Chondroid Chordoma in the Cavernous Sinus: Case Report

The authers report a case of chondroid chordoma in the cavernous sinus. The chondroid chordoma is an uncommon variant of typical chordoma(0.2% of intracranial tumors) and reported usual locations of the chondroid chordoma are clival, parasellar, intrasellar, temporal region, other skull base and extracranial areas. Reported cases of this tumor arising in the cavernous sinus is very rare. We report a case of cavernous sinus chondroid chordoma presenting with clinical symptoms by hemorrhage.

Unusual Anterior Arch Fracture of C1

Fractures of C1 are not uncommon, constituting only 10% of all cervical spine injuries. There is a high prevalence of concomitant fractures of the second and first cervical vertebral complex. Surgical treatment is controversal. Mainstay of treatment is various combination of traction and cervical orthosis according to degree of displacement and location of fracture. We experienced unusual type of fracture, anterior arch fracture of C1 who had a history of total laminectomy of C1,2 due to cervical cord tumor(neurilemmoma arising from C2 root). We performed C1,2 lateral mass screw fixation with posterior fusion with good postoperative outcome.

The Clinical Significance of Brain Computed Tomography at Three Days after Cerebral Aneurysm Surgery

OBJECTIVE: Despite recent technical advances in neurological surgery and medical management, patients with aneurysmal subarachnoid hemorrhage(SAH) who underwent surgery have been still at high risk of morbidity and mortality. For early prediction of postoperative outcome and proper management, we analyzed brain computed tomography(CT) findings taken at three days after cerebral aneurysm surgery. METHODS: Focusing on the relationship between the surgical outcomes and postoperative brain CT findings, the authors studied 153 consecutive patients with aneurysmal subarachnoid hemorrhage who had been treated surgically between January 1993 and December 1996. RESULTS: Brain CT findings were classified into following categories; non-specific(49 cases, 32.0%), hematoma at operation site(14 cases, 9.2%), ventricular dilatation(10 cases, 6.5%), subdural hygroma(27 cases, 17.6%), low density (28 cases, 18.3%), hemorrhage at remote site(0 cases, 0%) and combined lesions(25 cases, 16.3%). The poor surgical outcomes were 6% in normal CT finding group and 36% in abnormal CT finding group(p=0. 00011, Chi-square test). CONCLUSION: These findings suggest that postoperative third day brain CT findings could be used for an early predictor of outcomes and proper active managements could improve the poor outcome.

A Case of Takayasu's Arteritis Associated with Subarachnoid Hemorrhage and Intracranial Aneurysm: Case Report

A rare case of Takasu's arteritis associated with subarachnoid hemorrhage and intracranial aneurysm is described. It is well known that diseases such as intracranial venous malformations, carotid artery stenosis, moyamoya syndrome, brain neoplasm, coarcatation of aorta, polycystic kidney disease, connective tissue diseases, etc are often associated with aneurysms, however an association with Takayasu's arteritis has not been reported. We discussed clinical features, radiologic finding, treatments of the case and reviewed the literatures of this disease entity.

Management of Intracranial Arachnoid Cysts

The authors have operated on fifteen cases of intracranial arachnoid cyst during the last 4 years. Among them, eleven cases of middle cranial fossa arachnoid cyst have undergone uniformly cystoperitoneal shunt. The craniotomy and fenestration(open surgery) was performed in three cases which located in quadrigeminal cistern(1 case) and harvored other combined problems(2 cases, intracystic hemorrhage and exophthalmos due to defect of lateral orbital wall respectively). A case of intraventricular arachnoid cyst was managed by ventriculocystostomy. All of above procedures showed good clinical and radiological results with acceptable morbidity and no mortality. With these observation, we thought as follows : 1) In middle cranial fossa cysts, cystoperitoneal shunt is sufficient as the first choice of operative intervention because it revealed good results with low morbidity and negligible complications. 2) Open surgery seems to be indicated only in deep seated cyst around brainsterm where the introduction of shunt catheter is difficult and dangerous and in cyst combinind other problems necessitating surgical intervation also.

Sudden Respiratory Arrest after Surgery for Cerebellar Cystic Astrocytoma

The authors experienced a case of cystic cerebellar astrocytoma which showed sudden respiratory arrest after an uneventful operation. Preoperative cerebrospinal fluid diversion was not performed despite moderate hydrocephalus because we thought that complete removal of tumor enables the cerebrospinal fluid pathway to be reconstitute. After full awakening from anesthesia postoperatively, the patient's mentality deteriorated again rapidly with sudden respiratory arrest. Brain CT scan taken immediately after revealed no specific finding except moderate hydrocephalus which was the same degree as the preoperative one. This hydrocephalus was alleviated and the patient recovered slowly. We postulate several pathogenic mechanisms for this unusual event. First, chronic compression of fourth ventricle resulted in marked subependymal gliosis and obliteration of outlets of fourth ventricle. Therefore, postoperative reaccumlation of cerebrospinal fluid in ventricles caused serious pressure effect on the lower brain stem with resultant sudden respiratory arrest. Second, sudden decompression of brain stem might induce marked hemodynamic change in the brain stem. Third, there was some traction injury to brain stem by gravity in the sitting position. We suggest that preoperative cerebrospinal fluid diversion and its adeqaute postoperative maintenance is important in posterior fossa tumor surgery in cases with obliteration of perimesencephalic cistern and fourth ventricle, and with brain stem compression or angulation in preoperative magnetic resonance images.

A Trial of Hyperfractionated Radiotherapy in Supratentorial Gliomas

Fractionation dose and number have been known as radiation factor affecting the radiation complication and the effectiveness in radiotherapy for brain tumors. In this study hyperfractionation technique with 115cGy/fractioin 2 fractions daily 5days/wk, upto 5750-6900cGy to partial brain volume was compared with conventional fractionation technique with daily 200cGy/fraction 5 fraction/wk, upto 5400-6000cGy, in regarding to the effectiveness of hyperfractionated radiotherapy and eraly and later radiation reavtion. The survival period was longer in hyperfractionated irradiated group particularly if the tumors were located in the posterior portion of brain, however there was no singificant statistics due to small number of patients. Mean survival period for glioblastoma multiforme was 11.8 months in hyperfractionated group vs 8.7 months in conventional fractionated group and for high grade astrocytoma 36month in hyperfractionated group, but in conventional fractionated group all was died in 18 months. Acute radiation reaction occurred less frequently in hyperfractionated group, 15.8% vs 47.8% in conventional fractionated group(p<0.024). Alopeci was developed in 31.6% of the hyperfractionated group vs 82.6% of the conventional fractionated group(p<0.0031). One case of later radiation necrosis in cancer region was suspected in the hyperfractionated group but we has been in a dilemma for confirmatory diagnosis in present available diagnostic technique. The hyperfractionated irradiation technique was proven to be superior to conventional fractionated technique regarding the radiation reaction and the effectiveness of the treatment.

A case of Aplasia Cutis Congenita

No abstract available.

A case of Aplasia Cutis Congenita

No abstract available.