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

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

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

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

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

Choroid plexus carcinomas are extremely rare in adults. They can behave aggressively and their optimal management is uncertain. A 35-year-old woman was admitted with an episode of loss of consciousness. Magnetic resonance imaging showed a homogeneously enhancing mass in the trigone of the right lateral ventricle. Detailed examinations found no evidence of an extraneural primary focus. She underwent total removal of the tumor. Pathological diagnosis was confirmed as a choroid plexus carcinoma. She is doing well eight months after surgery.
Adult* ; Choroid Plexus* ; Choroid* ; Diagnosis ; Female ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging ; Unconsciousness

Surgery and radiotherapy are mainly used for plasma cell neoplasm which constitutes about 1~2% of human malignancy. The authors carried out Fractionated Stereotactic Radiotherapy(FSRT) on the residual tumor after the subtotal removal of intracranial plasmacytoma. A huge mass lesion was observed on MRI (magnetic resonance image) in the left anterior and middle cranial fossa of a 63-year-old man with left exophthalmus which lasted for a month, and was suspected as a meningioma with strong contrast enhancement. Extramedullary plasmacytoma was diagnosed on histopathological examination. After the surgery, FSRT was also carried out on the residual tumor which invaded the skull base. One-year follow up after FSRT showed contrast enhancement only in the left sphenoid bone on MRI, which indicated significant decrease in the size of the tumor without any abnormal neurologic deficits. We treated intracranial plasmacytoma which invaded left anterior and middle cranial fossa and surrounded cavernous sinus without cranial nerve deficit through subtotal tumor removal and FSRT.
Cavernous Sinus ; Cranial Fossa, Middle ; Cranial Nerves ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Meningioma ; Middle Aged ; Neoplasm, Residual ; Neoplasms, Plasma Cell ; Neurologic Manifestations ; Plasmacytoma* ; Radiotherapy* ; Skull Base ; Sphenoid Bone

OBJECTIVE: The aim of this study was to evaluate the microanatomy and histological features of the central myelin in the root exit zone of facial nerve. METHODS: Forty facial nerves with brain stem were obtained from 20 formalin fixed cadavers. Among them 17 facial nerves were ruined during preparation and 23 root entry zone (REZ) of facial nerves could be examined. The length of medial REZ, from detach point of facial nerve at the brain stem to transitional area, and the thickness of glial membrane of central myelin was measured. We cut brain stem along the facial nerve and made a tissue block of facial nerve REZ. Each tissue block was embedded with paraffin and serially sectioned. Slices were stained with hematoxylin and eosin (H&E), periodic acid-Schiff, and glial fibrillary acid protein. Microscopy was used to measure the extent of central myelin and thickness of outer glial membrane of central myelin. Thickness of glial membrane was examined at two different points, the thickest area of proximal and distal REZ. RESULTS: Special stain with PAS and GFAP could be differentiated the central and peripheral myelin of facial nerve. The length of medial REZ was mean 2.6 mm (1.6-3.5 mm). The glial limiting membrane of brain stem is continued to the end of central myelin. We called it glial sheath of REZ. The thickness of glial sheath was mean 66.5 microm (40-110 microm) at proximal REZ and 7.4 microm (5-10 microm) at distal REZ. CONCLUSION: Medial REZ of facial nerve is mean 2.6 mm in length and covered by glial sheath continued from glial limiting membrane of brain stem. Glial sheath of central myelin tends to become thin toward transitional zone.
Brain Stem ; Cadaver ; Eosine Yellowish-(YS) ; Facial Nerve* ; Formaldehyde ; Glial Fibrillary Acidic Protein ; Hematoxylin ; Membranes ; Microscopy ; Myelin Sheath* ; Paraffin

Cortical laminar necrosis appears as hyperinense lesions with a laminar pattern on T1 weighted magnetic resonance (MR) imaging, without signs of hemorrhage or calcification on T2 weighted MR imaging or computed tomography. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present a 12 month-old male infant who suffered diffuse brain injuries following car accident and showed laminar necrosis of cortex.
Anoxia ; Brain Injuries ; Hemorrhage ; Humans ; Infant ; Magnetic Resonance Spectroscopy ; Male ; Necrosis