Brain metastases are a leading cause of morbidity and mortality for patients with systemic cancer and are among the most common intracranial tumors in adults. Its incidence increases as cancer therapies improve, and patients live longer, providing new challenges to the multidisciplinary teams that manage these patients. The contemporary neurosurgical treatment of intracranial metastases has become gradually more complex as the available therapeutic options increase. For the past 50 years, whole brain radiotherapy and systemic corticosteroids have been considered as the standard of care for patients with brain metastases. However, in recent years, stereotactic radiosurgery is spotlighted as an alternative therapeutic modality for these patients because of its relatively short, convenient, and non-invasive treatment course. Stereotactic radiosurgery is a radiation therapy technique in which multiple focused radiation beams intersect over a target, which results in the delivery of highly conformal, high-dose of radiation to the target and minimal radiation to surrounding normal parenchyma. The purpose of this review is to provide an overview of stereotactic radiosurgery as a treatment modality for patients with brain metastases.
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, Kee Duk Park, Kyoung Gyu Choi To observe the developmental maturation of brainstem auditory evoked potential(BAEP) for neonates by obtaining the normative data of each BAEP component in our own electrophysiological laboratory.
We reviewed 129 BAEP recordings in neonates ranging in gestational age from 33 weeks to 44 weeks. The BAEP recording were analyzed into latency(wave I,III,V), interpeak latency(I-III,III-V,I-V) and amplitude ratio(I/V) at 75dB sensation level clicks according to gestational age.
The latencies of each BAEP component decreased with maturation. Interpeak latency of waveI-V(central conduction time)also decreased with increasing age during 33-40 weeks of gestational age.
These results provided the concept of abnormal in neonatal BAEPs and opportunity of functional evaluation about the auditory or brainstem maturation in pathologic conditions.
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, Jun-Hyeok Song, Myung-Hyun Kim The approaches for skull base lesions should allow excellent visualization, minimized working distance and avoid brain retraction. We consider the supraorbital approachto be the approach of choice for orbital, anterior and middle cranial fossae lesions. Thetechnique of procedure is described and reviewed its advantages.
the authors reviewed the eleven cases which were operated bysupraorbital approach and one case which were operated by supraorbital bifrontal approach,from May 1992 to May 1996.
Eleven patients(four cases of tuberculum sellae meningiomas, one case of pituitarymacroadenoma, two case of suprasellar germinoma, one case of cavernous hemangioma in theorbit, two cases of huge size of craniopharyngiomas, one case of optie and oculomotor nervepalsy due to compound fiacture of orbit) were cured or improved with the supraorrbtal andsupraorbito-bifrontal approsch. But one case of suprasellar germinoma died.
The supraorbital approach is preferred in lesions of orbital, anterior and middlecranial fossae, because it minimize brain retraction, shorten the distance of the target of lesionsand provide multiple pathways for dissection of the lesions. Also this approach may combinewith other skull base approaches.
, Eun Chul Chung The cavernous malformation is increasingly recognized as a vascular malformation of the brain that presents with seizures, hemohhage, or neurologic deficit. We have identified 24 lesions in 12 patients that were diagnosed cavernous malformation of the brain based on the findings of follow-up magnetic resonance image and sugical biopsy. The location of the lesions were the supratentorial area in 20 and infratentorial area in 4. Ten lesions were seen at the periventricular white matter. Combined venous angioma was noted in 4 patients. The appearance of the lesions classified by signal intensities on MRI was divided into reticular pattern in 11, punctate pattern in 9, hematoma pattern in 3, and cystic pattern in one. Recent hemorrhage was identified at 9 lesions that classified into extralesional type in 5 and intralesion type in 4. Among 9 hemorrhagic lesions, eight lesions were located at the periventricular white matter and six lesions showed reticular patterns. We concludedthat the correlation between the evidence of recent hemorrhage and location and pattern of the lesions should be evaluated to predict possibility of rebleeding of the cavernous malformation.
The clinical value of three-dimensional time-of-flight magnetic resonance angiography(MRA)was retrospectively evaluated in 23 patients with arteriovenous malformations(AVM) in 8 and aneurysms in 15 cases. MR angiogram were compared with conventional angiogram(CA) in all cases. The topography of the AVM nidus and feeding artery were equally well appreciated on the MRA as on the conventional angiogram except one of nidus that was obscured by methemoglobin stated hematoma. Howevere, in four of 8 AVM, the draining veins were incompletely shown on MRA because of slow flow effect or out of field of view. In cases of aneuryms, all were equally depicted on MRA as on the conventional angiogram. But, the neck of aneurysm was more better shown on MRA than CA. MR angiography reliably depict intracranial vascular lesions, especially aneurysm and arteriovenous malformation.
The present study was conducted to compare the MMPI profile of 29 Posttraumatic StressDisorder patients with 25 Organic Brain Affective or Personality Disoder patiene who were admitted to Ewha Womans University Hospital from March to August of 1995. MMPI-R(Minnesota Multiphasic Personality Inventory), consisted of 556 items and of the revised standard form, was administered to the subjects. No significant difference was found between thetwo groups in age, sex, and education level.
Results of the present study were as follows :
1) Two subgroups were formed as a result of multivariate cluster analysis of T scores of allMMPI scales from the Posttraumatic Stress Disorder group. The first sub-group (N=22) showed moderate high socre on 3-1-2, 7-8 scales. The second sub-group (N=7) presented severehigh score on F validity scale and all clinical scale exept 5 scale so the t scores of 8-6-7,1-2-3-4scales were within 65-80.
2) Two subgroups were formed as a result of multivariate cluster analysis of T scores of allMMPI scales from the Organic Brain Affective or Personality Disorder group. The first subgroup (N=8) gave mild high score on K scale and on no clinical scales. The second sub-group(N=17) presented moderate high score on F scale and on 1,2,3,6,7,8 scales.
3) Exept for the defensive groups, it was found that F,6 scales and 3 scale were useful to differntiate the Posttraumatic Stress Disoders from the Organic Brain Affective or Personality Disorders.
4) The results suggest that MMPI is useful to differentiate the Posttraumatic Stress Disodersfrom the Organic Brain Affective or Personality Disorders.
The effect of high dose of glucocorticoid in acute spinal cord injury has been well proved experimentally and clinically. In addition, the beneficial effect of steroids in cerebral vasogenic edema has been well documented and clinically steroids are now a part of the treatment of intracranial neoplasms. Consequent trials of high dose steroid therapy in CNS injury have been proved its ineffectiveness or adverse effecis in clinical and experimental studies. Also, dexamethasone treatment in hypoxic-ischemic brain damage in rats showed adverse effects on neurons in most of the studies in adult and immature rats, except one report which showed neuroprotective effects of dexamethasone pretreatment in 7-day-old immature rats.
This study was designed to see if there was same neuroprotective effect in adult rat since no previous experiments used same amounts of steroid at this time intervals. Hypoxic-ischemic injury was induced in adult Sprague-Dawley rats, 150~240 gms, by Levine procedure with some modification (left carotid artery ligation and exposure to 8% oxygen-92% nitrogen gas for 2 hours). The animals were divided into four groups and dexamethasone was injected as follows : (I) hypoxic-ischemic control group without dexamethasone injection(n=16) ; (II) 0.5mg/kg i.p. 3 times, 48 and 24 hours, and immediately before the carotid artery ligation and 8% oxygen treatment(n=16) ; (III) 2.0mg/kg at same time with (II) (n=14) ; (IV) 1.0gm/kg 3 times at immediately after, 24 and 48 hours after the procedure(n=20). The neuropathological changes were interpreted 7 days after the procedure.
The results are summarized as follows :
1) In hypoxic-ischemic control group(I), 5 out of 16 rats(31.3%) of rats showed large infarction involving ipsilateral side of the brain and other 4~5 rats showed severe neuronal damage in anterior and posterior cortex, hippocampus, striatum, and thalamus.
2) Compare to control group, dexamethasone 0.5mg/kg 3 times pretreatment group(II) showed similar neuronal damage in all areas, although the infaction was focal in striatum and thalamus in group II and generalized in group I. The changes were not statistically significant.
3) Group III showed no significant difference from groups I, II, and IV.
4) Group IV showed more neuronal damage in CA1-2 area of hippocampus compare to groups I and II(p<0.01, p<0.005, respectively).
5) Mortality rate was not significantly different between groups.
In conclusion, dexamethasone pretreatment did not improve hypoxic-ischemic neuronal damage in adult rats. Dexamethasone posttreatment aggravated neuronal damages in CA1-2 area of hippocampus compare to control and pretreatment groups.
, Sun Ho Chee The authors describe a case of the brain abscess in the left temporal lobe which was accurately diagnosed by computerized tomography brain scan and complete surgical excision of abscess capsule was accomplis with great success. SUMMARY The case presented by authors was otogenic in origin and diagnosed accurately by the computerized tomographic scan, and total excision of the abscess capsule was performed by two stage operation.
, Do Sang Cho, Sung Hak Kim, Dong-Been Park 
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