateral disc herniation, differentiation must be made from symptoms of conjoined nerve root and congested epidural vein.

Surgical Treatment for Metastatic Spinal Tumors

The authors analysed 33 cases of metastatic spinal tumors admitted to the department of neurosurgery, Hanyang University Hospital from January 1983 to December 1992. During this period, we operated 12 cases of 33 cases. The results were as follows : 1) The common incidence of age was fifth decade, the most frequent primary site of metastatic tumors was lung, and the thoracic region was the most common site of metastatic tumors. 2) The most common complaints of patients were pain, weakness of extremities and sphincter disturbance in order. 3) The indication to surgical treatments comprises spinal instability, aggravation of neurologic symptom, diagnosis in doubt, known radioresistance of tumor and intractable pain. Anterior approach was used in cervical area for tumor removal and fusion and posterior approach was used in the thoracolumbar area for decompressive laminectomy. The result was better in surgery group. 4) Early identification of spinal metastasis were considered to be important for better prognosis. 5) The survival rate of the primary lesion may imfeuence on the pregnosis of metastatic spinal tumor.

Histopathological Changes of the Renal Arterial Wall After Bipolar Coagulation in Experimental Rat Models

The bipolar coagulator has been frequently used in reducing the size of aneurismal neck or dissecting the aneurismal sac. However the effects of bipolar current on the wall of vessels have not been adequately documented. The author studied the histopathological changes of the renal arterial wall after bipolar coagulation. Thirty one Sprague-Dawley strain rats of both sexes and of various age were used. Under penthobarbital anesthesia, the left renal artery was coagulated with bipolar forcep just distal to it's origin from the aorta. The rats were divided into two groups:Group A was coagulated for two seconds:Group B for one second. The coagulation sites of vessels were examined grossly and microscopically in three and six months, respectively. The results were summarized as followings: 1) In both three and six months groups:the internal elastic membrane and elastic fibers were destructed, fragmented and thinned;the medial smooth muscle cells were damaged and decreased in number. 2) While the endothelial cells were severely desquamated and scattered in three months group, but there was an evidence of partial regeneration of endothelium and reduction of inflammatory reaction in six months group. Fibrosis was more augmented in six month group than three month group. 3) Between group A and B, There weemed to be no definite discrepancy in histopathological findings. 4) Pseudoaneurysms were developed in 72.2% of three months group and in 61.5% of six months group, but there was no significant statistical difference in the rate of pseudoaneurysm formation between the two groups(p>0.05, chi2=0.393). 5) Above findings suggest that the pseudoaneurysm which might be produced by bipolar coagulation of vessels in the neurosurgical operation, would be progressed to the true aneurysm if continuous hemodynamic factors are exerted upon the pseudoaneurysm. Therefore, it is desirable that the bipolar current should be used very catiously during the surgery of cerebrovascular disease.

A Case Report in Intradiploic Cyst

Intradiploic cyst, non-neoplastic process simulating neoplasm, is rare in skull. The pathogenesis of this lesion remains obscure. But, results of the hemorrhage into the diploic space after trauma in newborn and young children may attribute as one of the major cause to form a intradiploic cyst. A case of intradiploic cyst in a 7 months-old male, which involved right parietal vertex, is presented with reviews of the literatures. Diagnosis was made with the plain skull X-rays, Brain CT, surgical and pathological findings.

Clinical Evaluation of Ultrasonic Aspiration of Intracranial Tumors

The Cavitron ultrasonic Surgical Aspirator has been used clinically in 79 cases for removal of intracranial tumors. Ultrasonic aspiration of intracranial tumors has definite advantage in comparison with the previous conventional technique. The results were summarized as follows; 1) Ultrasonic aspirator provides a method of removing intracranial tumors that are not of a consistency to allow removal with suction and cautery alone. 2) There is a good proprioceptive feedback for the surgeon while using the ultrasonic aspirator. So the blood vessels were selectively exposed, operation was performed without severe bleeding. 3) Ultrasonic aspirator obviates the need for the cautery cutting loop. This is particularly advantageous when dealing with tumors in the cerebellopontine angle or close to important structures, such as the optic nerve or carotid artery. 4) Ultrasonic aspirator allows direct visualization of the tissue being removed.