Pathologic Study of Primitive Neuroectodermal Tumor: Report of 5 cases

Primitive neuroectodermal tumor (PNET) occuring in the brain (especially in the cereburm) of young individuals is a rare and highly malignant neoplasm. The authors analyzed 5 cases of primitive neuroectodermal tumor, operated from January 1986 to September 1987. They had characteristic clinical, radiologic and pathologic features. Patient's age ranged from 2 years to 14 years old (mean 8.2 years old) and there were 3 boys and 2 girls. They were rapidly growing tumor, with a brief duration of symptoms taking a rapidly progessive course. Computerized tomographic findings were characteristic, revealing the large, irregular, typically iso-to hyper-dense mass lesions with calcification and cystic or necrotic areas, and showing dense heterogeneous contrast enhancement of the mass in the cerebral hemisphere. Grossly all of the 5 cases showed hemorrhage and necrosis with sharp border and 2 cases showed calcification and cystic change grossly. Microscopically, they were predominantly composed of undifferentiated small dark cells with evidence of focal differentiation along glial and or neuronal lines. Four cases showed glial differentiation and three cases showed neuronal differentiation. Mesenchymal components were predominant in 3 cases.

Clinical Study of Intracranial Meningioma

To provide a guideline of accurate diagnosis and proper methods of treatment of meningioma, the most common benign intracranial tumor, the author studied 57 cases of meningioma who had been diagnosed and operated at the Department of Neurosurgery, Inje Medical College, Paik Hospital, Pusan from July, 1983 to June, 1988. The results were as followings. 1) The ratio of male to female was 1 to 2.2 and 31.6% of the 57 patients were in the 5 th decade of age and 29.8% in the 6 th decade. 2) The predilection sites were parasagittal and falx(33.3%), convexity(26.3%) and sphenoid ridge (21.1%) areas. The most frequent histological type was meningotheliomatous type(47.4%) which was followed by transitional(15.8%) and fibroblastic(10.5%) type. 3) The common initial clinical features were headache(29.3%), visual disturbance(24.6%), seizure(22.8%) and motor weakness(10.5%). In radiologic diagnostic tests, there were abnormal findings in 47.4% on plain skull X-ray, the possibility of diagnosis as the meningioma was 91.2% by means of brain CT scan only, which was regarded as the most accurate and safe method. 4) The extent of operation were total(84.2%), subtotoal(12.3%) and partial(3.5%) removal, The surgical outcome were excellent(49.1%) and good(29.8%). 5) The preoperative embolization of feeding artery was effective to reduce the operative bleeding, and the CO2 laser was thought to be effective surgical tool to remove the meningioma, with its unique properties of non-mechanical bloodless evaporation of tumor and minimalizing of brain edema.

Clinical Analysis of Multiple Intracranial Aneurysms

Author reviewed the 31 cases of multiple intracranial aneurysms clinically from January 1981 to July 1987, at Inje College Busan Paik Hospital. The results obtained were as follows: 1) The incidence of multiple intracranial aneurysm was 7.8%. In most cases(94%), the number of aneurysm was two. 2) Approximately over 70% of patients were 6th and 7th decades, male to female ratio was 1:3.4. 3) The location of multiple intracranial aneurysms was in order, on the opposite side(39%), on the same side(26%), one in the midline and one on the side(29%). The location of indivisual aneurysms was in order, P-com. A(36%), MCA(25%), A-com. A(17%), ICA(13%). 4) The site of the ruptured aneurysm was determined by CT finding(55%), focal mass effect and spasm in angiography(29%), and others. The accurary was 97%. The possibility of rupture at each location was A-com. A(73%), P-com. A(57%), ICA(38%), MCA(31%). 5) 12 cases among them were treated with one-stage operation and 9 cases with two-stage operation. The post-operative favorable outcome was estimated in 13 cases(54%), the surgical mortality was 13%. There was no statistical difference between two groups.

Clinical Analysis of Multiple Intracranial Aneurysms

Author reviewed the 31 cases of multiple intracranial aneurysms clinically from January 1981 to July 1987, at Inje College Busan Paik Hospital. The results obtained were as follows: 1) The incidence of multiple intracranial aneurysm was 7.8%. In most cases(94%), the number of aneurysm was two. 2) Approximately over 70% of patients were 6th and 7th decades, male to female ratio was 1:3.4. 3) The location of multiple intracranial aneurysms was in order, on the opposite side(39%), on the same side(26%), one in the midline and one on the side(29%). The location of indivisual aneurysms was in order, P-com. A(36%), MCA(25%), A-com. A(17%), ICA(13%). 4) The site of the ruptured aneurysm was determined by CT finding(55%), focal mass effect and spasm in angiography(29%), and others. The accurary was 97%. The possibility of rupture at each location was A-com. A(73%), P-com. A(57%), ICA(38%), MCA(31%). 5) 12 cases among them were treated with one-stage operation and 9 cases with two-stage operation. The post-operative favorable outcome was estimated in 13 cases(54%), the surgical mortality was 13%. There was no statistical difference between two groups.

Clinical Analysis of Posterior Fossa Tumors

We analyzed the 43 cases of the posterior fossa tumors at the Busan Paik Hospital, Inje Medical College from January 1980 to December 1986. The posterior fossa tumors included 12 cases of cerebellar astrocytoma, 10 cases of acoustic neurinoma, 5 cases of medulloblastoma, 5 cases of brain stem glioma, 2 cases of meningioma, 2 cases of hemangioblastoma, 2 cases of tuberculoma, 1 case of glioblastoma multiforme, 1 case of oliodendroglioma, 1 case of rhabdomyosarcoma, 1 case of glomus jugulare tumor and 1 case of arteriovenous malformation. The posterior fossa tumors were occupied on the cerebellar hemisphere in 18 cases, the cerebellar vermis in 8 cases, the cerebellar pontine angle in 12 cases and the brain stem in 5 cases. The 25 cases out of the 43 cases of the posterior fossa tumors were accompanied with hydrocephalus. The 10 cases received the radiation therapy and/or the chemotherapy after operation. After treatment of the posterior fossa tumors, 52.6% favorable outcome, 34.2% unfavorable outcome and 13.2% mortality were estimated.

Two Stage Operation for Large Cerebral Arteriovenous Malformation

This report describes three cases of large arteriovenous malformation which were removed totally with two stage operation. When a large arteriovenous malformtaion had to be removed, prediction of profuse bleeding and brain swelling could be made. We clipped large feeding arteries and arteires and made a cleft around the AVM during the first operation, and the progressive reduction of the shunt flow by clipping the dominant peduncles on after the other diminished the risk of profuse bleeding and brain swelling. 7 to 10 days later, we removed AVM totally as the second operation. All three lesions were resected by microsurgical techniques, and the results were excellent. The rationale for the two stage operation for large cerebral AVM is discussed.

Intracranial Aneurysms in Identical Twins: Case Report

Intracranial aneurysms are usually regarded as congenital in origin but their etiology is unknown. The occurrence of familial aggregation of intracranial aneurysm is rare but well documented, and suggests a hereditary basis for some intracranial aneurysms. We experienced two cases of intracranial aneurysm in monozygotic twin brothers and reviewed literatures.

A Case of Atlanto-axial Dislocation due to Os Odontoideum

A patient who had an atlanto-axial dislocation due to an os odontoideum is presented. She was operated on successfully with preliminary realignment of the dislocation by skeletal traction and subsequent posterior cervical fusion with wiring and iliac bone.

Trigeminal Neurinomas: Report of 2 Cases

No abstract available.