Immunohistochemical Examination of Meningioma

Immunohistochemical characteristics were examined in 76 cases of primary meningioma, 10 cases of recurrent meningioma, 3 cases of hemangiopericytoma and 2 cases of meningeal sarcoma. Six antibodies, those against epithelial membrane antigen, vimentin, cytokeratin, S-100 protein and alpha-1-antitrypsin, and 80-90% for neuron-specific enolase. Cytokeratin was negative in all cases. In recurrent meningioma, positivity rates for viementin were slightly lower in comparsion with promary meningioma. The man staining patterns of epithelial membrance antigen, vimentin, S-100 protein and alpha-1-antitrypsin were diffuse and that of neuron-specific enolase was focal. In hemagiopericytoma and meningeal sarcoma, epithelial membrane antigen and cytokeratin were negative and the other antigens were positive. Positivity for epithelial membrance antigen is thus of some use in distinguishing meningioma from hemagiopericytma or meningeal sarcoma. However vimentin, S-100 protein, neuron-spcific enolase and alpha-1-antitrypsin are not specific

Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve

Successful neuroendoscopic treatment of intraventricular brain abscess rupture

Intraventricular rupture of a brain abscess is still associated with a high mortality rate. Here, we report such a case in a patient with normal immunity that was treated successfully using neuroendoscopic approach. A 69-yearold man who had presented with headache and fever developed confusion and restlessness. Magnetic resonance imaging revealed a mass with ring enhancement extending to the right ventricle. Emergency aspiration of cerebrospinal fluid (CSF) from the spinal canal revealed severe purulent meningitis. Bacterial culture of the CSF and blood was negative. Because of prolonged consciousness disturbance, the patient underwent evacuation of the intraventrcular abscess using a neuroendoscope. The pus was centrifuged and collected for bacterial culture, and this revealed Streptococcus intermedius/milleri. After implantation of a ventricular catheter, gentamicin sulfate was administered twice a day for 9 days. Cefotaxime sodium was also administered intravenously for 14 days, followed by oral administration of cefcapene pivoxil hydrochloride for 10 days. The patient made a complete recovery, and was discharged 31 days after admission. After 20 months of follow-up, he is doing well and has returned to his work. In cases of intraventricular rupture of a brain abscess, a neuroendoscopic approach is useful for evacuation of intraventricular debris or septum, and identification of the causative bacterium for selection of antibiotics, possibly reducing the period of hospitalization