Undifferentiated sarcomas are rarely identified in the intracranial region. A 23-year-old man was admitted with a chief complaint of headache. Initial magnetic resonance images showed signs of low-grade glioma in the frontal lobe. Stereotactic biopsy was performed, and a diagnosis of diffuse astrocytoma was confirmed. Three months later, the patient presented with a high-grade tumor as seen on imaging studies. He underwent total resection of the tumor and histopathological tests identified an undifferentiated sarcoma. The patient died eight months later due to massive tumor bleeding. To the best of our knowledge, this is the first report of undifferentiated sarcoma arising from low-grade glioma without any chemotherapy or radiotherapy.
Astrocytoma ; Biopsy ; Diagnosis ; Drug Therapy ; Frontal Lobe ; Glioma* ; Headache ; Hemorrhage ; Histiocytoma, Malignant Fibrous ; Humans ; Radiotherapy ; Sarcoma* ; Young Adult

OBJECTIVE: There were previous reports of redundant nerve roots (RNRs) focused on their clinical significance and pathogenesis. In this study, we investigated the significant radiologic findings that correlate with RNRs occurrence. These relations would provide an advanced clue for clinical significance and pathogenesis of RNRs. METHODS: Retrospective research was performed with data from 126 patients who underwent surgery for central lumbar spinal stenosis (LSS). Finally, 106 patients with common denominators (inter-observer accuracy : 84%) were included on this study. We divided the patients into two groups by MRI, patients with RNRs and those with no RNRs (NRNRs). Comparative analyses were performed with clinical and radiologic parameters. RESULTS: RNRs were found in 45 patients (42%) with central LSS. There were no statistically significant differences between the two groups in severity of symptoms. On the other hand, we found statistically significant differences in duration of symptom and number of level included (p<0.05). In the maximal stenotic level, ligamentum flavum (LF) thickness, LF cross-sectional area (CSA), dural sac CSA, and segmental angulation are significantly different in RNRs group compared to NRNRs group (p<0.05). CONCLUSION: RNRs patients showed clinically longer duration of symptoms and multiple levels included. We also confirmed that wide segmental angulation and LF hypertrophy play a major role of the development of RNRs in central LSS. Together, our results suggest that wide motion in long period contribute to LF hypertrophy, and it might be the key factor of RNRs formation in central LSS.
Hand ; Humans ; Hypertrophy ; Ligamentum Flavum ; Retrospective Studies ; Spinal Stenosis

Schwannomas are relatively common, benign tumors that are thought to arise from the nerve sheath cell. Schwannomas of the C1 root are extremely rare and seldom invade lateral masses because they gradually increase in size and can extend through the wide space behind the lateral mass instead of the intervertebral foramen. We present here an unusual case of a benign schwannoma that aggressively invaded the lateral mass of C-1.
Female ; Humans ; Middle Aged ; Neoplasm Invasiveness ; Neurilemmoma/*pathology ; Spinal Neoplasms/*pathology ; Spinal Nerve Roots/*pathology

OBJECTIVE: Primary intraventricular hemorrhage(PIVH) is uncommon and accounts for only 3.1 % of all non-traumatic intracerebral hemorrhage. The aim of this study is to analyze clinical characteristics, image features, etiology and prognostic factors of outcome in patients with PIVH. METHODS: We identified 25 patients with PIVH during 9-year period between 1994 and 2002 at our institute. The clinical data, complimentary examination, outcome and computed tomographic blood amounts were reviewed. RESULTS: Major symptoms included sudden decreased level of consciousness, headache, nausea/vomiting and neck stiffness. Cerebral angiography was performed in 12 patients(48%) and revealed vascular malformation in 6 patients(24%). The positive result of angiography was more common in young patients and among vascular malformation the incidence of Moyamoya disease was relatively high(4 patients). Other causative factors were coagulation disorder, arterial hypertension, tumor bleeding. Outcome were death in 9 patients(36%): 7 patients(28%) died by direct consequence of bleeding and 2 patients died after other adverse events(sepsis, hepatic failure) but prognosis of survivor was good. Factors correlating with the outcome were the presence of coagulopathy, initial Glasgow Coma Scale(GCS), obstruction of 4th ventricle and ventricular blood amount including hemorrhagic dilatation of temporal horn of lateral ventricle, 3rd and 4th ventricle. CONCLUSION: The poor prognosis factors of PIVH are the presence of coagulopathy, low initial GCS, obstruction of 4th ventricle and large ventricular blood amount. Additionally patients whose initial clinical condition is not serious need an appropriate work up including cerebral angiography, because cause of bleeding is vascular malformation especially in young patients.
Angiography ; Animals ; Cerebral Angiography ; Cerebral Hemorrhage ; Coma ; Consciousness ; Dilatation ; Headache ; Hemorrhage* ; Horns ; Humans ; Hypertension ; Incidence ; Lateral Ventricles ; Moyamoya Disease ; Neck ; Prognosis ; Survivors ; Vascular Malformations

We report a case of extraventricular neurocytoma(left parietal lobe) in a young man presented with hemiparesis. The tumor, a radiologically well-circumscribed, cystic and enhancing mass, was partially removed. The patient, who received postoperative radiotherapy, is living well after 15 months of follow-up. Pathology showed a well-differentiated lesion composed of uniform, round cells with perinuclear halos in a neuropil background, immunohistochemically positive for neuronal markers. This was a cystic extraventricular neurocytoma(glio-neuronal tumor) arising from the left parietal lobe. Its features were consistent with neurocytoma pathologically and were different from those of intraventricular neurocytoma pathophysiologically. We outline the morphological and immunohistochemical evaluations necessary to recognize this rare tumor.
Follow-Up Studies ; Humans ; Neurocytoma* ; Neurons ; Neuropil ; Paresis ; Parietal Lobe ; Pathology ; Rabeprazole ; Radiotherapy ; Synaptophysin

Meningioma is a common brain tumor and the associated calcification is frequently found in imaging study. However, calcification of entire tumor bulk in meningioma is very rare finding. We present the clinical and radiological summery of our case which showed totally calcified meningioma and discuss the pathogenesis and clinical significance of such a tumoral calcification.
Brain Neoplasms ; Meningioma*

Aneurysms of the distal anterior cerebral artery (DACA) are rare and their surgical treatments present some unique difficulties from a technical standpoint. In this report, we presented our experiences of cases with DACA aneurysms, and analyzed the clinical features and prognostic factors affecting the final outcomes. Among 770 cases of intracranial aneurysms operated from 1990 to 1998, 19 cases of DACA aneurysms (2.5%) were studied retrospectively. The characteristic findings were female preponderance (M:F=1:2.8), common multiple aneurysms (57.9%), and frequent intracerebral hemorrhage (ICH) on initial brain CT scan (42.1%). All patients were operated via interhemispheric approach. Intraoperative aneurysmal rupture was developed only in 3 cases (15.8%), and had no relationship with the final outcome Fifteen out of 19 patients (78.9%) showed favorable outcome with a mortality rate of 5.3%. The follow-up data suggest that the initial ICH on brain CT scan portend a poor prognosis.
Adult ; Age Distribution ; Aged ; Cerebral Hemorrhage/mortality/pathology/surgery ; Female ; Human ; Incidence ; Intracranial Aneurysm/mortality/*pathology/*surgery ; Male ; Middle Age ; Sex Distribution ; Treatment Outcome

OBJECTIVE: The anterior communicating artery(ACoA) is known to be the most frequent location of intracranial aneurysms, but the complex arterial anatomy of the ACoA region makes this aneurysm among the most difficult one to treat. In the treatment of ACoA aneurysms, the direction of aneurysmal fundus is known to be very important in the surgical tactics. All ACoA aneurysms in our series were classified according to its direction, and analyzed the clinical features in order to investigate the prognostic factors influencing upon the surgical outcome. METHODS: The authors reviewed 236 cases of ruptured ACoA aneurysms that were operated from 1990 to 1997, were classified according to Pia's classification. RESULTS: The incidence rate of the ACoA aneurysm was 35.1%(236/672). Ventral group was more common than dorsal group, especially in ventro-caudal projection subgroup(36.0%). Poor preoperative clinical grade(Hunt-Hess grade IV and V) patients were more common in dorsal group(13.1%) than ventral group(2.6%). Rebleeding and intracerebral hematoma were more commonly seen in ventral group. However, vasospasm, hydrocephalus, hyponatremia, and intraventricular hemorrhage were observed more frequently in dorsal group. Worse outcome was more common in dorsal group than ventral group, especially in dorso-caudal projection subgroup. Also, poor outcome was identified in patients with intracerebral hematoma, intraventricular hemorrhage, hyponatremia, and hypertension, although statistically insignificant. In cases with the A1 dominancy, there was no difference in surgical outcome between the right and left side approach. The higher the aneurysmal neck from the planum sphenoidale, the worse outcome via pterional approach. CONCLUSION: It seems that the preoperative clinical grade, aneurysmal direction, and the height of aneurysmal neck, especially in the pterional approach, would be the major prognostic factors, and that intracerebral hematoma, intraventricular hemorrhage, hyponatremia, hydrocephalus and the intraoperative aneurysmal rupture would be the minor prognostic factors.
Aneurysm ; Classification ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Hyponatremia ; Incidence ; Intracranial Aneurysm* ; Neck ; Rupture ; Temazepam

OBJECTIVES: The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. MATERIAL AND METHOD: A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. RESULTS: In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. CONCLUSION: It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.
Age Distribution ; Basal Ganglia ; Cerebral Hemorrhage* ; Coma ; Geriatrics ; Hematoma ; Hemorrhage ; Humans ; Mortality ; Prognosis* ; Retrospective Studies ; Vascular Diseases

Spinal osteochondroms are very rare, and are thought to arise through a process of progressive endochondral ossification of aberrant cartilage of a growth plate, as a consequence of congenital defect or trauma. A case of diffuse type osteochondroma involving the posterior elements of L1-L5 that progressed after laminectomy in a 33-year-old man is reported. Usually, the spinal osteochondroma shows clear demarcation between tumor margin and normal spine elements, and can be exised completely. However, there was no clear demarcation between tumor and normal spine element in our case and therefore it was not possible to removal completely.
Adult ; Bone and Bones* ; Cartilage ; Congenital Abnormalities ; Growth Plate ; Humans ; Laminectomy ; Osteochondroma* ; Spine*