Choroid Plexus Carcinoma in an Adult

Choroid plexus carcinomas are extremely rare in adults. They can behave aggressively and their optimal management is uncertain. A 35-year-old woman was admitted with an episode of loss of consciousness. Magnetic resonance imaging showed a homogeneously enhancing mass in the trigone of the right lateral ventricle. Detailed examinations found no evidence of an extraneural primary focus. She underwent total removal of the tumor. Pathological diagnosis was confirmed as a choroid plexus carcinoma. She is doing well eight months after surgery.

Primary Malignant Melanoma in the Fourth Ventricle: Case Report

We describe a case of primary malignant melanoma in the fourth ventricle treated with surgery and fractionated high dose radiotherapy. A 27-year-old man was referred to our institution due to drowsy mentality, dysconjugated gaze, and pupil dilatation following vertigo and posterior neck pain. Preoperative magnetic resonance images revealed a fourth ventricular tumor extending to C2 level. The mass was high-signal intensity on T1-weighted image, low- on T2-weighted and homogeneous strong enhancement. Extraneural focus of primary site was not found. After grossly total removal in two staged operations, fractionated high dose radiotherapy was given(6300 cGy, 180cGy X 35 fraction). No tumor recurrence was seen for 12 months after operation. Aggressive treatment involving operative total tumor removal and combined radiotherapy is considered to increase the life span of the patient even with this type of tumor.

Papillary Endothelial Hyperplasia of the Sella, Cavernous Sinus, Ethmoid and Sphenoid Sinus

Papillary endothelial hyperplasia(PEH), usually originates in extracranial soft tissue, is considered a reactive proliferation of endothlium and an unusual form of thrombus organization. However the occurance of PEH in the cranial cavity is very rare. The authors report a case of a PEH involving intracranial sella, parasella, cavernous sius, ethmoid and sphenoid sinus in an 11-year-old boy. The patient was presented with sudden right visual disturbance. Magnetic resonance image showed a well-enhanced mass in the right cavernous sinus extending into the ethmoid and sphenoid sinus. The cerebral angiography demonstrated a vigorous tumor staining supplied by both internal and external carotid arteries. The right fronto-temporal craniotomy and subtotal resection of the tumor were performed. The mass was comprised in a highly vascular red-black nodular tissue associated with a mixture of fresh and organizing thrombi. The histopathological examination revealed papillary structures lined by endothelium within vascular space with organized thrombus. While the patient was waiting for second operation in order to remove remaining small tumor in the ethmoid and sphenoid sinues, the lesion exhibited rapid regrowth and the size became to the preoperative size at three months after operation. At reoperation, gross total removal was accomplished by a combination of trans-cranial and trans-sphenoidal approaches. Postoperative radiotherapy was given.

Clinical Analysis of Spinal Cord Hemangioblastoma

OBJECTIVES: The authors present a retrospective analysis of 14 patients treated for spinal cord hemangioblastoma (SCH) between Dec. 1986 and Mar. 2000. This study was conducted to evaluate and compare the difference of the functional outcomes associated with the extent of surgical removal of SCH. METHODS: Eleven patients were male and three patients were female. Their mean age was 37.2 years that ranged from 19 to 62 years. Preoperative magnetic resonance(MR) imaging of the spine was performed in all cases, and preoperative angiography in eleven cases. They were followed from 15 months to 161 months(median follow-up period, 47 months), and we investigated the change of neurological symptoms and functional outcomes with radiological features, especially on MR imaging. RESULTS: Six patients were accompanied by von Hippel-Lindau disease, and three of them had multiple CNS tumors. Thirteen patients had intramedullary tumor, and the remaining one had extradural. Syringomyelia around the tumor was observed in ten cases. All patients underwent surgical removal, and gross total removal(GTR) was achieved in ten cases. Preoperative embolization was performed in four cases. In four patients who were treated with preoperative embolization, intraoperative loss of blood was minimal and GTR was possible. One patient developed a transient swallowing difficulty postoperatively without permanent postoperative neurological deficits. In three of four patients in whom GTR was not possible, their functional outcomes were worsened postoperatively. The functional status at discharge was improved in seven patients, stationary in four patients, and worse in three. At the last follow-up(15-161 months), one of four patients who had been stationary at discharge showed improvement but, the rest did not show any change. All patients who showed neurological improvement were patients with GTR, and the patients with GTR had significant better outcome than those without GTR(p=0.015). CONCLUSION: Surgical treatment, and especially, GTR is considered as treatment of choice for spinal cord hemangioblastoma. Preoperative embolization may prevent intraoperative bleeding and improve surgical outcome.

A Study on the Selection Criteria of Surgical Approaches to Vestibular Schwannomas

This study was carried out in order to clarify the selection criteria of the surgical approaches and validate their efficacy in patients with vestibular schwannoma. The evolution and modification of the transpetrosal approach was evolved into combined approaches to vestibular schwannomas. These approaches have been advocated to reduce the mortality and morbidity as well as to improve the surgical results especially in large acoustic neurinoma. Having been stimulated with the fascinating preliminary surgical results of the suboccipital and combined transpetrosal approaches, we have builded up a decision making policy based on the tumor size and the preoperative hearing status for the surgical approaches to vestibular schwannomas. Between May 1996 and September 1997, 21 patients with vestibular schwannoma including one case of NF II underwent either suboccipital or various transpetrosal approaches. There was no surgical mortality. Gross total removal was achieved in 20 patients(95%). Facial nerve function was preserved in 19(90%) and hearing function in 6(46%) among the 13 patients who underwent hearing preservation surgery. The authors confirmed the validity of various transpetrosal approaches in this study and conclude that our policy on the surgical approaches to vestibular schwannomas is quite reasonable.

Two Cases of Early Rebleeding after Total Removal of Hematoma due to Metastatic Choriocarcinoma

Among metastatic brain tumors, choriocarcinoma has a highly malignant nature and because of the vascular invasion of trophoblastic cells,tends to hemorrhage. Surgery is recommended for patients with a single cerebral metastasis, or for those who fail to respond to chemotherapy. We encountered two unusual cases in which early rebleeding occurred after the total removal of a hematoma arising from metastatic choriocarcinoma, and confirmed by post-operative tissue biopsy.

Clinical Characteristics and Surgical Results of Craniopharyngiomas in Adults and Children

The records of 59 patients with craniopharyngioma treated at the Department of Neurosurgery, SNUH, from Jan. 1981 to May 1990 were reviewed in order to compare the characteristics of the tumor in children and adults in view of clinical features, radiological findings, surgical results and follow-up outcome. This study was also done to evaluate the outcome and recurrence rate according to the extent of surgical removal between the two groups. Of the 59 patients, 22 patients were under the age of 15 and 37 patients were adults. In the child group the most frequent presenting symptoms were IICP symptoms(63.6%) followed by visual disturbance(27.3%) whereas visual disturbance(51.4%) were more often than IICP symptoms(24.3%) in the adult group. In the radiologic findings calcification(95.5%) and cystic change(95.5%) were more common in the children than the adults. In the adults calcification showed in 59.5% of patients and cystic change showed in 86.5% of patients. Hydrocephalus was noticed in 63.6% of the children whereas 16.2% of the adults showed hydrocephalus on the CT scan. Twenty-five operations were undertaken for 22 children and 39 surgical procedures were performed for 37 adults. Most of the surgical procedures were carried out by the pterional or subfrontal approach or a combined approach. Eighteen child patients and 12 adult patiens underwent total removal and 3 child patients sand 14 adult patients underwent subtotal removal. Surgical results were good in 33 adult patients and in 21 child patients. One patient died postoperatively after partial removal due to pulmonary embolism. The mean follow up period was 27.0 months in children and 22.6 months in adults. Clinical recurrence study with the subtotal and partial removal group revealed that recurrence happened more often and in a shorter period of time in children. Presumed factors influencing the total removal of tumor such as age, symptom duration, cysic protion, calcification, size and location of mass were analyzed. The total removal of the tumor is the best method of treatment, however, the recurrence rate in cases of subtotal removal and the morbidigy accompanying total removal, were also considered in planning the surgical treatiment.

A Case of Multiple Huge Brain Abscesses Caused by Paragonimiasis

Cerebral paragonimiasis, occurring as an extrapulmonary infestation, is one of the important intracranial lesions in Korea. We have experienced a case of multiple huge brain abscesses caused by cerebral paragonimiasis. The patient, 17 year old boy, had chief complaints of headache and vomiting followed by mental deterioration. Neurologically, the patient presented mental change, papilledema, left abducense palsy and right hemiparesis. The treatment included the closed drainage followed by total removal of abscess capsules which was confirmed histopathologically. This paper is concerned with the description of the clinical features of cerebral paragonimiasis and review of literatures.

A Case of Primitive Clioma

Among the intracranial glioma, primitive glioma is very rare. We report a case of primitive glioma involving left parietofrontotemporal lobe of 8-year-old boy who had about 12 months duration of right sided hemiparesis, headache, vomiting and papilledema. CT scan showed a large, well defined round area of low density with peripheral rim of high density and high density small mass suggesting mural nodule in left frontoparietotemporal region. A left frontoparietotemporal osteoplastic craniotomy was carried out. A small nodule and cystic membrane containing pale yellowish colored proteinous cystic fluid were almost totally removed without difficulty. Postoperatively, the right hemiparesis and headache gradually cleared. Pathologic diagnosis was primitive glioma.

A Case of Cervical Cord Hemangioblastoma

Solitary intramedullary hemangioblastoma of the high cervical cord is rare. The incidence of spinal cord hemangioblastomas varies from 1.6% to 3% of primary spinal cord tumors. The case report dealt with a small solitary hemangioblastoma of 0.4cm in diameter arising in the intramedullary portion of the high cervical cord. Computerized axial tomograms of the brain including the cervical cord could not detect the tumor and cervical myelograms also failed to identify the mass. However, the vertebral angiography revealed a vascular nodule with abnormally dilated feeding artery arising from the right vertebral artery. The tumor was excised in toto from the surrounding medullary tissue without difficulties. The postoperative course of the patient had been uneventful. The possibility of missing such a small tumor like this one was emphasized.