• Journal of Korean Neurosurgical Society
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• v.51 no.3
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• pp.151-154
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• 2012

We report here two cases of primary intraosseous meningioma with aggressive behavior. A 68-year-old man presented with a one year history of a soft, enlarging mass in the right parietal region. Magnetic resonance image (MRI) revealed a 6 cm sized, heterogeneously-enhancing, bony expansi1e mass in the right parietal bone, and computed tomograph (CT) showed a bony, destructive lesion. The tumor, including the surrounding normal bone, was totally resected. Dural invasion was not apparent Diagnosis was atypical meningioma, which extensively metastasized within the skull one year later. A 74-year-old woman presented with a 5-month history of a soft mass on the left frontal area. MRI revealed a 4 cm sized, multilobulated, strongly-enhancing lesion on the left frontal bone, and CT showed a destructive lesion. The mass was adhered tightly to the scalp and dura mater. The lesion was totally removed. Biopsy showed a papillary meningioma. The patient refused adjuvant radiation therapy and later underwent two reoperations for recurred lesions, at 19 and at 45 months postoperative. The patient experienced back pain 5 years later, and MRI showed an osteolytic lesion on the 11th thoracic vertebra. After her operation, a metastatic papillary meningioma was diagnosed. These osteolytic intraosseous meningiomas had atypical/malignant pathologies, which metastasized to whole skull and the spine.

• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.282-288
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• 2021

Objective : Electrooculography (EOG) records eyeball movements as changes in the potential difference between the negatively charged retina and the positively charged cornea. We aimed to investigate whether reliable EOG waveforms can be evoked by electrical stimulation of the oculomotor and abducens nerves during skull base surgery. Methods : We retrospectively reviewed the records of 18 patients who had undergone a skull base tumor surgery using EOG (11 craniotomies and seven endonasal endoscopic surgeries). Stimulation was performed at 5 Hz with a stimulus duration of 200 μs and an intensity of 0.1-5 mA using a concentric bipolar probe. Recording electrodes were placed on the upper (active) and lower (reference) eyelids, and on the outer corners of both eyes; the active electrode was placed on the contralateral side. Results : Reproducibly triggered EOG waveforms were observed in all cases. Electrical stimulation of cranial nerves (CNs) III and VI elicited positive waveforms and negative waveforms, respectively, in the horizontal recording. The median latencies were 3.1 and 0.5 ms for craniotomies and endonasal endoscopic surgeries, respectively (p=0.007). Additionally, the median amplitudes were 33.7 and 46.4 μV for craniotomies and endonasal endoscopic surgeries, respectively (p=0.40). Conclusion : This study showed reliably triggered EOG waveforms with stimulation of CNs III and VI during skull base surgery. The latency was different according to the point of stimulation and thus predictable. As EOG is noninvasive and relatively easy to perform, it can be used to identify the ocular motor nerves during surgeries as an alternative of electromyography.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.39-43
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• 2008

Purpose: We evaluated whether it was necessary to perform whole body acquisition of $^{18}F$-FDG PET/CT including whole skull and lower extremity (LE) distal to mid-thigh (MT) in patients with multiple myeloma (MM). Materials and Methods: Thirty patients underwent 45 whole body $^{18}F$-FDG PET/CT scans including skull and LE distal to MT. PET scans were divided by 2 subgroups according to the presence of abnormal focal $^{18}F$-FDG uptake in skull or LE distal to MT. Clinical characteristics including age, sex, and stages were compared between the 2 subgroups. Results: Of total 45 whole body PET/CT scans, focally increased abnormal FDG uptake in the skull or LE distal to MT suggesting myeloma involvement was found in 22 scans (48.9%) of 14 patients (46.7%). Skull lesions were more frequently observed than LE lesions distal to MT on PET (86.4% vs. 40.9%, p<0.005). There were no significant differences in age, sex, initial Durie/Salmon stage, and tumor burden at the time of PET scan suggested by serum hemoglobin level, serum calcium level, serum and urine paraprotein level, and serum creatinine level between the two subgroups. The presence of the skull or LE distal MT lesions on PET did not affect on the Durie/Salmon plus stage except only 1 case (1/22, 4.5%, p>0.05). Conclusion: Abnormal lesions in the skull or LE distal to MT on $^{18}F$-FDG PET/CT did not affect significantly on the tumor burden and Durie/Salmon plus stage of MM. Therefore, torso PET acquisition including head may be sufficient for evaluating patients with MM.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.321-330
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• 2014

Objective : Based on surgical outcomes of patients with infratentorial meningiomas surgically treated at our institution, we analyzed the predictors for surgical resection, recurrence, complication, and survival. Methods : Of surgically treated 782 patients with intracranial meningioma, 158 (20.2%) consecutive cases of infratentorial location operated on between April 1993 and May 2013 at out institute were reviewed retrospectively. The patients had a median age of 57.1 years (range, 16-77 years), a female predominance of 79.7%, and a mean follow-up duration of 48.4 months (range, 0.8-242.2 months). Results : Gross total resection (Simpson's grade I & II) was achieved in 81.6% (129/158) of patients. Non-skull base location was an independent factor for complete resection. The recurrence rate was 13.3% (21/158) and the 5-, 10-, and 15-year recurrence rates were 8.2%, 12.0%, and 13.3%, respectively. Benign pathology, postoperative KPS over than 90, low peritumoral edema, and complete resection were significantly associated with longer recurrence-free survival rate. The 5-, 10-, and 15-year survival rates were 96.2%, 94.9%, and 94.9%, respectively. Benign pathology, postoperative KPS over than 90 and complete resection were significantly associated with a longer survival rate. The permanent complication rate was 13% (21/158). Skull base location and postoperative KPS less than 90 were independent factors for the occurrence of permanent complication. Conclusion : Our experience shows that infratentorial meningiomas represent a continuing challenge for contemporary neurosurgeons. Various factors are related with resection degree, complications, recurrence and survival.

• Journal of Korean Neurosurgical Society
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• v.39 no.3
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• pp.198-203
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• 2006

Objective : To evaluate the natural histories and growth rates of meningiomas, the authors perform this retrospective observational study and attempt to identify those factors predicting tumor growth. Methods : Between 1993 and 2004, a total of 83 patients were diagnosed by computed tomography[CT] scans or magnetic resonance[MR] imaging as having an intracranial meningioma, and were treated by observation only using regular clinical and radiological examinations. Twenty-six of these 83 patients, with available data were included in this study. Follow up periods ranged from 9 to 137 months [mean, 55.6 mo.; median, 60 mo.]. The tumor volumes, absolute growth rates, and tumor doubling times were calculated. Results : Patient age and sex distributions were comparable to those of other studies, but exceptionally 16 meningiomas [62%] were located at the skull base in the present study. During follow-up monitoring, the majority of meningiomas grew, though 77% showed low absolute annual growth rates [$<1cm^3/yr$]. The tumor doubling times ranged from 2.87 to 201.72 years [mean, 42.91 yr]. Based on Imaging analysis, peritumoral edema and the absence of calcification were probable factors predicting tumor growth. Tumor-related symptoms seemed to be slightly related to tumor growth. Other factors, e.g., gender, age, tumor location, and T2-weighted signal Intensities on MR imaging, were not significantly related to tumor growth. Conclusion : This study shows that the majority of meningiomas are slow growing. However, variations in tumor growth are unexplained, thus individualized optimal treatment strategies should be provided in each meningioma.

• Journal of Periodontal and Implant Science
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• v.24 no.2
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• pp.255-260
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• 1994

We experienced a case of Sturge-Weber Syndrome in a 32 years old female. The diagnosis was established by clinical features of Sturge-Weber Syndrome including unilateral facial portwine nevus, vascular hyperplasia of oral mucosa(espectially 1st & 2nd division of trigeminal nerve). But, plain radiographys of the skull revealed no evidence of calcification. A brief review of related literatures was made. Common Clinical findings in Sturge-Weber Syndrome and specific signs & symptoms manifested by this patient were discussed.

• Journal of Korean Neurosurgical Society
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• v.43 no.1
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• pp.34-36
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• 2008

Meningioma en plaque (MEP) is a rare tumor characterized more by its clinical and biological behavior than its histological appearance. Hyperostosis of the skull is one of the characteristic signs of MEP. This bony change can produce clinical symptoms and signs in MEP by pressing against adjacent structures. The authors report a rare case of an osteolytic MEP extending from the sphenoid wing into the orbital wall, middle fossa, and temporalis muscle.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.110-113
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• 2006

Surgery and radiotherapy are mainly used for plasma cell neoplasm which constitutes about $1{\sim}2%$ of human malignancy. The authors carried out Fractionated Stereotactic Radiotherapy[FSRT] on the residual tumor after the subtotal removal of Intracranial plasmacytoma. A huge mass lesion was observed on MRI [magnetic resonance image] in the left anterior and middle cranial fossa of a 63-year-old man with left exophthalmus which lasted for a month, and was suspected as a meningioma with strong contrast enhancement. Extramedullary plasmacytoma was diagnosed on histopathological examination. After the surgery, FSRT was also carried out on the residual tumor which invaded the skull base. One-year follow up after FSRT showed contrast enhancement only in the left sphenoid bone on MRI, which indicated significant decrease in the size of the tumor without any abnormal neurologic deficits. We treated intracranial plasmacytoma which invaded left anterior and middle cranial fossa and surrounded cavernous sinus without cranial nerve deficit through subtotal tumor removal and FSRT.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.495-497
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• 2007

Purpose: Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from somatic soft tissues or peripheral nerves. Primary MPNST of the scalp is extremely rare. The case is being reported for its rarity. Methods: A 53-year-old female was presented with a scalp mass on vertex area. The tumor was localized in scalp skin and did not invade underlying periosteum or skull and treated with complete surgical excision followed by adjuvant chemotherapy and radiotherapy. Results: Histologically, the tumor showed malignant spindle cells with focal S-100 positivity on immunohistochemistry and a diagnosis of MPNST was made. Conclusion: Authors experienced a rare case of primary scalp MPNST and report the case.

• Imaging Science in Dentistry
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• v.30 no.4
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• pp.281-285
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• 2000

An uncommon case of a patient with recurrent mandibular ameloblastoma involving various adjacent soft tissues is presented with plain film radiography, computed tomography and magnetic resonance imaging (MRI) and bone scan. The tumor involved mandible and eroded several bones including foramen ovale. This case shows that although an ameloblastoma primarily affect mandible, exact radiographic evaluation of tumor extent will assist the surgeon in the progress of rational approaches to the management of ameloblastoma.