Twelve cases of brainstem gliomas are reviewed in this report. Ten of these cases were patients with diffuse pontine glioma, while the other 2 were medullary tumors. The mean age of the patients at the time of diagnosis was 27years. Eight of the patients were adults and 4 were children. Overall, the median time to progression was 26 weeks and the median survival time was 71 weeks. Eleven patients who had died at the time of their last follow-up were divided into 2 groups based on the median survival time : 1) Long-term survivors (LTS), or patients who survived more than 71 weeks after the initial diagnosis, and 2) Short-term survivors (STS), or patients who survived 71 weeks or less than 71 weeks after the initial diagnosis. There were some features differentiating the LTS and STS groups. As to the patient's age, 5 of 7 adult patients were LTS and all of the child patients were STS. Of the 6 patients who had enhanced lesions in their initial CT/MRI, 5 of them were STS. Five of the 6 patients whose symptoms had a duration of more than I month were LTS. On the other hand, All the 5 patients with a duration of symptoms of less than 1 month was STS.

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We investigated usefulness of Spetzler chemically pure titanium clip during aneurysmal surgery in view of handling ease and influence on postoperative neuro-imaging. Aneurysm clipping was performed in seven patients using Spetzler clips. Handling ease was comparable to that of the Sugita cobalt alloy clip, as there were no difficulties experienced with aneurysm clipping in any patients. Metal artifact with postoperative neuro-imaging, especially MRI, was little and did not increase with a higher magnetic field (1.5 tesla). On postoperative MR angiographic (MRA) images, however, small defects in the surrounding parent arteries of the aneurysms were found, even with the chemically pure titanium clip. As a result, evaluation with MRA for aneurysm obliteration after surgery was inaccurate. We conclude that the Spetzler chemically pure titanium clip is an excellent choice for aneurysmal surgery in view of its handling ease and influence on postoperative MRI, although aneurysm obliteration should be evaluated using conventional cerebral angiography, because of a small defect on the MRA image caused by the clip.

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We report a case of human chorionic gonadotropin (HCG) -producing germinoma in the basal ganglia with precocious puberty. A nine-year-old boy was admitted with headache, vomiting, left hemiparesis, and precocious puberty. On admission, the serum HCG level was 90 mIU/ml. Computed tomography and magnetic resonance imaging revealed a mass in the right basal ganglia. A stereotactic biopsy was performed. Based upon the histological examination and the elevated serum HCG level, the tumor was diagnosed as a HCG-producing germinoma. The patient received chemotherapy with ifosfamide, cisplatin, and VP-16, followed by extended local irradiation (24Gy). The tumor almost disappeared, and the serum HCG level normalized. In this case, precocious puberty appeared with LH-like activity as a result of the HCG produced by the tumor.

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Kissing aneurysms pose various problems when neck clipping of them because they often partially adhere to each other. On the other hand, it is not easy to treat a patient suffering from subarachnoid hemorrhage (SAH) with a serious vasospasm. A 41-year-old female presented with SAH due to a ruptured aneurysm originating from the left internal carotid-posterior communicating artery (IC-PcomA). She also had an unruptured aneurysm arising from the bifurcation of an ipsilateral internal carotid-anterior choroidal artery (IC-AchA). Intraoperative findings revealed that these were kissing aneurysms. An intentionally delayed operation (neck clipping of aneurysms) was performed due to her symptomatic vasospasm. She was discharged with right hemiparesis. In this paper, we would like to emphasize the rarity of kissing aneurysms and the difficulty in diagnosis and management of such cases.

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A case of dural arteriovenous fistula (AVF) in the anterior cranial fossa associated with intracerebral hemorrhage in the temporal lobe is reported. A 66-year-old man was hospitalized because of aphasia of sudden onset. Computerized tomography disclosed a left temporal intracerebral hematoma. Angiography revealed dual AVF in the anterior cranial fossa, fed by the left anterior ethomoidal artery, and draining into both the superior sagittal sinus via cortical veins and the basal vein of Rosenthal via the left olfactory vein. The intracerebral hematoma was surgically evacuated and the draining vein was disconnected uneventfully. Postoperative angiography revealed complete obliteration of the dural AVF. The patient was discharged without any neurologic deficits. Dural AVF in the anterior cranial fossa usually presents with intracranial hemorrhage. Association with temporal lobe hematoma is very rare and a possible mechanism for it is discussed.

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We report a unique case of an intradiploic epidermoid cyst in the left parietal bone in a 25-year-old woman. A craniogram showed two osteolytic lesions in the left parietal bone. CT revealed two seperated masses with destruction of the parietal bone extending from the inner to the outer table. The masses were shown by MRI as hypointensity on the T1-weighted image and as hyperintensity on the T2-weighted image. Based on these findings, a preoperative diagnosis of diploic epidermoid cyst was made. The patient underwent surgery and two tumors, which were consisted of a white cheesy material and which extended into the scalp by eroding the outer table, were totally removed. The pathological diagnosis was an epidermoid tumor. The patient was discharged 15 days after the operation in good condition.

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