A rare case of hemifacial spasm caused by an ipsilateral tentorial meningioma is described. Magnetic resonance imaging showed a huge tumor in the right cerebellar hemisphere, distant to the cerebello-pontine cistern. The facial-vestibulocochlear nerve complex was stretched by the shift of the brainstem and the right cerebello-pontine cistern was effaced. After removing the tumor, the hemifacial spasm resolved completely. We review our case with the pertinent literature regarding the etiological mechanism.
Brain Stem ; Hemifacial Spasm ; Infratentorial Neoplasms ; Magnetic Resonance Imaging ; Meningioma

Transient mutism has ben known as a rare complication following a posterior fossa approach to cerebellar tumors, although its pathophysiology remains unclear. Cerebellar mutism may be defined as a transient mutism occurring after a posterior fossa tumor approach in children with unimpaired consciousness, unimpaired symbolic functions, no detectable deficit of cranial nerves or peripheral organs of speech, and no lesions of long pathways in the course of the cranial nerves at the level of the brain stem. Forty two cases in children, and only two cases in adults have been found in the literature. We report a case of transient mutism with oropharyngeal apraxia after total excision of 4th ventricle choroids plexus papilloma in a 6-year-old girl. Postoperatively, the patient became mute and refused food intake without disturbance of consciousness, or lower cranial nerve function. Computed tomography(CT) and magnetic resonance image(MRI) demonstrated no abnormal findings except the surgical lesion in the posterior fossa. The mutism lasted for 3 weeks, but she gradually became fluent. The mechanism of "cerebellar mutism" is briefly discussed with literature review.
Adult ; Apraxias ; Brain Stem ; Cerebellar Neoplasms ; Child* ; Choroid Plexus* ; Choroid* ; Consciousness ; Cranial Nerves ; Eating ; Female* ; Humans ; Infratentorial Neoplasms ; Mutism* ; Papilloma ; Papilloma, Choroid Plexus*

This is a retrospective study on 41 cases with hydrocephalus caused by posterior fossa tumors treated at neurosurgery Dep., Cho Ray hospital from 1993 to 1995. All child patients entering the study had the intracranial pressure syndrome and evidence clinical, paraclinical symptoms. 18/41 cases had cerebellar symptoms (50%). 27 cases had the pathological results after tumor removal in which 20 cases were medulloblastoma (74.04%). The percentage of patients becoming worse postoperatively was still high: 7/27 cases (25.92%). To enhance the quality of treatment, it is necessary to make the diagnosis early and treat the patients actively.
Infratentorial Neoplasms ; Hydrocephalus

Intracranial gliomas were found more commonly in childhood(70 to 80%) than in adulthood(40 to 45%). The common infratentorial tumors in children were cerebellar astrocytoma(26.9%), medulloblastoma(18.5%) and brain stem glioma(10.5%). Brain stem gliomas were infiltrating type of tumor and frequently involved the pons and medulla. An almost pathognomic syndrome of the brain stem gliomas consists in the presences of multiple bilateral cranial nerve abnormalities in combination with involving signs of pyramidal tract and cerebro-dentato-rubro-thalamic tract in the absence signs of increased ICP, especially in the early stage. These tumors take grave course because of clinical malignancy and lack of definite therapy. Once diagnosed, radiation therapy was at best palliative treatment. Sometimes surgical therapy could be attempted to find out curable cysts. We have been experienced in a case of brain stem glioma recently that was confirmed with an autopsy;astrocytoma grade II to III, microscopically.
Brain Stem* ; Brain* ; Child ; Cranial Nerves ; Glioma* ; Humans ; Infratentorial Neoplasms ; Palliative Care ; Pons ; Pyramidal Tracts

OBJECTIVE: This study is designed to identify the clinical characteristics and the optimal treatment modality of hydrocephalus in posterior fossa tumors. METHODS: The authors reviewed 154 infratentorial tumor patients. Age, sex, clinical symptoms, types of treatment, and surgical results of posterior fossa tumor patients with hydrocephalus were analyzed, retros-pectively. Factors which might predict the need for external ventricular drainage(EVD) or ventriculo-peritoneal shunt were analyzed statistically. RESULTS: Hydrocephalus was noted in 86 cases(56%), and it was associated with medulloblastoma in 16 cases(89%), hemangioblastoma in 12(63%) and brain stem glioma in three(33%). The surgical results of the posterior fossa tumors with hydrocephalus were poorer than those without hydrocephalus(p<0.05). A large tumor(p<0.05) and an incomplete removal(p<0.05) were factors predicting the need for EVD or shunt. Complications of intraoperative EVD or shunt developed in four cases. They were infection, he-morrhage at puncture site, and obstruction. Five patients in whom intraoperative EVD or shunt had not been performed developed a fatal hydrocephalic attack at immediate postoperative period, and the pos-toperative computed tomography scan revealed intraventricular hemorrhages in three cases cerebellar swellings in two cases. CONCLUSION: Intraoperative EVD or shunt is a safe, effective treatment modality especially in large size tumor and/or incomplete tumor resection. Intraventricular hemorrhages or cerebellar swellings during immediate postoperative period might cause fatal hydrocephalic attack, therefore EVD or shunt might be recommended in selected cases.
Brain Stem ; Glioma ; Hemangioblastoma ; Hemorrhage ; Humans ; Hydrocephalus* ; Infratentorial Neoplasms* ; Medulloblastoma ; Postoperative Period ; Punctures ; Ventriculoperitoneal Shunt

Ganglioglioma comprises about 2% of all intracranial neoplasm, however, it is rarely originated from the brain stem. We report a case of ganglioglioma arising from the brain stem. A 15-year-old girl presented with gait disturbance and dysarthria. Magnetic resonance image revealed a high signal intensity mass with cystic cavities in the right cerebellum and the brain stem. The patient underwent subtotal resection and microscopic examination revealed a ganglioglioma. It is suggested that ganglioglioma should be included in the differential diagnosis of posterior fossa tumors, even located in the brain stem.
Adolescent ; Brain Neoplasms ; Brain Stem* ; Brain* ; Cerebellum ; Diagnosis, Differential ; Dysarthria ; Female ; Gait ; Ganglioglioma* ; Humans ; Infratentorial Neoplasms ; Magnetic Resonance Imaging

The authors experienced a case of mutism developed after the posterior fossa tumor surgery in a child. Mutism is a symptom mainly developed by supratentorial lesion in organic form. The possible pathogenesis of mutism after posterior fossa tumor surgery is discussed with a review of 18 additional previously reported cases.
Child* ; Humans ; Infratentorial Neoplasms* ; Mutism*

Traumatic hematomas in the posterior fossa is relatively rare (only 2.8% in the total cases of hematomas in the cranium), but dangerous because clinical symptoms are not specific and sudden suspension of breathing may lead rapidly to mortality. The author had analysed these cases to find out experiences in the diagnosis and treatment of this disease. The rate of mortality after surgery and medical treatment was 14.3%.
Hematoma ; Diagnosis ; Therapeutics ; Infratentorial Neoplasms

We have experienced 56 cases of posterior fossa tumors which were diagnosed with clinical symptoms, angiography, brain computerized tomography scan and/or operative and pathologic findings at the department of neurosurgery of Catholic University Medical College from January 1983 to December 1987. The results were summarized as follows: 1) Cerebellar astrocytomas were the most common posterior fossa tumors(21%). 2) The male to female ratio of posterior fossa tumors was equal. The astrocytoma and hemangioblastoma were frequent in male, but brain stem glioma, acoustic neuroma and meningioma were more frequent in female. 3) The posterior fossa tumors were more frequent in younger persons. 4) The most common duration symptoms were within 3 months(39%) and the common clinical features were headache(73%), nausea and vomiting(48%). In neurological examination, cerebellar signs were present in most cases(63%). 5) In brain computerized tomography scan, low density(46%) and contrast enhancement(63%) were common features and in vertebral angiography, mass effect(93%) in posterior fossa tumors. 6) The most postrior fossa tumors showed relatively good prognosis(61%) but mortality rate was high(30%).
Angiography ; Astrocytoma ; Brain ; Brain Stem ; Female ; Glioma ; Hemangioblastoma ; Humans ; Infratentorial Neoplasms* ; Male ; Meningioma ; Mortality ; Nausea ; Neurologic Examination ; Neuroma, Acoustic ; Neurosurgery

We have experienced 56 cases of posterior fossa tumors which were diagnosed with clinical symptoms, angiography, brain computerized tomography scan and/or operative and pathologic findings at the department of neurosurgery of Catholic University Medical College from January 1983 to December 1987. The results were summarized as follows: 1) Cerebellar astrocytomas were the most common posterior fossa tumors(21%). 2) The male to female ratio of posterior fossa tumors was equal. The astrocytoma and hemangioblastoma were frequent in male, but brain stem glioma, acoustic neuroma and meningioma were more frequent in female. 3) The posterior fossa tumors were more frequent in younger persons. 4) The most common duration symptoms were within 3 months(39%) and the common clinical features were headache(73%), nausea and vomiting(48%). In neurological examination, cerebellar signs were present in most cases(63%). 5) In brain computerized tomography scan, low density(46%) and contrast enhancement(63%) were common features and in vertebral angiography, mass effect(93%) in posterior fossa tumors. 6) The most postrior fossa tumors showed relatively good prognosis(61%) but mortality rate was high(30%).
Angiography ; Astrocytoma ; Brain ; Brain Stem ; Female ; Glioma ; Hemangioblastoma ; Humans ; Infratentorial Neoplasms* ; Male ; Meningioma ; Mortality ; Nausea ; Neurologic Examination ; Neuroma, Acoustic ; Neurosurgery