Surgical Experience of Multiple Recurrent Astrocytoma: Case Report

The treatment of recurrent supratentorial glioma is one of the most challenging and at the same time one of the oldest problem in neurosurgery, especially in case of multiple recurrence. We have experienced 15-year-old male, multiple recurrent supratentorial glioma patient who was subjected to 6 times of operation, radiation therapy and chemotherapy druing 5 year follow-up period. We reveiewed the literature and discussed about recurrent rate, malignant change, method of management and indication of reoperation in low grade glioma.

Surgical Treatment of Intracranial Arachnoid Cyst by Excision

Arachnoid cysts are benign developmental cysts that occur between aachnoid layers, which represent approximately 1 percent of all intracranial space-occupying lesions, their most common location being the middle cranial fossa. Current surgical treatment options for intracranial arachnoid cyst are either craniotomy and excision of cyst or shunting of cyst contents extracranially. We treated 10 cases of intracranial arachnoid cyst by excision during last two years. For the best surgical curability, we have, not only removed the cyst wall and adhesive gliotic tissue as possible, but also made the opening to basal cistern for communication. During average 8.4 months follow up, we observed, not specific morbidity and mortality, but good clinical improvement and brain expansion. As above result, if haven't specific problem, the direct surgical removal may be the primary choice for intracranial arachnoid cyst, especially in children with noncommunicating type in sylvian.

Basilar Bifurcation Aneurysm Associated with Carotid-Ophthalmic Aneurysm: A Case Report

The report of basilar bifurcation aneurysm accompanying carotid-ophthalmic aneurysm is extremely rare and some technical dexterity must be needed on surgical treatment for each of two aneurysms. Authors report a case of basilar top aneurysm accompanied with a carotid- ophthalmic aneurysm clipped successfully in one stage operation with review of literatures concerning basilar bifurcation aneurysm, carotid-ophthalmic aneurysm and multiple aneurysms.

The study of Serum Immunoglobulins and Complement C3 on Predictive Assessing Cerebral Vasospasm and Clinical Grade in Aneurysmal Subarachnoid Hemorrhage

The immune system contributes to body defence mechanism, but sometimes show unfavorable immune disease. Cerebral vasospasm is a major problem in aneurysmal subarachnoid hemorrhage(SAH), but the pathogenesis is poorly understood. Some authors suggest cerebral vasospasm is one type of autoimmune vasculitis. In 35 patients(male 20, female 15) with aneurysmal SAH. the levels of serum immunoglobulin(Ig) G, A, M, E and complement C3(C3) were determined to analyze the relation among Igs, C3, cerebral vasospasm and clinical grade. The results were as follows : 1) Highly significant correlation presented between C3 level and cerebral vasospasm(p<0.001). 2) Highly significant correlation presented between IgA level and cerebral vasospasm(p<0.001). 3) Significant correlation showed IgA with admission grade(p<0.001) and outcome(p<0.01). 4) Significant correlation showed C3 with admission grade(p<0.05) and outcome(p<0.01). 5) Among the 4 groups(SAH without vasospasm, SAH within vasospasm, hypertensive intracranial hematoma(HICH), herniated intervertebral disc(HIVD)), significant statistical difference at the level of IgA and C3 with others is observed in the group 2. 6) In serial determination of C3 levels performed in 8 patients(group 1 and group 2), correlative alteration between C3 level and cerebral vasospasm was observed. From the above results, these findings suggest that IgA and C3 levels not only might be reflected the severity of the neurological insult but also provide the usefulness as a predictable marker of cerebral vasospasm in aneurysmal SAH.

Three Cases of Free Tentorial Edge Meningioma

The authors report the clinical features, radiologic findings and the operative management of three patients with tentorial free edge meningioma. The frequent symptoms and signs were headache, facial pain, tinnitus, dizziness, increased intracranial pressure and cranial nerves deficits. Tentorial free edge meningiomas are not only very rare but also very difficulty in total removal without complications. In this presentation, we are discussed the nature of this tumor and operative technique with review of literature.