The outcome of surgical treatment for tumors of the craniocervical junction.

OBJECTIVE: The authors report the clinical, radiological, and surgicalfindings ofpatients with craniocervical junction tumors surgically treated in the institution over the last 8 years. MATERIAL AND METHOD: A retrospective study was performed. Clinical, radiological, and operative data were evaluated, and follow-up information was obtained from outpatient examinations, and telephone interviews. RESULTS: There were 25 patients consisting of nine chordomas, eight meningiomas, three cysts, two schwannomas, one each of aneurysmal bone cyst, plasmacytoma, and metastasis. Twenty-nine operative procedures were performed, classified as 12 anterior nine posterior-lateral, and eight posterior approaches. Gross total removal was achieved in 17 cases, subtotal removal in six cases, and partial removal in two cases. Re-operation was performed in six cases. Median follow-up time was 31 months. The authors found significant improvement in Karnofsky Performance Scale scores. CONCLUSION: Appropriate surgical approaches provide successful tumor removal with less surgical morbidities, nevertheless recurrent tumors occasionally occur and so, long-term follow-up is mandatory.

Successful resection of Hypothalamic Hamartoma with intractable gelastic seizures--by transcallosal subchoroidal approach.

A 19-year old female with intractable gelastic seizures was found to have 0.7 x 1.8 x 1.8 cm elliptical mass on the floor of the third ventricle. The signal intensity on the Magnetic Resonance Imaging (MRI) was consistent with the Hypothalamic Hamartoma (HH). Ictal EEG demonstrated rhythmic 7 Hz waves over Fp2, F4, and C4 with spreading to the right temporal region and then bilaterally. Ictal Single Photon Emission Computerized Tomography (SPECT) showed hyperperfusion at hypothalamic and medial frontopolar regions. The patient underwent surgical resection using Trans Callosal Subchoroidal Approach (TCSA) to the third ventricle. Pathological finding confirmed the diagnosis of hypothalamic hamartoma. Following the operation, she has been seizure free up to 12 months. Thereafter, provoked seizures seldom occurred and there has been improvement in her memory, emotional control and independence. This appears to be the first report of this surgical approach for HH, which is less likely to disturb memory function compared to previously described interfoniceal approach.

Three-dimensional frameless stereotactic-guided pedicle screw fixation of the spine: early experiences in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To study the accuracy and safety of pedicle screw insertion by three-dimensional frameless stereo-tactic-guided technique. MATERIAL AND METHOD: Twelve patients underwent spinal surgery using three- dimensional frameless stereo-tactic-guided technique at King Chulalongkorn Memorial Hospital (KCMH) during June - December 2004. In all patients, post-operative CT scan of the operated spinal segments were obtained and evaluated for the position of each screw placed. Medical records were reviewed and all patients were interviewed by telephone to assess clinical outcomes and complications RESULTS: 5I pedicle screws were inserted in 12 patients. Postoperative CT scan of the instrumented spine revealed that 50 screws were considered grade I screw while one screw was considered grade II. No patient suffered direct vascular or neurological injury. CONCLUSION: Three-dimensional frameless stereotactic-guided technique provides additional safety to spinal instrumentation

Currarino syndrome: report of two cases and review of the literature.

In the present paper the authors examine two cases of Currarino syndrome and review the existing literature on the disease. Both cases presented with chronic constipation. The first concerns a two year old male born with anorectal stenosis and diagnosed with Currarino syndrome when scimitar sacrum and anterior meningocele were finally detected. The second concerns a 25 year old female who suffered from chronic constipation but was not diagnosed until thorough examination revealed ectopic anus with Hirschsprung disease, scimitar sacrum and anterior meningocele. Because these patients were not diagnosed with Currarino syndrome when first seen, the authors reviewed its prevalence, embryogenesis, clinical manifestations, diagnosis and treatment. The authors' research supports the significance of prompt diagnosis in effective treatment and reduction of morbidity.

Supratentorial lobar anaplastic ependymoma resembling cerebral metastasis: a case report.

A 45-year-old man presented with progressive deterioration of vision. Visual acuity test revealed no light perception in both eyes. The fundoscopic examination demonstrated pale optic discs, consistent with secondary optic atrophy. Preoperative neuroimaging studies revealed a well-defined contrast-enhancing mass, 3 cm in diameter, at the left parietal region. Its radiologic appearances simulated those of cerebral metastases. A totally removed lesion was verified pathologically as an anaplastic clear cell ependymoma, which is rare in this location. A brief review of clinical features and neuroimaging of supratentorial lobar ependymoma is also included.