This is a retrospective study on 41 cases with hydrocephalus caused by posterior fossa tumors treated at neurosurgery Dep., Cho Ray hospital from 1993 to 1995. All child patients entering the study had the intracranial pressure syndrome and evidence clinical, paraclinical symptoms. 18/41 cases had cerebellar symptoms (50%). 27 cases had the pathological results after tumor removal in which 20 cases were medulloblastoma (74.04%). The percentage of patients becoming worse postoperatively was still high: 7/27 cases (25.92%). To enhance the quality of treatment, it is necessary to make the diagnosis early and treat the patients actively.
Infratentorial Neoplasms ; Hydrocephalus

Traumatic hematomas in the posterior fossa is relatively rare (only 2.8% in the total cases of hematomas in the cranium), but dangerous because clinical symptoms are not specific and sudden suspension of breathing may lead rapidly to mortality. The author had analysed these cases to find out experiences in the diagnosis and treatment of this disease. The rate of mortality after surgery and medical treatment was 14.3%.
Hematoma ; Diagnosis ; Therapeutics ; Infratentorial Neoplasms

The authors experienced a case of mutism developed after the posterior fossa tumor surgery in a child. Mutism is a symptom mainly developed by supratentorial lesion in organic form. The possible pathogenesis of mutism after posterior fossa tumor surgery is discussed with a review of 18 additional previously reported cases.
Child* ; Humans ; Infratentorial Neoplasms* ; Mutism*

Spontaneous ventriculostomy occurs with the spontaneous rupture of a ventricle resulting in a communication between ventricular system and subarachnoid space. It is usually the result of obstructive hydrocephalus but has been documented only rarely. Van Stackum verified the first case of spontaneous ventriculostomy at autopsy in 1910. Radiological demonstration of spontaneous ventriculostomy was reported by Leslie for the first time in 1964 and only 6 cases has been reported until now. We recently have experienced a case of spontaneous ventriculostomy beautifully demonstrated by conray ventriculography in a patient of posterior fossa tumor. We report our case with the brief review of the articles.
Autopsy ; Humans ; Hydrocephalus ; Infratentorial Neoplasms ; Rupture, Spontaneous ; Subarachnoid Space ; Ventriculostomy*

A rare case of hemifacial spasm caused by an ipsilateral tentorial meningioma is described. Magnetic resonance imaging showed a huge tumor in the right cerebellar hemisphere, distant to the cerebello-pontine cistern. The facial-vestibulocochlear nerve complex was stretched by the shift of the brainstem and the right cerebello-pontine cistern was effaced. After removing the tumor, the hemifacial spasm resolved completely. We review our case with the pertinent literature regarding the etiological mechanism.
Brain Stem ; Hemifacial Spasm ; Infratentorial Neoplasms ; Magnetic Resonance Imaging ; Meningioma

The authors analyzed 50 children(below 15 years old) with intracranial tumors which were confirmed by operation during 5.5 years from Jan, 1983 to Jul. 1989 retrospectively. The results were as follows : 1) Incidence of pediatric brain tumors was 13.1% among the all intracranial tumors(383 cases). 2) Pediatric brain tumors were found most frequently between the age of six and thirteen years(74.0%), and the ratio of male to female was 1.6 : 1. 3) In respect of location, supratentorial and infratentorial tumors were seen in each 25 patients, and the tumor of central neural axis(58.0%) was more frequent than that of lateral portion(42.0%). 4) The most common tumor was astrocytoma(32.0%) in the supratentorium, and medulloblastoma(26.0%) in the infratentorium. 5) Headache and vomiting were the most common complaining symptoms and papilledema was the most common sign. 6) Hydrocephalus associated with tumors was 24.0% in supratentorium and 88.0% in infratentorium. 7) Postoperative mortality within 1 month was 12.0%.
Brain Neoplasms* ; Brain* ; Female ; Headache ; Humans ; Hydrocephalus ; Incidence ; Infratentorial Neoplasms ; Male ; Mortality ; Papilledema ; Retrospective Studies ; Vomiting

Since introduction of magnetic resonance imaging(MRI), six cases of multiple intracranial meningiomas without signs of neurofibromatosis were found among the forty eight cases of meningiomas. The incidence of multiple intracranial meningiomas in our series was 12.5% of all meningiomas. We analyzed six cases of multiple intracranial meningiomas that were evaluated by MRI. Two tumors were found in five patients, whereas the other one patient had more than ten tumors at different sites. The tendency of unihemispheric distribution was not seen and two cases had bilaterally located tumors and other two cases had tumors above and below the tentorium without tentorial involvement. Relatively high occurrence of meningioma in posterior fossa was observed. Half of the six cases had posterior fossa tumors and 6 tumors(28.6%) of the total 21 tumors were located in the posterior fossa. All the cases were female. Mean age on admission was 61.3 years, ranged from 44 to 77 years. All six patients were treated surgically and three of them underwent multiple staged operations. Histologically, of the 12 tumors removed, 5 were transitional, 4 were fibroblastic, 3 were meningothelial. The histological subtypes of tumors in each case were different in two cases, but identical in other three cases. The surgical results, although the follow-up periods(ranged 3 months to 2.5 years) were not long enough in some cases, were favorable.
Female ; Fibroblasts ; Follow-Up Studies ; Humans ; Incidence ; Infratentorial Neoplasms ; Magnetic Resonance Imaging ; Meningioma* ; Neurofibromatoses

OBJECT: It is well known that infratentorial surgery is more difficult to approach to the lesion and may result in poorer outcome than supratentorial surgery. The prognostic factors and outcome were analyzed for one hundred forty-five consecutive patients who underwent surgical treatment for infratentorial tumor between 1989 and 1997. METHODS: Neurilemmoma was the most common tumor(41 cases), followed by astrocytoma(19 cases), hemangioblastoma(19 cases), medulloblastoma(18 cases), meningioma(17 cases) respectively. We studied the relationship between postoperative outcome known various factors retrospectively: age at surgery, pathology, duration of symptoms, tumor size, location of tumor, presence of hydrocephalus, and extent of resection. A statistical analysis of clinical characteristics was conducted to evaluate the significance of associations by student t-test. Surgical results were evaluated by Ojemann's method. RESULTS: Of 145 cases, excellent were in 25 patients, good in 60 patients, fair in 41 patients, poor in 9 patients, and dead in 10 patients. Large size of tumor(p<0.01) and presence of hydrocephalus(p<0.05) were factors that indicate poor outcome. Surgical results of tumors in the cerebellopontine angle(CPA) or clival area were poorer than those in cerebellum(p<0.05). Age, duration of symptom, pathology, and extent of resection did not influence postoperative outcome significantly. The most common postoperative complication was facial palsy(21 cases). The operative mortality was 6.9% and sepsis was the leading cause of death. CONCLUSION:Large size(p<0.01), presence of hydrocephalus(p<0.05), and location in CPA and clival region(p<0.05) were factors that indicate poor outcome after infratentorial tumor surgery.
Cause of Death ; Humans ; Hydrocephalus ; Infratentorial Neoplasms* ; Mortality ; Neurilemmoma ; Pathology ; Postoperative Complications ; Retrospective Studies ; Sepsis

OBJECTIVE: This study is designed to identify the clinical characteristics and the optimal treatment modality of hydrocephalus in posterior fossa tumors. METHODS: The authors reviewed 154 infratentorial tumor patients. Age, sex, clinical symptoms, types of treatment, and surgical results of posterior fossa tumor patients with hydrocephalus were analyzed, retros-pectively. Factors which might predict the need for external ventricular drainage(EVD) or ventriculo-peritoneal shunt were analyzed statistically. RESULTS: Hydrocephalus was noted in 86 cases(56%), and it was associated with medulloblastoma in 16 cases(89%), hemangioblastoma in 12(63%) and brain stem glioma in three(33%). The surgical results of the posterior fossa tumors with hydrocephalus were poorer than those without hydrocephalus(p<0.05). A large tumor(p<0.05) and an incomplete removal(p<0.05) were factors predicting the need for EVD or shunt. Complications of intraoperative EVD or shunt developed in four cases. They were infection, he-morrhage at puncture site, and obstruction. Five patients in whom intraoperative EVD or shunt had not been performed developed a fatal hydrocephalic attack at immediate postoperative period, and the pos-toperative computed tomography scan revealed intraventricular hemorrhages in three cases cerebellar swellings in two cases. CONCLUSION: Intraoperative EVD or shunt is a safe, effective treatment modality especially in large size tumor and/or incomplete tumor resection. Intraventricular hemorrhages or cerebellar swellings during immediate postoperative period might cause fatal hydrocephalic attack, therefore EVD or shunt might be recommended in selected cases.
Brain Stem ; Glioma ; Hemangioblastoma ; Hemorrhage ; Humans ; Hydrocephalus* ; Infratentorial Neoplasms* ; Medulloblastoma ; Postoperative Period ; Punctures ; Ventriculoperitoneal Shunt

A 24-year-old female patient presented with a midline extra-axial posterior fossa lesion. We failed to suspect this lesion could be a giant thrombosed aneurysm of PICA(posteior inferior cerebellar artery) preoperatively, and didn't perform preoperative angiogram even after rather typical finding of thrombosed giant aneurysm on MRI. We suggest a giant thrombosed aneurysm should be included in the differantial diagnosis of any round extra-axial mass lesion in the skull base.
Aneurysm* ; Arteries* ; Diagnosis ; Female ; Humans ; Infratentorial Neoplasms* ; Magnetic Resonance Imaging ; Pica ; Skull Base ; Young Adult