Why a Catheter Can Be Correctly Placed in the Anterior Horn of Lateral Ventricle by Inserting Perpendicular to the Frontal Bone on the Ventricular Drainage? Demonstration of the Accuracy of an Inserting Path by Computed Tomographic Image Study and Clinical Practices.

Why a catheter can be correctly placed in the ventricle by inserting perpendicular to the frontal bone on the ventricular drainage? We performed a study on the accuracy of a path perpendicular to the skull surface into the anterior horn using computed tomography (CT), and a clinical study. Twenty patients were studied on CT images. Using the curved multi-planar reconstruction method, the curved frontal skull and brain were reconstructed to flat structures, and perpendicular lines were drawn from the flat surface to the foramen of Monro on the reconstructed images. In clinical practice, we made a device which guided a catheter inserting perpendicular to the frontal skull surface, and used it in the ventricular drainage surgery for 148 hydrocephalic patients (158 surgeries). We discovered that the curved surface of the frontal bone around Kocher's point represents the surface of a globe (mean radius, 75.9 ± 4.3 mm) centering on the foramen of Monro. The distribution of points ranged from 13.5-43.5 mm (mean, 43.5 ± 6.1 mm) to the midline, with points appearing more laterally as ventricular size increased. A catheter was placed in the ventricle in 148 surgeries (99.4%), and the catheter reached the ventricle with correct orientation toward the foramen of Monro in 128 (81.0%). The reason why the ventricular insertion perpendicular to the frontal bone surface can provide a consistent path toward the foramen of Monro is that the curved surface of the frontal bone around Kocher's point represents the surface of a globe centered on the foramen of Monro.

Oncocytic meningioma presenting with intratumoral hemorrhage.

Oncocytic meningiomas have been recently reported as a rare variant of meningiomas. Immunohistochemical analysis shows that neoplastic cells are positive for antimitochondrial antibodies. We report our first patient with oncocytic meningioma, presenting with intratumoral bleeding. A 72-year-old woman suffered from a disturbance of consciousness. A CT scan showed a tumor with intratumoral hemorrhage. An emergency craniotomy was performed and the tumor and hematoma were removed. Examination of the tumor revealed meningothelial cells with oncocytic change. We discuss the clinicopathological considerations of this uncommon variant and review the pertinent literature.

[Hemangiopericytoma on the intradural thoracic spinal cord: a case report].

Hemangiopericytoma develops from many organs. In the central nervous system, most tumors arise in the intracranial portion, and tumors originating from the spinal cord are rare. Its clinical course and neurological characteristics have not been disclosed. We present a case of a 51-year-old woman with gradually progressing paraparesis. Magnetic resonance (MR) images of the thoracic spine demonstrated an intradural tumor at the 6 and 7 thoracic vertebral body level. The patient underwent total excision of the tumor. The histological diagnosis was hemangiopericytoma. MR images after the operation showed no residual tumor and the patient was followed up without adjuvant therapy. However, 5 years later, the patient complained of back pain and gait disturbance again, and MR images showed a recurrence of the tumor. We resected the tumor under motor evoked potential (MEP) monitoring and removed the extradural part of the tumor, but the part of the tumor which had infiltrated the spinal cord was left due to the lowering of MEP amplitude. The operation resulted in partial resection. Spinal intradural hemangiopericytoma is very rare, and only 15 cases including the present case have been reported. This paper will discuss the clinical characteristics and treatment for this tumor.

[Subdural hematoma at the cranio-vertebral junction following head trauma: a case report].

We report a 62-year-old woman patient who slipped and hit the occipital portion of her skull and suffered an acute spinal subdural hematoma caused by head injury. She complained of headache, neck pain, vomiting, dizziness, and was transferred to our hospital. A skull roentgenogram and CT showed occipital bone fracture and thin subarachnoid hemorrhage, and a small amount of acute subdural hematoma on the contra lateral side. Three hours after the accident, she complained of aggravating neck pain. A repeated CT showed acute subdural hematoma at the cranio-vertebral junction extending to the C3 vertrebral body level. At the emergent operation, we found a dural laceration at the foramen magnum just beneath the fracture, and acute spinal subdural hematoma. After evacuation of the hematoma, the patient recovered completely. Spinal acute subdural hematomas after head injuries are relatively rare. In this case, the migration of the extradural hematoma through the dural laceration at the cranio-vertebral junction was supposed to be responsible for the spinal subdural hematoma. It is crucial that a cervical CT be taken to rule out the possibility of spinal hematoma for patients with head injuries complaining of neck pain.

Malignant fibrous histiocytoma in the craniocervical junction presenting with severe occipitalgia.

We report a patient who complained of severe occipitalgia caused by destruction of the atlantooccipital joint by tumor invasion. Her symptoms were relieved by tumor resection and occipitocervical fixation. Histological examination of the resected tumor revealed that the tumor cells had an irregular arrangement, remarkable atypia, and pleomorphism with multinucleated bizarre giant cells. The tumor demonstrated no definitive sarcoma differentiation and was identified as malignant fibrous histiocytoma. After tumor resection, the patient received adjuvant radiation and chemotherapy. The tumor regrew outside the radiation field. Chemotherapy with ifosfamide, cisplatin, and etoposide caused remarkable tumor reduction, but suspension of chemotherapy resulted in tumor recurrence. The results of our drug protocol suggest that this regimen is feasible as postoperative adjuvant chemotherapy for malignant fibrous histiocytoma. The role of adjuvant chemotherapy and radiation therapy for this highly malignant rare tumor should be evaluated in a prospective study with precise histological diagnosis.

Calcification on the ventricle wall associated with a shunt tube--case report.

A 53-year-old man with renal failure presented with symptoms of shunt malfunction 11 years after placement of a ventriculoperitoneal shunt. Computed tomography showed high-density lesions on the lateral ventricle wall around the shunt tube. The shunt tube was replaced under monitoring with a neuroendoscope. The resected specimen from the ventricle wall lesion showed calcification and fibrosis. Disturbed calcium and phosphate metabolisms associated with renal failure may have been involved in this abnormal calcification on the ventricle wall.

A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation.

BACKGROUND: Several surgical procedures have been reported for the treatment of chronic subdural hematoma. Whether irrigation is required is not clear. We compared the results of treatment of chronic subdural hematoma obtained with burr hole drainage and burr hole irrigation retrospectively. METHODS: Forty patients with chronic subdural hematoma underwent surgery at our institution in the last 3 years. The first 20 patients were treated by burr hole irrigation (irrigation group), while the last 20 patients underwent burr hole drainage (drainage group). The rates of recurrence, changes in hematoma size, and number of days of postoperative hospitalization for the two groups were compared. No significant differences were found between the two groups in the presence of head injury, alcohol consumption, age, gender, or preoperative hematoma size. RESULTS: Duration of postoperative hospitalization was 14.1 days in the drainage group and 25.5 days in the irrigation group. Recurrence was observed in 1 case (5%) in the drainage group, and in 5 cases (25%) in the irrigation group. In the drainage group, postoperative hematoma size was significantly decreased compared to preoperative hematoma size on the first postoperative day, after which change in hematoma size was minimal. On the other hand, in the irrigation group, hematoma size was decreased on the first postoperative day, but not to a significant extent. CONCLUSION: For treatment of chronic subdural hematoma, postoperative hospitalization was shorter and the recurrence was less frequent with drainage than with irrigation.