• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.204-207
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• 2015

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.58-60
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• 2014

Spinal meningiomas typically adhere to the dura matter. Non-dural based spinal meningiomas are rare and most are clear cell meningiomas. We report here the first case of a fibrous meningioma with non-dural attachment. The patient was a 49-year-old female, who complained of numbness in the legs and a gait disturbance. Magnetic resonance imaging revealed a $1.7{\times}1.4-cm$ mass in the C7-T1 intra-dural extramedullary space, showing peripheral gadolinium enhancement without a "dural tail sign". A complete microsurgical resection was performed. The mass was covered with a white membrane but was not adhered to the dura, and its appearance was consistent with a neurilemmoma. The histopathological diagnosis was fibrous-type meningioma. The recovery of the patient was uneventful. No surgical complications and no recurrence of the tumor had occurred at the 6-month follow-up.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.48-50
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• 2008

We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.

• Journal of Korean Neurosurgical Society
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• 제41권2호
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• pp.120-122
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• 2007

Meningiomas arise from meningothelial cells that line the arachnoid membrane. So most meningiomas are dural-based lesion. But meningiomas without dural-attachment do occur and are less common. We report our experience of intraparenchymal sylvian fissure menigioma. A 21-year-old female presented with a one-month history of headache that was associated with long-term intermittent partial seizure. CT revealed about $4.5{\times}4.3{\times}5.5cm$ sized calcified mass with enhancement in right temporal lobe. On MR imaging, the lesion was observed in the right temporal lobe that was low-signal intensity on T2WI and iso-signal intensity on T1WI with well enhancement. Operation was performed via right orbitocranial approach. The internal surface of dura was intact. Tumor was totally removed except the capsule of tumor adhered to main trunk of middle cerebral artery. The histopathology showed meningioma, psammomatous type. Intraparenchymal meningioma should be considered in the differential diagnosis of intraaxial lesions in patients of any age group.

• Korean Journal of Radiology
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• 제24권5호
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• pp.444-453
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• 2023

Objective: Meningeal lymphatic vessels are predominantly located in the parasagittal dural space (PSD); these vessels drain interstitial fluids out of the brain and contribute to the glymphatic system. We aimed to investigate the ability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing the dynamic changes in the meningeal lymphatic vessels in PSD. Materials and Methods: Eighteen participants (26-71 years; male:female, 10:8), without neurological or psychiatric diseases, were prospectively enrolled and underwent DCE-MRI. Three regions of interests (ROIs) were placed on the PSD, superior sagittal sinus (SSS), and cortical vein. Early and delayed enhancement patterns and six kinetic curve-derived parameters were obtained and compared between the three ROIs. Moreover, the participants were grouped into the young (< 65 years; n = 9) or older (≥ 65 years; n = 9) groups. Enhancement patterns and kinetic curve-derived parameters in the PSD were compared between the two groups. Results: The PSD showed different enhancement patterns than the SSS and cortical veins (P < 0.001 and P < 0.001, respectively) in the early and delayed phases. The PSD showed slow early enhancement and a delayed wash-out pattern. The six kinetic curve-derived parameters of PSD was significantly different than that of the SSS and cortical vein. The PSD washout rate of older participants was significantly lower (median, 0.09; interquartile range [IQR], 0.01-0.15) than that of younger participants (median, 0.32; IQR, 0.07-0.45) (P = 0.040). Conclusion: This study shows that the dynamic changes of meningeal lymphatic vessels in PSD can be assessed with DCE-MRI, and the results are different from those of the venous structures. Our finding that delayed wash-out was more pronounced in the PSD of older participants suggests that aging may disturb the meningeal lymphatic drainage.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.71-74
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• 2011

A 34-year-old female patient was presented with leg and hip pain for 6 months as well as voiding difficulty for 1 year. Magnetic resonance imaging revealed a well-demarcated mass lesion at L2-3. The mass was hypo-intense on T1- and T2-weighted images with homogeneous gadolinium enhancement. Surgery was performed with the presumptive diagnosis of intradural extramedullary meningioma. Complete tumor removal was possible due to lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma, a rare and newly included World Health Organization classification of meningioma usually affecting younger patients. During postoperative 2 years, the patient has shown no evidence of recurrence. We report a rare case of cauda equina clear cell meningioma without any dural attachment.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.1-4
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• 2009

Objective : In the present study, the authors investigated the clinical and imaging features as well as the therapeutic outcomes of SIH (spontaneous intracranial hypotension) patients. Methods : A retrospective review of 12 SIH patients was carried out. The diagnostic work-up included lumbar tapping and measurement of CSF opening pressure, radioisotope cisternography, brain and spinal magnetic resonance imaging (MRI), and computed tomography (CT) myelography. Autologous epidural blood patching was performed in patients who did not respond to conservative therapies, including analgesics, steroids, hydration and rest. Results : Typical postural headache was found in 11 (91%) patients. Nine (75%) patients showed pachymeningeal enhancement on their initial T1-weighted MR images. The CSF opening pressure was less than 60 mm$H_2O$ in 9 of 11 patients. Autologous epidural blood patching was performed in 7 patients, and all of them showed good responses. Conclusion : SIH can present with various clinical presentations and neuroimaging findings. Autologous epidural blood patching is thought to be the treatment of choice for patients with SIH.

• 대한영상의학회지
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• 제83권3호
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• pp.719-723
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• 2022

Rosai-Dorfman Disease (이하 RDD)는 드문 조직구 증식성 질환이며 두개 내에만 발생하는 경우는 매우 드물다. 대부분의 두개 내 RDD는 균질한 조영증강을 동반하는 경막의 종괴들로 나타나서, 심한 경부 림프절증을 보이지 않는 경우에는 수술하기 전에 뇌수막종과의 감별이 어렵다. 저자들은 65세 남자 환자의 두개 내에만 발생한 RDD의 드문 증례에 대해 보고하고자 한다. 뇌 MRI에서 우측 전엽 원개에 경계가 분명한 조영증강되는 종괴의 형태로 보였으며 미세한 확산제한이 관찰되었다. 하지만 수술 전 뇌혈관조영상에서는 겨우 미세한 홍조만이 보였다. 비록 두개 내에만 발생한 RDD가 드물기는 하지만, 경막에 기반한 종괴가 뇌혈관조영상에서 저혈관성의 형태로만 보일 때 감별질환으로 생각할 수 있다.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1439-1442
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• 2001

Solitary fibrous tumor(SFT) is a spindle cell neoplasm that usually arises in the pleura. Its involvement of the meninges is rare but increasingly being reported. Our case was a 33-year-old man who presented with clonic seizure around the right mouth angle and sensory disturbance at the right hand. Radiological studies showed a large extra-axial, dural-based mass in the left fronto-parietal region, typically isointense with gray matter and heterogeneous strong enhancement on T1-weighted images. Histologically, the tumor was composed of spindle-shaped cells growing in fascicles within the collagenous matrix. Immunohistochemical staining demonstrated diffuse CD34 positivity. Awareness of this neoplasm is necessary to accurate diagnosis.

• Korean Journal of Radiology
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• 제2권3호
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• pp.171-174
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• 2001

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement.