An Ependymoma in the 4th Ventricle: Report of 1 Case

Storch is credited as being the first to describe in 1899 what we call "ependymoma" today. And ependymomas were first set apart as a single group by Bailey in 1924. The literature up to the present contains numerous reports of tumors classified as "ependymoma". From 1 to 6 percent of all intracranial tumors are ependymomas. As the above, the tumors are very rare. The incidence is higher in those with large proportion of young patients and average age is approximately 20 years. About 40 percent of intracranial ependymomas are supratentorial and the remainders are infratentorial. We experienced a case of 4th ventricular ependymoma with subarachnoid hemorrhage. A 23 year old female was admitted to the hospital because of severe headache and frequent vomiting, who had been intermittently suffered from the headache for 8 months prior to admission. On admission, the neurologic examinations revealed irritable mentality, vomiting and papilledema, and xanthochromic CSF was identified on lumbar puncture. X-ray films of skull series showed evidence of increased ICP. A mass lesion was suspected in the posterior fossa on vertebral angiogram and brain C-T films revealed a mass lesion in the midline of the posterior fossa, slightly enhanced on contrast study and associated with hydrocephalus. Following Torkildsen's shunting procedure suboccipital craniectomy was performed, and we removed the tumor mass incompletely within the 4th ventricle. The pathologically microscopic finding was papillary ependymoma, grade II. Total neuraxis irradiation was applied for 6 weeks. The post-operative course was satisfactory.

Thoracolumbar Intramedullary Astrocytoma of the Spinal Cord: Report of 1 Case

The intramedullary glioma of spinal cord has occupied 22.5% of intraspinal neoplasm, and is the most common among the intramedullary spinal cord tumor, and the first successful operative removal was performed in 1907 by Elsberg. The intramedullary astrocytoma has frequent incidence in the thoracic and cervical region of the spinal cord, which has more frequent grade I astrocytoma. We experienced a case of intramedullary grade II astrocytoma of the thoracolumbar region which has associated a paraplegia as neurological deficit. A 26 year old Korean female has admitted to our clinic because of paraplegia with incontinence for 2 years. On admission, the neurological examination revealed a paraparesis below T12 level with urinary and fecal incontinence and then local tenderness from T10 to L1 level. The simple X-ray film of the thracolumbar spine has showed erosion of both pedicle, widening of interpeduncular distance and scalloping change of posterior vertebral margin from T12 to L1, which were similar to the picture of intramedullary spinal cord tumor. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion, and found a complete block at L1 level and T10 level on myelogram. Then the immediate total laminectomy from T8 to L1 was applied. The operative finding was a intramedullary mass with cystic fluid, which has compressed the spinal cord. After aspiration of cystic fluid, we removed the tumor mass incompletely because of intermingling with spinal cord but the decompression was enough. The neurological defict was improved gradually for post-operative 4 weeks, thereafter improvement was stopped and remained the paraparesis. The post-operative pathological diagnosis was grade II astrocytoma, which composed of anaplastic cell and radiotherapy has followed.

Intradural Extramedullary Tuberculoma of the Spinal Cord: Report of 1 Case

Tuberculoma of the spinal cord is one of rare lesions and usually produced by secondary lesion of tuberculosis. The first tuberculoma of spinal cord was described in 1830 by E.R.A. Serre and the first operative removal was performed in 1909 by Krauss and Mcguire. The most common age of tuberculoma is younger age group, especially under 30 years old and male is more frequent. The clinical symptom is rapid course and symptomatic Traid are motor, sensory, and sphincter disturbance, but early involvement is shpincter dist urbance. The authors present a case of intradural extramedullary tuberculoma of the spinal cord which was located at the thoracic region. The 63 years old female patient has complained the upper back pain and paraplegia by spontaneous onset before 3 days. On admission, paraplegia, urinary incontinence and weakness of anal sphincter were found. There were revealed within normal limit on simple flims of chest and thoracic spine. The color of the C.S.F. was xanthochromic, the amount of the protein was increased, and Quecken sted test was not patent. The contrast media was obliterated at the lower margin of 8th thoracic level and upper margin of 10th thoracic level, on myelogram by puncture of cisterna magna and lumbar region. We performed total laminectomy from T8 to T10 and removed a ID EM tuberculoma. We found white yellowish extramedullary tumor at the right postebrane. The extramedullary tumor was intermingling with dorsal nerve root on T9. The right dentate ligament and dorsal nerve root were cut and tumor was completely removed. Macroscopically the gross feature were 1.5 by 2 cm in size, white-yellowish color, hard and irregular round shape. The microscopic finding were showing multifocal granulomas with caseous necrosis. The granuloma was composed of epitheloid cells, lymphocytes and Langhans' giant cell. Post-operative recovery was very satisfactory.

Ewing's Sarcoma of the Thoracic Spine Associated with Paraplegia: Report of 1 case

Since Ewing has reported a primary malignant tumor as medullary origin in 1921, the Ewing's sarcomas have been reported more than 1,000 cases in the literatures. The Ewing's sarcoma has frequent incidence in the long tubular bone but very rare in the skull and spine for primary malignant tumor of the bone. The incidence of the Ewing's sarcoma in the spine is very rare than in the skull. We experienced a case of Ewing's sarcoma of the thoracic spine which has associated a paraplegia as neurological deficit. A 24 years old Korean female has admitted to our clinical because of paraplegia with incontinence for 2 days. On admission, the neurological examination revealed a paraparesis below T3 level with urinary and fecal incontinence, and then local tenderness on T2 level. No fever and leucocystosis were checked. Only the ESR has elevated up to 38 mm/hr. The simple X-ray film of the thoracic spine has showed a mottled destruction of the T2 vertebral body and abscence of the pedicle shadow, which were more similar to the picture of malignant tumor(primary or metastatic) than the bony change of ostemyelitis. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion. We found a complete block at T2 level by myelography. Then the immediate total laminectomy on T2-3 was applied. The operative finding was a extradural mass, which has compressed the spinal cord. We removed the tumor mass incompletely but the decompression was enough. The neurologic deficit has improved gradually for post-operative 2 weeks, but the improvement of neurologic deficit has stopped to T10 sensory recovery. We performed a radiation therapy as 4500 rads dose for 4 weeks, but not further improvement has been found. The post-operative pathological diagnosis was Ewing's sarcoma as a anaplastic small cell type.