Biomedical subjects

R Shirane

Publications and source records attributed to R Shirane.

At least 55 records · Page 3Linked to original sources

PubMed1999

Effect of inhalational anesthesia on cerebral circulation in Moyamoya disease.

To clarify the effects of inhalational anesthesia on cerebral circulation in patients with Moyamoya disease, the authors measured regional cortical blood flow (CoBF), jugular bulb oxygen saturation (SjO2), and frontal regional oxygen saturation (rSO2) by near infra-red spectroscopy under total intravenous and inhalational anesthesia in 13 patients undergoing revascularization procedures. Cortical blood flow decreased in some regions under inhaled anesthesia in all cases, and the mean value decreased significantly (p<0.01). Patients' SjO2 levels rose during inhalational anesthesia in 10 of 11 cases (p<0.01). Frontal rSO2 declined in 9 of 11 cases. Regional CoBF levels may be decreased by inhaled anesthesia in patients with Moyamoya disease, and such anesthesia may provoke intracerebral steal. Total intravenous anesthesia, however, lacked these effects.

Adolescent↗

PubMed1999

Clinical course, surgical management, and long-term outcome of moyamoya patients with rebleeding after an episode of intracerebral hemorrhage: An extensive follow-Up study.

BACKGROUND AND PURPOSE: Revascularization surgery for moyamoya patients is believed to prevent cerebral ischemic attacks by improving cerebral blood flow. However, measures preventing the occurrence of hemorrhagic moyamoya in patients have not yet been established in the literature due to the low rate of hemorrhage onset as well as the originally limited numbers of patients with moyamoya disease, poor understanding of the clinical course of rebleeding, correct surgical management, and long-term outcome. We present here the results of an overall survey of patients with hemorrhagic moyamoya disease in a district of Miyagi Prefecture in Japan and examine their clinical course, efficacy of revascularization surgery, and long-term outcome. METHODS: This study included 28 moyamoya patients with episodes of intracranial hemorrhage between 1976 and 1988. The mean follow-up period was 14.2 years. There were 4 males and 24 females, aged 7 to 69 years (mean 39.2 years). Cerebral angiography and CT scans were performed for all patients. Surgical treatment was performed in 19 patients (67. 9%), and 10 patients (35.7%) underwent revascularization surgery. We observed the clinical course of all 28 patients. We also studied the relationship between the efficacy of surgical treatment and long-term outcome. RESULTS: Five of the 28 patients (17.9%) died of the initial intracranial hemorrhage, and 2 patients died of other causes. Rebleeding occurred in 6 of the remaining 21 patients (28. 6%). The interval to rebleeding ranged from 2 to 20 years (mean 7.3 years). Of these 6 patients, 4 died of rebleeding. Rebleeding was observed in 1 of 8 patients who underwent bypass surgery and in 5 of 13 patients who did not, which suggested that rebleeding was less likely to occur in patients who had undergone bypass surgery. However, there was no significant difference in rebleeding ratio or mortality between patients with and those without revascularization surgery (P>0.05). CONCLUSIONS: In this study, we compiled the results of meticulous follow-up conducted over the past 10 years for patients with hemorrhagic moyamoya disease. Because hemorrhagic moyamoya disease is known for its high rate of mortality at the time of rebleeding and often causes rebleeding long after the initial episode (as much as 20 years later), implementation of long-term preventive measures for rebleeding is necessary. This suggests that a long-term prospective study of a large number of patients with hemorrhagic moyamoya disease is required to determine whether bypass surgery prevents rebleeding of hemorrhagic moyamoya disease.

Adolescent↗

PubMed1999

Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter. Case report.

A rare case of cerebral pseudoaneurysm located at the internal carotid artery (ICA) was caused by the removal of a ventricular catheter in an infant. This 4-month-old girl underwent ventriculoperitoneal shunt revision, during which the old ventricular catheter was removed from the posterior horn of the left lateral ventricle, but the choroid plexus was pulled out by the tip of the catheter. Intraventricular hemorrhage (IVH) and subarachnoid hemorrhage were observed postoperatively. Magnetic resonance (MR) angiography performed on the 12th postoperative day revealed ICA stenosis and aneurysm formation at the C1 portion of the left ICA. Contrast-enhanced computerized tomography (CT) scans obtained on the 21st postoperative day revealed recurrent IVH and enlargement of the lesion. The patient underwent surgery for treatment of the aneurysm. Operative findings revealed a pseudoaneurysm arising from the left ICA at the proximal end of the anterior choroidal artery (AChA). The aneurysm was removed and the wall of the ICA was reconstructed. Postoperative three-dimensional CT scanning and MR angiography demonstrated disappearance of the aneurysm and preservation of the ICA. The patient was discharged without additional neurological deficits. Many complications, including IVH, are associated with removal of a ventricular catheter. This case shows that pseudoaneurysm formation can occur in a remote region due to avulsion of the AChA from the ICA. In most circumstances a ventricular catheter can be removed without difficulty. However, precision and caution should be exercised when removing a ventricular catheter.

Aneurysm, False↗

PubMed1999

The relationship between cerebral infarction and angiographic characteristics in childhood moyamoya disease.

BACKGROUND AND PURPOSE: In childhood-onset moyamoya disease, the angiographic disease process of stenoocclusive lesions is progressive, and cerebral infarctions often develop as a result of ischemia. Our purpose was to determine how the severity of stenoocclusive lesions in the anterior and posterior circulations affects the distribution of cerebral infarction in patients with childhood-onset moyamoya disease. METHODS: In 69 patients with childhood-onset moyamoya disease, angiograms were reviewed for stenoocclusive lesions, and CT scans, MR images, or both were reviewed for the sites and extent of cerebral infarction. The relationship between the angiographic and CT/MR findings was examined. RESULTS: The prevalence and degree of stenoocclusive lesions of the posterior cerebral artery (PCA) significantly correlated with the extent of lesions around the terminal portion of the internal carotid artery (ICA). The prevalence of infarction significantly correlated with the degree of stenoocclusive changes of both the ICA and PCA. Infarctions tended to be distributed in the anterior borderzone in less-advanced cases, while in more advanced cases lesions were additionally found posteriorly in the territory of the middle cerebral artery, the posterior borderzone, and the PCA territory. CONCLUSION: Our results indicate that progressive changes of the anterior and posterior circulations are associated with the distribution of cerebral infarction, culminating in a patchily disseminated or honeycomb pattern of infarction on CT and MR studies in late stages of the disease.

Adolescent↗

PubMed1999

Developmental changes of cerebral blood flow and oxygen metabolism in children.

BACKGROUND AND PURPOSE: Normal values for cerebral blood flow (CBF) and metabolism in adults are well established, but not for children. Our goal, therefore, was to clarify functional developmental changes of the brain in children in relation to CBF and oxygen metabolism. METHODS: We measured regional CBF (rCBF), regional cerebral metabolic rate for oxygen (rCMRO2), and regional oxygen extraction fraction (rOEF), using positron emission tomography (PET). We performed 30 PET studies in 24 children ages 10 days to 16 years (nine boys, 15 girls), using a steady inhalation method with C(15)O2, (15)O2, and 15CO in order to measure rCBF, rCMRO2, and rOEF, respectively. Regions of interest were set in the primary cerebral areas (sensorimotor, visual, temporal, and parietal cortex), cerebral association areas (frontal and visual association), basal ganglia (lenticular and thalamus), and posterior fossa (brain stem and cerebellar cortex). Subjects were grouped by age (< 1, 1 to < 3, 3 to < 8, and > or = 8 years), and the absolute values of the parameters were compared with those obtained from 10 healthy adults. RESULTS: rCBF and rCMRO2 were lower in the neonatal period than in older children and adults, and increased significantly during early childhood. rCBF was higher as compared with adults, peaking around age 7, whereas rCMRO2 was relatively high, with the last area to increase being the frontal association cortex. Both rCBF and rCMRO2 reached adult values during adolescence. No difference in rCBF was observed between the basal ganglia and the primary cerebral cortex; however, it was prominent in the occipital lobe in every age bracket. No significant changes in rOEF were found during childhood. CONCLUSION: The dynamic changes of rCBF and rCMRO2 observed in children probably reflect the physiologic developmental state within anatomic areas of the brain.

Adolescent↗

PubMed1998

Cervical myelocystocele with Chiari II malformation: magnetic resonance imaging and surgical treatment.

BACKGROUND: The myelocystocele is a rare clinical entity, and there have only been six case reports concerning the cervical myelocystocele, including ours. METHODS: The case of a female neonate with cervical myelocystocele, who presented with respiratory distress beginning at birth is reported. RESULTS: Magnetic resonance (MR) imaging disclosed a cystic lesion surrounded by two layers of membrane, which were recognized to be the dural and arachnoid layer and the ependymal lining layer, respectively, during operation and on histopathologic examination. Hydromyelia at C2-C7 with Chiari II malformation was also observed. After a thorough repair and untethering surgery, the hydromyelia was diminished on a follow-up MR examination. The patient's respiratory status normalized several days postoperatively, and her growth and development were within normal limits at the 2-year follow-up. CONCLUSIONS: In cases of cervical myelocystocele with Chiari II malformation, untethering through intradural exploration to treat the tethered cord and outer decompression of the foramen magnum are needed. MR imaging is the best modality for preoperative determination of anatomic relationships.

Arnold-Chiari Malformation↗

PubMed1998

Hemispheric asymmetry of the auditory evoked N100m response in relation to the crossing point between the central sulcus and Sylvian fissure.

The positions of the bilateral N100m sources of the auditory evoked magnetic fields (AEFs) were measured in relation to the central sulcus (CS) using an MRI-linked whole head magnetoencephalography system in 20 right-handed normal male subjects. The location of the N20m source of the median nerve-stimulated somatosensory evoked magnetic fields (SEFs), in the left hemisphere was 3.9+/-5.4 mm (mean+/-SD) posterior to that in the right hemisphere (P < 0.005). The crossing point (CP) between the CS and Sylvian fissure in the left hemisphere was 4.3+/-4.8 mm posterior to that in the right hemisphere (P < 0.001). The N100m sources were posterior to the CP in both hemispheres. The left hemispheric N100m source was 9.4+/-6.4 mm posterior to that on the right (P < 0.0001) in absolute position. The relative distance between CP and the N100m source was 22.7+/-8.5 mm in the left hemisphere and 17.7+/-5.3 mm in the right hemisphere (P < 0.01). Comparison of positions of the AEF sources and the CS as defined by the SEF demonstrated functional asymmetry of the human temporal lobe and possible source extension of the AEF-N100m beyond the Heschl gyrus over the planum temporale.

Adult↗

PubMed1998

Clinical usefulness of 11C-MET PET and 201T1 SPECT for differentiation of recurrent glioma from radiation necrosis.

The clinical usefulness of L-methyl-11C-methionine positron emission tomography (11C-MET PET) and thallium-201 single photon emission computed tomography (201T1 SPECT) for distinguishing glioma recurrence from radiation-induced changes was evaluated. Ten patients with lesions highly suggestive of recurrent glioma on magnetic resonance imaging underwent 11C-MET PET and 201T1 SPECT studies. Two patients were examined twice, so a total of 12 studies were performed. The clinical diagnoses were five recurrent gliomas and seven radiation necrosis. The five recurrent gliomas appeared as increased uptakes on both 11C-MET PET and 201T1 SPECT scans. Four of the seven radiation necrosis lesions also appeared as increased uptakes on the 201T1 SPECT scans. In contrast, only one radiation necrosis appeared as increased uptake on the 11C-MET PET scans. There was no significant difference in 201T1 SPECT indices between radiation necrosis and tumor recurrence, but the ratio of the differential absorption ratio of tumor tissue to that of the homologous contralateral gray matter in PET of recurrent glioma was significantly higher than that of radiation necrosis. 11C-MET PET is superior to 201T1 SPECT for the differentiation of tumor recurrence from radiation necrosis and delineation of the extent of the tumor.

Adult↗

PubMed1998

Sequential assessment of cerebral blood flow in diffuse brain injury by 123I-iodoamphetamine single-photon emission CT.

PURPOSE: Our goal was to elucidate the temporal profile of cerebral circulation and its relationship to prognosis in patients with diffuse brain injury by using single-photon emission CT (SPECT) and 123I-iodoamphetamine (IMP). METHODS: A total of 67 assessments were made in 26 patients with diffuse brain injury (Glasgow Coma Scale score < or = 8). The microsphere method was used for quantifying cerebral blood flow (CBF). The hemispheric CBF was defined as a mean regional CBF (rCBF), and the total cerebral hemispheric CBF (tCBF) as a mean of the bilateral hemispheric CBF. The relationship between patient outcome and tCBF was investigated. RESULTS: The rCBF in patients with diffuse brain injury showed dynamic and global changes with little regional differences. The tCBF values increased in 1 to 3 days, and they were higher in the poor-outcome group than in the good-outcome group. During the period of 14 to 42 days, the tCBF values stayed within normal range in the good-outcome group, whereas they were below normal range in the poor-outcome group. CONCLUSION: Our results revealed a good correlation between patient outcome and CBF values. Quantitative and sequential CBF studies with IMP SPECT are promising for helping to determine the prognosis for patients with diffuse brain injury.

Adolescent↗

PubMed1998

[Interhemispheric asymmetry exists in female in the N100m source position of the auditory evoked magnetic fields].

The N100m source of the auditory evoked magnetic fields (AEFs) is located more posterior in the left than the right hemisphere in male subjects. However, whether this asymmetry exists in female subjects is controversial. The present study, analyzed the N100m source positions of the AEFs due to monaural tone stimuli using a helmet-shaped 66-channel magnetoencephalography system (CTF Systems) in 62 right-handed normal adults (24 females and 38 males). The best fit sphere was calculated for each subject from the head shape reconstructed from three-dimensional magnetic resonance images. N100m source positions were estimated using a double-dipole model. The contralateral N100m response to the stimulated ear was measured relative to the midpoint of the bilateral auricular points. Statistical analysis used a standardized head size for each subject based on the mean value of all subjects (r = 8.27 cm). In females, the N100m dipole positions were 0.00 +/- 1.02 cm anterior in the left hemisphere and 0.35 +/- 0.74 cm in the right (p < 0.02). In males, the N100m dipole positions were -0.31 +/- 0.81 cm (mean +/- standard deviation) anterior in the left hemisphere and 0.61 +/- 0.78 cm in the right (p < 0.0001). The interhemispheric difference in the N100m positions was 0.35 +/- 0.65 in females and 0.92 +/- 0.77 in males (p < 0.005). In conclusion, the left hemispheric N100m is located more posterior to the right in both genders. However, this functional asymmetry is more evident in males, like previous findings of more evident anatomical asymmetry in males.

Adult↗

PubMed1998

[Neonatal intracranial tumor highly suspected of teratoma in the lateral ventricle consisting of multiple cysts: case report].

Neonatal intracranial teratoma is rare and early attempts at surgical treatment are not usually successful. We describe an exceptionally rare case of neonatal intracranial tumor in the lateral ventricle composed of multiple cysts with little mass content which was highly suspected of teratoma and treated successfully by microsurgery. A 55-day-old male was admitted to our hospital with complaints of convulsive seizure. Examination found no obvious neurological deficit except mild enlargement and bulging of anterior fontanel. There were no abnormal laboratory findings. Computerized tomography with contrast medium revealed an 8 cm multicystic lesion with little mass content in the right lateral ventricle and hydrocephalus. Magnetic resonance imaging showed the cystic content as slightly higher in intensity than CSF on the T1-weighted image and of higher intensity than CSF on the T2-weighted image. The cyst wall was enhanced on T1-weighted image with gadolinium. The aqueduct was obstructed by compression due to the intraventricular cyst. A right occipitoparietal craniotomy was performed, which disclosed a hair in the cyst wall, two huge cysts, and independence of the intracystic lesion from the lateral ventricle. The tumor was removed except for a small part adjacent to the pineal region, from which the tumor had presumably originated. Mature teratoma was highly suspected on the basis of the hair in the cyst wall and histological examination of the specimen, which revealed hamartomatous tissues derived from two germ cell layers. After surgery, his hydrocephalus was improved and convulsive seizures were reduced remarkably. He was discharged ten days later and is being followed up. Reoperation will be performed if regrowth of the residual tumor occurs.

Cerebral Ventricle Neoplasms↗

PubMed1997

Perioperative factors related to the development of ischemic complications in patients with moyamoya disease.

In purpose of clarifying the risk factors of perioperative ischemic complications in cases with moyamoya disease, a retrospective study was conducted on the perioperative care of 36 patients who underwent vascular reconstruction for moyamoya disease. Following surgery, 8 patients developed ischemic complications (5 with minor completed strokes and 3 with transient ischemic attacks). Three factors including the presence of a preoperative low density area (LDA), intra-operative urinary output, and a reduction in the hematocrit significantly differed with complications and those without. In an evaluation of individual cases, intra-operative hypercapnia, hypotension, and a reduction in the circulating blood volume also were identified as potential factors associated with complications. On the basis of these findings, it was concluded that it is necessary to infuse an adequate amount of fluids, maintain normocapnic and normothermic states, and actively correct anemia in patients undergoing vascular reconstruction for moyamoya disease. It is also necessary to pay particular attention to perioperative care in patients in whom a LDA is detected by preoperative CT.

Adolescent↗

PubMed1997

Proton magnetic resonance spectroscopy in children with moyamoya disease.

Proton magnetic resonance spectroscopy (MRS) is an effective method to noninvasively investigate cerebral metabolism. The aim of this study was to evaluate cerebral metabolic changes in children with Moyamoya disease using proton MRS. A total of 11 patients under 15 years old were enrolled, whose main symptoms were transient ischemic attacks. In nine patients, the more and less affected hemispheres could be determined according to their symptoms and/or single-photon emission computed tomography (SPECT). A single voxel point resolved spectroscopy was performed in the frontal or parietal white matter bilaterally by using 1.5 Tesla MR system (repetition time 2000 ms and echo time 272 ms). Voxels were located within areas that were normal on T1- and T2-weighted MR imaging. Choline (Cho), creatine (Cre) and N-acetyl aspartate (NAA) were semiquantitated as a metabolite value using an external standard reference. Pre-operative Cho, Cre and NAA values were within respective normal ranges. No metabolite showed a significant difference between the more and less affected hemispheres. A total of six patients were examined before and after revascularization surgery on one side. Pre- and post-operative comparisons demonstrated that all three metabolites showed statistically significant increases following surgery. These results suggest that, although the mechanism of spectroscopic changes needs to be further investigated, proton MRS provides a valuable method to evaluate cerebral metabolism in children with Moyamoya disease.

Aspartic Acid↗

PubMed1997

Assessment of encephalo-galeo-myo-synangiosis with dural pedicle insertion in childhood moyamoya disease: characteristics of cerebral blood flow and oxygen metabolism.

In the surgical treatment of childhood Moyamoya disease, we have been performing a new non-anastomotic bypass surgery using encephalo-galeo-myo-synangiosis (EGMS) with dural pedicle insertion over the brain surface. To assess the results obtained using this procedure, the long-term clinical outcome and the characteristics of cerebral blood flow and oxygen metabolism using PET were evaluated. The subjects were 19 patients with childhood Moyamoya disease admitted to our institution over 8 years from 1988 to 1996. This type of surgery was performed 39 times and the patients have been followed up from 10 months to 8 years. Preoperatively, although cerebral blood flow and oxygen metabolism were varied from individual to individual, low values of regional cerebral blood flow (rCBF) and regional cerebral metabolic rate of oxygen (rCMRO2) with relatively high values of regional oxygen extraction fraction (rOEF) were found in the frontal region in most of the patients compared to normal children. Postoperatively, obvious improvement of cerebral blood flow and hemodynamics in all the areas in the operative site and clinical symptoms and signs ameliorated or disappeared during the follow-up period. In conclusion, the present method appeared to be useful to improve the hemodynamic in the brain and its long-term clinical outcome was satisfactory.

Age Distribution↗

PubMed1997

Supratentorial primary intra-axial tumors in children. MR and CT evaluation.

PURPOSE: To evaluate the MR and CT features of pediatric supratentorial intra-axial tumors with respect to differential diagnosis and the role of each investigation modality. MATERIAL AND METHODS: MR and CT findings in 40 children with 12 types of pathologically proven histological tumors were reviewed. RESULTS: The location of tumors might be one clue to differential diagnosis. In our material, cysts (60%), calcifications (45%), and intratumoral hemorrhages (27%) were found in the tumors. Characteristic features noted in some lesions included: peritumoral hemosiderin deposition in cavernous angiomas; intratumoral flow void in a choroid plexus carcinoma and in glioblastomas; and hemicerebral atrophy in germinomas. A comparison between malignant and benign tumors showed perifocal edema and a mass effect to be significantly more common in malignant lesions. Homogeneous enhancement suggested a benign tumor and an inhomogeneous pattern represented malignancy, while the lack of obvious enhancement did not always suggest benignity. Intratumoral calcium deposition was a not uncommon finding in malignant tumors. CONCLUSION: In most cases, the exact diagnosis should be made by histological examination but it is important for treatment planning that the appropriate depiction of tumor extension and tissue characterization be made by MR and CT.

Adolescent↗

PubMed1997

[Saccular aneurysm-like bleb formation after rupture of the internal carotid-posterior communicating artery aneurysm: a case with interesting angiographic findings].

A case of saccular aneurysm-like bleb formation after rupture of an aneurysm in the internal carotid-posterior communicating artery. In connection with this, an interesting angiographic finding was reported. A 65-year-old man suffered from sudden disturbance of consciousness and left hemiparesis. Computed tomography (CT) scan revealed typical subarachnoid hemorrhage localized in the right Sylvian fissure. Next day, a cerebral angiography was performed, but no aneurysm was detected. A second angiography was performed 21 days after the onset, and it revealed a saccular right internal carotid-posterior communicating artery (IC-PC) aneurysm. An operation for the IC-PC aneurysm was performed by conventional pterional approach. However, intraoperative findings were unexpected. The collapsed ruptured true IC-PC aneurysm was found at the orifice of the larger bleb, and the ruptured point was in the neck of the true aneurysm. Clipping of the aneurysm was performed successfully. The patient was discharged on foot. The aneurysm detected by the second angiography was not a true one but a bleb formation. Continuous hemodynamic stress on the rupture point may induce the formation of such an aneurysm-like bleb. It should be kept in mind that an aneurysm found in the chronic period might be an aneurysm-like bleb.

Aged↗

PubMed1997

[A case of pineal teratoma arising from hydrocephalus of unknown cause].

We report a case of "functional aqueductal stenosis" which reveals dilatation of the lateral and 3rd ventricles without stenosis at the aqueduct in MRI. This case shows a pineal teratoma which presents one year later with symptoms of hydrocephalus caused by "functional aqueductal stenosis". A seven-year-old boy was admitted to our department owing to headache and vomiting. CT and MRI showed hydrocephalus. The lateral and 3rd ventricles were dilated while the 4th ventricle was normal. Furthermore, tumoral obstruction of the aqueduct was not found. After a ventriculoperitoneal shunt, he recovered well without neurological deficits. One year later, symptoms of precocious puberty, that is the appearance of public hair and deepening of his voice, were found. A follow-up MRI demonstrated a pineal region tumor. Although human chorionic gonadotropin level in the serum and urine was transiently elevated, it normalized before surgery. The operation was performed by the occipital transtentorial approach and the tumor was totally removed. Histological examination proved this tumor to be a mature teratoma, showing three germ cell layers. About two weeks later, he was discharged without any neurological deficit. In this case, although hydrocephalus occurred, MRI didn't demonstrate aqueductal obstruction caused by the tumor. However, one year later, a pineal region tumor was confirmed by MRI. This suggests that hydrocephalus might have some association with the appearance of the pineal region tumor. Therefore, it is necessary to be aware of the possibility of the occurrence of tumors whenever we encounter "functional aqueductal obstruction", when MRI doesn't demonstrate aqueductal obstruction caused by a tumor.

Brain Neoplasms↗

PubMed1997

[A case of malignant rhabdoid tumor in the pineal region in early infancy].

A 6-month-old girl was admitted to another hospital because of consciousness disturbance, preceded by 2 weeks of decreased activity and vomiting. She was referred to our hospital after ventricular drainage had been instituted for hydrocephalus and the tumor in the pineal region. The patient was noted to have conjugate upward gaze palsy and papilledema. CT scan and MRI revealed a large tumor in the pineal region with tumoral hemorrhage and a small mass in the right frontal lobe. At surgery, the pineal region tumor was removed subtotally. Histological examination showed the tumor to be composed of sheets of large polyhedra or round cells with an eccentric round nuclei, prominent nucleoli, and cytoplasmic inclusions. Immunohistochemical studies were positive for GFAP, vimentin, S-100, CK, EMA, and SMA, but negative for AFP, HCG, PLAP, and CEA. Following surgery, she received three 5-day cycles of chemotherapy, consisting of intravenous administration of cisplatin 20 mg/m2/day and etoposide 60mg/m2/day. After these therapies, MRI showed a decrease in the area of high intensity in the pineal region, but almost no change in the right frontal mass lesion. Follow-up radiological examination showed that the tumor had grown rapidly one month after chemotherapy and the patient died 5 months after her first hospitalization. Malignant rhabdoid tumor of the CNS is rare and remarkably malignant. This tumor should be treated using multidisciplinary management with surgery, intensive chemotherapy, and radiotherapy depending on the patient's age.

Brain Neoplasms↗