Primary sarcomas of the central nervous system are rare. These tumors is rapid growth often produces mass effect on the brain. Diagnosis is rendered pathologically after resection. Surgical resection is the mainstay treatment and need the adjuvant therapy. We report a 44-year-old female with a meningeal sarcoma of frontal meninges. She complained headache for 2 months and palpable forehead mass for 3 weeks. Brain MRI demonstrated a soft tissue mass sized as 5.3×3.7×3.1 cm with well-defined osteolysis on the midline of the frontal bone. The mass attached to anterior falx without infiltration into the brain parenchyme. The tumor had extracranial and extraaxial extension with bone destruction. The tumor was totally removed with craniectomy and she had an adjuvant radiotherapy. However, an isolated subcutaneous metastasis developed at the both preauricular area of the scalp, originating from the scar which was remained the first surgery. After complete removal of this metastasis, she had an adjuvant radiotherapy in other hospital. However, she expired after six months after first surgery. We believe that the occurrence of tumor seeding at the site of incision in the scalp is related to using the fluid for irrigation after tumor resection and the same surgical instruments for the removal of the brain tumor.
Adult ; Brain ; Brain Neoplasms ; Central Nervous System ; Cicatrix ; Diagnosis ; Female ; Forehead ; Frontal Bone ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms ; Meninges ; Neoplasm Metastasis ; Osteolysis ; Radiotherapy, Adjuvant ; Sarcoma* ; Scalp* ; Surgical Instruments

Objective: : Though the operating microscope (OM) has been the standard optical system in neurosurgery, a new technology called three-dimensional (3D) exoscope has emerged as an alternative. Herein, two types of 3D exoscopes for brain tumor surgery are presented. In addition, the advantages and limitations compared with the OM are discussed. Methods: : In the present study, 3D exoscope VOMS-100 or VITOM 3D was used in 11 patients with brain tumor who underwent surgical resection; the Kinevo 900 OM was used only in emergency. After completion of all surgeries, the participants were surveyed with a questionnaire regarding video image quality on the display monitor, handling of equipment, ergonomics, educational usefulness, 3D glasses, and expectation as a substitute for the OM. Results: : Among 11 patients, nine patients underwent neurosurgical resection with only 3D exoscope; however, two patients required additional aid with the OM due to difficulty in hemostasis. Regarding video image quality, VITOM 3D was mostly equivalent to the OM, but VOMS-100 was not. However, both 3D exoscopes showed advantages in accessibility of instruments in the surgical field and occupied less space in the operating theater. Differences in ergonomics and educational usefulness between the exoscopes were not reported. Respondents did not experience discomfort in wearing 3D glasses and thought the exoscopes could be currently, and in the future, used as a substitute for the OM. Conclusion : Although many neurosurgeons are not familiar with 3D exoscopes, they have advantages compared with the OM and similar image quality. Exoscopes could be a substitute for OM in the future if some limitations are overcome.

PURPOSE: We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy. MATERIALS AND METHODS: This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores <12, and lack of biopsy location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM. RESULTS: Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group. CONCLUSIONS: This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.
Aged ; Biopsy, Large-Core Needle/methods ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Prostatectomy/*methods ; Prostatic Neoplasms/*pathology/*surgery/ultrasonography ; Retrospective Studies ; Ultrasonography, Interventional/methods