A Rare Case of Pituicytoma Presenting Cystic Formation

Pituicytoma is a rare solid benign tumor of the sellar and/or suprasellar region originating from the pituicytes of the neurohypophysis or infundibulum, which is not differentiated from a pituitary adenoma that is diagnosed mostly in the sellar and/or suprasellar region. In addition, cystic tumors are very rare and have not been reported due to their solid and hypervascular natures. A 33-year-old man presented with a chronic headache which exacerbated recently. MRI was performed and revealed a cystic tumor in the sellar and suprasellar regions with a small parenchymal island in the cyst compressing the optic chiasm. The endoscopic endonasal transsphenoidal approach was used to remove the tumor. Immunohistochemical staining was positive for thyroid transcription factor 1, S-100 protein, and glial fibrillary acidic protein. The pituicytoma was diagnosed based on histologic findings. The authors review herein the literature on clinical presentation, diagnosis, surgical management, and outcome.

Spontaneous Spinal Epidural Hematoma on the Ventral Portion of Whole Spinal Canal: A Case Report

Spontaneous spinal epidural hematoma is an uncommon but disabling disease. This paper reports a case of spontaneous spinal epidural hematoma and treatment by surgical management. A 32-year-old male presented with a 30-minute history of sudden headache, back pain, chest pain, and progressive quadriplegia. Whole-spinal sagittal magnetic resonance imaging (MRI) revealed spinal epidural hematoma on the ventral portion of the spinal canal. Total laminectomy from T5 to T7 was performed, and hematoma located at the ventral portion of the spinal cord was evacuated. Epidural drainages were inserted in the upper and lower epidural spaces. The patient improved sufficiently to ambulate, and paresthesia was fully recovered. Spontaneous spinal epidural hematoma should be considered when patients present symptoms of spinal cord compression after sudden back pain or chest pain. To prevent permanent neurologic deficits, early and correct diagnosis with timely surgical management is necessary.

Time Course and Characteristics of Astrocyte Activation in the Rat Brain after Injury / 대한신경손상학회지

OBJECTIVE: After injury to the central nervous system (CNS), glial scar tissue is formed in the process of wound healing. This can be is a clinical problem because it interferes with axonal regeneration and functional recovery. It is known that intracellular proteins, including the glial fibrillary acidic protein (GFAP), nestin, and vimentin increase in the astrocytes after an injury to the CNS. By studying the time course and co-expression pattern of these intracellular proteins, this study will attempt to prove that these proteins are involved in the processes of glial scar formation. METHODS: Twenty-five male Sprague-Dawley rats were used in this study. Bregma of the cerebral cortex, an area was incised with a sharp blade, and perfusion was performed. The expressions of the intracellular proteins were assayed, while the co-localization of the intermediate filament (GFAP, nestin, and vimentin) and A2B5 were examined. RESULTS: At 12 hours, the GFAP was expressed in the white matter underlying the lesion, and in the cerebral cortex. Nestin was expressed in the astrocytes in the perilesional area after 3 days, while A2B5 was observed in the edge of the wound at 12 hours post-injury, with its expression reaching a peak at 7 days. Vimentin was detected in the white matter at 12 hours, and in the cortex, reaching a peak at 7 days. CONCLUSION: In the processes of glial scar formation, nestin, vimentin, and A2B5 were revealed in the astrocytes, and these factors may be involved in the division, proliferation, and transportation of the astrocytes.

Nail Gun Induced Open Head Injury: A Case Report / 대한신경손상학회지

Increasing use of the nail gun has led to higher injury rates from the use of tools with sequential actuation. Nail gun injury can occur to various parts of the body. Very deep penetration in the brain can have fatal results. A 46-year-old male fired shots from a nail gun into his brain in a suicide attempt. This case demonstrated successful surgical management of the resultant open head injury.

Endovascular Treatment of Wide-necked Cerebral Aneurysms with an Acute Angle Branch Incorporated into the Sac: Novel methods of Branch Access in 8 Aneurysms / 신경중재치료의학

PURPOSE: The optimal management of geometrically complex aneurysms remains challenging. The aim of this retrospective study was to evaluate the safety and feasibility of branch-selective technique (BT) in wide-necked aneurysms with an acute angle branch incorporated into the sac. MATERIALS AND METHODS: Eight consecutive patients harboring wide-necked cerebral aneurysms with an incorporated, acute angle branch (mean, 30.4degrees) underwent coiling over an 18-month period. Dome-to-neck ratio ranged from 0.9 to 1.8 (mean, 1.2). Every procedure utilized BT, i.e., stent- or catheter-assisted coiling through the incorporated branch. RESULTS: Technical success was achieved in all cases. With the aim to avoid the risk of aneurysmal rupture during struggling intraaneurysmal wire navigation, a 'looping method' and retrograde approach of a preshaped 0.014' microcatheter (C or J) was used for branch access in five cases and a 'looping method' and antegrade approach in one case. In the remaining one, just the C-preshape was enough to directly enter the branch without intraaneurysmal wire navigation. Overall, stent-assisted coiling was performed in seven cases, while catheter-assisted coiling was undertaken in one. The only complication was thrombotic posterior inferior cerebellar artery occlusion in one case, which was recanalized after tirofiban infusion. New neurological deficits were not identified in any cases. CONCLUSION: BT seems safe and feasible for wide-necked aneurysms with an acute angle branch incorporated into the sac. The looping method may offer safe access to the incorporated, acute angle branch and should be considered for replacement of the fearful intra-aneurysmal wire navigation.

A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve

OBJECTIVE: Despite rapid evolution of shunt devices, the complication rates remain high. The most common causes are turning from obstruction, infection, and overdrainage into mainly underdrainage. We investigated the incidence of complications in a consecutive series of hydrocephalic patients. METHODS: From January 2002 to December 2009, 111 patients underwent ventriculoperitoneal (VP) shunting at our hospital. We documented shunt failures and complications according to valve type, primary disease, and number of revisions. RESULTS: Overall shunt survival time was 268 weeks. Mean survival time of gravity-assisted valve (GAV) was 222 weeks versus 286 weeks for other shunts. Survival time of programmable valves (264 weeks) was longer than that of pressure-controlled valves (186 weeks). The most common cause for shunt revision was underdrainage (13 valves). The revision rate due to underdrainage in patients with GAV (7 of 10 patients) was higher than that for other valve types. Of 7 patients requiring revision for GAV underdrainage, 6 patients were bedridden. The overall infection rate was 3.6%, which was lower than reported series. Seven patients demonstrating overdrainage had cranial defects when operations were performed (41%), and overdrainage was improved in 5 patients after cranioplasty. CONCLUSION: Although none of the differences was statistically significant, some of the observations were especially notable. If a candidate for VP shunting is bedridden, GAV may not be indicated because it could lead to underdrainage. Careful procedure and perioperative management can reduce infection rate. Cranioplasty performed prior to VP shunting may be beneficial.

Models of Experimental Brain Tumors

Despite concentrated basic and clinical research efforts including the initial successful combination of surgery, radiotherapy and chemotherapy with BCNU, significant progress in the treatment of human brain tumors have been slow and looks for more successful strategies developed based upon the information from animal model system. It is to recreate in the laboratory under experimental condition a model of human brain tumors. Although no unique model of the numerous animal tumors resembling the spontaneous human brain tumors developed in these days, experimental animal models to have own specific adventages can be induced by exposure to oncogenic viruses or chemical carcinogens. Intracerebral injection of oncorna viruses can produce glioblastoma mutiformes, astrocytomas and sarcomas, while medulloblastoma, choroids plexus papilloma and ependymomas can be induced by papova viruses, and human adenovirus may cause neuroblastoma, medulloepithelioma and retinoblastomas. Chemical induction in adult animals and transplacental chemical induction were ependymoblastomas, glioma, gliosarcoma and malignant neurinomas. Reproducibility of location, cell type, and time of tumor appearances;expense;growth in tissue culture;trauma to brain;nature of vasculature, and amount of brain and tumor tissue available for examination are the variables to be considered in choosing a model to use in evaluating drug and other therapies, cell kinetics and immunological studies.

Penile Skin Graft: Report of Two Cases / 대한비뇨기과학회지

Two cases of necrotic penile skin treated with scrotal skin graft are hereby reported. These cases revealed scrotal swelling and complete loss of penile skin which might have been due to ischemic tissue necrosis under local anesthesia withmixed solution of 1% procaine HC1. 2% Lidocain HCl and 0.5% epinephrine. Epinephrine was administered with over dosage to control bleeding during circumcision implantation of the penis into the scrotum for the purpose of plastic reconstruction of penile skin, i.e. scrotal tunnel method, was performed successfully under spinal anesthesia.

Clinical analysis of 34 diffuse axonal injured (DAI) patients below GCS 8

A consecutive series of 34 severe head-injured patients (DAI) were studied prospectively. Patients were categorized according to a new, simple classification system comprised of four lesion types according to the compression or obliteration of the ventricles or cisterns. Five patients belonged to type II and 19 patients to type IV. Each type was further subdivided into two GCS score ranges (5 to 8 and below 5). The distribution of the posttraumatic infarction was mainly in the frontal and temporal lobes (60% of all cases). Our data demonstrated that the ICP was significantly lower at a 30 degrees head elevation than at 0 degree (18.6 +/- 7.21 mmHg vs 23.0 +/- 10.60 mmHg. t = 4.22 p< 0.001), but head position did not statistically affect CPP (69.4 +/- 19.86 mmHg vs 68.2 +/- 19.87 mmHg. t = -0.54, p< 0.59). The effect of intensive therapy on ICP, CPP and AVDO2 was studied in all cases, employing steroids and diuretics in a modified intensive care scale. In cases where barbiturates were employed, there were statistically significant changes in ICP and AVDO2 (p< 0.001), but CPP was not affected (p< 0.59). Surviving patients were analyzed by using the GOS and the neurological grading score (NGS, Nihon University) of the persistent vegetative state. Our data suggests that head elevation of 30 degrees and barbiturate therapy are more effective on ICP and AVDO2, and NGS more exact than GOS in vegetative patients.

A Case of Bilateral Ureterocele / 대한비뇨기과학회지

A case of bilateral ureterocele developed in the 23 years old Korean male soldier was presented with review of literatures. It was not accompanied any secondary complications and the treatment was conservative rather than surgical intervention.

A Clinical Observation on Head Injuries in Infants and Children

A clinical analysis was carried out with 108 cases of head injuries under 15 years of age, admitted at the Department of Neurosurgery, In Ha University Hospital in 11/2 years between Jan., 1987 and June., 1988. The material was classified into three groups according to main lesions, i.e. 1) simple cerebral contusion without skull fractures. 2) various types of skull fractures. 3) intracranial hemorrhagic lesions, representing such lesions as follows:a) epidural hematoma b) subdural hematoma. c) intracerebral hematoma, intraventricular and subarachnoid hemorrhage. The results were as follows: 1) The age incidence was greatest in 7 years of age, and 51 cases(47.2% of total) were included in the age group between seven and ten. 2) The accident occurred mostly between March and May. 3) Males outnumbered females by almost 2:1. 4) The head injuries were caused by traffic accident(52 cases:48%), fall down(47 cases:43%), hit(9 cases:9%). 5) In clinical picture, vomiting(57 cases:53.7%) and convulsion(8 cases:7.4%) and neck sprain(55 cases:50.9%) were developed and at accident, forty seven cases(43.5%) had the history of loss of consciousness. 6) Of the patients between GCS 5 and 14, 57 cases(92%) were included in the simple cerebral contusion. Of the patients below GCS 13, 45 cases(98%) were included in the skull fracture or intracranial hemorrhagic lesions but eighteen cases of the patients below GCS 13 were taken operation. 7) In skull fracture patients, the location in the order of frequency was parietal, occipital, temporal and frontal bone. The vault skull fracture was about twelfth fold as frequent as basal skull fracture and the incidence of linear skull fracture was higher than that of depressed skull fracture, the ratio being about 7:1. 8) Among the intracranial hemorrhagic lesions, the epidural hematoma was most common lesion. Twenty one cases(81%) of the patients with intracranial hemorrhagic lesions were accompanied by skull fracture but of the patients with skull fracture, 21 cases(47%) were accompanied by intracranial hemorrhagic lesions. Seventeen cases(46%) with the linear skull fracture involved in the intracranial hemorrhagic lesions. 9) Contre coup injury was developed in 6 cases(12%) and Lucid interval was observed in 4 cases(5%) of the cases with intracranial hemorrhagic lesions. 10) Associated injuries were found in about 27% of the total patients. The frequent ones were clavicle fracture, femur fracture, tibia/fibular fracture, pelvic fracture and so on order. 11) Sequelae were noticed in about 20% of the total patients. The most frequent one was post traumatic syndrome. 12) The period of hospitalization was about 2 weeks on an average in non-surgical cases(83%) and 4-6 weeks on an average in surgical cases(70%).

A Clinical Analysis of Pediatric Head Injuries

OBJECTIVES: With the advancement of a social life, the pediatric head injuries(PHI) occur greater than ever. Since the PHI differs from adult head injury with regards to mechanism of trauma, prognosis, and mortality, it is important to identify the characteristics of the PHI for its proper treatments and prognosis. METHODS: For this study, a series of 365 PHI patients under 15 years of age who were admitted to our hospital, were evaluated from January 1991 to December 1996. The clinical variable studied were age, sex, Glasgow coma score(GCS), causes of trauma, diagnosis, symptoms, associated injuries and Glasgow outcome score (GOS). The characteristics of PHI were evaluated according to presentations of skull fractures, intracranial hemorrhages, associated injuries, GCS at admission and GOS. RESULTS: Mean age of the studied patients was 6.51 years of age. The majority of PHI patients were under the 7 years of age(66.7%). The ratio of male to female was 2.2:1. Seasonally, PHI occurred more frequently during March to August(61.6%). The main causes of the injuries were accidental falls and traffic accidents(47.1% and 46.3%). One hundred ninety seven(54%) patients suffered from skull fractures and 110(30.1%) patients were developed intracranial hemorrhages and acute epidural hematomas(17.8%) which were the most common intracranial hemorrhages. There was statistical significance between skull fractures and intracranial hemorrhage (p=0.032) and between GCS and GOS(p=0.001). However, there was no statistical significance between skull fractures and intracranial hemorrhage(epidural hematomas, subdural hematomas, and intracerebral, intraventricular and subarachnoid hemorrhage)(p=0.061, 0.251 and 0.880). Also there were no significance of prognosis between under the seven and over the 8 years of age(p=0.349). CONCLUSIONS: The core management for PHI is prevention from its occurrences. However, when unexpected accident occurs, early diagnosis and treatment for PHI by through examination for associated injuries and other damages even if there is no skull fracture are essential in managing patient's outcome.

Three Cases of Syringomyelia with Operative Treatment

Authors experienced the myelotomy for the syringomyelia in 3 cases. Moreover a recent case who underwent the craniovertebral decompression with myelotomy was associated with Arnold-Chiari malformation. Post-operative courses were uneventful in two but a case with the thoracic myelotomy became paraparetic after 5 years of follow up due to the spinal arachnoiditis. It seems that the careful studies, including the ventriculography and/or C-T scan are necessary to find the hind-brain malformation and to give the appropriate management.

Effects of MgSO4 on Cerebral Infarction after Permanent Middle Cerebral Artery Occlusion in Rat

OBJECTIVE: This study is aimed to prove the neuroprotective effect of magnesium ion, which is known to have competitive action against calcium influx in the process of neuronal damage. METHODS: One hundred twenty five male Sprague-Dawley rats weighing 300-350gm were divided into control and MgSO4 injected groups. Middle cerebral artery occlusion was induced by nylon insertion near internal carotid artery bifurcation via external carotid artery. Forty rats which were alive for 48 hours after the induction of cerebral infarction were drawn from each group. Thirty minutes after the induction of cerebral infarction, 750mumol/Kg of MgSO4 was intramuscullary injected for the experimental group and same amount of normal saline was injected for the control group. Each group was subdivided into groups of 20 rats 48 hours after the cerebral infarction. Brain-sections of a subgroup were obtained after transcardially perfusion of 2% 2', 3', 5'-triphenyl-tetrazolium chloride and infarction volume was measured using imaging analysis program. Brain-sections of the other subgroup were stained with terminal deoxynucleotidyl-transferase-mediated biotin dUTP nick end labeling(TUNEL) and apoptotic index(AI) was estimated. RESULTS: The volume of cerebral infarction of the control and MgSO4 injected groups were 52.44+/-5.68% and 38.38+/-9.02% respectively, and the infarction volume was significantly reduced in MgSO4 injected group(p<0.001). Brain edema volume were 209.01+/-75.41mm3 in control group and 140.7+/-81.89mm3 in MgSO4 injected group that was a significant reduction in MgSO4 injected group(p<0.001). AI of 53.68+/-6.38 for control group and 29.80+/-6.77 for MgSO4 injected group were estimated and MgSO4 injected groups showed a significant reduction(p<0.001). CONCLUSION: Magnesium ion has neuroprotective effect in reduction of cerebral infarction volume, brain edema volume and AI. In the future, various attempts to prove protecting mechanism of magnesium ion should be made and TUNEL stain is thought to be an effective comparison method in such studies.

Extracranial Extension of A Pterional Meningioma: Case Report

The authors report a case of pterional meningioma invading the sphenoid bone, orbital roof and lateral orbit, and temporal bone with hyperostosis, which extended into temporal muscle. Extensive removal of orbital, sphenoid and basal skull bone was carried out with total excision of tumor mass in and out of the cranium. Preoperative exophthalmos still remained postoperatively. The mode of extension, result of surgery and CT findings are discussed.

Significance of Serum and Urinary Malonate Concentration in Patients with Traumatic Brain Injury

When the brain is damaged, lipid peroxidation and malonate concentration are increased. The malonate activates the NMDA receptor and induces neuronal toxicity. To investigate the importance of malonate concentration as a prognostic factor, we measured its concentration in serum and urine of 20 patients with head trauma from August 1993 to Feburary 1994. Controls were 20 healthy volunteers. Blood and urine samplings ware taken at first day after head trauma. Malonate concentration in serum and urine was measured by utilizing the malonyl-CoA synthetase from Rhizobium trifolii. Direct spectrophotometric assay at 540 nm was used for purification and characterization. Mean serum malonate concentration in patients with head trauma was 1.83+/-.64 mM/L and 0.72+/-.20 mM/L in controls. The serum malonate concentration in patients was more significantly increased than controls (p0.05). A regression analysis on the relationship between malonate concentration, higher the malonate concentration, worse the Glasgow Outcome(r=0.64). In conclusion, when head injury occurs, concentration of serum malonate increases and this tends to be related to poor outcome. But, it must be further investigated to varify whether the relationship between traumatic brain injury and malonate concentration is more closely related without other factors affecting its concentration.

A Statistical Observation on Genitourinary-tract Injuries of Korean Army in Vietnam War / 대한비뇨기과학회지

A statistical observation ryas made on Genito-Urinary-Tract injuries of Korean Army Personnel in Vietnam War during the period of November, 1965 to November, 1966. and the following results were obtained. 1. The Genito-Urinary-Tract injuries were 15 cases(5.3 per cent) among 825 war causalities. 2. As for the causes of injuries, 25 cases (55.5 per cent) were caused by gunshot, 9(20.O per cent) by booby trap, 5(11. O per cent) by mortar, 3(6.6 per cent) each by crush and grenade. 3. Concerning the frequency of injuries in each organ, 12 cases (6. 6 per cent) each were observed in urethra, in scrotum and testis, 10 (22.2 per cent) in kidney, 8 (17.7 per cent) in bladder, and 3 {6. 6 per cent) in penis. 4.The incidence of Genito-Urinary-Tract injuries associated with the other organs was as follows. In kidney injuries, Z cases were associated with intestine, 4 with liver, 3 with spleen and one each with radial nerve and iliac vessel. In bladder injuries. 2 cases were associated with pelvic bone, and one with spleen. In urethra injuries, 6 cases were associated with pelvic bone and 2 with intestine. 5. As for the multiplicity of Genito-Urinary-injuries, 4 cases were observed in scrotum, testis and urethra, and 3 each in urethra and bladder, and scrotum and testis. 6. The evacuation time from battle fields to the evacuation hospital was one hour in average by helicopter

A Case of Intramedullary Glioblastoma Multiforme in Child

A case of primary cervical intramedullary glioblastoma multiforme which is infrequently reported is presented. An 11 year old girl was admitted to the Department of Neurosurgery, Catholic Medical College in September 1976 because of flaccid paralysis of both upper extremities, neck pain and vomiting for 3 months. On admission, the patient was found to have flaccid paralysis of both arms and weakness of both legs. Sensory examination revealed hyperthesia below C2 dermatome. Babinski's toe sign was positive bilaterally and she was unable to void. Plain cervical spine revealed widening of interpedicular distance at C5 & 6. Myelogram through lumbar and cisternal route showed obstruction and widening of cord at the level of C4 & 7 respectively. Total laminectomy was performed through C3 to C6 and a purplish-blue mass was extruded out through the dorsal myelotomy. Pathologic diagnosis of the tumor was glioblastoma multiforme. Postoperatively there was marked improvement of motor power of all limbs. The patient has not shown any worsening in neurological status until this paper is submitted since she was discharged from the hospital October 1976.

A Case of Intramedullary Glioblastoma Multiforme in Child

A case of primary cervical intramedullary glioblastoma multiforme which is infrequently reported is presented. An 11 year old girl was admitted to the Department of Neurosurgery, Catholic Medical College in September 1976 because of flaccid paralysis of both upper extremities, neck pain and vomiting for 3 months. On admission, the patient was found to have flaccid paralysis of both arms and weakness of both legs. Sensory examination revealed hyperthesia below C2 dermatome. Babinski's toe sign was positive bilaterally and she was unable to void. Plain cervical spine revealed widening of interpedicular distance at C5 & 6. Myelogram through lumbar and cisternal route showed obstruction and widening of cord at the level of C4 & 7 respectively. Total laminectomy was performed through C3 to C6 and a purplish-blue mass was extruded out through the dorsal myelotomy. Pathologic diagnosis of the tumor was glioblastoma multiforme. Postoperatively there was marked improvement of motor power of all limbs. The patient has not shown any worsening in neurological status until this paper is submitted since she was discharged from the hospital October 1976.

A Case of Clear Cell Meningioma: A Case Report

Clear cell meningioma is a rare pathological entity among many variants of intracranial meningioma from new Word Health Organization(WHO) classification of tumors of the central nervous system. The authors report a case of clear cell meningioma located at the petroclival area in a 39-year-old male, which was totally removed by transcochlear approach. The clinical, radiological, histopathological, and neurosurgical features of this lesion are discussed with a review of the literatures.