A case of pineocytoma totally removed

A case of pineocytoma which is thought to be uncommon is reported. A 50-year-old man complaining of occasional dizziness and tinnitus of the left ear was referred to our Center on Feb. 10, 1989. No noteworthy signs were detected out neurologically. Plain CT scan disclosed a homogeneous iso- to high-density area in the pineal region, which was markedly enhanced on the post-contrast study. On the T1 MRI, that pineal tumor appeared as a low intensity area and on the T2, a high intensity area with intratumoral low signal intensity suggesting calcification. The tumor was conspicuously enhanced by Gd-DTPA. Left vertebral angiography demonstrated a faint tumor blush which was confirmed to be fed by the medial and the lateral posterior choroidal and the thalamo-perforating arteries bilaterally. The superior thalamic and the internal cerebral veins were displaced upwardly and the precentral cerebellar vein posteriorly. On Feb. 20, the tumor was totally removed via infratentorial-supracerebellar approach. Histological examination of the removed tumor disclosed that it was a "true" pineocytoma. The patient was discharged on Mar. 15 and has been free from signs and symptoms by the 4th postoperative month. Neither irradiation nor chemotherapy was added. Literature concerned are reviewed and brief discussion on pineocytoma done.     

Hemichorea-hemiballismus caused by lacunar infarction in the basal ganglia. A case report

Unilateral hemichorea-hemiballismus developed suddenly in a 60-year-old man. Computed tomography revealed a small area of low density in the region of the left anterior limb of the internal capsule and the head of the caudate nucleus which was consistent with a lacunar infarction. Haloperidol gradually abolished the symptoms within 7 days of their onset. No further choreoballistic movements were experienced. This report reveals that ballistic movements may occasionally be caused by lesions lying some distance from the subthalamic nucleus of Luys.     

A case of two staged operation of pericardial abscess after left-ventricular aneurysmectomy

A 54-year-old man who had undergone the left ventricular aneurysmectomy and double saphenous vein bypass grafting for the old myocardial infarction suffered from the pericardial abscess 6 years after the first operation. He was operated upon the persistent drainage of the lesion and returned to his daily life. Two years after the 2nd operation, he recognized pulsatile bleeding from the fistula and was admitted to our hospital. He underwent the radical operation for the cardio cutaneous fistula under the cardiopulmonary bypass. The post operative course was uneventful and he has continued to do well. We discussed the treatment for this kind of complication and stressed the limited usage of Teflon felt and other artificial materials.     

A case of Kallmann syndrome with bilateral calcifications at the basal ganglia

A twenty-year-old male with hematoemesis was transported to our department in an unconscious state. His past history was epilepsy in infancy and the evacuation of an undescended testis for cryptochidism at three years of age. His familial history included duodenal ulcers and amyotrophic lateral screlosis among his relatives on his father's side of the family. On arrival, he demonstrated a sleeping tendency regardless of his stabilized vital signs. He had experienced a delayed puberty. A head CT examination revealed bilateral calcification at both the globus pallidus, caudate nucleus and periventricular regions, and an endoscopic study showed a duodenal ulcer. An EEG depicted a 2 Hz spike and slow waves in the occipital areas. An endocrinological examination demonstrated a low value of free testosterone and follicle stimulating hormone (FSH). The FSH and luteinizing hormone (LH) both demonstrated a hypo-reaction to the LH-releasing hormone test. A head MRI revealed bilateral olfactory bulb aplasia while the venous olfactory test with thiamine propyldisulfide was negative. Accordingly, he was diagnosed to have Kallmann syndrome. A follow-up endoscopic examination exhibited an improvement in his ulcer and he was also discharged on the 13th hospital day. Kallmann syndrome should thus be included in the differential diagnosis when young individuals present with calcifications in the basal ganglia.     

Mixed germ cell tumor of the basal ganglia: A case report

A case of mixed germ cell tumor (germinoma and immature teratoma) of right cranial basal ganglia is presented. We followed the natural course for 8 months, and the change in his clinical, radiologic, and endocrinologic features was remarkable.     

Long-term survival case of esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis successfully treated by staged operation: A case report

IntroductionPatients with esophageal cancers including carcinosarcoma sometimes have underlying liver cirrhosis because of a history of heavy drinking. It is definitely required to determine the appropriate surgical strategy and to manage the patients promptly when performing esophagectomy for the esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis.Presentation of caseA 56-year-old male patient with a history of chest pain and difficulty swallowing was admitted to our hospital. He had a history of drinking 250 g of alcohol per day. Endoscopy revealed an irregular protruding tumor on the left wall of the lower-third thoracic esophagus. Computed tomography showed a tumor lesion in the lower-third thoracic esophagus; the images also showed irregularities on the surface of the liver, suggestive of coexisting alcoholic liver cirrhosis. The preoperative diagnosis was T3N2M0, Stage III esophageal leiomyosarcoma. In consideration of the underlying alcoholic liver cirrhosis, a staged operation was planned for this patient as a curative treatment. The patient had an uneventful postoperative clinical course and was discharged on the 47th day after the first surgery. Final histopathological diagnosis was T2N0M0, Stage II esophageal carcinosarcoma. The patient is alive without recurrence three years after surgery.DiscussionThis is the first report of long-term survival case of esophageal carcinosarcoma with alcoholic liver cirrhosis that was treated successfully by staged operation.ConclusionsDespite coexisting with alcoholic liver cirrhosis, staged operation could reduce the surgical invasiveness, so that very good short-term outcome and long-term survival was obtained in the patient with esophageal carcinosarcoma.     

One-stage unifocalization followed by staged Fontan operation

We report a successful case of staged Fontan operation for single ventricle, pulmonary atresia, major aortopulmonary collaterals and absent central pulmonary artery. The one-stage unifocalization, concomitant with central pulmonary artery creation by autologous pericardium and modified Blalock-Taussig shunt at 1 month of age as the first palliation, and the Glenn operation and pulmonary arterial augmentation with superior vena caval patch at 9 months of age as the second palliation were performed. Extracardiac conduit Fontan operation was completed at 22 months of age. The pulmonary artery continued developing with increasing pulmonary arterial index and stable pulmonary arterial pressure throughout the clinical course. The one-stage unifocalization in early infancy and the repeated surgical intervention to the pulmonary artery without prosthetic material provided excellent pulmonary arterial growth and Fontan completion.     

A case of embryonal carcinoma arising in the basal ganglia of the cerebrum]

The occurrence sites of intracranial primary germ cell tumors are most often the pineal and suprasellar regions. The histological type observed most frequently in these tumors is germinoma. Cases of embryonal carcinoma arising in the basal ganglia are rarely reported. To our knowledge, only 4 such cases have been previously reported in the literature. A case of an embryonal carcinoma arising in the basal ganglia is reported. A 17-year-old boy was admitted to our hospital on July 30, 1988 because of headache and vomiting, and a right hemiparesis. On admission, physical inspection showed no abnormalities and neurological examination revealed obtunded consciousness, a right central facial paresis and a right hemiparesis with Hoffman and Babinski reflexes. Noncontrast CT scan showed a large mass of low-to slightly high-density in the region of the left basal ganglia accompanied with midline shift and ventricular dilatation. Enhancement of the lesion was made by contrast CT scan. It was not homogeneous. Cerebral angiogram displayed a contralateral shift and an unrolling of the anterior cerebral artery, a lateral stretch of middle cerebral artery, a downward stretch of anterior choroidal artery and a tumor stain fed by the Heubner artery. On August 3, left frontotemporal craniotomy was performed. The tumor was totally removed in a piecemeal manner using microsurgical techniques. Histopathological diagnosis was mixed-type of germ cell tumor comprising embryonal carcinoma and teratoma. Postoperative CT scan showed complete disappearance of the tumor. A course of radiation of 4950 rads and two courses of a combination chemotherapy with cis-platinum, vinblastine and bleomycin were given within 3 months after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)     

微创手术治疗重型高血压基底节区脑出血

目的探讨应用经侧裂微侵袭入路治疗重型高血压基底节区脑出血的临床效果. 方法微创组28例,采用经侧裂微侵袭入路手术;对照组26例,采用传统血肿清除术治疗.比较2组近期(1个月)和远期(6个月)的疗效. 结果在重型高血压基底节区脑出血救治方面,微创组的近期优良率53.6%(15/28)和病死率17.9%(5/28),与对照组近期优良率46.2%(12/26)和病死率15.4%(4/26)比较无明显差异(χ2=0.297,P=0.586;χ2=0.000, P=1.000).但微侵袭组的远期存活患者的生存质量ADL Ⅰ～Ⅲ级(63.2%,12/19)优于对照组(23.6%,4/17)(z=-2.189,P=0.029). 结论微侵袭手术治疗重型高血压基底节区脑出血较传统血肿彻底清除术,能提高患者术后存活的生活质量,值得推广.     

A case report of total aortic reconstruction and choice of staged operation in Marfan syndrome]

A 37-year-old man with Marfan syndrome underwent four operations for extensive cardiovascular disease. He was diagnosed as having AAE, AR and DeBakey type I aortic dissection. First, Bentall operation using Piehler procedure and total aortic arch replacement using retrograde cerebral perfusion and profound hypothermia at 18 degrees C were performed on May 11, 1994. Second, repair of leakage of the right coronary artery anastomosis and grafting for the descending thoracic aortic aneurysm were performed on December 3, 1994. Y-type grafting for the AAA was performed on December 21, 1996. Last, grafting for TAAA was performed under hypothermia at a rectal temperature of 20 degrees C on November 17, 1997. This surgical strategy of staged operation for extensive cardiovascular disease in Marfan syndrome is an effective method. Regular follow-up by CT is necessary for deciding the time and method of reoperation.     

A meningioma associated with AVM: a case report

This paper reports a case of meningioma associated with AVM. A 67 years old lady showed transient rt. lower hemiparesis with severe headache, nausea and consciousness disorder. Bilateral carotid angiogram and CT scan revealed lt. convexity meningioma and AVM. Lt MCA and ACA entered into the AVM from which several draining vessels entered into the deep venous system. These two lesions were removed by one stage. It is quite rare that cerebral tumor associates with intracranial AVM. Only two cases of meningioma associated with AVM have been reported.     

Encapsulated chronic intracerebral hematoma caused by venous angioma of the basal ganglia: a case report

A case is reported of venous angioma at the right basal ganglia simulating the encapsulated chronic intracerebral hematoma. A 29-year-old man was admitted to our hospital on July 14, 1988 with a two-month history of headache. Neurological examination revealed left homonymous lower quadrantic anopsia. CT scans showed a mosaic high density lesion at the right basal ganglia with extensive adjacent edema. MRI revealed that the high density lesion on CT scans was the combination of a reticulated core of mixed signal intensity with a surrounding rim of decreased signal intensity. The lesion was accompanied with extensive edema. Followed up CT scans showed the transformation of the lesion and ring-shaped enhancement. A right frontotemporal craniotomy was performed on August 9, 1988. After thorough dissection of the sylvian fissure and small corticotomy to the insula, a tough capsule was seen. There was blood in various stages of organization in the capsule. A histological examination gave a diagnosis of venous angioma in the membrane similar to the outer membrane of chronic subdural hematomas. Postoperatively, the patient showed slight left motor weakness, but it gradually improved and he was discharged on foot, on October 19, 1988. There have been a lot of reports about angiographically occult intracranial vascular malformation (AOIVM). But AOIVM at the basal ganglia is rare, and to our knowledge, only 8 cases have been reported. In our case, the presence of adjacent extensive edema, and ring-shaped enhancement on CT scans confused the preoperative diagnosis. Those findings might have been caused by encapsulation. By using CT scans and MRI, a complete and accurate diagnosis was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)     

A large AVM extensively involving the parietal region and posterior fossa

A 47-year-old male was concerned with a large AVM involved extensively in the parietal region and the posterior fossa. Radiological examinations showed multiple radiolucencies in the parietal and occipital bone and torturous vascular nets (nidus) in those bones on the angiograms. Nidus was found also in the dura mater in the posterior fossa. Therefore, this case seemed to be an extremely rare case of calvarial AVM in the parietal region with the mixed calvarial dural AVM in the posterior fossa. His symptoms were bruit, transient hemiparesis and Gerstmann's syndrome in addition to the symptoms due to raised intracranial pressure. Favorable results of therapies could be attained by extensive exfoliation of dura mater from the cranial bone and incision of proximal dura mater in the sinus.     

Ectopic mediastinal thyroid removed by U-VATS approach. A case report

IntroductionEctopic thyroid tissue is a rare entity, and accounts for approximately 1% of all mediastinal tumours. It is a differential diagnosis of the mediastinum tumors or metastatic deposits from an orthotopic gland, as well as other benign or malignant masses. Although most cases are asymptomatic and discovered incidently by imaging, symptoms related to tumor size and its compression of adjacent structures may also appear which necessites explorations and lead to diagnosis.Case presentationThis is a 59-year-old women, followed for glaucoma and operated for bilateral congenital cataract reffered to our structure by the service of pnemology for a right laterotracheal mediastinal mass. The patient presented respiratory symptoms over four months, and the physical examination found patient in good condition with PS 0 and normal vital signs, a poor oral health was noticed. The CT scann showed a left basal opacity and a right laterotracheal mediastinal mass at the upper right mediastinum, pushing forward the superior vena cava and compressing the trachea on the contralateral side, with well-defined borders and without signs of infiltration of adjacent structure. The brochoscopy was perfomed which showed the yellowish granulous aspect and the pathophysiology revealed a pulmonary actinomycosis. The patient was treated with antibiotic based on parenteral infusion of penicillin G at 20 million / day for 6 weeks relayed by oral administration of 3 g / day for 3 months with a good response and the left basal opacity disappeared on the CT control but the mediastinal mass persisted. After multidisciplinary concertation, the mediastinoscopy was perfomed and has revealed an ectopic thyroid which was removed by Uniportal Videoassisted Thoracoscopic Surgery (U-VATS) approach.DiscussionThe first case of ectopic thyroid gland was described by Hickman in 1869, since a few cases have been reported by the literature. Its prevalence is about 1 per 100 000–300 000 people, rising to 1 per 4000–8000 patients with thyroid disease. The main techniques indicated in the management of undetermined lesions of the anterior mediastinum, are midline exploratory sternotomy, anterior lateral thoracotomy and VATS. U-VATS has demonstrated its feasibility and safety compared to conventional techniques by several advantages.ConclusionEctopic mediastinal thyroid is an unusual presentation of thyroid pathology. Complete surgical resection remains a therapeutic and a key diagnosis. The aim of this study is to prouve the feasibility, efficiency and efficacity of U-VATS approach as minimally invasive thoracic surgery for mediastinal mass resection.     

Evaluation of invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas

BACKGROUND: The aim of this study was to evaluate the invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas (LBGHs). METHODS: The invasiveness and efficacy of the temporal (15 cases) and the frontal (15 cases) microsurgical keyhole approach were retrospectively evaluated in 30 early-operated patients with LBGH, using recorded neuronavigation data. Invasiveness was assessed calculating the angles of brain retraction and the volume of brain exposed to surgery. Reduced invasiveness was related to a fall of these values. Efficacy was evaluated by comparing the volume of microscopically visualized clot and the largest hemorrhage diameter exposed with the 2 different keyhole approaches. Increased efficacy was related to a rise in these parameters. All estimations were correlated to the volume of residual clot detected on postoperative computed tomography scan. RESULTS: The comparison between both approaches revealed a significant reduction of invasiveness (smaller angles of brain retraction [P<.001] and reduced brain exposition [P<.001]), as well as a raised efficacy (increased volume of visualized clot [P<.001] and largest hemorrhage diameter exposed to surgery [P<.001]) for frontally approached LBGH. These patients showed less postoperative residual hematomas (P<.05). Residual clots were correlated to the evaluated brain retraction (P<.001) and volume of brain (P<.001), as well as volume of clot surgically exposed (P<.05). CONCLUSION: We conclude that the frontal approach to LBGH leads to less invasiveness and higher efficacy as evaluated by using neuronavigation data. This approach shows a reduced number of patients with residual postoperative clots.     

A case of pulmonary carcinoma removed safely from SVC by using CUSA

A 50-year-old man, who had his medical history of right pulmonary tuberculosis, was pointed out an abnormal shadow in the right upper mediastinum on the chest X-ray. Chest CT scan demonstrated a large tumor mass that was suspected to make partial invasions upon the great vessels (SVC and right PA). We could perform a safety removal of the tumor from the great vessels without perforation of vessels by using CUSA. The output of CUSA was set up 20-30% of the maximum (amplitude; 60-90 microns). The tumor came from rS2 and rS3 and was large cell carcinoma. Nevertheless taking a time, CUSA is a useful device for a bleeding-less tumor removal.