Visual Outcome after Surgical Removal of Craniopharyngiomas

OBJECTIVE: In the present study, we evaluate visual outcomes after surgical removal of craniopharyngiomas and analyze the factors that are considered to affect visual outcomes. METHODS: This study includes 30 patients with craniopharyngioma, who underwent surgery in this clinic during the last 10 years. The changes of visual function (visual acuity and field) of the patients were assessed preoperatively and postoperatively, and paired data of this change were compared. Also, the factors that influence on this change were analysed. RESULTS: Among the 21 patients complaining of decreased vision before the operation, 8 patients were improved (38.0%), and 7 patients were worse (33.3%). However, Four out of 9 patients without any preoperative visual symptoms developed worse vision after the operation (44.4%). The average duration of symptom was 17.2 months in the improved group and 23.6 months in the aggravated group. The tumors recurred in only 5 patients after the gross total resection: Four of them showed the aggravation of visual function after surgical removal and 1 had improvement. CONCLUSION: After removal of craniopharyngiomas, the overall rate of vision improvement, no change and aggravation are 26.6%, 36.7% and 36.7%, respectively. Aggravation of postoperative visual function is higher in males, children and patients with a longer duration of symptom and the tumor recurres more frequently in patients who complained of worsened vision after surgical removal.

Hemangiopericyotma with Metastasis to the Cervical Spine: Case Report

We report a case of metastatic hemangiopericytoma to the cervical spine. A 55-year-old female having a history of intracranial cavernous hemangiopericytoma, which was found 78 months ago was admitted to our hospital with posterior neck pain and left arm radiating pain. Magnetic resonance image revealed a tumor invading the C6 and C7 vertebral body and compressing the spinal cord. The histopathologic findings were characteristic of hemangiopericytoma. Extracranial metastases of hemangiopericytoma can occur long after the previous treatment in unexpected sites, especially in skeletal system. Bone scintigraphy is an useful tool to detect osseous metastasis, furthermore single negative scan is not sufficient to exclude bone metastasis.

Cystic Meningioma Complicated by Delayed Hemorrhage from a Pseudoaneurysm: Case Report

We report a case of delayed rupture of pseudoaneurysm after operation for meningionma. A 68-year-old female presented with mild headache and hemiparesis. Magnetic resonance imaging showed a cystic mass lesion with a solid component, which was attached to dura in the right frontal area. The mass was totally removed, and diagnosed to transitional type meningioma with histopathological examination. Postoperatively, almost of preoperative symptoms were impoved. About a month later, she developed sudden onset deterioration of mental state and hemiparesis. Computed tomography disclosed a large intracerebral hemorrhage at the site of the tumor bed. Emergency operation was performed. During the evacuation of hematoma, we found a ruptured pseudoaneurysm, and secured it with circumferential wrappig and clipping. The patient recovered well and became ambulatory. In case of delayed intracerebral hematoma at the postoperative site, a possibility of the rupture of pseudoaneurysm should be considered.

Clinical Analysis of Posterior Thoracic and Endoscopic Surgical Approach for Essential Hyperhidrosis

OBJECTIVES: Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. MATERIALS AND METHODS: To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. RESULTS: The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. CONCLUSION: Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.