Chae-Heuck Lee

A understanding of the temporal stem.

OBJECTIVE There has been inconsistency about definition of the temporal stem despite of several descriptions demonstrating its microanatomy using fiber dissection and/or diffusion tensor tractography. This study was designed to clarify three dimensional configurations of the temporal stem. METHODS The fronto-temporal regions of several formalin-fixed human cerebral hemispheres were dissected under an operating microscope using the fiber dissection technique. The consecutive coronal cuts of the dissected specimens were made to define the relationships of white matter tracts comprising the temporal stem and the subcortical gray matters (thalamus, caudate nucleus, amygdala) with inferior limiting (circular) sulcus of insula. RESULTS The inferior limiting sulcus of insula, limen insulae, medial sylvian groove, and caudate nucleus/amygdala were more appropriate anatomical structures than the roof/dorso-lateral wall of the temporal horn and lateral geniculate body which were used to describe previously for delineating the temporal stem. The particular space located inside the line connecting the inferior limiting sulcus of insula, limen insulae, medial sylvian groove/amygdala, and tail of caudate nucleus could be documented. This space included the extreme capsule, uncinate fasciculus, inferior occipito-frontal fasciculus, anterior commissure, ansa peduncularis, and inferior thalamic peduncle including optic radiations, whereas the stria terminalis, cingulum, fimbria, and inferior longitudinal fiber of the temporal lobe were not passing through this space. Also, this continued posteriorly along the caudate nucleus and limiting sulcus of the insula. CONCLUSION The temporal stem is white matter fibers passing through a particular space of the temporal lobe located inside the line connecting the inferior limiting sulcus of insula, limen insulae, medial sylvian groove/amygdala, and tail of caudate nucleus. The three dimensional configurations of the temporal stem are expected to give the very useful anatomical and surgical insights in the temporal lobe.

Central core of the cerebrum

OBJECT The purpose of this study was to understand 3D relationships of white matter fibers and subcortical areas of gray matter in the central core. METHODS The lateral and medial aspects of 4 cerebral hemispheres were dissected, applying the fiber dissection technique under the microscope. RESULTS The central core between the insula and midline includes the extreme, external, and internal capsules; claustrum; putamen; globus pallidus; caudate nucleus; amygdala; diencephalon; substantia innominata; fornix; anterior commissure; mammillothalamic tract; fasciculus retroflexus; thalamic peduncles, including optic and auditory radiations; ansa peduncularis; thalamic fasciculus; and lenticular fasciculus. It is attached to the remainder of the cerebral hemisphere by the cerebral isthmus, which is composed of white matter fibers located between the dorsolateral margin of the caudate nucleus and the full circumference of the circular sulcus of insula. The rostral fibers of the corpus callosum are included in the frontal portion of the cerebral isthmus. CONCLUSIONS It is very useful for neurosurgeons to facilitate the understanding of spatial relationships and pertinent surgical approaches in and around the central core with a highly complex anatomy by using fiber dissection.

Intraventricular Cavernous Hemangiomas Located at the Foramen of Monro

Intraventricular cavernous hemangiomas are uncommon. Among them, those occurred at the foramen of Monro in the third ventricle may be of particular interest because of its rarity, development of hydrocephalus, being differentiated from other brain lesions. We present a rare case of intraventricular cavernous hemangioma at foramen of Monro which was resected through microsurgery and also review the relevant literatures.

Cytogenetic and molecular genetic study on granular cell glioblastoma: a case report.

Granular cell astrocytoma is a rare infiltrative malignant glioma with prominent granular cell change. Granular cell astrocytomas are biologically aggressive compared with conventional infiltrating astrocytomas of similar grades, but their genetic alterations are poorly known. We report a case of granular cell glioblastoma and its genetic and molecular features. Histologically, the tumor not only showed features typical of granular cell astrocytoma but also demonstrated frequent mitoses, pseudopalisading necrosis, and vascular endothelial hyperplasia, compatible with glioblastoma. Array-based comparative genomic hybridization and focused molecular genetic analyses demonstrated gain of chromosome 7; losses of chromosome 1p, 8p, 9p, 10, 13q, and 22q; amplification of epidermal growth factor receptor; and homozygous deletion of CDKN2A as well as MGMT promoter methylation. However, neither isocitrate dehydrogenase 1 mutation nor codeletion of 1p/19q was found. Our results indicate that granular cell glioblastomas, despite having its peculiar granular cell changes, share common molecular genetic features with conventional glioblastoma, especially the classical subtype.

Primary Intracranial Leptomeningeal Melanomatosis

Primary intracranial malignant melanoma is a very rare and highly aggressive tumor with poor prognosis. A 66-year-old female patient presented a headache that had been slowly progressing for several months. A large benign pigmented skin lesion was found on her back. A brain MRI showed multiple linear signal changes with branching pattern and strong enhancement in the temporal lobe. The cytological and immunohiostochemical cerebrospinal fluid examination confirmed malignant melanoma. A biopsy confirmed that the pigmented skin lesion on the back and the conjunctiva were benign nevi. We report a case of primary intracranial malignant melanoma and review relevant literatures.

Middle Cerebral Artery Aneurysm in a Premature Neonate

Intracranial aneurysms in the neonate are very rare and their clinicopathological findings remain unclear. We report a 26-day-old premature neonate who underwent microsurgical clipping on the ruptured middle cerebral artery bifurcation aneurysm successfully with a review of relevant literature.

WITHDRAWN: Cytogenetic and molecular genetic study on glioblastoma arising in granular cell astrocytoma: a case report.

This article has been withdrawn at the request of the authors. The Publisher apologizes for any inconvenience this may cause. The full Elsevier policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Spontaneous regression of an unruptured and non-giant intracranial aneurysm.

It is well known that spontaneous thrombosis in giant cerebral aneurysm is common. However, spontaneous obliteration of a non-giant and unruptured cerebral aneurysm has been reported to be rare and its pathogenic mechanism is not clear. We describe a case with rare vascular phenomenon and review the relevant literatures.

A parieto-occipital artery arising from ICA directly and resultant incomplete PCA

A parieto-occipital artery arising from internal carotid artery (ICA) directly was identified in a 46-year old man. The left ICA angiograms showed that a parieto-occipital artery was arising from ICA located between posterior communicating artery (PcomA) and anterior choroidal artery (AchoA). And also, incomplete posterior cerebral artery (PCA) which had not a parieto-occipital branch was arising from prominent PcomA. AchoA arose from ICA located just distal to the anomalous origin of the parieto-occipital artery. The vertebral angiograms showed no contrast filling of left PCA. Herein, we present a very rare case which has an anomalous origin of the parieto-occipital artery and resultant incomplete PCA.

Cortical Laminar Necrosis in an Infant with Severe Traumatic Brain Injury

Cortical laminar necrosis appears as hyperinense lesions with a laminar pattern on T1 weighted magnetic resonance (MR) imaging, without signs of hemorrhage or calcification on T2 weighted MR imaging or computed tomography. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present a 12 month-old male infant who suffered diffuse brain injuries following car accident and showed laminar necrosis of cortex.