Shi Hun Song

Vestibular schwannoma with repeated intratumoral hemorrhage

A symptomatic hemorrhage from a vestibular schwannoma is extremely rare, despite its relatively high incidence in the cerebellopontine angle. Much more unusual are repeated intratumoral hemorrhages. The authors report on such a rare case of repeated intratumoral hemorrhage from a vestibular schwannoma, presenting with sudden exacerbation of headache, nausea and vomiting. This second hemorrhage was confirmed by CT scan on the day of the onset of symptomatic exacerbation, which was 9 days after the initial CT scan, showing an enlarged amount of blood within the tumor. The MRI scan confirmed this CT finding. After removal, the tumor proved to be a typical vestibular schwannoma of mixed Antoni types A and B. Thin-dilated vessels with hemorrhage and hemosiderin-laden macrophages were observed. The patients postoperative course was uneventful. A total of 28 reported cases of a single intratumoral hemorrhage in vestibular schwannomas, and one reported case of repeated hemorrhage are reviewed.

Outcome of pediatric patients with severe brain injury in Korea : a comparison with reports in the West

Abstract There have been relatively wide variations in the results of studies examining the outcomes of severe brain injury in children. Among the reasons for these variations in outcome, prehospital care can be considered as one of the factors. In Korea, major hospitals use an aggressive and sophisticated management policy very similar to that practiced in the West. However, effective prehospital management, such as emergency care at the scene of injury and during transport by paramedics, have not yet been established. In order to evaluate the influence of prehospital care on the outcome in severely brain-injured children, we report the outcome recorded in 73 pediatric patients treated in our hospital following severe brain injury and compare these results with those reported from centers in the western community, where well-trained paramedic care and an excellent transfer system are in operation. The overall mortality rate in our patients was 23%; 41% had a good recovery, 22% moderate disability, and 12% severe disability, and 1% remained in a vegetative state. In conclusion, we would like to suggest that prehospital care does not remarkably influence mortality rates in severely brain-injured children.

Clinical Experience in Conformal Stereotactic Radiotherapy of Irregularly Shaped Intracranial Tumors

PURPOSE The dosimetric advantages of multiple non-coplanar stationary fields for stereotactic radiotherapy or adiosurgery (SRT/S) are well known. However, this technique is not widely used due to the logistical problems associated with producing and testing customized collimators. We report our experience of SRT/S using multiple non-coplanar stationary fields (conformal SRT/ S). MATERIALS AND METHODS Between August 1997 and February 2002, we performed frameless SRT/S in 63 patients. We chose conformal SRT/S when the tumor was of a very irregular shape or larger than 4 cm. We obtained three pieces of information: 1) the couch translations required to bring the target point to the isocenter, 2) the distance between the stereotaxic markers in the CT study, and the distance between the markers determined from orthogonal beam films, taken in the anterior- posterior and lateral directions, and 3) the rotational movement of the head position between the CT study and actual treatment position. We evaluated two kinds of data: 1) the precision of the isocenter setup, and 2) the reproducibility of the head position in the a) translational and b) rotational components. RESULTS Twenty-six of the 63 patients receiving stereotactic treatment received conformal SRT/S. The precision of the isocenter setup for the conformal SRT/S was x=-0.03+/-0.26 mm, y=0.19+/-0.25 mm and z=-0.20+/-0.27 mm. The reproducibilities of the head position with the conformal SRT/S were 0.5 mm and less than 1degrees C, for the translational and rotational components, in any plane. CONCLUSION We were able to apply conformal stereotactic irradiation, which has a dosimetric advantage, to irregularly shaped intracranial tumors, with precision and reproducibility of head position for the isocenter setup nearly equivalent to that of frame-based SRS or multiple-arc SRT/S.