The incidence and risk factors of symptomatic and asymptomatic hyponatremia were investigated in 94 patients who underwent transsphenoidal surgery and serum sodium level monitoring between January 2002 and December 2006. The records were retrospectively reviewed to determine the incidence and risk factors (age and sex, tumor size, endocrinologic findings) of hyponatremia. Postoperatively, the serum sodium levels of the patients were measured at least once within 2 or 3 days. Hyponatremia was found in 17 of the 94 patients, of whom 7 became symptomatic. The mean sodium level of symptomatic patients with hyponatremia at diagnosis was 123.5 mEq/l, compared with 129.8 mEq/l of asymptomatic patients. The serum sodium levels began to fall on mean postoperative day 7 and reached nadir on mean day 8. All 17 patients with hyponatremia were treated with mild fluid restriction. Four symptomatic patients with severe hyponatremia were treated with 3% hypertonic saline infusion in addition to fluid restriction. One symptomatic patient with severe hyponatremia was treated with fluid restriction only. All patients recovered within 5 days of management. Sex, tumor type, and tumor size did not correlate with development of delayed hyponatremia, but patients aged AE50 years were more likely to develop hyponatremia. Postoperative hyponatremia after transsphenoidal surgery is more common than previously reported and may lead to fatal complications. Therefore, all patients should undergo serum electrolyte level monitoring regularly for at least 1 or 2 weeks after transsphenoidal surgery.

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Ginsenoside is known to have potential cancer-preventive activities. The major active components in red ginseng consist of a variety of ginsenosides including Rg3, Rg5 and Rk1, each of which has different pharmacological activities. Among these, Rg3 has been reported to exert anticancer activities through inhibition of angiogenesis and cell proliferation. However, the effects of Rg3 and its molecular mechanism on glioblastoma multiforme (GBM) remain unclear. Therefore, it is essential to develop a greater understanding of this novel compound. In the present study, we investigated the effects of Rg3 on a human glioblastoma cell line and its molecular signaling mechanism. The mechanisms of apoptosis by ginsenoside Rg3 were related with the MEK signaling pathway and reactive oxygen species. Our data suggest that ginsenoside Rg3 is a novel agent for the chemotherapy of GBM.

Abstract. Allicin, the main flavor compound in garlic, has anti-carcinogenic activities in a range of cancer cells, however, the underlying molecular mechanisms are not completely understood. This study examined the effect of allicin on the cell viability of U87MG human glioma cells along with its molecular mechanisms of induction of cell death. Apoptosis was determined by TUNEL and Hoechst 33258 staining as well as by western blot analysis. Allicin inhibited the cell viability of U87MG human glioma cells in a dose-and time-dependent manner. Allicin-induced inhibition of cell viability was due to apoptosis of cells. The mechanisms of apoptosis were found to involve the mitochondrial pathway of Bcl-2/Bax, the MAPK/ ERK signaling pathway and antioxidant enzyme systems. These results suggest that allicin can serve as a novel chemotherapeutic candidate for the treatment of glioblastoma multiforme.

Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and it commonly spreads by direct extension and infiltration into the adjacent brain tissue and along the white matter tract. The metastatic spread of GBM outside of the central nervous system (CNS) is rare. The possible mechanisms of extraneural metastasis of the GBM have been suggested. They include the lymphatic spread, the venous invasion and the direct invasion through dura and bone. We experienced a 46-year-old man who had extraneural metastasis of the GBM on his left neck. The patient was treated with surgery for 5 times, radiotherapy and chemotherapy. He had survived 6 years since first diagnosed. Although the exact mechanism of the extraneural metastasis is not well understood, this present case shows the possibility of extraneural metastasis of the GBM, especially in patients with long survival.

ObjectiveAlthough standard method has not been established for the chronic subdural hematoma (CSDH), burr-hole trephination and closed system drainage with or without irrigation has been widely accepted as the treatment of choice. The aim of this study is to analysis the post-operative recurrence rates after burr-hole trephination of the CSDH according to the conduction of irrigation.MethodsWe retrospectively reviewed 184 patients with CSDH who underwent surgical treatment between January 2009 and December 2013. And 152 patients fulfilled the inclusion criteria as follows: 1) CSDH diagnosed on computed tomography (CT), 2) unilateral hematoma, 3) burr-hole trephination with closed system drainage, and 4) follow-up CT for at least 3 months. Those patients were divided into two groups. Group A (n=38) underwent burr-hole trephination without irrigation, and Group B (n=114), burr-hole trephination with saline irrigation.ResultsThe overall post-operative recurrence rate was 19.1% (n=29) in this study. The majority of recurrence showed in Group B. Twenty-eight patients (24.6%) of Group B had recurrence and only 1 patient (2.6%) of Group A showed recurrence. The recurrence rate was significantly higher in Group B compared with Group A (p=0.003). Another affecting factor for the recurrence was the amount of postoperative pneumocephalus (p=0.02). No catastrophic complications were found in postoperative course.ConclusionAlthough there was no difference of clinical outcome in both groups, the recurrence rate was higher in saline irrigation group compared with no irrigation group. We suggest that saline irrigation procedure be reserved only for selected cases in CSDH burr-hole surgery.

This prospective study was performed to determine the efficacy, safety, and tolerability of concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy with temozolomide (TMZ) in the treatment of patients with WHO grade III gliomas. Thirty-three adult patients with WHO grade III glioma and aged >17 years were enrolled from three institutions between 2003 and 2008. The median age was 41 years (range, 17-60 years). The pathological diagnoses were anaplastic astrocytomas in 21 patients and anaplastic oligodendrogliomas in 12 patients. The preoperative Karnofsky performance scale score was >60 for all patients. The patients received fractionated focal irradiation in daily fractions of 2 Gy administered five days per week for six weeks, for a total of 60 Gy, in combination with continuous daily TMZ, followed by six cycles of adjuvant TMZ. The median dose of radiotherapy was 59.4 Gy (range, 28.8-61.2 Gy) and the duration of CCRT was 7.0 weeks (range, 3.1-8.3 weeks). A median of 6.2 cycles (range, 2-12 cycles) of TMZ chemotherapy were performed during the period of adjuvant chemotherapy. The response rate was 61% and the tumor-control rate was 82%. Mean progression-free survival (PFS) was 48.7 months (95% CI, 36.0-61.4) and the 12, 24, and 36-month PFS was 74%, 60%, and 50%, respectively. Mean overall survival (OS) was 66.4 months (95% CI, 56.4-76.4) and the 12 and 24-month OS was 97% and 77%, respectively. The extent of surgical resection was a significant prognostic factor for PFS and OS (hazard ratio, 0.24; 95% CI, 0.02-0.73; and hazard ratio, 0.12; 95% CI, 0.01-0.88, respectively; P < 0.001). However, there was no significant difference in the PFS and OS of patients regarding loss of heterozygosity in chromosomes 1p and 19q and methylation of O (6)-methylguanine-DNA methyltransferase promoter, because of the small number of patients available. Only five cases (15%) receiving CCRT with TMZ and three cases (9%) receiving adjuvant chemotherapy had hematological toxicity greater than grade 3. All these patients, however, tolerated the therapy well enough to continue treatment. No opportunistic infections were noted. This protocol for WHO grade III gliomas was relatively safe and tolerable. It showed the possibility of achieving favorable results compared with those of historical controls. A randomized controlled study with a long-term follow-up may be mandatory to evaluate its efficacy.

findings. The motor power of her lower limbs was normal, and rectal examination revealed normal anal tone.Magnetic resonance (MR) imaging showed a well-demarcated 1.5×1.9×2.9 cm sized mass lesion at L2-3. The mass was hypo-intense on T1-and T2-weighted images with homogeneous gadolinium enhancement. There was also a cystic lesion within the spinal cord on the cranial side of the mass at T12-L2. The cyst was isointense to the cerebrospinal fluid and was diagnosed to be tumor associated syrinx (Fig. 1). Myelography of the lumbar spine revealed obstruction of contrast flow due to the intradural mass. Operation was conducted with the presumptive diagnosis of intradural extramedullary meningioma. An L1-3 laminectomy and intradural exposure revealed a yellowish pink, well-encapsulated, elliptical mass of firm consistency. The tumor was found to be draped by and adhered to the nerve roots at its upper pole near the conus medullaris and cauda equina at its lower pole without dural attachment. However, the tumor was successfully dissected from the nerve roots and removed completely. The patient recovered uneventfully after the operation. The postoperative MR imaging showed no residual tumor with marked reduction of the syrinx. All of the patient's preoperative symptoms improved after surgery.The histology of the tumor showed patternless sheets of polygonal cells with clear glycogen-rich cytoplasm and small clusters of cells in a meningothelial pattern with whorl formation (Fig. 2). A Periodic acid-Schiff (PAS) stain showed a positive reaction in the cytoplasm of tumor cells containing glycogen (Fig. 3). Tumor cells were stained positive for vimentin (Fig. 4) and epithelial membrane antigen (EMA). These findings were compatible with the diagnosis of clear cell meningioma. Postoperatively, the patient's symptoms were dramatically alleviated. Ad- INTRODUCTIONClear cell meningioma is a very rare histological type of meningioma that is included in the World Health Organization (WHO) classification as a peculiar variant affecting younger patients 10,14,24,25) . Clear cell meningiomas have been reported in only 0.2% of meningioma cases and have a more aggressive and complicated course due to their histological nature and anatomical locations 25) . Most meningiomas are attached to the dura mater and very seldomly they grow without dural attachment. To the best of our knowledge, only several cases of intraspinal nondura based clear cell meningioma have been reported 2,5,17,19,20) . In this article, we present an unusual case of intraspinal clear cell meningioma characterized by the absence of dural attachment. CASE REPORTA 34-year-old female patient was admitted with complaints of pain in her lower limbs and both hips for 6 months and voiding difficulty for 1 year. She had also experienced numbness in her lower limbs. Her symptoms worsened over time. One year prior to admission, she visited a local obstetrics and gynecology clinics complaining voiding difficulty and was treated conservatively under the diagnosis of cystitis with...