Metastasis of neuroblastoma into the central nervous system is well known, but, in fact, rare clinically. Recently we had experienced one such case, which was characterized by sudden onset of paraplegia and blindness and delayed appearance of radiologic findings. A 7 years old Korean boy was admitted to the pediatric ward of the Seoul National University Hospital on September 28, 1975 due to sudden onset of paraplegia. All physical, laboratory and simple thoracic spine X-ray findings were normal except for albuminocytologic dissociation in the C.S.F. Guillain-Barre syndrome was suspected and steroid therapy was recommended. On November 10, 1975, he was readmitted due to sudden loss of visual acuity bilaterally. At first all radiologic examinations revealed no clue to the lesion. After 4 months from the onset, there appeared typical pedicular destruction of the thoracic spine and confirmed it as neuroblastoma by surgery.
Blindness ; Central Nervous System ; Child ; Guillain-Barre Syndrome ; Humans ; Male ; Neoplasm Metastasis ; Neuroblastoma* ; Paraplegia ; Seoul ; Spine ; Visual Acuity

A 19-year-old boy was admitted with complaints of headache and generalized seizure for 5 months. On physical examination, he had a moon-face, a farty breast, no sexual hair, and childish voice. Neurological examination showed no abnormality except slightly decreased visual acuity in the left eye. Lumbar CSF had total 194 leucocytes in a high power field, and among these 95% was lymphocyte. Marked sellar ballooning was seen in simple X-rays. Both carotid angiogram revealed bilateral A1 elevation as tent-like fashion, and subfrontal mass was suspected in lateral view. Transfrontal Conray ventriculography was done, and accidentally tumor cyst was punctured and dark pinkish blood was evacuated. Transcoronal ventriculography was again performed and we knew the cystic subfrontal midline mass. Tumor mass was nearly removed, and pathological report was germinoma. He was discharged and radiation theraphy was given. He is well for 7 months post-operatively.
Breast ; Frontal Lobe* ; Germinoma* ; Hair ; Headache ; Humans ; Lymphocytes ; Male ; Neurologic Examination ; Physical Examination ; Seizures ; Visual Acuity ; Voice ; Young Adult

A 19-year-old boy was admitted with complaints of headache and generalized seizure for 5 months. On physical examination, he had a moon-face, a farty breast, no sexual hair, and childish voice. Neurological examination showed no abnormality except slightly decreased visual acuity in the left eye. Lumbar CSF had total 194 leucocytes in a high power field, and among these 95% was lymphocyte. Marked sellar ballooning was seen in simple X-rays. Both carotid angiogram revealed bilateral A1 elevation as tent-like fashion, and subfrontal mass was suspected in lateral view. Transfrontal Conray ventriculography was done, and accidentally tumor cyst was punctured and dark pinkish blood was evacuated. Transcoronal ventriculography was again performed and we knew the cystic subfrontal midline mass. Tumor mass was nearly removed, and pathological report was germinoma. He was discharged and radiation theraphy was given. He is well for 7 months post-operatively.
Breast ; Frontal Lobe* ; Germinoma* ; Hair ; Headache ; Humans ; Lymphocytes ; Male ; Neurologic Examination ; Physical Examination ; Seizures ; Visual Acuity ; Voice ; Young Adult

The familial occurrence of bilateral acoustic neuroma has rarely been reported in the literatures, and its inheritance is known to be an autosomal dominant trait in association with or without von Recklinghausen's disease. Recently, we experienced an unusual case of bilateral acoustic neuroma, which was familially occurred in mother and her son. A 18-year-old Korean boy was referred to us due to bilateral hearing disturbance and staggering gait of one year duration. There were no stigmata of von Recklinghausen's disease. Neurological examination, simple skull films and vertebral angiograms revealed various evidences of bilateral cerebellopontine angle tumors. At operation, a hen egg-sized firm mass was subtotally removed at the left cerebellopontine angle region and a peanut-sized mass was totally removed at the right cerebellopontine angle region via suboccipital craniectomy. The histological diagnosis was neurofibroma. In family history, 13 years ago his mother was operated on C6-7 neurofibroma at her age of 28 years, and again operated on bilateral acoustic tumors 2 years later. The histological diagnosis was also neurofibroma.
Acoustics* ; Adolescent ; Cerebellopontine Angle ; Christianity ; Diagnosis ; Gait ; Hearing ; Humans ; Male ; Mothers ; Neurofibroma ; Neurofibromatosis 1 ; Neurologic Examination ; Neuroma, Acoustic* ; Skull ; Wills

OBJECTIVE: Gamma knife radiosurgery (GKRS) is the least invasive surgical option for patients with trigeminal neuralgia (TN). However, the indications and long term outcomes of GKRS are still controversial. Additionally, a series with uniform long-term follow-up data for all patients has been lacking. In the present study, the authors analyzed long-term outcomes in a series of patients with TN who underwent a single GKRS treatment followed by a minimum follow-up of 60 months. METHODS: From 1994 to 2009, 40 consecutive patients with typical, intractable TN received GKRS. Among these, 22 patients were followed for >60 months. The mean maximum radiation dose was 77.1 Gy (65.2-83.6 Gy), and the 4 mm collimator was used to target the radiation to the root entry zone. RESULTS: The mean age was 61.5 years (25-84 years). The mean follow-up period was 92.2 months (60-144 months). According to the pain intensity scale in the last follow-up, 6 cases were grades I-II (pain-free with or without medication; 27.3%) and 7 cases were grade IV-V (<50% pain relief with medication or no pain relief; 31.8%). There was 1 case (facial dysesthesia) with post-operative complications (4.54%). CONCLUSION: The long-term results of GKRS for TN are not as satisfactory as those of microvascular decompression and other conventional modalities, but GKRS is a safe, effective and minimally invasive technique which might be considered a first-line therapy for a limited group of patients for whom a more invasive kind of treatment is unsuitable.
Follow-Up Studies ; Humans ; Microvascular Decompression Surgery ; Radiosurgery ; Trigeminal Neuralgia

The ganglioneuroblastoma is a rare tumor originating from the sympathetic chain. Both cytologically and biologically it is intermediate between the highly malignant neuroblastoma and the benign gauglioneurinoma. The predilection site of neuroblastoma is adrenal medulla, but ganglioneuroblastoma and ganglioneurinoma are frequently located in the retroperitoneum and mediastinum. We have recently experienced the dumb-bell shaped ganglioneuroblastoma at L-2 and 3 level. A 2 year-old-girl was admitted to Seoul National University hospital on May-1975 with complaints of lumbar back pain and kyphosis for 6 months. She had normal motor and sphincter function. Neurological examination showed normal. Simple lumbar spine X-ray showed the widening of interpedicular distance and erosion of the pedicle at L-2 and L-3. On lateral view scalloping of posterior border of L-2 was found. Lumbar puncture and myelography were failed. Total laminectomy at L-2, L-3 was done. Dumb-bell shaped mass was seen half in the extradural intraspinal space and half in the extraspinal space with pedicle in the widened intervertebral foramen. The mass was adult thumb-tip sized, dark grayish tan color, nodular surfaced, and well encapsulated. The tissue diagnosis was ganglioneuroblastoma. Post-operatively urinary secretion of vanyl-mandelic acid level was normal limit.
Adrenal Medulla ; Adult ; Back Pain ; Diagnosis ; Ganglioneuroblastoma* ; Humans ; Kyphosis ; Laminectomy ; Mediastinum ; Myelography ; Neuroblastoma ; Neurologic Examination ; Pectinidae ; Seoul ; Spinal Puncture ; Spine ; Triacetoneamine-N-Oxyl

Rupture of the lumbar intervertebral disc into the dural sac is very rare. Total of 11 cases have been reported in the literatures. In Korea, one case of the intradural herniated disc of L4,5 interspace was reported at Seoul National University Hospital in 1972. Patients of the intradural herniated disc have usually a long history of recurrent low back pain and sudden exacerbation of symptoms with radiating pain on both lower extremities precipitated by minor trauma. A 47 years old female was admitted to Seoul National University Hospital complaining of wevere low back pain and radiating gluteal pain on both sides. She had had intermittent lumbago of 25 years' duration. Eight months prior to admission, radiating gluteal pain on both sides developed in addition to the aggravation of the lumbago due to minor back trauma. Physical and neurological examination showed local protrusion and the tenderness of the L3, L4 spinous process area, the hyperalgesia on the right L3, L4, and L5 dermatomes, no saddle anesthesia, normal dorsiflexion of both ankles and great toes, slight decrease of the right knee jerk and bilateral absence of the ankle jerk, and no sphincter dysfunction. Myelogram showed complete block at t he L3-4 interspace level. Total laminectomy of the L3 and L4 was done. When the dura was opened, a solid round mass of a thumb-tip size was seen occupying the whole dural sac, compressing the nerve roots. The mass was a herniated disc from L3-4 interspace that had ruptured through central part of the posterior longitudinal ligament and ventral dural wall. Protruded intradural mass was removed en masse after incision of the overlying arachnoid membrance and the remaining L3-4 interspace disc material was removed in pieces extradurally. The mass was revealed as a degenerated nucleus pulposus on microscopic examination. The patient had an uneventful recovery with improvement of the neurological deficits.
Anesthesia ; Ankle ; Arachnoid ; Female ; Humans ; Hyperalgesia ; Intervertebral Disc ; Intervertebral Disc Displacement ; Knee ; Korea ; Laminectomy ; Longitudinal Ligaments ; Low Back Pain ; Lower Extremity ; Middle Aged ; Neurologic Examination ; Rupture ; Seoul ; Toes

Fluorescein retinal angography has been used in order to make differential diagnosis between true papilledema and pseudopapilledema, and to make early confirmation of the incipient papilledema. After injection of 5 cc of 10% fluorescein sodium into antecubital vein, the fluorescein retinal angiographic findings of 6 normal adults and 17 papilledematous patients of the brain tumor were obtained by Zeiss fundus camera(exciter filter:Kodak Wratten 47 A, barrier filter:Schott GG 14). 1. The characteristic findings of papilledema in the disc are: a. Leakage of fluorescein from capillaries and persistence of the fluorescence till late stage. b. Capillary dilatation. c. Microaneurysm. 2. The massive leakage of the fluorescen is seen in the patients of the 3 rd ventricular or posterior fossa tumors. 3. The decreased visual acuity is prominent in the patients showing marked capillary dilatation and microaneurysm.
Adult ; Brain Neoplasms* ; Brain* ; Capillaries ; Diagnosis, Differential ; Dilatation ; Fluorescein* ; Fluorescence ; Humans ; Infratentorial Neoplasms ; Papilledema* ; Retinaldehyde ; Veins ; Visual Acuity

A 46 years old woman was admitted to the department of Neurosurgery, Seoul National University, complaining of a sudden severe headaches and vomiting 7 days before admission. Three days later her vision became poor in the left eye and totally blind on the day of admission. She had amenorrhea for 15 years. On neurological examination, she was somewhat lethargic but fully conscious. Both optic discs were normal. Left pupil was dilated, fixed and totally ophthalmoplegic. Because of poor cooperation the visual field examination was not performed. Tongue protrusion was deviated to the right side. Cerebrospinal fluid was bloody. Skull X-rays showed a large pituitary fossa with erosion of the left anterior clinoid process and dorsum sellae. Left carotid anyiogram showed a finding of suprasellar extension of the intrasella mass. Retrograde brachial angiogram showed remarkable posterior displacement of the distal portion of the basilar artery. Left subfrontal approach was done and found a huge suprasellar mass compressing the left optic nerve. The tumor was aspirated and blood clot was obtained. The capsule was incised and content with hematoma was evacuated. Histologic examination showed complete blood clot with no recognizable neoplasm. Post-operatively, her left eyeball began to move and she was able to see some objects in close distance few hours after surgery.
Amenorrhea ; Basilar Artery ; Cerebrospinal Fluid ; Female ; Headache ; Hematoma ; Humans ; Middle Aged ; Neurologic Examination ; Neurosurgery ; Optic Nerve ; Pituitary Apoplexy* ; Pupil ; Seoul ; Skull ; Tongue ; Visual Fields ; Vomiting

Recently we had experienced a case of posterior migration of herniated lumbar nucleus pulposus over the cauda equina, simulating a cord tumor clinically and radiologically. But we could hardly find any previous case report on it. A 35 years old man was admitted to our ward due to paraparesis on July 17, 1975. He had a history of back sprain five years ago with intermittently appearing mild lumbago. Two weeks prior to admission, there appeared severe left leg pain and soon resulted in paraparesis. Preoperative positive neurologic findings were paraparesis with left side foot drop, hypesthesia on the left L4, 5 and S1 dermatome and bilaterally decreased ankle and knee jerks. Myelogram revealed complete block at L2-3 with suspicious indentation filling defect at left L-5 interspace. C.S.F. protein value marked 738mg%. On operation, the dural sac was compressed by a posteriorly overriding mass on it at the L2-3 level. The mass was traced to its origin from the left side of the L2-3 interspace and into the ruptured posterior longitudinal ligament with a narrow pedicle. L4-5 interspace revealed a typically protruding type disc lesion. These were composed of degenerated nucleus pulposus on histological examination.
Adult ; Ankle ; Cauda Equina* ; Foot ; Humans ; Hypesthesia ; Knee ; Leg ; Longitudinal Ligaments ; Low Back Pain ; Neurologic Manifestations ; Paraparesis ; Sprains and Strains