Idiopathic hypertrophic spinal pachymeningitis: a case report.

Idiopathic hypertrophic pachymeningitis (IHP) is a rare, chronic nonspecific and granulomatous inflammatory disorder of the dura with unknown etiology. The diagnosis can be established by open biopsy and exclusion of all other specific granulomatous and infectious diseases. We report a typical case of spinal IHP occurring in a long segment of cervical and thoracic dura from C6 to T8. The patient was 56-yr-old female, who had been suffered from pain on her upper back and both arms for 3 months and recent onset motor weakness of both legs. During the 9 months of follow-up period, she experienced the improvement of her neurologic symptoms with combined therapy of partial excision and corticosteroid medication. Since early surgical intervention and subsequent pulse steroid therapy are mandatory for this disease to avoid irreversible damage of nervous system, the identification of this unique disease entity is essential on frozen diagnosis. A few cases have been reported in Korean literature.

Long-term follow-up of stereotactic Gamma Knife radiosurgery in epilepsy.

From June 1990 to May 1995, 31 patients with epilepsy were treated by stereotactic Gamma Knife radiosurgery at the Asan Medical center. The effect of radiosurgery for epilepsy was assessed in 23 patients followed for longer than 1 year. The seizures were medically intractable in all patients: generalized in 13 cases, complex partial in 6 cases and partial in 4 cases. The duration of epilepsy ranged from 1 to 25 years, with a mean of 11.6 years. Electroencephalography and magnetic resonance imaging (MRI) were performed in all patients to identify and localize the seizure focus. The lesions on MRI were nonprogressive and less than 2.0 cm in diameter. At follow-up, 12 patients had an excellent result (class I according to Engel's classification). In 3 of these patients, antiepileptic medication was discontinued. In a further 2 patients, the seizure frequency decreased (class II and III). In the remaining 9 patients, the frequency of seizures was unchanged (class IV). Radiation-induced edema did not seem to affect the outcome with respect to seizure control. The role of radiosurgery in the treatment of epilepsy is still unclear. It is premature to draw any definite conclusions about its efficacy for intractable epilepsy in our series. However, even this small group certainly suggests the possibility of a new safe treatment method in selected patients.

Gamma knife radiosurgery for malignant tumors.

Between May 1990, and June 1994, 79 patients with malignant tumors were treated radiosurgically using a Leksell gamma unit at Asan Medical Center. Of these patients, 57 were metastatic brain tumor, 12 were glioblastoma multiforme (GM), 4 were primitive neuroectodermal tumor, 3 were malignant germ cell tumor, 2 were recurrent lymphoma, and 1 was adenoid cystic carcinoma of the orbit. Among 57 patients with metastatic tumors, 28 patients harboring 60 tumors were followed clinically and radiographically. The median marginal dose for these tumors was 30 Gy and the median survival rate was 15 months. Twenty-one tumors disappeared and 32 tumors decreased in size during 2 to 6 months after radiosurgery on computed tomographic or magnetic resonance imaging scans. All 12 patients with GM were treated with conventional radiation (6,240 approximately 6,500 cGy) after surgical resection or biopsy prior to radiosurgery (13 approximately 15 Gy to margin). The results were varied. Radiosurgical treatment of two recurrent lymphomas and three recurrent mixed germ cell tumors after radiation and chemotherapy provided rapid clinical improvement with disappearance of the tumor. However, new lesions appeared in two lymphomas and one mixed germ cell tumor within 3 to 4 months. One patient with adenoid cystic carcinoma of the orbit, who was treated radiosurgically prior to resection, is alive without recurrence 31 months after the treatment. Gamma knife radiosurgery appears to be the best alternative method to surgical excision plus radiation therapy for single and multiple cerebral metastases. It also provides rapid palliation of symptoms due to recurrent malignant tumors. And it may have an adjuvant role in the treatment of some tumors delaying local recurrence, if given prior to resection. However, the preliminary results for the malignant gliomas were inconclusive.

Short-term follow-up of stereotactic Gamma Knife radiosurgery in epilepsy.

The efficacy of stereotactic Gamma Knife radiosurgery (STGKRS) for epilepsy was assessed in 9 patients followed up for more than 1 year. The mean duration of seizures was 9 years (range 1-22 years). In all 9 patients the epilepsy was classified as medically intractable. MRI showed nonprogressive focal cerebral lesions of less than 2.0 cm in size with or without calcification. After STGKRS, 8 patients had an excellent result (seizure free, single seizure episode, or auras only). In 2 of these patients antiepileptic drug therapy could be discontinued. One patient had no worthwhile improvement. Neither the anatomic distribution of the lesion on neuroimaging study nor extracranial EEG-recorded epileptiform activity appeared to be significant determinants of outcome. Radiation-induced edema did not seem to affect the outcome of seizure control. This preliminary report indicates that, in selected patients with medically intractable seizures associated with a focal cerebral lesion, STGKRS may be effective in controlling or greatly reducing the seizures.

Stereotactic Gamma Knife radiosurgery for the treatment of dystonia.

A case of dystonia treated with Gamma Knife radiosurgery is reported. A 37-year-old female patient had a history of tuberculous meningitis at the age of 10 and subsequently developed a left hemidystonia. MRI showed an old infarction in the right caudate nucleus, globus pallidus and putamen. Stereotactic Gamma Knife radiosurgery was employed to make a lesion in the right posteroventral globus pallidus. Postoperatively, the patient's condition improved. However, homonymous hemianopsia developed postoperatively.

Cerebral energy metabolism following ESWL brain injury model and effects of cerebral protective drugs.

The goal of this study was to introduce a new method inducing an experimental brain injury model using ESWL(Extracorporeal Shock Wave Lithotripsy) and to evaluate findings of localized lesions on 1H MR imaging and the response of cerebral energy metabolism using a 31P MR spectroscope to the ESWL brain injury in cats. This study also examined effects of cerebral protective drugs. 1) There were no statistically significant changes in pH at all measurement points. 2) In the trauma group, initial decrease of PCr/Pi was seen at 30 to 60 minutes with return to control levels by 2 hours after injury(P < 0.05), followed by a second decline at 4 hours which lasted until 8 hours after injury. 3) Significant recovery in PCr/Pi(P < 0.05) was observed in both the THAM and dexamethasone treated groups at all measurement points and in the mannitol treated group only temporary recovery at 30 and 60 minutes (P < 0.05). 4) High intensity signals were seen on 1H MR imaging in traumatized animals. This study demonstrated the immediate and persistent recovery of cerebral energy metabolism using THAM or dexamethasone and an immediate but transient effect with mannitol in traumatized animals.

Cytogenetic analysis of meningiomas.

Cytogenetic analysis of 4 cases of meningiomas from 3 male and 1 female patients is reported. One of male patients suffered from neurofibromatosis type 2. Histologically, the meningiomas were meningotheliomatous (1), transitional (2), and psammomatous (1). Chromosomal abnormalities were found in all cases with a karyotype 45,XY,-22, 45,XY,-16, 45,XX,-2, and 45,XY,t (15p;22q), respectively. Monosomy of chromosome 22 was detected only in the patient with neurofibromatosis type 2. These cytogenetic analysis demonstrates that variable clonal karyotype aberrations exist in meningiomas.

Comparison of blood flow and patency in arterial and vein grafts to basilar artery.

Blood flow and patency rates obtained by lingual to basilar artery anastomosis were compared with those obtained by saphenous vein bypass graft from the carotid to the basilar artey in two groups of ten dogs. Flow was measured by an electromagnetic technique while blood pressure and blood gases were monitored. Graft patency also was determined by angiography and histological examination. The arterial and venous grafts carried more than enough blood to maintain a normal flow (9.5 ml per minute) through the basilar system of dogs. Immediately after anastomosis, average flow through the vein grafts was 15.5 ml per minute (range 10 to 24 ml per minute). Six weeks later, average flow through the vein graft was 11.5 ml per minute and through the arterial graft 13 ml per minute. With induced hypertension, flow increased in the arterial grafts to an average of 26.2 ml per minute and in the vein grafts 24 ml per minute. Hypercarbia increased arterial graft flow to an average of 27.8 ml per minute and vein graft flow to 23.5 ml per minute. By angiography, graft patency was shown in only 80% of the grafts at one week and in 60% at six weeks postoperatively, even though all grafts were patent by flow and histological determinations. This failure of angiography represents a limitation of the radiographical resolution in millimeter-sized vessels.