• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.56-58
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• 2007

A 64-year-old man was admitted to our hospital in semicomatous consciousness. Brain computed tomography scans demonstrated $2.6{\times}2.5\;cm$ sized hyperdense mass in the pineal region with multiple punctate calcifications and hydrocephalus. Brain magnetic resonance imaging demonstrated a pineal mass which was heterogeneously enhanced with gadolinium. After external ventricular drainage, the patient regained consciousness. The mass was totally removed via occipital transtentorial approach. No consequent ventricular shunt was needed and the patient recovered without any neurological deficit. Final pathologic report of the tumor was ependymoma.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.128-132
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• 2001

Aneurysm of the basilar artery trunk are rare and the surgical approach is very difficult because of the complexity of surgical anatomy around the basilar trunk and the vulnerable adjacent neurovascular structures. The development of brain CT and MRI makes the accurate diagnosis and produces the improvement of surgical approaches at the lesion of the skull base. One of the surgical approaches of basilar trunk aneurysms, the retrolabyrinthine presigmoid transtentorial transpetrosal approach to the aneurysm of the basilar trunk has some advantages of minimal retraction of cerebellum and temporal lobe, intact auditory and facial nerve function by the preservation of the vestibulocochlear and facial nerves, a preservation of sigmoid sinus and vein of Labbe and a relatively good operation field. We had a good result with this approach for the patient of basilar trunk aneurysm and reported the case with the review of literatures.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.366-370
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• 2001

Objective : The authors present three cases of brain tumors in which epidural hematomas(EDHs) were developed postoperatively in the remote areas from craniotomy sites. The preventive tactics as well as possible mechanisms of development of remote EDH are discussed. Material and Methods : The magnetic resonance imagings of three patients revealed a left lateral ventricular mass located just aside of foramen Monro in a 27-year-old male, a large cystic mass in the temporal lobe in a 35-year-old male, and a partially calcified pineal mass in a 27-year-old male patient. The surgical removals of these tumors were performed without any noticeable events during surgery via left frontal transcortical transventricular approach for lateral ventricular tumor, left temporal craniotomy for cystic temporal tumor, and right occipital transtentorial approach for pineal tumor. Results : Postoperative EDHs remote from the sites of craniotomy were detected by the immediate postoperative computerized tomographic scans. We obtained good outcomes without any morbidity in all three patients with emergent evacuation of the hematoma. The pathologic diagnoses were lateral ventricular ependymoastrocytoma, temporal craniopharyngioma and mixed germinoma of the pineal region. Conclusion : It is postulated that a sudden reduction of intracranial pressure(ICP) at the time of tumor removal may strip the dura from the inner table of the skull to cause EDH from the remote site of craniotomy. Gradual reduction of ICP with slow drainage of cerebrospinal fluid before tumor removal as well as lowering the head position of patient during surgery might be helpful for preventing this unusual complication.

• Journal of Korean Neurosurgical Society
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• v.56 no.6
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• pp.504-508
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• 2014

A 59-year-old male patient had 5-month history of gait disturbance and memory impairment. His initial brain computed tomography scan showed $3.5{\times}2.8cm$ sized mass with high density in the pineal region. The tumor was hypointense on T2 weighted magnetic resonance images and hyperintense on T1 weighted magnetic resonance images with heterogenous enhancement of central portion. The tumor was totally removed via the occipital transtentorial approach. Black mass was observed in the operation field, and after surgery, histopathological examination confirmed the diagnosis of malignant melanoma. Whole spine magnetic resonance images and whole body 18-fluoro-deoxyglucose positron emission tomography could not demonstrate the primary site of this melanoma. Scrupulous physical examination of his skin and mucosa was done and dark pigmented lesion on his left leg was found, but additional studies including magnetic resonance images and skin biopsy showed negative finding. As a result, final diagnosis of primary pineal malignant melanoma was made. He underwent treatment with the whole brain radiotherapy and extended local boost irradiation without chemotherapy. His preoperative symptoms were disappeared, and no other specific neurological deficits were founded. His follow-up image studies showed no recurrence or distant metastasis until 26 weeks after surgery. Primary pineal malignant melanomas are extremely rare intracranial tumors, and only 17 cases have been reported since 1899. The most recent case report showed favorable outcome by subtotal tumor resection followed by whole brain and extended local irradiation without chemotherapy. Our case is another result to prove that total tumor resection with radiotherapy can be the current optimal treatment for primary malignant melanoma in the pineal region.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.170-173
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• 2001

Germinoma associated with chronic granulomatous inflammation of pineal gland has been rarely reported in the literature. The mechanism of chronic granulomatous inflammation is not understood well. We report a case of chronic granulomatous inflammation in pineal germinoma. In a 17 year-old male who suffered from headache and diplopia for six months, the mass of pineal gland was detected by brain MRI and removed through occipital transtentorial approach. The pathological specimen revealed the mass was predominantly composed of chronic granulomatous inflammation associated with small portion of germ cell tumor nests In the pathological interpretation of chronic granulomatous inflammation of pineal mass, it would be obliged to search for the presence of germ cell component.

• Journal of Korean Neurosurgical Society
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• v.30 no.10
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• pp.1200-1209
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• 2001

Objective : A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of $Labb{\acute{e}}$ in surgical removal of petroclival meningiomas. Patients and Methods : The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent & equal on both sides), Type B(confluent & non-dominant on tumor side), Type C(confluent & dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of $Labb{\acute{e}}$ was analyzed with respect to its draining point and its collaterals to other superficial veins. Results : Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of $Labb{\acute{e}}$, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. Conclusion : For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of $Labb{\acute{e}}$.