A Case of Primary Rhabdomyosarcoma in the Left Cerebello-Pontine Angle

The primary rhabdomyosarcoma of the brain is very rare. There are only 14 cases reported in the literatures till 1975, and the majority of them were arised in the cerebellum. The intracranial rhabdomyosarcomas may be originated from the multipotent mesenchymal cells of aberrent muscle tissue in the leptomeninges. The histological 3 types are adult pleomorphic, alveolar and embryonal type. The demonstration of cross-striation is confirmed for diagnosis of this tumor. All of these tumors tend to have a short clinical course, but the survival time seems to be slightly improved by surgical excision followed by radiotherapy. We have recently experienced one case of primary rhabdomyosarcoma in the left cerebellopontine angle of 9 year-old girl, which was confirmed by operation and complete autopsy.

Cerebral Paragonimiasis: An Analysis of 7 Cases

Pagonimus Westmani, occuring as an important human infestation of the lung, is widely distributed in the Far East ; Korea, Japan, China and the Philippines. Since Otani found the parasites for the first time in the human brain in 1887, it has been established that cerebral infestation occurs with the highest frequency among extrapulmonary involvement. In 0.8 to 25 percent of patients infested with the lung flukes cerebral paragonimiasis may be developed. The larvae may procedure arachnoiditis, abscess, fibrous cystic lesions and granulomas in the brain. Based on a review of the literatures and upon the 7 cases of cerebral paragonimiasis which have been observed by the authors at the National Medical Center, Seoul, Korea, the following points are stressed. 1) Males had a significantly higher prevalence than females. Cerebral paragonimiasis was most commonly found in young adults(16 to 25yrs). 2) Clinically the patients with cerebral involvement were characterized by Jacksonian type of epilepsy, headache and visual disturbance. Mental deterioration, hemiplegia, hemihypesthesia, homonymous hemianopsia and optic atrophy were the five major signs. 3) The patients having symptoms for less than 6 months developed mild leukocytosis in many cases. All the cases of cerebral paragonimiasis revealed positive reaction in the intradermal tests with purified antigens of P. Westermani. 4) On skull films multiple round or oval cystic calcification was diagnostic value for cerebral paragonimiasis. On angiogram vascular staining and abnormal vessels were not disclosed. On pneumoencephalogram subcortical atrophy or filling defect of the ventricle may be showed. 5) The predilection area of the granuloma and fibrous cystic mass were the occipital, posterior parietal and posterior temporal lobes. 6) The patients with chronic stabilized cerebral paragonimiasis. having intractable symptoms and signs, could not be improved with Bithionol treatment. But headache, vomiting, visual disturbance, facial weakness and especially intractable seizure were improved in our cases treated with surgical operation.

A Case of Intraventricular Oligodendroglioma Associated with Arterio-Venous Malformation

Bailey and Cushing described the oligodendroglioma firstly in 1926. The oligodendroglioma is rare tumor and involves the ventricular system in 7% to 10% of all cases. The authors present a case of intraventricular oligodendroglioma associated with arterio venous malformations in a 34 year old male who had the history of visual disturbance and mental deterioration, for one month. The diagnosis was confirmed by operation and autopsy.

Analysis of 6 Cases of Brain Stem Glioma

An analysis of recent experiences for the brain stem glioma with surgery and autopsy established confirmation of the characteristic symptoms and signs, and of diagnostic criterias of Conray-ventriculogram and vertebral-angiogram. The cases consisted of 2 cases of exophytic brain stem glioma and 4 cases of pontomedullary glioma, and 5 of 6 patients had the signs of the increased intracranial pressure in this cases. A resurgence of interest in the Conray ventriculogram has been produced by cut-off sign of aqueduct of Sylvius in 2 cases of the exophytic brain stem glioma. The survival period in adults (1-3 years) were longer than that in children (less than 3 months) in this series.

Clinical Analysis of Brain Scans Using Technetium-99M

Technetium 99 M pertechnetate has become a valuable for the radioisotopic brain scan. This was introduced by Haper in 1963 and is now widely used in the medical field. The advantages are easy administration, high count rate with potential for high speed scanning, absence of beta radiation and decreasing time for test. We used Siemens Scintimat 2 Scanner with a 3x2 inch Na(T1) crystal and 151-hole collimator in our study. 10 mci Technetium 99 M was injected intravenously and obtained both lateral, anterior and posterior view in 80 cases of brain lesion from Mar. 75 to Sep. 76. The scans were classified as positive, negative and suspicious. The overall detection rate in 40 cases of brain tumors was 60%, especially high uptake in mengioma, malignant pituitary tumor, astrocytoma, metastatic brain tumor and acoustic neuroma. But in nontumors diseases of the brain including CVA, head injury and hydrocephalus the uptake rate was a little value.

Malignant Schwannoma Associated with Von Recklinghausen' Disease

Malignant peripheral nerve tumors are very rare and derived from the neurofibromatosis in about 13%. There are two classes of malignant tumors in the peripheral nerve, one those of mesoblastic origin, is far most common and made up of malignant neurofibroma and much common fibrosarcoma, and metastasis in 20% of fibrosarcoma, and the other is neuroepithelial origin. These are characterized by increased cellularity, atypical form of cells, mitoses and invasiveness. The choice treatment is radical removal of the tumor, and not affected the prognosis by radiation or chemotherapy. We have been recently experienced of one case of malignant schwannoma on the cervical roots in a case of von Recklinhausen's disease.

A Case of Oligodendroglioma

Since oligodendroglioma was first described by Bailey & Cushing in 1926, there have been numerous studies reporting detailed description of the clinical and pathological characteristics of the tumor. It is a slow growing tumor usually in adults, with the highest frequency between 30 and 50 years, and affect the cerebral hemispheres, particularly the frontal lobes. Of all brain tumors the oligodendroglioma is the most likely to contain calcareous deposits which can be demonstrated radiologically in 40% to 50%. It consists of a continous sheet of uniformed small, round & densely packed cells interruptedly only by remarkably regular network of small blood vessels in histology. We have been recently experienced of a case of typical oligodendroglioma and reviewed the literatures.

A Case Report of Meningioma "en plaque"

Meningioma en plaque are extremely rare, not only dose it form a thin layer on the inside of the dura but also infiltrates it an invades the adjacent bone. Painless, slowly developing exophthalmos with palpable swelling in the ipsilateral temporal region, and later impairment of vision and ocular motility indicate menigioma "en plaque" in the temporal region. The authors report a case of meningioma "en plaque" arisen from the outer third of sphenoid ridge.

Malignant Pituitary Adenoma

The authors present 2 cases of malignant pituitary adenoma. One case has remote metastases to the right frontal lobe, and the other case has invasion into the adjacent temporal lobe and malignant features histologically. Malignant pituitary adenoma constitute less than 1% of the large reported series of pituitary adenoma, which defined as (1) it burst its capsule to invade the adjacent nervous structures or bone, (2) it shows malignant features histologically, such as frequent mitoses, anaplasia with hyperchromatic pleomorphic cells, loss of alveolar arrangement, and (3) presence of distant metastases.

A Giant Cell Tumor of the Thoractic Vertebra: Case Report

No abstract available.

Cloward's Technique for Lumbar Disc Lesion

The surgical technique for removal of ruptured lumbar intervertebral disc has changed very little since it was introduced by Mixter and Barr in 1934. The technique of the interlaminar operation used by most neurosurgeons was used successfully in early cases to relieve the sciatica, but many patients were unable to return to heavy work because of low back pain. Cloward described a different surgical technique for removal of a ruptured lumbar intervertebral disc. The operation utilizes a transverse skin incision and a wide bilateral stlipping and retraction of fascia and muscles. The ligamentum flavum is not removed but detached and reflected medially in a flap. Only the bone margins of the adjacent facets are removed. A complete laminectomy is never done except for spondylolisthesis when the separate neural arch is disarticulated and removed. Using a "Vertebral Spreader", and interlaminar exposure is developed two to three times larger than that obtained y the "standard" technique. The advantages are obvious: 1. Both operations were done through a single transverse incision. A wider lateral exposure for the skin wound, being made parallel to the lumbar operation was possible and the normal skin lines, heals better with less scar. 2. The entire ligament is preserved, by separating its attachments from the lamina and reflecting in a flap, a larger opening into the spinal canal is obtained and the replaced flap protects the dura and prevents scarring. 3. Cloward recommends the use of a narrow, sharp chisel and hammer, but we used the spinal rongeurs including the Kerrison punch to remove part of the laminal edge. We leave the articular facets of the lumbar disc surgery because the articular facets are considered important major elements in the articulation of the vertebral joints, and as an essential bony surface to be used in posterior spinal fusion operation. 4. The routine use of intrathecal cortisone after lumbar disc operation has not been used in our cases because of increased pressure of the cerebrospinal fluid in modified prone position of the patient.

Acute Subdural Hematomas Review of 100 Cases

The authors reported 100 cases of acute subdural hematomas confirmed by operation from Jan. 1972 to Sept. 1975. We discussed the relationship of the type of operation to mortality in acute subdural hematomas. The types of surgical operations were divided in 4 groups. The surgical mortality rate was 19% for frontotemporoparietal craniotomy, 29% for multiple burr holes technique, 42% for craniectomy and 48% for subtemporal decompression with burr holes and total over-all mortality was 36% in our cases. The authors reviewed the literatures described the surgical operative method and it's mortality and so we thought large frontotemporoparietal craniotomy is more valuable method for operation of the acute subdural hematomas.

Intramedullary Dermoid Cyst Associated with a Congenital Dermal Sinus: Case Report

Congenital dermal sinuses result from a failure of separation of the cutaneous epithelial ectoderm from the neuroepithelial ectoderm along the dorsum of the embroy during the first month of intra-uterine life. These sinus tracts can occur at any level of the cerebro-spinal axis, but are located predominantly in the occipital and lumbosacral regions and occasional cases involving the cervical and thoracic regions. The dermal sinus tract is lined by stratified squamous epithelium and extends from the surface through the deeper tissues into the cranial or spinal cavity, usually ending on the dura or within the dura in conjunction with a terminal epidermoid or dermoid cyst. An intra-medullary epidermoid or dermoid with a dermal sinus is an unusual association. We have been able to find a previously reported coincidence of these malformations although there are many definitive papers on these uncommon entities. We are experienced in one case who are 14 months old boy with a intra-medullary dermoid cyst associated with a congenital dermal sinus at the T4 level, and reviewed related reports.

Angiographic Pattern of Space Occupying Lesions in the Anterior Cranial Fossa

Although reports have been assessed to locate lesions in the frontal lobe or anterior cranial fossa, the exact localization of the lesion is invariably difficult in neurological examination. However angiographic pattern is one of the most significant clue to the diagnosis of this area. For the past 2 years, from may in 1968 to December in 1970, we have analyzed angiographic patterns of space occupying lesion in the frontal lobe and anterior cranial fossa in a total of subsequent 100 cases. It is suggested that these lesions be classified into four groups according to their characteristic patterns and, for accurate localization and practical feasibility, their surgical approach. The characteristic angiographic patterns of each group are summarized as follows: (Frontal-pole) A-P view: 1. Round shift of A.C.A. 2. Flattening of carotid fork. 3. Elongation of AI. 4. No chekrein effect. 5. Sylvian point & M.C.A.... normal / (Fronto-central) A-P view: 1. Round shift of A.C.A.-mild. 2. Checkrein effect. 3. Depression of M1. 4. Flattening or mushroom appearance of carotid-fork. 5. Sylvian point... normal. / Lateral view: 1. Posterior displacement of A.C.A. 2. Vertical stretching of A2-A3. 3. Stretching of frontopolar artery. 4. Downward displacement of M2. 5. Depression of candelabra artery. 6. Closing of carotid siphon. 7. Ophthalmic artery... normal. / Lateral view: 1. Rectangular erection of C1-M1. 2. Right angle of C1-C2. 3. Elevation of M2-M3. 4. P.C.A. & ant. Choroidal artery... better. / (Fronto-lateral) A-P view: 1. Round shift of A.C.A. 2. Infrequent checkrein effect. 3. Flattering of carotid fork. 4. Vertical stretching of C1. 5. Sylvian point... normal. / Lateral view: 1. Mild stretching of A2-A3. 2. Continuous line of C2-M2. 3. Depression of M2. 4. Stretching of candelabra artery. / (Fronto-basal) A. subfrontal; A-P view: 1. Round or angular shift of A.C.A. 2. Flattening of carotid bifurcation. 3. No checkrein effect. 4. Sylvian point... normal. / Lateral view: 1. Bowing and downward convexity of A.C.A. 2. Closing of carotid siphon. 3. Depression of sylvian artery group. 4. Enlargement of ophthalmic artery. B. Inferior frontal; A-P view and lateral view: 1. Same as subfrontal lesions. 2. Relative preservation of A.C.A. branches. 3. Enlarged ophthalmic artery... mild. 4. Depression or elevation of M2.