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Authors report five patients(four males and one female, aged 28-54 years) with intracranial meningioma in which ^(60)Co-irradiation produced a beneficial effect. Radiation was delivered over periods from 39 to 51 days with a total dose of 5000 to 5500ccGy. Irradiation alone was performed in two patients including one recurrent case ; irradiation followed by surgery in one, and postoperative irradiation for the residual tumor in two. Histopathological examination was one in four cases and none of them were malignant or hemangiopericytic type. Two cases of highly vascular tumors showed marked shrinkage of the tumor after irradiation. Another highly vascular meningioma showed decrease of the tumor vascularity and degree of contrast enhancement in magnetic resonance image(MRI). One recurrent case developed a prominent cystic change suggesting development of tumor necrosis due to irradiation and the tumor growth has been arrested for one year after irradiation. In one patient with a cavernous sinus meningioma, the tumor with progressive growth after incomplete resection showed a definite decrease in its size. With these observations, it is suggested that; 1) benign meningiomas may develop marked shrinkage, cystic change or decreased vascularity in response to irradiation ; 2) there is a tendency that irradiation may be helpful for the operation on highly vascular meningiomas ; 3) in patients with a high surgical risk, irradiation alone may be performed to obtain reduction of the tumor volume or arrest of growth ; 4) preoperative irradiation may facilitate surgical removal of the tumor by reducing amount of intraoperative bleeding even in benign meningiomas ; 5) as a role treatment or a preoperative adjuvant therapy, irradiation should be considered in patients who are not favorable candidates for operation or radiosurgery.
In order to identify the risk factors for shunt dependency and to select the optimal treatment modality of hydrocephalus in medulloblastoma patients, fifty two patients with medulloblastoma, who were treated at Seoul National University Hospital from 1982 to 1% were reviewed. Retrospectively the authors analyzed the types of treatment and the results in the fifty patients of hydrocephalus associated with medulloblastoma. Two cases of perioperative death were excluded from the statistical analysis. The initial management of hydrocephalus in 50 patients included 1) ventriculoperitoneal shunt(WS) before the removal of tumor in 6.2) external ventricular drainage(EM)> before the removal of tumor in 4, 3) intraoperative ventricular puncture and placement of EVD or internalized reservoir(IVD, internalized ventricular drainage) for continuous or intermittent cerebrospinal fluid(CSF) drainage postoperatively in 29.4) no procedures of CSF drainage before or during the operation for tumor removal in 11. Among the 44 patients in whom preoperative VPS was not inserted. 16 finally required permanent VPS after tumor removal and 28 remained shunt-free. Factors which might predict the need for permanent VPS were analyzed and tested statistically. The presence of symptoms and signs of increased intracranial pressure, the severity of hydrocephalus on computerized tomography (CT), T and M stage, and the type of initial management of hydrocephalus were not statistically significant factors influencing the shunt dependency. The only two statistially sigmfkant features predicting the need for a subsequent permanent shunt were : 1) incomplete tumor removal(p=0.025) and 2) postoperative hematoma in the fourth ventricle(p=0.004). Among the 11 patients without preoperative or intraoperative EVD, 4 required shunt placement after tumor removal. of which 3 needed urgent placement of EVD. Preoperative or intraoperative EVD could have played a role as a safety mechanism in those patients. On the other hand. the preoperative or intraoperative EVD did not enhance the rate of infection or shunt dependency. In the cases of ventricular installations for CSF drainage, simple externalization of ventricular catheter and postoperative continuous CSF drainage(EVD) seemed to be associated with a lower rate of infection compared with the method of postoperative intermittent puncture and drainage through the internalized reservoir(IVD), but the difference of infection rates between the two groups were statistically insignificant(p=0.557). The average duration of CSF drainage in the externalized EVD group was shorter than that of internalized reservoir group(5.4 versus 10.7 days). In conclusion 1) the preoperative or intraoperative EVD is useful as a safety mechanism while it dose not enhance the possibilities of shunt dependency and infection, 2) for the patients in whom the placement of subsequent permanent shunt is highly expected the EVD with the internalized reservoir can be a good choice. An algorithm for the management of hydrocephalus was suggested.