Clinical Analysis of Acute Epidural Hematoma

The authors have analyzed the factors influencing the outcome of the 168 patients with acute epidural hematoma who had been managed in our hospital for 3 years from July 1986 to June 1989. 1) Sex incidence showed that male patients were 4.8 times more commonly affected than females, and the most commonly affected age group was the 3rd decade. 2) The most common cause of injury was motor vehicle accidents. The patients with unknown cause of injury which probably suggested significant delay in starting the clinical managements had a higher mortality rate. 3) The most common site of hematoma was the FTP convexity(63.6%). The patients with diffuse hematoma in the fronto-temporo-parietal region had a high mortality and deteriorated level of consciousness. 4) Skull fractures were not seen only in 9.5% of the patients with acute epidural hematoma. 5) The main factors associated with the higher mortality rate were rapid development of hematoma, pupillary dilatation, low score in Glasgow Coma Scale on arrival, and more midline shifting on brain CT. 6) The patients with concomitant intracranial lesions had a high mortality rate(25.8%), and the patients with acute epidural hematoma alone had a low rate(2%), and the overall mortality rate of the patients with acute epidural hematoma was 11.3%.

A Case of Intracranial Meningeal Mesenchymal Chondrosarcoma: A Case Report

Recently, the authors have experienced a case of intracranial meningeal mesenchymal chondrosarcoma. Mesenchymal chondrosarcoma is a rare tumor of the bone and soft tissue. It has been reported that the most common site of their extra-osseous origin is the central nervous system. Precise differential diagnosis should be done because of 1) its similarity to angioblastic meningioma or hemangiopericytoma in pathological aspect, 2) much more malignant tendency. We present one case of intracranial meningeal mesechymal chondrosarcoma with a brief review of the relevant literature.

Clinical Survey of Intracranial Acute Subdural Hematoma

One Hundred and eight patients received operation for acute subdural hematoma were evaluated in prognostic factors. They were admitted to the Neurosurgical Department in S.R.C.H during the 3 years from January, 1986 to December, 1988. The results were as follows ; 1) The patients were consist of 85 male patients and 23 female patients with the sex ratio 3.7 : 1. 2) Evaluated prognostic factors were age and sex, preoperative Glasgow coma scale(GCS), preoperative pathological physical findings, time interval from injury to operation, type of injury, midline shift, location of hematoma, thickness of hematoma, and operative procedure. 3) On the statistical analysis, factors of GCS and midline shift were considerable significant factors. 4) In the overall results of 108 patients, 47 patients(43.5%) had good recovery, 9 patients(8.3%) had moderate disabled state, 2 patients(1.9%) were severe disabled state, 4 patients(3.7%) were vegetative state, and 46 patients(42.6%) died.

Sacral Spinal Meningeal Cyst(Perineurial Cyst): A Case Report

We experienced a rare case of sacral meningeal cyst so called sacral perineurial cyst(Tarlov cyst). A 15 years old girl was admitted to the hospital because of sudden severe low back pain and Lt. sciatica for about one week. We performed delayed myelography and spinal computeized tomographic myelography(C.T.M) for differential diagnosis. Delayed filling of contrast media in the cyst was significant in diagnosis of sacral meningeal cyst type II. Laminectomy of sacrum(S1) was performed for partial excision of cystic wall and plastic suture. Operative finding was typical sacral perineurial cyst(Tarlov cyst) which was recently clssified as sacral meningeal cyst type II. The classification of spinal meningeal cysts in the literature was indistinct and confused. We also agree with Nabors et. al, in current classificcation of spinal meningeal cysts, in which the spinal meningeal cysts, in which the spinal meningeal cysts were divided into 3 groups as extradural spinal Mcs Type I(Diverticulum), Type II(perineurial cyst), intradural spinal Mcs(arachnoid cyst).

A Case of Left Temporal Gliosarcoma

A case of left temporal gliosarcoma is reported. The patient was a 40-year old man who had headache, behavior change, dysphasia, and mental confusion for about 2 months duration. On brain CT, a large partially cystic mass with homogeneous enhancement was located at left temporal lobe and associated with remarkable peritumoral edema and mass effect. Angiographic tumor vascularity was faintly visualized. Surgical subtotal resection of the tumor and post-operative radiotherapy offered transient symptomatic improvement, being followed within several months by clinical deterioration and regrowth of the tumor on brain CT. Light microscopic studies of the H & E and special stained specimens showed two different components within the tumor in a mixed fashion, i.e. intermingled glioblastoma multiforme and fibrosarcoma. Electron microscopic study of the sarcomatous cells disclosed intracytoplasmic Weibel-Palade-like bodies, a specific marker of endothelial cells. The fibrosarcomatous component of gliosarcoma is believed to be originated from malignant transformation of the hyperplastic endothelial cells within the anaplastic glioma. Literature concerned with gliosarcoma is reviewed.

A Case of Peripheral Neuroblastoma (Involing Skull)

The peripheral neuroblastomas are malignant neoplasms that originate from the adrenal gland and sympathetic nervous tissues. They usually occur in childhood. They exhibit such malignant features that they metastasize early to lung, liver, bone, rarely skull and other structures. The patients with peripheral neuroblastoma have short duration of symptom and short survival period. They reveal the characteristic light microscopic features that resemble other small cell carcinomas. The establishment of final diagnosis of peripheral neuroblastoma needs various special stainings for small cell carcinomas, and the electron microscopic findings are the most reliable. The authors recently experienced a case of peripheral neuroblastoma in a 26-year-old man which involved right frontoparietal skull vault. The only chief complaint was a local non-tender mass at right frontoparietal scalp. Neither headache nor any neurological deficits was detected. Simple skull X-ray revealed a punched out radiolucency at right frontoparietal bone and brain CT showed a superficial elliptical high density mass that enhanced strongly. The mass was totally removed by wide craniectomy. The tumor invaded and penetrated the dura but the arachnoid membrane. At the tumor bed was not invaded by the tumor. The tumor was confirmed as peripheral neuroblastoma by various special stainings for small cell carcinomas. Following surgical resection of the mass, post-operative radiotherapy was offered(4800 rads for about 5 weeks). The patient aggrevated progressively and showed numerous metastases to such bones as lumbar vertebrae, pelvis and humerus to became paraplegic. 8 months after the operation, the patient died.

Cervical Neurilemmoma Associated with Cavernous Angioma: Report of One Case

We report a rare case of cervical intradural extramedullary neurilemmoma associated with extradural cavernous angioma in adolescent male patient. This 19-year-old man complained of increasing weakness of left extremities with pain and numbness, starting upwards from the region of left leg since 2 months before, which has aggravated gradually and developed to right side. Neither the patient nor any family member displayed the stigmata of spinal tumor. Neurological examination showed spastic qudriparesis, more severe on left side, disclosed absent vibratory sense and diminution of pain and touch below level of cervico-thoracic junction. Myelogram demonstrated a large filling defect at the C4-6 vertebral level, which was interpreted as an intradural extramedullary or extradural mass. Laminectomy was performed 4 days after admission. At surgery, reddish, diffuse and well demarcated friable mass was found extradural space at the level of C4-6. But post-operative course was not improved for 2 weeks, so we are performed second operation after identified another intradural extramedullary mass by spinal CT. A total removal of tumor mass was accomplished at second procedure. Hostological examination confirmed the diagnosis of cavernous angioma at the extradural mass, neurilemmoma at the intradural extramedullary mass. The post-operative course was satisfactory.