Choi Ks

Pineal tumors: experience with 48 cases over 10 years

Abstract The authors retrospectively reviewed 48 patients treated at Seoul National University Hospital (SNUH) between 1986 and 1995. There were 35 children and 13 adults, accounting for 10.1% of 345 pediatric and 0.68% of 1914 adult brain tumors in SNUH during the same period. The 48 cases consisted of 33 cases of germ cell tumor (69%, GCT); 6 of pineoblastoma (PB, 12.5%); 3 of pineocytoma (PC, 6.3%); 3 of anaplastic astrocytoma (6.3%); 1 of astrocytoma; 1 of glioblastoma; and 1 of ependymoma. The median age was 13 years (range 1–59) and the male-to-female ratio was 3.36:1. The most frequent presenting symptom was due to increased intracranial pressure (90%), followed by Parinaud syndrome or diplopia (50%). Patients with a benign tumor, such as teratoma (TE), astrocytoma, or ependymoma, underwent surgery by the occipital transtentorial approach (OTT) for attempted radical resection without adjuvant therapy, while patients with immature teratoma (imTE), PC, and anaplastic astrocytoma underwent regional radiotherapy (RT) after debulking via OTT. Seven patients with nongerminomatous malignant GCT (NG-MGCT) and 3 with germinoma (GE) underwent craniospinal radiation only, 6 with GE, a NG-MGCT, and 2 with GE+TE received craniospinal radiotherapy (CSRT) after debulking via OTT. Three patients with GE, 4 with NG-MGCT, and 3 with PB underwent radiochemotherapy after debulking via OTT. Forty-four patients were followed up after treatment. The median follow-up period was 36 months. All patients with GE were alive after RT at 36 months (median) of follow-up (range 7–70 months). All with GE+TE and TE were alive. Three patients with PC or astrocytoma were also alive with stable or no evidence of disease. In 1 of the 3 cases of imTE there was a recurrence. However, 4 patients with NG-MGCT died, all of whom had undergone CSRT only; 2 PB patients were alive (12, 19 months), 1 in a moribund status (36 months), and 2 were dead (6, 60 months). The overall mean survival time with pineal tumors was 66 months and the 3-year survival rate was 84% with minimal posttreatment complications. It is concluded that pineal region tumors have male and childhood predominances, and the most common tumor is GCT. The majority of pineal region tumors are malignant. Pineal region tumors can be approached safely and effectively and the surgical complications are mostly transient. Their prognosis is dependent on the pathologies and treatment modalities.

Cerebral aspergillosis in immunologically competent patients

Aspergillosis of the central nervous system is a rare disease, especially if the patients immune system is not compromised. The authors report three cases of cerebral aspergillosis in the immunocompetent state: a rhinocerebral form in a diabetic patient, a direct extension from chronic Aspergillus otitis media, and a postoperative Aspergillus brain abscess after brain tumor surgery. In spite of the poor prognosis of cerebral aspergillosis, two of the patients survived. The pathogenesis, predisposing factors, radiologic findings including magnetic resonance image, and the outcome are presented. The pertinent literature of cerebral aspergillosis is also reviewed.

Bacterial expression, purification of full length and carboxyl terminal fragment of Alzheimer amyloid precursor protein and their proteolytic processing by thrombin

Human amyloid protein precursor(APP770) and its carboxyl terminal portion (CT105) including beta/A4 domain were highly expressed using strong expression systems in E. coli. These recombinant APP peptides were purified with a combination of urea solubilization and ion-exchange chromatography and used for proteolytic processing by thrombin. Three thrombin cleavage sites were predicted by the decrease of APP770 and the appearance of M(r) 56, 27 and 18 kDa fragments containing beta/A4 domain on SDS-PAGE gel and on the immunoblot. A similar but limited proteolysis of platelet APPs exposed to thrombin resulted in the stimulated production of 60 and 27 KDa carboxyl terminal peptides containing the intact beta/A4. This thrombin mediated proteolysis was completely blocked by hirudin, the specific thrombin inhibitor. These results suggest that thrombin may play a role in altered processing of APP to generate potentially amyloidogenic intermediates in vivo leading to amyloid deposition.

Intracranial mesenchymal chondrosarcoma: a case report and literature review.

Intracranial mesenchymal chondrosarcoma is a rare entity. The case of a 13-year-old girl with mesenchymal chondrosarcoma which seemed to arise from the dura mater is presented here together with a review of the literature. In the present case, the tumor involved the superior sagittal sinus. It recurred 21 months after gross total removal of the mass and coagulation of the involved wall of the superior sagittal sinus. Reoperation was performed followed by radiation therapy.

99mTc-HMPAO labeled leukocyte spect in intracranial lesions

BACKGROUND Scintigraphy with 111In (indium-111)-oxine or 99mTechnetium-hexamethylpropyleneamine oxime (99mTc-HMPAO) labeled leukocytes has been used to differentiate brain abscess from brain tumor. However, there are false positive or false negative results from planar scintigraphic images. So a more specific and sensitive scintigraphic technique needs to be developed. METHODS Planar and single photon emission computed tomography (SPECT) images were obtained and reviewed in 14 patients with intracerebral ring-enhancing lesions on computed tomography (CT) or magnetic resonance imaging (MRI). In all patients, diagnosis was confirmed by histopathologic examination. The effect of steroids or antibiotics on scintigraphic finding was examined. RESULTS Abscess was confirmed in six patients, tumor in six, tuberculoma and cysticercosis in one each, respectively. In all the patients with abscess, SPECT showed increased focal activity irrespective of steroid or antibiotic therapy. Increased radioactivity, which could not be detected on planar images, could be identified in two patients with abscess. In three of the six patients with tumor, radiolabeled leukocytes did not accumulate in the tumor. In the other three patients with tumor, SPECT showed focally increased activity that was less intense than the activity shown in the patients with abscess. CONCLUSIONS 99mTc-HMPAO labeled leukocyte SPECT is useful for the differential diagnosis of intracerebral ring-enhancing lesions, and the use of steroids or antibiotics does not influence the sensitivity of SPECT. Diagnostic sensitivity of scintigraphy with labeled leukocytes could be improved by SPECT in addition to planar image.

Moyamoya Disease in Korea

This study is based upon the collected data investigated by written inquiry from 33 institutions with neurosurgery residency programs in Korea. The first typical moyamoya disease in Korea was reported by Kim and Cho under the title of Hemangiomatous Malformation of the Brain at the Korean Neurosurgical Society meeting in 1969.

Acute cerebral infarction and changes of regional cerebral blow flow (rCBF) following experimental middle cerebral artery (MCA) occlusion

An unanaesthetized cat model of acute focal cerebral ischaemia has been established by the technique of transorbital snare ligature for middle cerebral artery (MCA) occlusion. The model was used to investigate the patterns of changes of regional cerebral blood flow (rCBF) for up to 16 h following MCA occlusion by the hydrogen clearance technique and to explore the correlation among changes of rCBF, neurological deficits, and pathological changes. The animals were divided into 2 groups according to the size of infarct which was identified by 2% triphenyl tetrazolium chloride (TTC) solution stain. Infarct larger than 10% of coronal section surface of ipsilateral hemisphere was found in 18 cats (Group A), and a smaller infarct was found in the remaining 7 cats (Group B). Between these 2 groups, there was a statistically significant difference in the average rCBF value of the ipsilateral MCA territory. The increasing grade of contralateral paralysis correlated well with the decreasing rCBF in the ipsilateral MCA territory, and the increasing grade of cerebral hemispheric swelling was directly proportional to the increasing grade of paralysis. Three patterns of changes of rCBF were observed: persistent severe ischaemia (15 cats, Group A); persistent mild to moderate ischaemia (7 cats, Group B); and immediate severe ischaemia followed by early post-ischaemic hyperaemia and death (3 cats, Group A). During the initial stage of ischaemia, a significant decrease in rCBF of the contralateral hemisphere was observed in both groups, however, in Group A rCBF gradually increased to preocclusion level, while Group B presented a further decrease in rCBF suggesting the occurrence of interhemispheric diaschisis. Thus, Group B appeared to take advantage of diaschisis during the late phase of infarct development, as well as the substantial collateral flow from the surrounding anterior and posterior cerebral artery territories.