OBJECTIVE: It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri- or intraventricular tumors without hydrocephalus. METHODS: Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. RESULTS: Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. CONCLUSION: Endoscopic biopsy or resection of peri- or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.
Astrocytoma ; Biopsy ; Brain ; Brain Injuries ; Brain Neoplasms ; Catheterization ; Germinoma ; Humans ; Hydrocephalus ; Neoplasms, Neuroepithelial ; Neuroendoscopy ; Pineal Gland ; Pinealoma ; Thalamus ; Third Ventricle ; Track and Field

OBJECTIVE: This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. METHODS: We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. RESULTS: At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. CONCLUSION: The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.
Adult ; Drainage ; Follow-Up Studies ; Humans ; Hydrocephalus ; Male ; Retrospective Studies ; Ventriculostomy

OBJECTIVES: The purpose of this study was to identify the risk factors of metabolic syndrome (MS) and to analyze the relationship between the risk factors of MS and medical cost of major diseases related to MS in Korean workers, according to the scale of the enterprise. METHODS: Data was obtained from annual physical examinations, health insurance qualification and premiums, and health insurance benefits of 4,094,217 male and female workers who underwent medical examinations provided by the National Health Insurance Corporation in 2009. Logistic regression analyses were used to the identify risk factors of MS and multiple regression was used to find factors associated with medical expenditures due to major diseases related to MS. RESULT: The study found that low-income workers were more likely to work in small-scale enterprises. The prevalence rate of MS in males and females, respectively, was 17.2% and 9.4% in small-scale enterprises, 15.9% and 8.9% in medium-scale enterprises, and 15.9% and 5.5% in large-scale enterprises. The risks of MS increased with age, lower income status, and smoking in small-scale enterprise workers. The medical costs increased in workers with old age and past smoking history. There was also a gender difference in the pattern of medical expenditures related to MS. CONCLUSIONS: Health promotion programs to manage metabolic syndrome should be developed to focus on workers who smoke, drink, and do little exercise in small scale enterprises.
Female ; Health Expenditures ; Health Promotion ; Humans ; Insurance, Health ; Korea* ; Logistic Models ; Male ; National Health Programs ; Physical Examination ; Prevalence ; Risk Factors ; Smoke ; Smoking

No abstract available.
Intracranial Hypotension*

Recently, combination of surgery and radiation therapy (RT) has been recommended in the treatment of craniopharyngioma. RT could be associated with late complications, including vasculopathy. We report two cases of the moyamoya syndrome seen in children with craniopharyngioma who received RT after surgical resection. Thirty-five patients in pediatric age with craniopharyngioma were surgically treated. Fifteen out of 35 patients underwent surgical resection followed by RT or gamma knife surgery. Two of the 15 were found to have symptoms of transient ischemic attack and were diagnosed as moyamoya syndrome through the cerebral angiography. Age at RT was 4 and 13 years, respectively. The latent period for development of the moyamoya syndrome was 27 months and 3 years, respectively, after RT. The RT dose of both patients was 54 Gy. These two patients received bilateral encephaloduroarteriosynangiosis procedures. We report here these two cases of radiation-induced moyamoya syndrome in pediatric craniopharyngioma. Pediatric patients with craniopharyngioma who received RT should be reminded, during follow-up, about the risk of development of the moyamoya syndrome.
Cerebral Angiography ; Child ; Cranial Irradiation ; Craniopharyngioma ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Moyamoya Disease

McCune-Albright syndrome (MAS) is characterized by a triad of poly/monostotic fibrous dysplasia, cafe-au-lait macules and hyperfunctioning endocrinopathies including human growth hormone excess. Acromegaly as a manifestation of endocrine hyperfunction with MAS is uncommon. Surgical excision may be challenging due to the associated severe fibrous dysplasia of the skull base. Through the endoscopic procedures, we treated a case of MAS presenting with compressive optic neuropathy due to fibrous dysplasia and acromegaly caused by growth hormone secreting pituitary adenoma. We reviewed the literature on GH excess in MAS to highlight its surgical and medical challenges.
Acromegaly ; Decompression* ; Fibrous Dysplasia, Polyostotic* ; Growth Hormone ; Human Growth Hormone ; Optic Nerve Diseases* ; Pituitary Neoplasms ; Skull Base

McCune-Albright syndrome (MAS) is characterized by a triad of poly/monostotic fibrous dysplasia, cafe-au-lait macules and hyperfunctioning endocrinopathies including human growth hormone excess. Acromegaly as a manifestation of endocrine hyperfunction with MAS is uncommon. Surgical excision may be challenging due to the associated severe fibrous dysplasia of the skull base. Through the endoscopic procedures, we treated a case of MAS presenting with compressive optic neuropathy due to fibrous dysplasia and acromegaly caused by growth hormone secreting pituitary adenoma. We reviewed the literature on GH excess in MAS to highlight its surgical and medical challenges.
Acromegaly ; Decompression* ; Fibrous Dysplasia, Polyostotic* ; Growth Hormone ; Human Growth Hormone ; Optic Nerve Diseases* ; Pituitary Neoplasms ; Skull Base

BACKGROUND AND OBJECTIVES: Individual genetic susceptibilities to chemical carcinogens have been recognized as a major important host factors in human cancers. The cytochrome P450 family (CYPs) and glutathione-S-transferase (GST) have been reported to be associated with risks to the smoking-related human cancers. The purpose of this study is to determine the frequencies of the genotypes of CYP1A1 and GSTM1 genes in healthy control of Koreans and to identify the high-risk genotypes of these metabolic genes in head and neck cancer patients. MAERIALS AND METHODS: Ninety-six healthy controls and 93 head and neck squamous cell carcinoma patients are analysed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The distributions of CYP1A1 and GSTM1 in healthy controls according to the MspI site and absence or presence of PCR products were as following: m1/m1:m1/m2:m2/m2=39.6%:47.9%:12.5%, GSTM1 (-):GSTM1 (+)=45%:55%. GSTM1 (-) type and CYP1A1 m2/m2 types were more frequent in cancer patients than healthy controls. Among the combined genotypes of CYP1A1 and GSTM1 genes, the relative risk of CYP1A1 m1/m2, GSTM1 (-) genotypes was 2.13 times of relative odds' ratio in head and neck cancer patients. According to the tumor location, CYP1A1 m2/m2, GSTM1 (-) genotypes of larynx and CYP1A1 m1/m2, GSTM1 (-) genotypes of oral and pharynx were the highest risk groups to cancers in their locations. CONCLUSION: These results suggest that the genetic polymorphisms of CYP1A1 and GSTM1 were an important major factor to determine the individual susceptibility to head and neck cancers in Korean. And these polymorphisms and cancers susceptibile genotypes of CYP1A1 and GSTM1 in Korean population are very unique in comparison with the other ethinics.
Carcinogens ; Carcinoma, Squamous Cell* ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 Enzyme System ; Cytochromes* ; Genetic Predisposition to Disease* ; Genotype ; Glutathione Transferase* ; Glutathione* ; Head and Neck Neoplasms ; Head* ; Humans ; Larynx ; Neck* ; Pharynx ; Polymerase Chain Reaction ; Polymorphism, Genetic

Sturge Weber syndrome (SWS) is a rare, congenital neurocutaneous syndrome. We rarely experienced neurocutaneous disorders in forensic practice but there are unexpected sudden deaths of patients with SWS due to epilepsy, intracranial hemorrhage, thromboses and secondary accident. We introduce a case of drowning death probably due to an epileptic attack of a person diagnosed as a patient of SWS by an autopsy. We review some of the neurocutaneous syndromes and a discussion of autopsy approach is presented.
Autopsy ; Death, Sudden ; Drowning ; Epilepsy ; Humans ; Intracranial Hemorrhages ; Neurocutaneous Syndromes ; Sturge-Weber Syndrome ; Thrombosis

OBJECTIVE: Meningioma is the second most common primary central nervous system neoplasm. In contrast, chordoid meningioma is rare; due to the paucity of cases, little is known about its clinical features or treatment outcomes. The objectives of this study were to describe the clinical characteristics and outcomes for patients with chordoid meningioma. METHODS: In total, 16 patients, with newly diagnosed chordoid meningioma who underwent surgical excision between 1999 and 2012 were included. We retrospectively evaluated the medical records, radiological findings, and pathological findings. The median follow-up period was 56.5 (range, 3-170) months. The MIB-1 labeling index ranged from 1 to 26.60% (median, 5.04). RESULTS: Simpson grade I, II, and III resections were performed in four, nine, and three patients, respectively. The overall recurrence rate was 37.5%. Overall progression-free survival (PFS) after resection was 94.7 months (95% CI=62.9-126.6). Of the 4 patients with Simpson grade I resection, recurrence occurred in one patient. Among the Simpson grade II and III resection groups, eight patients underwent adjuvant radiation therapy and they showed significantly longer PFS (121 months, 95% CI=82.1-159.9) than the patients who underwent surgery alone (40.5 months, 95% CI=9.6-71.3) by the log-rank test (p<0.05). CONCLUSION: Chordoid meningiomas are difficult to manage and have a high rate of recurrence. Complete resection of the tumor is a key determinant of better outcomes. Adjuvant radiation therapy is recommended, eparticulary when Simpson grade I resection was not achieved.
Central Nervous System ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Medical Records ; Meningioma* ; Recurrence ; Retrospective Studies ; Treatment Outcome*