Ki Seong Eom

Diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with glial fibrillary acidic protein expression: A case report

Rhabdoid papillary meningioma is a recently described clinically aggressive variant of meningiomas with a high recurrence rate. Additionally, only one case of intraventricular rhabdoid meningioma has been reported so far. We present a case of a 50-year-old man who developed an intracranial tumor of the left lateral ventricle at the trigone, for which he underwent total tumor resection followed by gamma knife radiosurgery for recurrence of the tumor. The histological diagnosis was rhabdoid papillary meningioma. Five years after surgery, diffuse craniospinal leptomeningeal metastases developed and subtotal removal of the spinal tumor was performed. The spinal tumor was considered to have metastasized via cerebrospinal fluid (CSF) in view of its histological features that were identical to those of the primary tumor. Immunohistochemistry revealed the unusual cytoplasmic expression of glial fibrillary acidic protein (GFAP) of tumor cells. To our knowledge, this is the first reported case of diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with GFAP expression and the second reported case of the rhabdoid subtype amongst intraventricular meningiomas.

Bilateral diffuse intracerebral hemorrhagic infarction after cranioplasty with autologous bone graft

We present the first case of a bilateral diffuse intracerebral hemorrhagic infarction following cranioplasty using an autologous bone graft. The case is that of a 63-year-old man who had undergone previous decompressive craniectomy due to right middle cerebral artery and posterior cerebral artery territory infarction. In order to avoid this extremely rare complication, the possible pathogenic mechanism underlying the deleterious cascade following cranioplasty is discussed.

Primary hypothyroidism mimicking a pituitary macroadenoma: regression after thyroid hormone replacement therapy

We report a 9-year-old girl with pituitary hyperplasia due to primary hypothyroidism. She presented with growth arrest, abnormal thyroid function studies, and a pituitary mass on MRI. With thyroxine therapy, the pituitary mass regressed and her symptoms resolved. Primary hypothyroidism should be considered in the differential diagnosis of solid mass lesions of the pituitary gland.

Contralateral acute interdural haematoma occurring after burr hole drainage of chronic subdural haematoma

We report the case of a 78-year-old man with chronic subdural haematoma (CSDH) who presented with impairment in recent memory and gait disturbance. He underwent burr-hole craniostomy with a closed-drainage system. A computed tomography scan conducted on postoperative day 3 demonstrated an acute epidural haematoma over the contralateral frontoparietal convexity. Craniotomy and haematoma evacuation were immediately performed. The haematoma was located between the outer and inner dura mater that each comprise a single layer. To our knowledge, this is the first reported case of an acute haematoma located between the separated dura mater that occurred following drainage of a contralateral CSDH, and it is the second reported case of interdural haematoma over the cerebral convexity.We report the case of a 78-year-old man with chronic subdural haematoma (CSDH) who presented with impairment in recent memory and gait disturbance. He underwent burr-hole craniostomy with a closed-drainage system. A computed tomography scan conducted on postoperative day 3 demonstrated an acute epidural haematoma over the contralateral frontoparietal convexity. Craniotomy and haematoma evacuation were immediately performed. The haematoma was located between the outer and inner dura mater that each comprise a single layer. To our knowledge, this is the first reported case of an acute haematoma located between the separated dura mater that occurred following drainage of a contralateral CSDH, and it is the second reported case of interdural haematoma over the cerebral convexity.

Intraventricular Malignant Meningioma with CSF-Disseminated Spinal Metastasis : Case Report and Literature Review.

The authors report a case of 42-year-old woman with an intraventricular tumor in the trigone of the left lateral ventricle. The first operation achieved a microscopically complete resection. The tumor was histologically atypical meningioma. After 26 months, there were recurrences of intraventricular meningioma. Complete resection of the tumor and adjuvant radiation therapy were performed, and the histological diagnosis was malignant meningioma. Sixteen months after the second operation, spinal metastasis in cervicolumbar lesion was diagnosed and a subtotal removal of cervical intradural extramedullary mass was performed. We describe an unusual case of intraventricular malignant meningioma with cerebrospinal fluid-disseminated spinal metastases with review of the clinical courses of previous reports.

Preoperative embolization of a cerebellar haemangioblastoma using Onyx: case report and literature review

Haemangioblastoma is a slow-growing, highly vascular tumour and typically occurs in the cerebellum but can also occur in the brainstem and spinal cord. Because of their hypervascularity and location, cerebellar haemangioblastomas can be difficult to remove. The purpose of preoperative embolization of haemangioblastomas is to decrease the intraoperative blood loss and to facilitate excision. However, the safety and efficacy of this procedure remain controversial. Here, we report the case of a man with cerebellar haemangioblastoma who underwent preoperative embolization with Onyx. The tumour was completely removed with minimal tumour bleeding. There was no complication related to embolization.

Rapid Spontaneous Redistribution of Acute Epidural Hematoma : Case Report and Literature Review

Acute epidural hematoma (AEDH) occurring as a result of traumatic head injury constitutes one of the most critical emergencies in neurosurgery. However, there are only several reports that show the rapid disappearance of AEDH without surgical intervention. We suggest redistribution of hematoma through the overlying skull fractures as the mechanism of rapid disappearance of AEDH. A 13-year-old female fell from a height of about 2 m and presented with mild headache. A computed tomography (CT) scan performed 4 hours after the injury revealed an AEDH with an overlying fracture in the right temporal region and acute small hemorrhagic contusion in the left frontal region. A repeat CT scan 16 hours after injury revealed that the AEDH had almost completely disappeared and showed an increase in the epicranial hematoma. The patient was discharged 10 days after injury with no neurological deficits. This case is characterized by the rapid disappearance of an AEDH associated with an overlying skull fracture. We believe that the rapid disappearance of the AEDH is due to the redistribution of the hematoma, rather than its resolution or absorption, and fracture plays a key role in this process.

Intracerebral hemorrhage caused by rupture of a giant aneurysm complicating superficial temporal artery–middle cerebral artery anastomosis for moyamoya disease

IntroductionAneurysm formation at the anastomosis site after extracranial–intracranial (EC–IC) bypass surgery for major arterial occlusion or stenosis due to atherosclerosis has only been reported a few times previously. However, no case describing the formation of a giant aneurysm after EC–IC bypass surgery has been reported to date. Additionally, this complication associated with moyamoya disease is extremely rare, and only one case has been reported so far.Clinical reportWe report a case of a 51-year-old woman having a rare complication of intracerebral hemorrhage due to rupture of a giant aneurysm that developed after superficial temporal artery–middle cerebral artery anastomosis for the treatment of moyamoya disease.ConclusionTo the best of our knowledge, this is the first reported case of a giant aneurysm, also the largest so far occurring after EC–IC bypass surgery and the second reported case of a rupture of an aneurysm formed after bypass surgery for moyamoya disease.

A Case of Occipital Neuralgia in the Greater and Lesser Occipital Nerves Treated with Neurectomy by Using Transcranial Doppler Sonography: Technical Aspects

Occipital neuralgia is usually defined as paroxysmal stabbing pain in the greater or lesser occipital nerve (GON or LON) distribution. In occipital neuralgia patients, surgical considerations are carefully taken into account if medical management is ineffective. However, identification of the occipital artery by palpation in patients with thick necks or small occipital arteries can be technically difficult. Therefore, we established a new technique using transcranial Doppler (TCD) sonography for more accurate and rapid identification. The patient was a 64-year-old man who had undergone C1-C3 screw fixation and presented with intractable stabbing pain in the bilateral GON and LON distributions. In cases in which pain management was performed using medication, physical therapy, nerve block, or radiofrequency thermocoagulation, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed occipital neurectomy of the bilateral GON and LON by using TCD sonography, which helped detect the greater occipital artery easily. After the operation, the patients headache disappeared gradually, although he had discontinued all medication except antidepressants. We believe that this new technique of occipital neurectomy via a small skin incision performed using TCD sonography is easy and reliable, has a short operative time, and provides rapid pain relief.

Analysis of Mortality and Epidemiology in 2617 Cases of Traumatic Brain Injury : Korean Neuro-Trauma Data Bank System 2010–2014

Objective The aims of the Korean Neuro-Trauma Data Bank System (KNTDBS) are to evaluate and improve treatment outcomes for brain trauma, prevent trauma, and provide data for research. Our purpose was to examine the mortality rates following traumatic brain injury (TBI) in a retrospective study and to investigate the sociodemographic variables, characteristics, and causes of TBI-related death based on data from the KNTDBS. Methods From 2010 to 2014, we analyzed the data of 2617 patients registered in the KNTDBS. The demographic characteristics of patients with TBI were investigated. We divided patients into 2 groups, survivors and nonsurvivors, and compared variables between the groups to investigate variables that are related to death after TBI. We also analyzed variables related to the interval between TBI and death, mortality by region, and cause of death in the nonsurvivor group. Results The frequency of TBI in men was higher than that in women. With increasing age of the patients, the incidence of TBI also increased. Among 2617 patients, 688 patients (26.2%) underwent surgical treatment and 125 patients (4.7%) died. The age distributions of survivors vs. nonsurvivor groups and mortality rates according the severity of the brain injury, surgical treatment, and initial Glasgow Coma Scale (GCS) scores were statistically significantly different. Among 125 hospitalized nonsurvivors, 70 patients (56%) died within 7 days and direct brain damage was the most common cause of death (80.8%). The time interval from TBI to death differed depending on the diagnosis, surgical or nonsurgical treatment, severity of brain injury, initial GCS score, and cause of death, and this difference was statistically significant. Conclusion Using the KNTDBS, we identified epidemiology, mortality, and various factors related to nonsurvival. Building on our study, we should make a conscious effort to increase the survival duration and provide rapid and adequate treatment for TBI patients.