No abstract available.
Neurilemmoma* ; Neurofibromatoses* ; Neurofibromatosis 2*

OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Abducens Nerve Diseases ; Exophthalmos ; Female ; Fistula* ; Humans ; Orbit ; Punctures* ; Veins* ; Young Adult

Despite significant advances in neurosurgical and neuroanesthetic techniques, certain lesions such as giant aneurysms still present significant challenge to neurosurgoens. The authors experienced a case of giant MCA bifurcation aneurysm surgery using a technique of deep hypothermia and circulatory arrest with excellent outcome. Cannulation for cardiopulmonary bypass can be done either centrally through a sternotomy(aortic-right atrial), or peripherally through a small inguinal incision(femoral-femoral). In our case, femoral-femoral cannulation was done which can eliminate many serious complications following the sternotomy. The rationale for the application of the deep hypothermia and circulatory arrest in the complex intaracranial aneurysm surgery and the benefits of the femoral cannulation are disccused.
Aneurysm* ; Cardiopulmonary Bypass ; Catheterization ; Hypothermia* ; Sternotomy

A 24-year-old female patient presented with a midline extra-axial posterior fossa lesion. We failed to suspect this lesion could be a giant thrombosed aneurysm of PICA(posteior inferior cerebellar artery) preoperatively, and didn't perform preoperative angiogram even after rather typical finding of thrombosed giant aneurysm on MRI. We suggest a giant thrombosed aneurysm should be included in the differantial diagnosis of any round extra-axial mass lesion in the skull base.
Aneurysm* ; Arteries* ; Diagnosis ; Female ; Humans ; Infratentorial Neoplasms* ; Magnetic Resonance Imaging ; Pica ; Skull Base ; Young Adult

Between January 1990 and August 1992 sixteen patients with sellar tumors underwent 16 transsphenoidal approaches at Kang-Nam Sacred Heart Hospital. Pathological diagnosis include 14 pituitary adenomas, of which six belonged to microadenomas and the remaining eight cases were classified as macroadenomas. Other pathologies were one craniopharyngioma and one sphenoid mucocele. Thirteen patients underwent TSA as the primary procedures and the remaining three patients were subjected to TSA as the secondary procedures to the primary treanscranial approaches. Of the 13 primary TSAs excellent or good results were achieved in 11 patients and the remaining two patients were subjected to the secondary transcranial approaches to achieve good results. Six patients with microadenomas achieved gross total or subtotal removal of their tumors in all cases(100%) however, satisfactory removal was achieved only in six macroadenoma cases(75%). There was neither surgical mortality nor major morbidity. Transient diabetes insipidus complicated in 6 patients(37.5%) and CSF rhinorrhea complicated in three cases*18.8%), which needed spinal drainage for three to ten days. Meningitis was complicated in one patient with CSF rhinorrhea(6.2%). This preliminary study agrees with that TSA is a safe and effective procedure even in macroadenoma cases.
Craniopharyngioma ; Diabetes Insipidus ; Diagnosis ; Drainage ; Heart ; Humans ; Meningitis ; Mortality ; Mucocele ; Pathology ; Pituitary Neoplasms

OBJECTIVE: We analyzed the main causes leading to a poor outcome (severe disability, a vegetative state and death) following surgical treatment for ruptured intracerbral aneurysms. METHODS: Between January 1994 and December 2007, we maintained a retrospective database of 339 patients who underwent surgical clipping. The various causes we investigated were the technical problems during operation, the initial SAH or ICH, vasospasm, hydrocephalus and the post-operative medical complications. The clinical outcome was assessed according to the Glasgow Coma Scale (GOS). RESULTS: There were 263 cases of good outcomes (77.6%) and 76 cases of poor outcomes (22.4%). The three main causes of a poor outcome were 1) preoperative causes such as the direct insult of the initial SAH and ICH in 21 cases (27.6%), 2) intra-operative causes such as the technical problems during dissection and clipping of the aneurysm neck in 29 cases (38.2%) and 3) postoperative causes such as clinical vasospasm in 16 cases (21.1%). The mean follow-up period was 17.6 months (range : 2 months to 9 years). CONCLUSION: A meticulous neck dissection and complete obliteration of the aneurysm preserving parent arteries and perforators are the most effective and prime methods that surgeons can employ to reduce the rate of poor outcomes when performing ruptured aneurysm surgery.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Microsurgery ; Neck ; Neck Dissection ; Parents ; Persistent Vegetative State ; Retrospective Studies ; Surgical Instruments

The incidence of the distal anterior cerebral artery(DACA) aneurysm comprises about 2-6% of all intracerebral aneurysms. Because of the low incidence, unique anatomies of the distal anterior cerebral arteries and some technical difficulties in surgery, these aneurysms present such challenge to neurosurgeons. Presently, early surgery using interhemispheric approach is preferred. The auhtors experienced six patients with DACA aneurysms in 130 consecutive intracerebral aneurysms surgically treated between May. 1994 and Dec. 1997. The patients received operations within five days from the ictus, except one patient because of symptomatic vasospasm. The surgical approaches were all unilateral interhemispheric approaches. During the operations, infusion of large amount of mannitol and CSF volume removal were applied, although there were few difficulties in the interhemispheric dissections, the outcomes of the patients were excellent in three, good in three. The authors suggest that early operative interventions using unilateral interhemispheric approach without generous craniotomy can improve the outcomes of the patients with ruptured DACA aneurysm.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Humans ; Incidence ; Intracranial Aneurysm* ; Mannitol

We report a case of esthesioneuroblastoma with intracranial extension treated with surgical resection and chemotherapy. A 5-year-old child presented with visual disturbance, and was subsequently found to have a huge sized mass in the anterior skull base, suprasellar region and lateral ventricle. A bifrontal craniotomy with excision of the tumor through subfrontal and interhemispheric approach was performed. The patient received postoperative chemotherapy according to Tandem protocol. A follow-up magnetic resonance(MR) image showed that the tumor showed partial regression, however, there was no change in tumor size in lateral ventricle. Second operation with excision of remnant mass through a transcallosal approach was performed. MR image, 9 months after first operation showed the postoperative change in frontal area without enhancing mass. By employing staged operation and chemotherapy, the authors obtained good results in the treatment of esthesioneuroblastoma with intracranial extension.
Child ; Child, Preschool ; Craniotomy ; Drug Therapy ; Esthesioneuroblastoma, Olfactory* ; Follow-Up Studies ; Humans ; Lateral Ventricles ; Skull Base

OBJECTIVE: Adenoid cystic carcinoma is a relatively slowly growing malignant tumor. Probably at least 40-50% of patients eventually develop distant metastases. We present the natural history and treatment modality of this malignancy from our experience and review of literature. METHODS: We report a case of a 30-year-old man who complained of a headache, facial pain and hearing disturbance in the right ear. Physical examination revealed soft, protruded mass and narrowed external auditory canal. The cranial MRI showed a well defined mass in the extradural middle cranial fossa. RESULTS: The patient underwent subtotal resection of the lesion after tumor embolization was performed. The pathological diagnosis was adenoid cystic carcinoma. The patient received postoperative radiation therapy(56Gy) resulting in a complete neurological recovery. Fifteen months later, the patient was readmitted for severe back pain. Bone scan disclosed hot uptakes at the upper cervical spine, the 4th lumbar vertebra, and the pelvic area. These areas were irradiated(40Gy) and the presenting symptoms were relieved. Twenty months later, he complained of respiratory difficulty and was found to have a multiple nodule(s) in the lung. He was given 10 cycles of chemotherapy but discharged because of unresponsivencess and development of new lesions. Brain MRI and bone scan were checked 10 months after his discharge due to more aggravated lung metastasis although local tumor was controlled. Adjuvant radiation therapy(18Gy) was performed and he continued to be functional independently, although he was no longer working as a registered nurse. Two months later, dyspnea and hemoptysis were more improved and chest X-ray showed decreased mass. During the follow up period, he complained of intercostal pain, chest X-ray showed more aggregated lung mass. Chest CT scan showed multiple lung metastases and liver metastasis. In spite of adjuvant radiotherapy, the patient died of multiple systemic metastases 47 months after the first operation. CONCLUSION: Surgery is essential in the treatment of adenoid cystic carcinoma. Radiotherapy has gained acceptance as a palliative therapy, as it reduces tumor bulk and relieves symptoms. The combined treatment do not, however, prevent further recurrence and distance metastasis.
Adenoids* ; Adult ; Back Pain ; Brain ; Carcinoma, Adenoid Cystic* ; Chest Pain ; Cranial Fossa, Middle ; Diagnosis ; Drug Therapy ; Dyspnea ; Ear ; Ear Canal ; Facial Pain ; Follow-Up Studies ; Headache ; Hearing ; Hemoptysis ; Humans ; Liver ; Lung ; Magnetic Resonance Imaging ; Natural History ; Neoplasm Metastasis* ; Palliative Care ; Physical Examination ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Spine ; Thorax ; Tomography, X-Ray Computed

The author performed radiosurgery with linear accelerator(LINAC) on two patients who were unable to receive surgical treatment. A 75-year-old-male patient(case 1) whose main complaints were gait disturbance and headache had undergone total resection of cerebellar hemangioblastoma five years before the admission and the lesion recurred. Because the patient's general condition was poor, radiosurgery with LINAC was performed and at 1 month after the radiosurgery, obstructive hydrocephalus developed, and ventriculoperitoneal shunt was done. After 11 months, follow-up brain magnetic resonance image findings showed the decrease of the size of the tumor, and the patient's consciousness returned to alertness. He could also walk using a cane. A 28-year-old male paient(case 2) whose main complaints were vertigo, ataxia refused to receive surgical resection due to his religious beliefs, and radiosurgery was performed, after cyst aspiration with ommaya reservoir insertion as an alternative. Eighteen months later, the tumor size has decreased and there were no radiosurgical complications. The patient has been followed-up at the outpatient without any notable symptoms. Through these two cases, the authors experienced tumor control by LINAC radiosurgery when surgical treatment is not acceptable. Radiosurgery seems safe and effective in the treatment of hemangioblastoma, but there is the need for further evaluation.
Adult ; Ataxia ; Brain ; Canes ; Consciousness ; Follow-Up Studies ; Gait ; Headache ; Hemangioblastoma* ; Humans ; Hydrocephalus ; Male ; Outpatients ; Radiosurgery* ; Religion ; Ventriculoperitoneal Shunt ; Vertigo