An 89-Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.
Aged, 80 and over ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Basosquamous* ; Cytoplasm ; Eosinophils ; Female ; Humans ; Islands ; Lip ; Ulcer

Epilepsy surgery in Korea began as early as in the 1940s and continued to develop through the second half of the 20th century. Introduction of neuroimaging modalities, establishment of epilepsy monitoring units and the epilepsy team approach contributed to the rapid development. �or about 300�- 400 operations carried out yearly��, t�here i��s at �prese�nt suffi���cien�t n�umb ��er of ep�ileps� y surg�ery cen�ters�� an�d q�ualifi��ed neurosurgeons in Korea. However, Korean neurosurgeons should adapt themselves to changing recent trends. Etiologies of epilepsy have dramatically changed from head trauma and infectious diseases to tumors and developmental abnormalities. Although traditional resective surgery still constitutes the main bulk of the operations, new therapeutic procedures based on neuro�modulation are emerging as alternative treatments. There should also be participation in basic science research which would leads to future innovations in treatment of epilepsy.

We describe a 23-year-old man showing typically clinical and histological features of targetoid hemosiderotic hemangioma. About 35 cases of this newly-described entity have been reported since the first description by Santa Cruz and Aronherg in 1988. It is important to distinguish these tumors from patch stage Kaposi's sarcoma, retiform hemangioendothelioma and progressive lymphangioma.
Hemangioendothelioma ; Hemangioma* ; Humans ; Lymphangioma ; Sarcoma, Kaposi ; Young Adult

OBJECTIVE: We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. METHODS: From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. RESULTS: Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. CONCLUSION: Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.
Arachnoid ; Cerebellum ; Deglutition Disorders ; Dysarthria ; Follow-Up Studies ; Foramen Magnum* ; Humans ; Membranes ; Meningioma* ; Recurrence ; Spinal Cord

Epilepsy associated with brain tumors (EABT) is a multi-faceted disease that both oncological and epileptological concerns should be taken into consideration. Usually, it is characterized by chronic drug-resistant epilepsy with a low-grade brain tumor in the cerebrum. However, the distinction of typical EABT and simple brain tumors with short-term epilepsy is obscure. We need a working formulation based on the patient's burden in both oncological and epileptological aspects. The diagnosis of EABT is straightforward, but the treatment should be more complex. Medical treatment with anticonvulsants aloneseems tobe anoutdated remedy for EABT because of the risk of tumor growth and malignant progression in some patients as well as the expected favorable seizure control after surgery. Surgical treatment of EABT has resulted in seizure-free state in about 80% of patients. Complete resection of the tumor is an important prognostic factor in seizure control and probably also in tumor control. Recently, many authors emphasized a lesion-directed surgery aimed at a complete tumor removal in EABT. However, in some patients, especially in patients with dual pathology, electrophysiological studies have to be thoroughly applied. For the treatment of EABT in the temporal lobe, more sophisticated surgical strategy is required. A lesionectomy saving the uninterrupted hippocampus could be applied for selected patients. Further research is strongly needed for better understanding and treatment of EABT and low-grade glioma.
Anticonvulsants ; Brain ; Brain Neoplasms ; Cerebrum ; Epilepsy ; Glioma ; Hippocampus ; Humans ; Seizures ; Temporal Lobe

More than 30% of epilepsy patients are not controlled by anti-epileptic medications. For patients having intractable epilepsy, epilepsy surgery is an effective treatment, which provides not only control of seizures but also improvement of quality of life. Epilepsy surgery can provide complete seizure control in over 60% of patients having medically intractable epilepsy. In order to identify surgical candidates, various diagnostic modalities are being used. The value of video-EEG monitoring and MR imaging study cannot be over-emphasized. For certain circumstances, other diagnostic modalities, such as PET, SPECT, and MEG, provide complementary data. If the findings from these non-invasive studies collectively indicate that the patient can benefit from surgery, surgical resection can be performed. However, if the findings do not,, invasive studies should follow. New surgical modalities for the treatment for epilepsy have been developed, including surgical resection of epileptogenic zone or lesion, disconnection of epileptogenic zone from the surrounding normal brain, and neuromodulation, such as vagal nerve stimulation, deep brain stimulation, etc. Also, newly emerging diagnostic modalities, such as high tesla MR imaging, magnetoencephalography or brain mapping technology, can help select surgical candidates more easily in the near future.
Brain ; Brain Mapping ; Deep Brain Stimulation ; Epilepsy ; Humans ; Magnetic Resonance Imaging ; Magnetoencephalography ; Quality of Life ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome ; Vagus Nerve Stimulation

Authors experienced 36 cases of middle cerebral artery aneurysms in 35 patients. Among 36 cases, M1 aneurysms were 4 cases, M1 bi-or trifurcation aneurysms 30 cases, and distal aneurysms 2 cases. The majority of M1 bi-or trifurcation aneurysms were operated upon by the superior temporal gyrus approach. Trans-sylvian approach was used only in M1 aneurysms, in cases of short M1, in associated anterior circulation aneurysms, and in second operation to the unruptured middle cerebral artery aneurysms. Our results were encouraging. Mortality was 5.6%, and morbidity was also 5.6%.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Mortality

In order to define the hospital course and the best surgical timing for the poor grade subarachnoid hemorrhage(SAH) patients, 131 patients(from 1989 to 1991) whose clinical grade on admission were Hunt and Hess grade III to V were analyzed. Their admission grades was III(90 patients), IV(30 patients), and V(11 patients). Patients were grouped into the early surgery group(within 3 days of the last hemorrhage), the intermediate group(4 to 14 days), the late surgery group(14 days after the last hemorrhage), and non-surgical group. Early surgery was performed on 17 patients, intermediate on 31 patients, and late on 54 paients. Twenty-nine patients did not undergo surgery. This non-surgical group had a high mortality rate(72.4%). During the waiting period for a delayed surgery(later than 3 days), 21% improved their clinical state, 53.5% were stationary and 25.5% became worse. Morbidity and mortality were compated among these three surgical groups and the non-surgical group, with sratistical analysis using chi square test and Fisher's exact test. No statistical differences were noted between the management groups in terms of associated disease, location of aneurysms, Fisher's grade, occurrence of hydrocephalus or symptomatic vasospasm. The mortality rate was significantly lower in the combined surgical groups than in the non-surgical group(p<0.05). Mortality was related to the timing of surgery. It was higher after early surgery than in the other two gorups, but it was not different between the intermediate and late surgery groups. Morbidity was not different among the three surgery groups. The major cause of morbidity and mortality in the early surgery group was brain swelling, while rebleeding, hydrocephalus, and vasospasm, were the main causes in the intermediate and delayed surgery groups. It is concluded that it is not recommended that early surgery must be done in all the poor grade SAH patients. However three days after the last hemorrhage, it is better to perform surgery as soon as possible, because there were no statistically significant differences between the intermediate group and the late surgery groups in the mortality and the morbidity rates.
Aneurysm ; Brain Edema ; Hemorrhage ; Humans ; Hydrocephalus ; Mortality ; Subarachnoid Hemorrhage*

Hypereosinophilic syndrome is characterized by marked eosinohia and eosinopbilic infiltrition of various organ-systems without any identifiable underlyin sathologic conditions such as hypersensitivity, drug eruption, parasitic infestat,ion, malignant tuinc, and autoimrnune and infectious d iseases. A 31 year-old male had weight loss, abnormal peripheral cirrultiction both extremities and two distinct skin lesions. One showed rice sized, erythematous follicular popules on both extremit.ies and trunk and the other showed a walnut sized, gangrenous ulcer on the left 2nd finger tip. The patients skin lesions and circulation defect. improved after retrnent with steroid and the blood eosinophilia returned to normal.
Adult ; Blood Circulation* ; Drug Hypersensitivity ; Eosinophilia ; Extremities* ; Fingers ; Humans ; Hypereosinophilic Syndrome* ; Juglans ; Male ; Skin ; Ulcer ; Weight Loss

Lichen aureus is a rare disorder classified as a pigmented purpuric dermatosis. This case report is of a 46-year-old female in whom a coin sized, gold tinted, erythematous maculopapule developed on the right lower quadrant of the abdomen l0 years ago which showed characteristic histological findings of lichen aureus consisting of lymphohistiocytic infiltration in the upper dermis and extravasation of red blood cells.
Abdomen ; Dermis ; Erythrocytes ; Female ; Humans ; Lichens* ; Middle Aged ; Numismatics ; Skin Diseases