Clinical Characteristics of Geriatric Brain Tumors

OBJECTIVE: The authors analyze the clinical characteristics of the geriatric brain tumors and suggest the treatment modality. METHODS: Patients older than 65years, managed between Jan 1980 and Feb 2002 in our department, were included in this study and the number of patients was 315. Age, sex, medical history, performance scale, treatment modality, morbidity and mortality as well as the incidence of brain tumor in this age group were analyzed. RESULTS: Geriatric brain tumors were comprised of 7.8% of the adult brain tumors. The mean age was 68.7 years and male to female ratio was 1 : 1.3. The most common one was meningioma(114, 36.2%), followed by metastatic tumor(49, 15.6%), high grade glioma(39, 12.4%), schwannoma(38, 12%) and pituitary adenoma(35, 10.5%) in the order of frequency. The incidence of pre-existing disease, such as hypertension(25%), caridiovascular disease(15%), diabetes melitus(12%) was high. Surgical outcome was good with acceptable operative morbidity and mortality rate 26% and 3% respectively. Frequent postoperative surgical complications were tumor bed bleeding and wound infection. During perioperative course, medical complications such as cardiovascular problem, delirium, pneumonia and sepsis were common. CONCLUSION: Incidence of combined medical problem in the geriatric patients was considerablly high. However, in the case of surgically accesible benign tumor or even malignant tumor, surgical treatment should be considered.

Surgical Results of 80 Patients with Growth Hormone-Producing Pituitary Adenomas : Analysis of Outcome and Prognostic Factors

No abstract available.

Brainstem Glioma: Survival and Prognostic Factors

OBJECTIVE: To clarify the biological behavior and prognostic factors of brain stem gliomas, the authors reviewed 48 patients with brain stem gliomas treated between 1980 and 1996. PATIENTS AND METHOD: The clinical presentation, tumor location, pathology, and treatment modalities were correlated with the prognosis of these tumors. Male to female ratio was 1.1:1, with the median age of 12.5 years. Thirty patients(63%) were below 15 years old, and 18 patients(38%) were of adult ages. Mean follow up period was 21.8 months. RESULTS: Focal tumors were in 22 cases and diffuse tumors were in 26. All nine midbrain tumors were focal type. Twenty-two(92%) cases among 24 potine tumors were diffuse type and two cases were focal type as dorsally exophytic tumor. Eleven(73%) cases among 15 medullary and cervicomedullary tumors were focal type and four(27%) cases were diffuse type. Pathologically, there were 14 anaplastic astrocytomas, 11 low grade astrocytomas, 4 glioblastomas, 3 oligodendrogliomas, and 1 ganglioglioma. Fifteen tumors were diagnosed only radiologically without histologic verification. Surgery was done in 33 patients(gross total or subtotal removal in 8, biopsy or partial removal in 15, stereotactic biopsy in 10). Radiation therapy was given in 41 patients(conventional in 29, hyperfractionated in 12). Chemotherapy was done in four patients. CONCLUSION: Statistically significant prognostic factors were symptom duration prior to diagnosis(p=0.0004), cranial nerve palsy(p=0.0206), extent of tumor growth(p=0.0219), contrast enhancement(p=0.0226), intratumoral cyst(p=0.047), histopathological grading(p=0.0304), surgery in patients with focal tumors(p=0.0018), and radiation therapy(p=0.0149).

Germline Mutations of the NF2 Gene in Korean Neurofibromatosis 2 Patient / 대한암학회지

PURPOSE: Neurofibromatosis 2(NF2) is an autosomal dominant disease characterized by development of bilateral acoustic neuroma and various central nervous system tumors such as meningiomas, ependymomas, and schwannomas. Recent cloning of the gene responsible for NF2, the NF2 gene, permits the presymptomatic genetic diagnosis of affected individuals by direct analysis of the gene. This paper was intended to identify germline mutations in Korean NF2 patients. MATERIALS AND METHODS: We collected blood samples from 15 clinically diagnosed NF2 patients treated at the Department of Neurosurgery, Seoul National University Hospital. Purified genomic DNA samples were analyzed for mutations of the NF2 gene by using polymerase chain reaction(PCR)-single strand conformation polymorphism(SSCP) method followed by direct DNA sequencing. RESULTS: We were able to identify germline mutation of the NF2 gene in one patient. The mutation identified was 1 base pair deletion(A) at codon 318, resulting in premature stop codon due to frameshift. CONCLUSION: Identification of the germline mutation in NF2 gene should enable us to test all individual family members at risk to determine whether or not they carry the mutant NF2 gene.

Experience with an Image-Guided Surgery Device-CANS Navigator-

The authors describe their experience with the CANS navigator, which has been in use since January 1997. The device uses magnetic field modulation technology for intraoperative localization: using a built-in scanner, a preoperative image with fiducial markers is input to a computer, and intraoperative localization uses a suctiontube integrated probe. During the previous ten months, we have used the device to perform surgery in 60 cases of brain lesion, mostly tumors. In five early cases, precise intraoperative localization was not successful, probably due to error in image input or registration, but after 2 months, there were only two failures, and for surgery, the device was very helpful: it was useful in the dessign of scalp incisionand bone flap, and for assessing the extent of resection in tumors, especially in cases in which surrounding brain tissue was poorly demarcated. It was also helpful in skull base surgery, in which precise localization of the work area is critical. The CANS navigator uses a magnetic field for localization, but except for the skull clamp, there was no problem in using metallic surgical instruments: there was no interference with laser, CUSA, or monitoring devices, and no complication attributable to its use. We suggest that for neurosurgery, the CANS navigator is a useful device: it is helpful for performing minimally invasive surgery.

Survival Rates and Prognostic Factors in Patients with Intracranial Oligodendroglioma: A Retrospective Multivariate Analysis

In order to determine the survival rate and prognostic factors of patients with intracranial oligodendroglioma as predictors of survival, a retrospective analysis of a total of 68 cases treated between 1982 and 1992 at our institute was performed. The 5-year and 10-year survival rates were 84.5% and 55.1% respectively while the median survival time was 116+/-5.3 months. The significant factors identified by the univariate analysis included the presence of preoperative seizure, the pre- and postoperative status, the presence of signs of increased intracranial pressure before operation and pathologic grade of the tumors. Factors such as age, types of chief complaints, blood types, the preoperative neurologic deficit, the size of tumor, the enhancement of tumor, cysts in tumor, the extent of removal and the postoperative seizure had no correlations with survival rates. The only significant prognostic factor determined by the multivariate analysis was the pathological grade(p=0.04).

Persistent Primitive Trigeminal Artery Aneurysm: A Case Report

The persistent primitive trigeminal artery is the most common of the carotid-basilovertebral anastomoses and is located in the most cephalic portion of them. Embryologically arising from the internal carotid artery in the 4mm embryo, it supplies the longitudinal neural artery. Failure of regression of the trigeminal artery in the 14mm embryo results in the persistent primitive trigeminal artery. It is associated with a vascular anomaly in 25% of the cases, such as aneurysm, arteriovenous malformation, agenesis or hypoplasia of the internal carotid artery, and moyamoya disease. The authors present a case of persistent primitive trigeminal artery aneurysm presenting with the abducens nerve palsy. The clinical features of the persistent primitive trigeminal artery aneurysm are discussed, with the review of literature.

Statistical Analysis of 2,616 Primary Intracranial Tumors Diagnosed During the CT Era(1976-1995)

To investigate the incidence and pattern of occurrence of primary brain tumors in Koreans, 2,616 cases of histologically confirmed primary intracranial tumors, which were operated on in our department between 1976 and 1995, were reviewed. In all cases, age, sex, tumor type, location and date of diagnosis were recorded, and tumors were pathologically classified according to the WHO Histological Type of CNS tumors, revised in 1993. The tumors studied included all those within the intracranial region, except for vascular or infectious masses and epidermoid or dermoid cysts associated with congenital dermal sinus. The total number of adult patients was 2,232(85.3%), while the number of pediatric cases(below 16 years of age) was 384(14.7%). The mean age of the patients was 36.4 years, and the male : female ratio(M:F ratio) was 1 : 1.06. Common tumors were those involving neuroepithelial tissue(874 cases ; 33.4%), the sellar region(787 cases ; 30.1%), the meninges(572 cases ; 21.9%), cranial and spinal nerves(232 cases ; 8.9%), and germ cell tumors(GCT)(59 cases ; 2.3%). Meningiomas, pituitary adenomas, and schwannomas occurred at a higher rate in females(M:F ratio : 1:1.92,1:1.21,1:1.19, respectively). GCT, medulloblastomas, craniopharyngiomas, and hemangioblastomas, on the other hand, occurred more often in males (M:F ratio : 1:0.44, 1:0.46, 1:0.67, 1:0.72, respectively). Common pediatric tumors were astrocytic tumors (23.2%), medulloblastomas(19.3%), and craniopharyngiomas(11.2%). The age distribution of tumors was similar to that found in other epidemiologic studies. Between 1976 and 1993, with the introduction of computerized tomography(CT), the reported incidence of primary intracranial tumors has increased by an average of 13% annually. The relative incidences of pituitary adenoma, glioma, hemangioblastoma and primitive neuroecrodermal tumors(PNET) have increased since 1988, when magnetic resonance imaging(MRI) was installed in our hospital.

The Clinical Behavior and Outcome of Operative Treatment of Craniopharyngiomas: Analysis of 102 Cases

The authors reviewed 102 cases of craniopharyngiomas with primary onset, which had occurred during a recent 15-year period. Among the 42 women and 60 men, 34 patients were children(aged 15 or less) and 68 were adults. The children showed clinical characteristics different from those of adults. With regard to initial presentation, headache was the most frequent chief complaint in children, while visual disturbance was most common in adults. The incidence of growth hormone deficiency was high in children, while in adults, adrenal corticosteroid deficit was most common. As seen on CT or MRI, the tumor was larger and calcification was more abundant in children than in adults. Gross total resection(GTR) was achieved in 46 cases. The main causes for incomplete removal were severe adhesion to the hypothalamus(31.3%) and the midbrain(18.8%), and heavy calcification(20.8%). The extent of surgery showed no significant influence on the Karnofsky Performance Score(KPS) on discharge, and in 82.4% of patients the results were good(KPS 80 or more). Postoperative endocrinological disturbances requiring hormonal replacement therapy were more common in the GTR group(p<0.01). In 22 recurrent cases, the median time from initial operation to recurrence was 18.5 months. Among patients who did not undergo postoperative radiation therapy, the recurrence rate was lower in those who had undergone GTR(p<0.05). An analysis of histological characteristics revealed that the adamantinomatous-type tumor recurred more frequently than the squamous papillary type. In conclusion, it is suggested that there is a difference in the growth pattern and clinical behavior of the tumor between adult and childhood craniopharyngioma. The authors recommend that unless expected postsurgical complications are detrimental to the patients, radical total resection should be attempted during the first operation, especially in patients who are under 15 and whose craniopharyngioma is of the adamantinomatous type. Radiation therapy should be considered for patients with a residual tumor and the treatment should be tailored to the individual.

Clinical Characteristics of Angiographically Occult and Histologically Confirmed Intracranial Vascular Malformations

The medical records of 30 patients with histologically confirmed and angiographically occult intracranial vascular malformations(AOVM), who underwent surgery between May 1988 and May 1993, were reviewed retrospectively to determine whether their radiological and clinical characteristics are helpful in differential diagnosis. Histological diagnoses were cavernous angioma(CA) in 17 cases, arteriovenous malformation(AVM) in nine, venous angioma in one and unclassified vascular malformation in three. The most common initial presenting mode was intracranial hemorrhage(ICH ; 18 cases, 60.0%), followed by seizure(11 cases, 33.3%) and headache(two cases, 6.6%). CA, once it had bled, tended to bleed repeatedly, and this occurred before surgery in seven of nine cases of CA presenting with ICH. On CT scan, calcification was observed only in CA(two cases). On MRI images obtained in 28 patients, a mottled density mass with or without adjacent ICH(ten of 16 CA's) and multiple lesions(three of 16 CA's) were pathognomonic for CA, while single stage ICH(two of eight AVM's) and signal void(three of eight AVM's) were observed only in cases of AVM. Findings of MRI such as multiple stage hemorrhage, low signal intensity rim or edema around the lesion were not helpful in differential diagnosis of the histological type of lesions. After enhancement with gadolinium, one case of AVM and another of venous angioma showed a serpentine pattern of enhancement. In 29 cases, the results of surgery were excellent ; there was no mortality and morbidity in only one case. In conclusion, CA, once it had bled, tended to rebleed and MRI was helpful in the differential diagnosis of AOVM's. MRI findings such as a mottled density mass or multiple lesions were pathognomonic for CA, while single stage hemorrhage or signal void were findings of AVM.

Phase III Randomized Trial of ACNU in Addition to Surgery and Radiotherapy for Patients with Supratentorial Malignant Gliomas / 대한암학회지

No abstract available

Jugular Foramen Schwannomas

The cases of ten patients with schwannomas of the jugular foramen who underwent surgery in our department between 1983 and 1996 are described. Seven were women and three were men(mean age 40 years) and the duration of their symptoms, the most predominant of which were hearing loss and tinnitus, ranged from 1 months to 20 years(median 8.5 months). Computerized tomography was performed in all cases, magnetic resonance imaging in eight, and angiography in three. Depending on their radiological and surgical features, the tumors were classified as follows : Type A, a tumor primarily at the cerebellopontine angle, with minimal enlargement of the jugular foramen(n=5) ; Type B, a tumor primarily at the jugular foramen, with or without intracranial extension(n=4) ; Type C, a primarily extracranial tumor with extension into the jugular foramen(n=0) ; Type D, a dumbbell-shaped tumor with both intra- and extracranial components(n=1). A retromastoid suboccipital craniectomy(RM-SOC) was performed for type A tumors, and the RM-SOC or staged infratemporal fossa approach/RM-SOC was used for type B and D. Total removal was achieved in six cases, and no patient died. Postoperative complications were detected in six cases, with low cranial nerve dysfunction most common(n=5). The follow-up period ranged from 14 to 173(mean 48) months. In one patient, a subtotally-resected tumor recurred ; this was again resected and LINAC radiosurgery was successful. In the remaining nine patients, tumors did not recur. It is suggested that jugular foramen schwannomas could be totally resected by RMSOC/ITFA ; to reduce postoperative complications, cases showing adhesion to critical structures could be managed with sub- or near-total resection.

The Effect of Moderate Hypothermia on Infarct Size and Early Change of Regional Cerebral Glucose Uptake in Permanent Focal Cerebral Ischemia in the Rat

Using a rat model, this study examined the cerebral protective effect of moderate hypothermia and evaluated the effect on early local metabolic change of permanent focal cerebral ischemia. The middle cerebral artery(MCA) of the rat was approached subtemporally and was occluded, and its surface was cooled. Cerebral infarct size was measured at 1, 4 and 7 days after MCA occlusion in non-treated(n=27), 2-hour hypothermia(n=27) and 3-hour hypothermia(n=27) group, respectively, and regional cerebral glucose uptake(rCGU) was determined at 1 and 4 hour after MCA occlusion in the non-treated(n=8) and 3-hour hypothermia(n=8) group, respectively. Infarct size measured at 1, 4 and 7 days after MCA occlusion was 22.2%+/-4.4%, 14.3%+/-6.6%, 13.7%+/-5.3% in the non-treated group, 19.6%+/-10.0%, 12.5%+/-6.2%, 12.0%+/-6.9% in the 2-hour hypothermia group and 12.9%+/-5.6%, 8.3%+/-3.3%, 8.2%+/-2.3% in the 3-hour hypothermia group. In the 2-hour hypothermia group, no significant size reduction was seen, but in the 3-hour hypothermia group, infarct size had decreased to half of that of the non-treated group(p<0.05). This protective effect was observed untill 1 week after MCA occlusion. rCGU in the non-treated group measured at 1 hour after MCA occlusion had increased in the periphery of the ischemic core, but at 4 hours, periischemic hypermetabolism had disappeared and the area of low metabolism in the center had become larger. rCGU in the 3-hour hypothermia group measured at 1 hour after MCA occlusion(BT 26degreesC) showed a uniform decrease in all regions, supressing temporary periischemic hypermetabolism, and at 4 hours(BT 37degreesC) after occlusion, hypermetabolism was not prominent and the area of low metabolism in the center had narrowed. This study indicates that 3 hour moderate hypothermia immediately after MCA occlusion significantly reduces infarct size, and that this protective effect was associated with suppression of periischemic hypermetabolism occurring around 1 hour after MCA occlusion.

A Study on the Formation of Organotypic Spheroids from Early Human Fetal Brain

The present study investigated whether organotypic spheroids derived from human fetal brain tissue, cultured at agarose-overlay media, may serve as an optimal invitro model for multidisciplinary studies in human neurobiology, particularly in the fields of tumor invasiveness and its biochemical mechanism, using light microscopy, electron microscopy and immunohistochemical staining. Eight fetal brain tissues of 8-9 weeks of gestation were minced and explanted into agarose-coated culture wells. After three to five days these human fetal brain tissue fragments emerged as spheroids and could be maintained as organotypic spheroids for up to seven weeks. Light and electron microscopic studies of sphereoids demonstrated that most cells were poorly differentiated and there were no definite mature neurons or glial cells after enough culture time, but some cells showed certain evidence suggestive of differentiation to neurons or glial cells. Immunohistochemical staining for glial fibrillary acidic protein(GFAP) and neur on specific enolase(NSE) demonstrated that NSE-positive cells were oval or spherical cells containing abundant cytoplasm and GFAP-positive cells were fibrillary cytoplasma-containing cells which showed some evidence suggestive of differentiation to glial cells by light microscopy. In future, adding some modifications in culture, this organotypic spheroids derived from the human fetal brain may serve as an optimal in vitro model for neurobiology especially in the field of studies on tumor invasiveness through co-culture with microtumor spheroids.

Diagnosis and Management of Patients with Neurofibromatosis Type 2 : Experience of 16 Cases

Neurofibromatosis type 2(NF-2) is a dominantly inherited disorder characterized by the occurrence of bilateral acoustic neurinomas and the frequent association of other central nervous system tumors. We present a retrospective review of 16 patients with NF-2 who were treated at our hospital from 1984 to 1995. In 13 cases, the diagnoses of NF-2 were based on the criteria developed at the Consensus Development Conference of National Institute of Health in the United States, and in another 3 cases, the criterias of NF-2 were not fully satisfied, but the diagnoses of NF-2 were highly suspected. The average age of the patients was 27.6 years, ranging from 13 years to 56 years. The most common symptom was hearing difficulty;intervals between symptom onset and deafness ranged from 8 months to 6 years(mean:2.9 years.) One family of NF-2 was documented, consisting of a sister, a brother and their mother. Nine patients underwent operations on unilateral acoustic neurinomas;these were subtotally removed in eight patient s and totally in one patient. Among these patients, five were deaf on the ipsilateral side at surgery. Among the other four patients with useful hearing before surgery, hearing was preserved to preoperative status in two patients. Four patients with diagnoses of meningioma, received operations to relieve mass effect with subtotal removal in two patients and total removal in the other two. Early diagnosis and treatment are the most important in the management planning of patients with NF-2 for reasons of early manifestation and rapid progression of the disease.

2 Cases of Multifocal and Recurrent Hemangioblastomas with Von Hippel-Lindau Syndrome: Case Report

Hemangioblastomas are benign tumors that most commonly occur in the posterior fossa around the 4th ventricle. Recurrent mutifocal hemangioblastomas are often found as a part of a systemic autosomal dominant disease, the Von Hippel-Lindau syndrome. Surgical removal of recurrent multifocal tumors are technically more difficult and challenging than solitary ones due to their proximity to critical structures, disturbed anatomical landmark and adehesion to the surrounding tissue, all of which may lead to high postoperative morbidity and mortality. Authors have experienced 2 cases of the multiple and recurrent hemangioblastomas with Von Hippel-Lindau syndrome. The patients of each of the cases underwent surgery for tumor removal at least 2 times. In the first patient, a 42-year-old male, a solitary cerebellar hemangioblastoma had been removed 6 years prior to recurrence. On followup MRI, more than three solid, homogenously enhanced nodules were found in the cerebellum. These tumors were operated on through the previous craniectomy site, but only two of them could be removed. This patient was discharged without additional neurologic deficit. The 2nd patient, a 40-year-old-male, had undergone three prior operations for cerebellar hemangioblastomas. On followup examination, he presented with progressive ataxia and confusion. Brain MRI showed multiple recurrent lesions of homogenously strongenhanced masses in the 4th ventricle and cerebellar vermis surrounded by cystic lesions, accompanied by obstructive hydrocephalus. No additional surgery of tumors were attempted, and only ventriculoperitoneal shunt was performed. He was discharged with improved neurological symtomes and sign.

The Operative Outcome of Primary Intramedullary Gliomas:Analysis of Related Factors

Presented below are the author's report of the result of surgical treatment of 53 intramedullary gliomas. In the analysis of survival data, twenty patients with low grade glioma(except the ependymoma) were followed for a period of mean 54 months, from 1 to 103 months. Five of these patients had died from progression of the disease and the 5 year survival rate was 75%. Nine patients from the above group received postoperative radiation therapy, 6 with no apparent benefit in terms of survival rate. The median survival of thirteen patients with high grade glioma patients were 11 months and there were significant increase of median survival time in patients receiving radiation therapy, from 4 to 17 months(P=0.04). The histological grade is the important factor in determining the survival of glioma patients(P=0.01). In sixteen, out of 20 ependymoma patients, 'radical removal(>95%)' was achieved and the patients showed no signs of recurrence until the mean follow-up period of 42 months. Two of the 4 ependymoma patie nts, whose tumors were partially removed, suffered recurrence and had to be re-operated. We concluded that the 'radical removal' in ependymomas is a significant factor in determining recurrence(P=0.009). The effect of radical removal on survival is not verified statistically. Total removal is more frequently performed in ependymomas than in gliomas(p=0.03). As to functional outcome, better outcome is expected in radical removal on long-term follow-up(p=0.00506), more so in ependymoma than in glioma. Intramedullary gliomas are extremely rare. Therefore sufficient data is unavailable for the determination of efficient treatment plan. However, recently aggressive surgical treatment with the aid of microsurgical techniques has become a trial option.

Intravenous Sodium Valproate(Depakine(R)):Antiepileptic Effect and Safety Assessment During the Postoperative Seven Days in Neurosurgical Patients

Diphenylhydantoin(DPH) has been used intravenously as a drug of choice in conditions which seizure patients are incapable of oral feeding or in a state of status epilepticus. However, its clinical use has limitations because of its serious side effects of cardiac depression or systemic hypotension. In Western countries, the recently developed intravenous sodium valproate has been reported as safe and effective for seizure control in such patients. To assess the safety and effectiveness in seizure control, we investigated the serum levels of the drug at 24 hours, 48 hours, and 7 days after intravenous administration of sodium valproate(Depakine(R)), occurrence of seizures in the perioperative period, and the side effects of the drugs in 30 neurosurgical patients older than 3 years of age. The mean serum concentrations of valproic acid after bolus injection of 15mg/kg followed by continuous infusion with the rate of 0.5mg/kg/hour, were over 45.0 microgram/ml;45.0+/-16.3 microgram/ml at 24 hours, 50.4+/-21.0 microgram/ml at 48 hours, and 58.9+/-20.7 microgram/ml at 7 days after the start of the administration. All the patients whose serum valproic acid level was within the therapeutic range(40-100 microgram/ml), had never experienced an episode of seizure attack during the perioperative days. There was no evidence of elevated liver enzyme activity, but there were evidence of some tendency of decreased platelet count in the peripheral blood at 2 days after the administration of intravenous valproic acid. Four patients experienced episodes of mild nausea and/or vomiting. In conclusion, perioperative intravenous administration of valproic acids in neurosurgical patients was safe and effective in seizure control. However, it must be used precauciously in the patients with compromised coagulation system.

Correlation of Treatment Outcome, Histologic Type, and PCNA Labelling Index in Craniopharyngiomas

Craniopharyngiomas exhibit benign histologic features. However, such tumors have a relatively high incidence of recurrence after surgical removal, In order to device reliable and efficient methods in identifying craniopharyngiomas with increased risk for recurrence after surgical removal, proliferating cell nuclear antigen(PCNA) expressions as well as histological characteristics of the tumor were analyzed. There were 43 patients who had been surgically confirmed and had paraffin-embedded tissue from June, 1984 to May, 1993 available for analysis from our department. Of the 43 patients, eighteen cases were in children(age of 15 years of less) and 25 cases were in adults. The mean follow-up period was 42.7 months. The histologic types were adamantinomatous in 30 cases, squamous papillary in 9 cases and mixed in 4 cases. There was no case of tumor recurrence in the squamous papillary group, while the recurrence rate was about 55% in the adamantinous group after surgical removal alone. The mean age of the admantinous group was younger than that of the squamous papillary group(17.5 vs. 37.9 years old. p=0.0012), and the squamous papillary type was found only in adults(age over 20). In the group of 30 patients treated by surgical removal without radiation, the PCNA labelling index, calculated by counting the basal cell layer only, was significantly higher in the group with recurrence than without recurrence(9.51 vs. 6.58. p=0.001). However, the PCNA labelling index obtained by counting all cells in the four high-power(x400) fields failed to demonstrate any correlation with tumor recurrence. With a reference value of 8, PCNA index of the basal cell layer demonstrated the predictive sensitivity of 81.8% and specificity of 84.2% for tumor recurrence. There was no significant difference in PCNA labelling indices between adamantinous and squamous papillary types. As PCNA labelling index of the basal cell layer, as well as the histologic type, are sensitive indicators for prediction of tumor recurrence after surgical removal of craniopharyngiomas, therefore they should be considered as an index for biologic behavior of the tumor.

Pontine Hemangioblastoma Presenting with Pontine Hemorrhage: Case Report

The authors report the case of a pontine hemangioblastoma with spontaneous pontine hemorrhage. The 19-year-old man presented with sudden right hemiparesis. The patient had showed recurrent episodes of neurological deterioration. Neurological examination revealed severe dysarthria, right hemiparesis and cranial nerve dysfunction(cranial nerve V-XII). Computerized tomography scans and magnetic resonance images showed recurrent hemorrhage in lower pons. Cerebral angiograms showed no vascular staining. Hematoma evaculation and wall biopsy were done. Histologic diagnosis was hemangioblastoma with hemorrhage. There has been no previous report of a pontine hemangioblastoma with hemorrhage. We also reviewed pertinent literature regarding a hemangioblastoma presenting with hemorrhage.