Craniopharyngiomas exhibiting histologic malignancy are extremely rare. Herein, we report the case of a 26-year-old male patient who underwent suprasellar mass excision via an interhemispheric transcallosal approach. Histopathological examination indicated that the craniopharyngioma was of the adamantinomatous subtype. The patient received postoperative medical treatment for endocrine dysfunction and diabetes mellitus without radiation treatment. Two years after the operation, he presented with progressive visual disturbance and altered mentality. Magnetic resonance imaging revealed a huge mass in the suprasellar cistern and third ventricle. He underwent a second operation via the same approach. The histopathological examination showed an adamantinomatous craniopharyngioma with sheets of solid proliferation in a spindled pattern, indicating malignant transformation. Malignant transformation of craniopharyngioma in the absence of radiation therapy has been reported in only five cases, including this one. We present a case of malignant transformation of craniopharyngioma with a brief review of relevant literature.
Adult ; Craniopharyngioma* ; Diabetes Mellitus ; Humans ; Magnetic Resonance Imaging ; Male ; Radiotherapy ; Third Ventricle

Upward migration of the peritoneal catheter of a subgaleo-peritoneal (SP) shunt and coiling into the subgaleal space is an extremely rare complication of a SP shunt. A 32-year-old male patient visited our hospital presenting with a large skull defect due to a prior craniectomy performed elsewhere. The patient underwent a cranioplasty with methylmetacrylate, but subsequently developed progressive pseudomeningocele and subgaleal cerebrospinal fluid (CSF) collection. The patient underwent CSF diversion via a SP shunt. After SP shunting, the pseudomeningocele disappeared completely. Six months later, the patient presented with progressive scalp swelling. Skull X-ray showed migration and coiling of the distal catheter of the SP shunt. The patient was treated by removing the entire shunt catheter and the dura was covered with a subgaleal flap. We would like to report our experience with a very rare complication of subgaleo-peritoneal shunting.
Adult ; Catheters* ; Cerebrospinal Fluid ; Humans ; Male ; Scalp ; Skull

Low-grade myofibroblastic sarcoma (LGMS) is a rare sarcoma with myofibroblastic differentiation. LGMS has a propensity for local recurrence and is associated with a low risk of metastatic spread. A 26-year-old man presented with a 12-month history of a slow growing palpable hard mass in the right parietal scalp. Enhanced CT scan of head showed a 3x4 cm sized well-defined and heterogeneously enhancing scalp mass. The patient underwent excision of the tumor. The histological and immunohistochemical features were consistent with a LGMS. We performed re-operation for remnant tumor removal after diagnosis. After 14 months of surgery, the patient was well-being state.
Adult ; Diagnosis ; Head ; Humans ; Myofibroblasts* ; Rabeprazole ; Recurrence ; Sarcoma* ; Scalp* ; Tomography, X-Ray Computed

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited familial tumor syndrome. Benign tumors such as pilocytic astrocytoma, optic glioma make up the majority of intracranial neoplasms in patients with NF1. There have only been a handful of cases in which adult glioblastoma presented with NF1. A 32-year-old male presented with headache and radiological studies showing a high grade intra-axial tumor. The patient underwent gross total surgical excision and the pathology revealed glioblastoma. After the surgery, he received concomitant chemo-radiotherapy with temozolomide and adjuvant temozolomide chemotherapy. We report a NF1 patient who developed glioblastoma and reviewed related articles.
Adult ; Astrocytoma ; Brain Neoplasms ; Drug Therapy ; Glioblastoma* ; Hand ; Headache ; Humans ; Male ; Neurofibromatosis 1* ; Optic Nerve Glioma ; Pathology

OBJECTIVE: This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system.METHODS: This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed.RESULTS: Of the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p < 0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06).CONCLUSION: Surveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.
Bacteria ; Craniotomy ; Gram-Negative Bacteria ; Humans ; Incidence ; Korea ; Length of Stay ; Logistic Models ; Multivariate Analysis ; Neurosurgery ; Neurosurgical Procedures ; Observational Study ; Prospective Studies ; Risk Factors ; Serratia marcescens ; Staphylococcus aureus ; Surgical Wound Infection ; Ventriculoperitoneal Shunt

OBJECTIVE: This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following spinal surgery using data from a Korean SSI surveillance system that included diagnoses made by surgeons.METHODS: This was a prospective observational study of patients who underwent spinal surgeries at 42 hospitals in South Korea from January 2017 to December 2017. The procedures included spinal fusion, laminectomy, discectomy, and corpectomy. Univariate and multivariate logistic regression analyses were performed.RESULTS: Of the 3080 cases included, 30 showed infection, and the overall SSI rate was 1.0% (an incidence of 1.2% in spinal fusion and 0.6% in laminectomy). Deep incisional infections were the most common type of SSIs (46.7%). Gram-positive bacteria caused 80% of the infections, and coagulase-negative staphylococci, including Staphylococcus epidermidis, accounted for 58% of the gram-positive bacteria. A longer preoperative hospital stay was significantly associated with the incidence of SSI after both spinal fusion and laminectomy (p=0.013, p < 0.001). A combined operation also was associated with SSI after laminectomy (p=0.032).CONCLUSION: An SSI surveillance system is important for the accurate analysis of SSI. The incidence of SSI after spinal surgery assessed by a national surveillance system was 1.0%. Additional data collection will be needed in future studies to analyze SSI in spinal surgery.
Data Collection ; Diagnosis ; Diskectomy ; Gram-Positive Bacteria ; Humans ; Incidence ; Korea ; Laminectomy ; Length of Stay ; Logistic Models ; Observational Study ; Prospective Studies ; Risk Factors ; Spinal Fusion ; Spine ; Staphylococcus epidermidis ; Surgeons ; Surgical Wound Infection

It is well known that spontaneous thrombosis in giant cerebral aneurysm is common. However, spontaneous obliteration of a non-giant and unruptured cerebral aneurysm has been reported to be rare and its pathogenic mechanism is not clear. We describe a case with rare vascular phenomenon and review the relevant literatures.
Intracranial Aneurysm ; Thrombosis

Erdheim-Chester disease is a rare form of non-Langerhans cell histiocytosis consisting of disseminated xanthogranulomatous infiltration and fibrosis that involves the long bones, visceral organs, orbital, retroperitoneal and soft tissues. Intracranial involvement is very rare, although the most common site is extra axial if it occurs. In our case study, a 53-year-old woman with one-month history of left hemianopsia was examined and treated. Her initial T2-weighted MRI revealed increase in signal intensity and an irregularly enhanced mass following gadolinium injection in the right temporal lobe. Stereotactic biopsy was done, and histopathological diagnosis was Erdheim- Chester disease, consist of sheets of foamy histiocytes with abundant cytoplasm. The patient was treated with oral corticosteroid for 4 weeks. During next 6 months, the clinical picture and the MRI showed improvements.
Biopsy ; Cytoplasm ; Diagnosis ; Erdheim-Chester Disease* ; Female ; Fibrosis ; Gadolinium ; Hemianopsia ; Histiocytes ; Histiocytosis ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Orbit ; Temporal Lobe

The authors describe a case of aneurysmal bone cyst of a thoracic vertebra. A 34-year-old woman presented with posterior neck and upper back pain. Radiological examination demonstrated an aneurysmal bone cyst involving the posterior elements of the second thoracic vertebra. The spinal cord was compressed severely also. Satisfactory results were obtained after complete resection of the lesion.
Adult ; Aneurysm* ; Back Pain ; Bone Cysts* ; Female ; Humans ; Neck ; Spinal Cord ; Spine*

OBJECTIVE: The use of decompressive craniectomy for treating massive cerebral infarction is attracting much attention because conventional medical treatment is associated with high mortality. The aim of this retrospective study was to evaluate the surgical treatment results and prognostic factors for patients suffering with malignant cerebral infarction. METHODS: We analyzed 9 consecutive patients who underwent decompressive craniectomy with or without temporal lobectomy after malignant cerebral infarction from 2000 to 2008. We reviewed the medical records, the radiological finding and the pre-operative clinical assessment using the Glasgow Coma scale (GCS). The postoperative functional outcome was assessed as the Barthel-Index (BI) and the modified Rankin scale (mRS). RESULTS: The male to female ratio was 3.5:1. The mean age was 50 years (range: 36-68). Eight patients (89%) showed involvement of the entire middle cerebral artery (MCA) territory and the concomitant anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. The preoperative mean GCS was 8.3 (range: 5-12) and the mean time to surgery after the onset of symptoms was 47.7 hours (range: 4-168 hours). All the patients underwent decompressive craniectomy and duroplasty. Among them, four patients (45%) underwent temporal lobectomy. The mean followup period was 7.3 months (range: 1-26 months) and five patients died within this period. CONCLUSION: Decompressive craniectomy with or without lobectomy for patients with malignant cerebral infarction decreases the mortality rate and it improves the functional outcome. In the survived group, comparison of the two surgical modalities didn't show any statistically significant difference. However, the decompressive craniectomy with lobectomy group demonstrated a high survival rate (75%). Future studies are needed to investigate the proper treatment modalities for malignant cerebral infarction.
Anterior Cerebral Artery ; Cerebral Infarction ; Decompressive Craniectomy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Retrospective Studies ; Stress, Psychological ; Survival Rate