Transaxillary Upper Thoracic Sympathectomy

Vascular lesions involving the upper extremities have been treated by different route of upper thoracic sympathectomy with varying success. More recently, the anatomic and physiologic interest for autonomic nervous system has been progressively mounted but the surgical attack has plateau. It may be worthy for academic interest and clinical practice to estimate and to compare with the different surgical method. This paper concerns the treatment of a case suffering from atherosclerotic occlusion whom were treated by upper thoracic sympathetic ganglionectomy through the transaxillary transpleural route. This operation seems to be simpler than other surgical methods with lower morbidity, fewer complication and satisfying results.

Three Cases o Hemangioblastomas in the Posterior Fossa

We have recently managed three cases of cerebellar hemangioblastomas in adult male in which the vertebral angiograms and C-T scan led us to diagnose the vascular mass lesions involving the right, left lobe and superior vermis respectively. Polycythemia, angiomatosis retinae and familial incidence were not detected but signs of increased intracranial pressure and of cerebellar dysfunction in varying degrees were common to all three cases. The duration of symptoms and signs ranged from weeks to years. The lesion in the right lobe was a fairly large mass harboring multiple small cysts in it and able to removed completely. The mass in the left lobe was paramedian in location and obstructing the 4 th ventricle. It was also large and entirely cystic accompanying a mural nodule in it and easily removed completely. The lesion occupying the cerebellar vermis was a large solid one and extending diffusely up to posterior third ventricle region and could only be removed partially.

Solitary Eosinophilic Granuloma of the Skull Bone

Eosinophilic granuloma, Hand-Schuler-Christian and Abt-Letterer-Siwe syndrome are considered to be different manifestations of one and the same disease of the reticulohistiocytic system, and are included under the term histiocytosis X, clinical and morphological manifestations are variable. The syndromes can be differentiated according to their course and extent of spread. Eosinophilic granuloma of bone is the mildest form, usually restricted to one or a few foci. This occurs chiefly in children but may occur at any age. The male sex is affected almost twice as often as the female. Cranial vault is most commonly affected site and jaw, humerus, rib and femur are also often affected. Recently we have experienced 2 cases of eosinophilic granuloma of the skull bone. One was 10 years old male with protruding mass on the right frontal bone, and the other was a mass on right parietal bone in 12 years old male. On admission, the patients had headache and local tenderness without any abnormal neurological signs. Histopathologic findings show the fibrocartilagenous tissue and bone. The soft tissue is densely replaced by infiltrations of histiocytes, eosinophils, lymphocytes, plasma cells and multinucleated giants cells. Bone tissue is also infiltrated with identical cells. The differential diagnosis distiction between the cerebral granulomatosis is difficult.

Ventriculoperitoneal Shunt Complicated by Ascitis and Hydrothorax

The majority of current shunting procedures involve either a ventriculoperitoneal or a ventriculoatrial placement. The ventriculoperitoneal placement have less serious associated morbidity than the atrial placement but revision of the placement is occasionally requested by complications associated with the shunting procedure. A case of ventriculoperitoneal shunt complicated by ascites and hydrothorax was reported, in which the shunting procedure was indicated for relief of hydrocephalus in an infant.

Ventriculoperitoneal Shunt Complicated by Ascitis and Hydrothorax

The majority of current shunting procedures involve either a ventriculoperitoneal or a ventriculoatrial placement. The ventriculoperitoneal placement have less serious associated morbidity than the atrial placement but revision of the placement is occasionally requested by complications associated with the shunting procedure. A case of ventriculoperitoneal shunt complicated by ascites and hydrothorax was reported, in which the shunting procedure was indicated for relief of hydrocephalus in an infant.

Percutaneous Streotaxic Gasserian Ganglionotomy with Radiofrequency Current in Trigeminal Neuralgia

Chemical destruction of Gasserian ganglion by either alcohol or phenol has remained a popular form of treatment for tic pain. However, control of the lesion size is inaccurate and various complications have often resulted. With advent of radiofrequency generator, percutaneous coagulation of the Gasserian ganglion is now possible, and the need for open surgery or chemical destruction have been drastically reduced. We treated 3 cases of trigeminal neuralgia with the radiofrequency current. Modified Hartel's anterior appaorch for the injection of the Gasserian ganglion is utilized and the radiofrequency lesions were made in the second branches of the trigeminal nerve selectively preserving the touch sensation in our patients. We reviewed the literature and described the technical procedures.

Percutaneous Cervical Cordotomy

A case has been reported in which stereotaxic percutaneous cordotomy has been performed for the treatment of an intractable pain in the arm. The 60-year-old male was admitted to this hospital because of right arm pain which was persistant, so severe and intractable to various medical treatment for 2 months prior to admission. The pain in association with right Horners' syndrome has been produced by the involvement of carcinoma in the right apex of the lung to the cords of brachial plexus and superior cervical ganglion. Since the patient was so emaciated and distressed with the pain, the percutaneous cordotomy was indicated for him to cure the pain. Under the local anesthesia the patient was maintained in the supine position with his head held lightly on the head holder. And unilateral high cervical cordotomy by the percutaneous stereotaxic method was performed on the left through C-C2 interlaminar space under radiographic and impedance measurements, which relieved the pain completely with no development of significant postoperative complications. It was simple, safe and effective for the patient who has poor general condition because it does not require a general anesthesia or a period of wound healing and the cooperation of the alert patient eliminates the possibility of paralysis and enhances the changes of securing the desired sensory loss.