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

No abstract available.
Spinal Cord Diseases* ; Spinal Cord*

We report a case of atlantoaxial subluxation with bilateral high-riding vertebral artery with narrow isthmus. Because of the potential risk of bilateral vertebral artery injury, we performed atlantoaxial fixation using rod and screw instead of transarticular screw fixation. Although postoperative computed tomography reconstruction demonstrated slight breach of bilateral vertebral artery groove, postoperative angiography showed no evidence of vertebral artery injury. Though technically demanding, atlantoaxial fixation using rod and screw can be a one of the treatment options for atlantoaxial instability with bilateral high riding vertebral artery.
Angiography ; Vertebral Artery*

Authors reviewed the relationship between the cerebral vasospasm in the cerebral angiograms and CT findings in the 41 cases of subarachnoid hemorrhage due to intracranial aneurysmal rupture during the period from July 1982 to February 1984. This study was based upon the CT scans performed within the first 5 days and angiograms obtained between 7 and 17 days after subarachnoid hemorrhagie. Conclusions were as following : 1) No relationship between the site of aneurysm and the amount of subarachnoid blood. 2) No relationship between the site of aneurysm and the development of vasospasm. 3) No definite additional influence of the intracerebral or intraventricular clots on the development of vasospasm. 4) High incidence of severe vasospasm with clot or thick layer in subarachnoid space.
Aneurysm ; Incidence ; Intracranial Aneurysm ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Tomography, X-Ray Computed ; Vasospasm, Intracranial*

BACKGROUND: Cerebral cortical dysplasia (CD) is one of the important causes of intractable epilepsies and characterized histologically by disorganized cortical lamination and cytomegalic dysplastic neurons. Although various cytoskeletal abnormalities have been found in dysplastic neurons of CD, the pathogenetic role of dysplastic neurons has rarely been investigated. METHODS: In this study, immunohistochemical analysis was performed using antibodies against non-phosphorylated high- or medium-molecular weight neurofilament protein and microtubule-associated protein 2 (MAP-2) in surgical specimens of CD. In order to know the possible relationship of dysplastic neurons with cytoskeletal abnormalities and various neurotrophin receptors, NGFR p75, trkA, trkB, and trkC immunoreactivities were also analyzed. RESULTS: Dysplastic neurons showed strong immunoreactivities for non-phosphorylated high- or medium-molecular weight neurofilament protein and MAP-2, which might reflect abnormal outgrowth and altered plasticity of the dysplastic neurons. TrkB and trkC were strongly expressed in dysplastic neurons and NGFR p75 was also strongly expressed in some dysplastic neurons. CONCLUSIONS: Since it has been known that brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) have effects on the differentiation of neuronal precursor cells from the cortex and on dendritic and axonal arborization, increased expression of trkB and trkC may play a role in cytoskeletal abnormalities and altered synaptic transmission in dysplastic neurons.
Antibodies ; Axons ; Brain-Derived Neurotrophic Factor ; Epilepsy ; Malformations of Cortical Development* ; Microtubule-Associated Proteins ; Neurons* ; Plastics ; Receptors, Nerve Growth Factor ; Synaptic Transmission

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

The perioperative use of anticonvulsants in patients receiving craniotomy for various CNS diseases has been a routine practice in neurosurgery. However, there have been no unified evidence-based guidelines for the perioperative use of anticonvulsants. We searched for published studies related to this subject in MEDLINE and reviewed them. Several randomized controlled studies were regarded as more important because they could provide strong evidence. The conclusions are as follows. First, postoperative seizures are serious problems in neurosurgical practice and should be strictly controlled. Second, anticonvulsants could decrease the occurrence of postoperative seizures. Third, the therapeutic serum levels of anticonvulsants are of utmost importance in the prevention of postoperative seizures. Fourth, valproic acid has no advantage over phenytoin in the prevention of postoperative seizures.
Anticonvulsants* ; Central Nervous System Diseases ; Craniotomy ; Humans ; Neurosurgery* ; Phenytoin ; Seizures ; Valproic Acid

OBJECTIVE: The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis. METHODS: A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets. RESULTS: Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild. CONCLUSION: In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.
Humans ; Incidence ; Neoplasm Metastasis ; Neoplasm, Residual ; Prevalence ; Radiation Tolerance ; Radiosurgery ; Reoperation ; Spinal Cord ; Spine