Transient mutism has ben known as a rare complication following a posterior fossa approach to cerebellar tumors, although its pathophysiology remains unclear. Cerebellar mutism may be defined as a transient mutism occurring after a posterior fossa tumor approach in children with unimpaired consciousness, unimpaired symbolic functions, no detectable deficit of cranial nerves or peripheral organs of speech, and no lesions of long pathways in the course of the cranial nerves at the level of the brain stem. Forty two cases in children, and only two cases in adults have been found in the literature. We report a case of transient mutism with oropharyngeal apraxia after total excision of 4th ventricle choroids plexus papilloma in a 6-year-old girl. Postoperatively, the patient became mute and refused food intake without disturbance of consciousness, or lower cranial nerve function. Computed tomography(CT) and magnetic resonance image(MRI) demonstrated no abnormal findings except the surgical lesion in the posterior fossa. The mutism lasted for 3 weeks, but she gradually became fluent. The mechanism of "cerebellar mutism" is briefly discussed with literature review.
Adult ; Apraxias ; Brain Stem ; Cerebellar Neoplasms ; Child* ; Choroid Plexus* ; Choroid* ; Consciousness ; Cranial Nerves ; Eating ; Female* ; Humans ; Infratentorial Neoplasms ; Mutism* ; Papilloma ; Papilloma, Choroid Plexus*

Down syndrome (DS, trisomy 21) is associated with neuroanatomical abnormalities, including choroid plexus cysts and various types of brain tumors. Trisomy 21 is associated with oncogenic factor, especially in brain tumor. The brain of DS patients had a smaller volume of gray and white matter and an unbalanced cerebellum volume, indicating a smaller volume overall than normal. We report a case of a DS male patient who had an incidentally discovered neuroglial cyst in left cerebellar vermis. He visited our hospital with gait disturbance and fatigue. But, the neurologic exam was normal. To the best of our knowledge, this is the first reported case of a neuroglial cyst in a trisomy 21 patient. As the developmental mechanisms of a cyst and the choroid plexus are related, more research is needed.
Brain ; Brain Neoplasms ; Central Nervous System Cysts ; Cerebellar Vermis ; Cerebellum ; Choroid Plexus ; Down Syndrome* ; Fatigue ; Gait ; Humans ; Male ; Neuroglia ; Trisomy ; White Matter

OBJECTIVES: To determine the presentation, incidence, and risk factors of seizures in patients treated for brain tumors. METHODS: One hundred patients who consecutively underwent a craniotomy for the treatment of supratentorial brain tumors were assessed. The pathologies of the patients enrolled in the study included glioma (n=56), meningioma (n=31), metastatic brain tumor (n=7), primary central nervous system lymphoma (n=4), and central neurocytoma (n=2). Anti-epileptic drugs (AEDs) were administered to all patients for up to six months after the surgery. Pre-defined variables for outcome analysis included tumor grade and location, extent of tumor resection, number of seizures, age at tumor diagnosis, adjuvant therapy, medication and radiological abnormalities. RESULTS: Thirty patients (30%) presented at least a single episode of seizure at the time of admission. Five of these patients (16.7%) developed the seizure during the follow-up period. Newly developed seizure was noticed in six out of seventy patients (8.6%) without prior seizure. Histopathology was malignant gliomas in 10 and supratentorial meningioma in one. Early seizure developed only in two patients. CONCLUSION: Compared with patients without seizure, patients with seizure at the time of admission showed younger age (p=0.003), a higher portion of low-grade glioma (p=0.001), tumor location in the frontal and temporal lobes (p=0.003) and cortical involvement (p=0.017). Our study suggestes that tumor progression is considered a significant risk factor for seizure development in glioma patients.
Brain Neoplasms* ; Brain* ; Central Nervous System ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Glioma ; Humans ; Incidence ; Lymphoma ; Meningioma ; Neurocytoma ; Pathology ; Risk Factors ; Seizures* ; Temporal Lobe

Tumors of the central nervous system are the second most frequent neoplasm in children. In a review of 43 children with brain tumor under the age of 16 evaluated at a pediatric and neurosurgical department at Severance Hospital Yonsei University during a 61/2 year period, following results were obtained. 1. All 43 cases were diagnosed by pathological examination as well as brain CT scan. The sex ratio of male and female was equal. The age distribution was highest between 13-14 year of age and 7% of them were under 1 year of age. 2. There was a small preponderance of infratentorial tumors (51%) over supratentoral tumors (49%). 3. Among 43 verified brain tumors by pathological examination, glioma represented 75%, of which astrocytoma was the commonest neoplasm being 19 cases (45%) and remainder were medulloblastoma 10 cases (23%), choroid plexus droglioma 2 cases (5%), ependymoma 1case (2%). The rest were craniopharyngioma 6 cases (14%), choroid plexus papilloma 1 case (2%), neuroblastoma 2 cases (5%), pineal teratoma 1 case (2%), melanotic neuroectodermal turmor 1 case (2%). 4. The most common symptom was headache occuring 63% of the patients followed by vomiting, motor weakness, visual disturbance, gait distrubance, mental disturbance and seizure in order of trequency. Neurological signs showed positive Babinski sign, papilledema, cerebellar sign, 6th nerve palsy and facial weakness. 5. Plain skull X-ray changes were noted in 26 out of the 43 cases (61%). Those were suture separation of skull noted 35% of tumors followed in frequency by increased digital marking, sella changes and calcification. 6. In brain CT scan studies, the most common abnormal finding was solid mass shadow followed by cystic mass shadow, solid and cystic mass shadow. After contrast infusion, diffuse enhancement was the most common features. 7. 27 cases were treated by operation only, 15 by operation and radiotherapy, 1 by operation, radiation and chemotherapy. 8. Progonsis of brain tumor was very poor. 5 of 43 cases died within 1 month of diagnosis, 1 year survival rate was 19%, and 2 year survival rate was 16%. The survival rate was better in the group of patients in whom total or subtotal resection combined with radiotherapy was performed. 53% of cases were not able to follow-up or discharged anainst advice without proper treatment.
Abducens Nerve Diseases ; Age Distribution ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Central Nervous System ; Child* ; Choroid Plexus ; Craniopharyngioma ; Diagnosis ; Drug Therapy ; Ependymoma ; Female ; Follow-Up Studies ; Gait ; Glioma ; Headache ; Humans ; Infratentorial Neoplasms ; Male ; Medulloblastoma ; Neural Plate ; Neuroblastoma ; Papilledema ; Papilloma, Choroid Plexus ; Radiotherapy ; Reflex, Babinski ; Seizures ; Sex Ratio ; Skull ; Survival Rate ; Sutures ; Teratoma ; Tomography, X-Ray Computed ; Vomiting

BACKGROUND: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. METHODS: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. RESULTS: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. CONCLUSIONS: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.
Brain Neoplasms ; Central Nervous System Neoplasms ; Central Nervous System ; Cytogenetics ; Diagnosis ; Frozen Sections ; Humans ; Meningeal Neoplasms ; Methods ; Neurilemmoma ; Pituitary Neoplasms ; Retrospective Studies

BACKGROUND: This report aims to provide accurate nationwide epidemiologic data on primary brain and central nervous system (CNS) tumors in the Republic of Korea. We updated the data by analyzing primary brain and CNS tumors diagnosed in 2013 using the data from the national cancer incidence database. METHODS: Data on primary brain and CNS tumors diagnosed in 2013 were collected from the Korean Central Cancer Registry. Crude and age-standardized rates were calculated in terms of gender, age, and histological type. RESULTS: A total of 11,827 patients were diagnosed with primary brain and CNS tumors in 2013. Brain and CNS tumors occurred in females more often than in males (female:male, 1.70:1). The most common tumor was meningioma (37.3%). Pituitary tumors (18.0%), gliomas (12.7%), and nerve sheath tumors (12.3%) followed in incidence. Glioblastomas accounted for 41.8% of all gliomas. In children (<19 years), sellar region tumors (pituitary and craniopharyngioma), embryonal/primitive/medulloblastoma, and germ cell tumors were the most common tumors. CONCLUSION: This study should provide valuable information regarding the primary brain tumor epidemiology in Republic of Korea.
Brain ; Brain Neoplasms* ; Central Nervous System ; Child ; Epidemiology* ; Female ; Glioblastoma ; Glioma ; Humans ; Incidence ; Korea ; Male ; Meningioma ; Neoplasms, Germ Cell and Embryonal ; Nerve Sheath Neoplasms ; Pituitary Neoplasms ; Registries ; Republic of Korea*

Mutation in the p53 suppressor gene is the most common genetic alteration found in human cancers including primary brain tumors. Ki-67 labeling index(LI) is known to be a marker of proliferating activity. The purpose of this study was to verify whether an immunohistochemical expression of p53 antibody and Ki-67 LI could be related to different clinicopathologic parameters including histologic grade, size, invasiveness and recurrence of the brain tumors. Materials were based on the 147 surgically resected brain tumors during the last two years. Of the 147 brain tumors, there were 35 astrocytic tumors, 35 meningiomas, 10 oligodendrogliomas, 7 craniopharyngiomas, 5 dysembryoplastic neuroepithelial tumors, 4 medulloblastomas, 5 ependymomas, 23 pituitary adenomas, 9 schwannomas, and 14 other brain tumors. The p53 expression and Ki-67 LI were higher in malignant brain tumors including astrocytic tumors, medulloblastoma, PNET and gliosarcoma. The p53 positivity was correlated with histologic grades and tumor recurrence. The brain tumors with a high Ki-67 LI(>6%) also showed a close relationship to a higher histologic grading, radiological invasiveness and recurrence. There was no evident correlation with the age and tumor size with p53 expression and Ki-67 LI. These results suggest that p53 overexpression and high proliferation potential of the tumor cells are associated with the higher histologic grade and aggressive clinical course in the central nervous system tumors.
Brain Neoplasms* ; Brain* ; Central Nervous System Neoplasms ; Craniopharyngioma ; Ependymoma ; Genes, Suppressor ; Gliosarcoma ; Humans ; Medulloblastoma ; Meningioma ; Neoplasms, Neuroepithelial ; Neurilemmoma ; Neuroectodermal Tumors, Primitive ; Oligodendroglioma ; Pituitary Neoplasms ; Recurrence

OBJECTIVE: The aim of this report is to provide accurate nationwide epidemiologic data on primary brain and central nervous system (CNS) tumors in Republic of Korea. In 2010, we had reported first nationwide epidemiologic data on primary brain tumors diagnosed in 2005. In this report, we updated the data by analyzing primary brain and CNS tumors diagnosed in 2010 using the data from national cancer incidence database. METHODS: Data on primary brain and CNS tumors diagnosed in 2010 were collected from the Korean Central Cancer Registry. Crude and age-standardized rates were calculated in terms of gender, age, and histological type. RESULTS: A total of 10,004 patients diagnosed with primary brain and CNS tumors in 2010 were included in this study. Brain and CNS tumors occurred in females more often than in males (female to male, 1.59 : 1). The most common tumor was meningioma (35.5%). Pituitary tumors (18.7%), gliomas (15.1%), and nerve sheath tumors (10.3%) were followed in incidence. Glioblastoma accounted for 34.6% of all gliomas. In children (<20 years), sellar region tumors (pituitary and craniopharyngioma), embryonal/primitive/medulloblastoma, and germ cell tumors were the most common tumors. CONCLUSION: Data from this study should provide valuable information regarding the primary brain tumors epidemiology in Republic of Korea.
Brain ; Brain Neoplasms* ; Central Nervous System ; Child ; Epidemiology* ; Female ; Glioblastoma ; Glioma ; Humans ; Incidence ; Korea ; Male ; Meningioma ; Neoplasms, Germ Cell and Embryonal ; Nerve Sheath Neoplasms ; Pituitary Neoplasms ; Republic of Korea*

The authors analized statistically 403 cases of C.N.S. tumors confirmed by pathology in the boundary of Daegu city and Kyungbook province from January 1984 to December 1986. The results were as follows: 1) The each cases of male and female were 220(54.6%) and 183(45.4%). 2) Intracranial tumors were 288 cases(71.5%), spinal tumors 75(18.6%), and others 40(9.9%). 3) Numbers of C.N.S. tumors were 8.7/100,000 population in city and 6.3/100,000 in country. 4) Among the intracranial tumors, glioma(30.9%) was the most common and followed by meningioma(16.3%) and metastatic tumor(8.7%). Among the spinal tumors, metastatic tumors was 34.6%, neurofibroma 30.7%, and meningioma 5.3%. 5) The majority of intracranial tumors were found in supratentorial region(76.3%), in which area frequency of tumor incidence were as follows; glioma, meningioma, metastatic tumor. Among the infratentorial area(22.6%), the sequence of tumor incidence were glioma, medulloblastoma, and neurilemmoma, 6) Tumors predominantly in male were oligodendroglioma(2:1), metastatic tumor(1.8:1), and medulloblastoma(1.7:1), and in female were meningioma(1:2), neurilemmoma(1:1.7), and pituitary tumor(1:1.5). 7) Peak age incidence of glioma, meningioma, and neurilemmoma were from 40 to 60 years, pituitary tumor and oligodendroglioma were 30 to 50 years, craniopharyngioma and ependymoma were around 10 years old, and metastatic tumor was 50 to 70 years old. 8) In the spinal tumors, the most favorable site of longitudinal axis was thoracic area(62.7%) and transverse location was epidural space(45.3%). 9) The most common site of metastatic tumor were came from lung(29.1%) in brain metastasis and prostate(19.2%) in spine.
Aged ; Axis, Cervical Vertebra ; Brain ; Brain Neoplasms ; Central Nervous System Neoplasms* ; Central Nervous System* ; Child ; Craniopharyngioma ; Daegu ; Ependymoma ; Female ; Glioma ; Humans ; Incidence ; Male ; Medulloblastoma ; Meningioma ; Neoplasm Metastasis ; Neurilemmoma ; Neurofibroma ; Oligodendroglioma ; Pathology ; Pituitary Neoplasms ; Spine

The authors analized statistically 635 cases of pathologically confirmed central nervous system tumors in the Chonnam and Chonbuk provinces from 1987 to 1989. The results were as follows ; 1) Of the 635 cases, 327 cases(51.5%) were male and 308 cases(48.5%) were female. 2) Intracranial tumors were 518 cases(81.6%), spine and intraspinal tumors 94(14.8%), scalp and skull tumors 23(3.6%). 3) Average incidence rate of tumors was 3.5/year/100,000 population, 3.1 for Chonnam province, 4.4 for Chonbuk province. 4) Among the brain tumors, glial tumors were the most common(28.4%), and followed by meningiomas(18%), pituitary tumors(15.2%), metastatic tumors(8.9%), Among the intraspinal tumors, neurinomas and neurofibromas were found most frequently(41.5%), and rests were metastatic tumors(23.4%), meningiomas(9.5%) in order. 5) Sexual predilection of tumors was as follows : male preponderance was noted for oligodendrogliomas(9:1), metastatic tumors(2.3:1), glioblastomas multiforme(GM)(1.8:1) cysticercosis(1.6:1), and female preponderance for meningiomas(1:3.2), pituitary tumors(1:2), paragonimiases(1:1.5). 6) The incidence rate of brain tumors in children below 15 years was 11.8% and that which occured infratentorially was 47.5%. 7) The brain tumors were found mainly in cerebral hemispheres, in which area most of tumors were meningiomas, astrocytomas in order. In sellar, parasellar most of tumors were meningiomas astrocytomas in order. In sellar, parasellar and suprasellar region, the majority of tumors were pituitary tumors and meningiomas. 8) Cysticercosis showed a predilection for the sixth and seventh decades, meningiomas, metastatic tumors, neurinomas for sixth decade, GM and supratentorial astrocytomas for fourth, fifth and sixth decades, oligodendroliomas for fifth decade, infratentorial astrocytomas, medulloblastomas and craniopharyngiomas for first and second decades. 9) In the spinal tumors, the favorable site was thoracic region and majority of them were located intradural extramedullarily and extradurally in similar incidence.
Astrocytoma ; Brain Neoplasms ; Central Nervous System Neoplasms* ; Central Nervous System* ; Cerebrum ; Child ; Craniopharyngioma ; Cysticercosis ; Female ; Glioblastoma ; Humans ; Incidence ; Jeollabuk-do* ; Jeollanam-do ; Male ; Medulloblastoma ; Meningioma ; Neurilemmoma ; Neurofibroma ; Pituitary Neoplasms ; Scalp ; Skull ; Spine