An Operative Case of Soft Disc Protrusion in Upper Thoracic Level: A Case Report

A case of T3-4 disc herniation is reported as follows. A 23 year-old patient was presented with paraparesis and anterior chest pain. With the anterolateral approach(transthoracic transpleural approach), decompression and removal of a disc fragment was refered; which resulted is an almost complete recovery of the patient. MRI of the thoracic spine suggested a soft disc herniation. In addition, literatures were reviewed in conjunction with this case report.

Surgical Experience of transpediculr Screw Fixation of the Spine

Vertebral transpedicular screws provide secure attachment for posterior spinal fixation device, the authors had experienced 29 cases of transpedicular screw fixation to obtain fixations of the thorcolumbar and lumbar spine instability, the patients were operated between February, 1992, and May, 1995. Spinal Fusion was attempted at one to four levels of thoracic and lumbar spine. Follow-up period was from 6 to 33 months, averaging 16 months. The result was summerized as follows: 1) Of the 29 cases, 20 were spondylolisthesis and 9 were fracture and dislocation. 10 patients(34.5%) were 30 years old, and 20 cases(69%) were female. Mean age was 42 years. 2) The symptom included low back pain, sciatica and intemittant claudificaton in the order of incidence. 3) The sites of spondylolisthesis were L4-5 in 12 cases(60%) and L5-S1 in 8 cases(40%). The average degree of slippage in spondylolisthesis was Meyerding's grade I(85%). The sites of fracture were T12 in 5 cases(55.6%), L1 in 2 cases(22.2%), L2 with L3 in 1case(11.1%) and L1 in 1 case(11.1%). 4) There was no patient with significant neurologic injury or functional root loss. A screw malposition was observed in one case. 5) The results of operations were considered exellent in 16 cases(55%), good in 10 cases(35%) and fair in 3 cases(10%), and satisfactory bony fusion was obtained.

The Analysis of Prognostic Factors of IVH with EVD Treatment

The author analyzed retrospectively 94 cases of spontaneous intraventricular hemorrhage(IVH) which were treated with external ventricular drainage(EVD) at the Department of Neurosurgery. Chungnam National University Hospital from January 1990 to June 1994. In all cases, infusion of urokinase was attemped for effective drainage. The peak age group of IVH patients were those in their sixth decade, but in primary IVH, younger patients were more frequently affected. The order of causes of primary IVH are hypertension, arteriovenous malformation, Moyamoya disease, and cerebral aneurysm, however, secondary IVH are mostly associated with hypertension and aneurysm. The overall mortality rate was 38%. A low initial Glasgow coma scale(under 5)(p<0.01), a high Graeb score(over 10)(p=0.001), fourth ventricular hemorrhagic dilation(p=0.001), secondary IVH(p=0.009), unilateral or bilateral pupil fixation at the preoperative stage(p<0.001) and long duration of EVD(p=0.045) are all poor prognostic factors associated with higher mortality.

Clinical Analysis of Less Extensive Microsurgical Decompression for Lumbar Spinal Stenosis

The cases of twenty-eight patients with spinal stenosis treated by microscopic decompressive surgery from January 1991 to September 1995, were analysed in an attempt to define is clinical feature, and to evaluate the results of our modified operation technique of preventing postoperative spinal instability. The main age group of the patients were in the fifties and sixties. On plain X-ray, most lumbar spine of the patients showed degenerative change. Pain in lower back and legs were the most common symptom, and intermittent neurogenic claudication was presented in three quarters of the patients. Radiologically, the diagnosis was confirmed by either myelography, CT, and MRI or by their combination. The major etiologic factors were thickening of ligamentum flavum, hypertrophy of laminae or facet joints and associated herniated nucleus pulposus. Since a significant rate of postdecompressive instability had been reported by other authors, therefore we have decided to performed less extensive decompressive total laminectomy procedure. The outcome of our decompressive laminectomy was favorable. In patients with no preoperative instability, newly developed instability following the less extensive decompressive total laminectomy was none.

Fibrous Dysplasia of the Skull(3 Cases): Case Report

Fibrous dysplasia is a bone disease of unknown etiology in which cellular fibrous tissue gradually replaces normal bone and involves the cranium infrequently. Recently, we have experienced 3 cases of fibrous dysplasia which involved the frontal, sphenoid and parietal bones with vault deformity. The 2 cases, in which the frontal and sphenoid bones were involved, presented with proptosis and exophthalmos. All of the cases manifested vault deformity which caused cosmetic problems. We performed decompressive and plastic surgery for the purpose of relieving the compression of cranial nerves and for the sake of the cosmetic effect. The clinical courses were uneventful.

Clinical Analysis of Craniocerebral Injury in Children

The clinical analysis was carried out with 182 cases of craniocerebral injuries under 15 years of age, admitted at the Department of Neurosurgery, Chung Nam National University Hospital during the period from September, 1990 to September 1993. Following results were obtained: 1) There were 133 males and 49 females and sex ratio was 2.7%. 2) Age incidence of the accidents was greatest at 6 years of age and mostly distributed to the age group between 4 to 7. 3) Seasonal peak of the accidents was at May. 4) The accident occurred mostly between 4 P.m. and 6 P.m. in a day. 5) The most frequent cause of the craniocerebral injuries was traffic accident(105 cases, 57.69%). 6) No deterioration of cans ciousness before and after the admission was doserved in 68 cases(37.36%). 7) Pupillary change was observed in 25 cases and Babinski sign was elicitable in 31 cases. 8) Early convulsion and vomiting were frequent symptoms in childhood. 9) Skull fracture was observed in 72 cases(39.56%) in which linear fracture was most frequent and predilection site was parietal bone. 10) The accompanying rate of skull fracture in intracranial hemorrhage was 65.54%. 11) Associated injuries were found in 44 cases(24.18%). The frequent ones were extremity fracture, clavicle fracture. 12) The overall mortality was 7.14%.

A Case of Intramedullary Oligodendroglioma in the Thoracic Spinal Cord: Case Report

Primary oligodendroglioma of the spinal cord is very rare tumor. On searching through the literature from 1931, we could find only about 46 cases, and this tumor is almost absent in Korea on the review of the literature. The authors present a case of 8-year-old female patient with the symptoms of paraparesis, urination difficulty, diffuse back pain and hypesthesia in both lower extremities. Spine MRI revealed the mass at the level of T3-T12, with combined nature of cystic and solid portion. Decompressive laminectomy and partial mass removal was performed, and then adjunctive radiotherapy and chemotherapy was done. The patient was improved after operation with radiotherapy and chemotherapy, so she walks alone and has no voiding difficulty at present(postoperative about 20 months) .

Clinical Analysis of the Effect of the Continuous External Ventricular Drainage with Urokinase Irrigation for the Treatment of Intraventricular Hemorrhage

The mortality and morbidity of the intraventricular hemorrhage(IVH) has been decreased since the introduction of external ventricular drainage(EVD) and direct intraventricular infusion of urokinase as an effective therapeutic method. In 1989, we already reported a series of 54 cases of IVH treated with simple EVD or EVD with urokinase irrigation in a few cases. Authors analyzed again a series of 50 cases of IVH treated by EVD with direct intraventricular urokinase irrigation after the pervious report. The mortality rate was 55.5% in former occasion, however 18% in this study and the complications were considerably low. We experienced again that the EVD with urokinase irrigation is an effective method and convenient, simple technique in the management of IVH even though there is no ICP monitoring. So we prefer EVD with urokinase irrigation therapy in managing the IVH even if the patient is moribund state.

Clinical Analysis of Basal Skull Fractures

The authors analysed 147 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1989 to December 1992. These fractures are difficult to diagnose by ordinary X-ray examination and are frequently inferred by clinical signs. The clinical features and radiological findings were reviewed. The results of the analysis are summarized as follows : 1) The basal skull fractures were more common in men than women-the ratio being 6 : 1. 2) In decreasing order of cause of basal skull fractures were traffic accidents(77%), fall down, assault and slipping. 3) The minor head injury, Glasgow Coma Scale Score(GCS) of 13 to 15, was 79 cases(54%), the moderate head injury 40 cases(27%) and the severe head injury 18 cases(19%). 4) In decreasing order of clinical features were otorrhea(71%) rhinorrhea(48%) and raccoon eye(33%) etc. 5) In decreasing order of the combined pathologies were skull fracture(55%), subdural hematoma(17%), epidural hematoma(16%) and intracerebral hematoma(12%) etc. 6) The facial nerve, vestibulo-cochlear nerve and optic nerve were the most commonly injured cranial nerve. 7) CSF leakage was noted in 139 cases and among them immediate type was far more common(96%) than the delayed type. 8) The incidence of meningitis was 5.4% and most of them associated with CSF leakage and the prophylatic antibiotic treatment has no effect to decrease infection rate. 9) In decreasing order of the frequency associated injuries were facial bone fracture(47%), clavicle fracture(19%), lower extremities fracture(9%) and upper extremities fracture(7%) etc.

3 Cases of Cystic Meningioma: Case Report

The authors report unusual three cases of large, peri- or intratumoral cystic lesions associated with intracranial meningiomas. These meningiomas may lead to an incorrect presumptive diagnosis because of minic appearance of a glial or metastatic tumor in computed tomography(CT) or magnetic resornance imaging(MRI) finding. Radiological evaluation and recognition are important for the surgical removal of these potentially curable neoplasms.

Pleomorphic Xanthoastrocytoma: Report of Three Cases

Pleomorphic xanthoastrocytoma is known as a rare specialized type of cerebral astrocytoma, which occurs mainly in the temporal loe of the brain in young ages in spite of marked pleomorphism with multinucleated giant cells, lipid-laden xantomatous cells, rich reticulin net-works, and the demonstration of glial fibrillary acidic protein, the prognosis is usually favorable. The authors report three cases of pleomorphic xanthoastrocytoma which were presented with headache and review the past literature.

Experimental Trial for the Prevention of Adhesion with Dural Substitutes in Craniectomy State

In a series of rabbits, two craniectomies were made in both side of the parietal hone. Each lesion was filled with gelfoam, lyocura, fat and dural film. Five rabbits were left empty as a control group. The animals were killed in one month after the operation. The degree of adhesion between the soft tissue of the scalp and various dural substitute was evaluated at the time of operative dissection and studied histopathologically. The results were as follows. 1) The insertion of dural substituted substances can prevent the adhesion between the scalp and dura mater. 2) The dural film was most effective in prevention of adhesion. 3) The dural film inserted group exhibited inflammatory reaction. 4) The gelfoam, lyodura and fat inserted groups were though to have had a moderate prevention effect of adhesion. With these results, we could conclude that the insertion of material between the dura and scalp can prevent adhesion. However the ideal inserted material which can pevent inflammatory reaction and adhesion has not been determined. At this point we have not found and ideal substitute. To get an ideal material for prevention of adhesion, further intensive study is required.

Histiocytosis-X with Giant Occipital Scalp Mass: A Case Report

Histiocytosis is a relatively rare disorder of the reticuloendothelial system involving the proliferation of histicoytes, granulation tissue, and inflammatory cells in many different organ systems1). Thus, the three manifestations of the same basic pathologic process:Eosinophilic granuloma, Hand-Schuller-Christian disease, and Letterer-Siwe disease have been classified as localized, chronic disseminated and acute disseminated histiocytosis-X. They were therefore included under the term histiocytosis-X and this concept has been generally accepted. The authors have experienced one case of histiocytosis-X, a rare disease. A 11 month-old femal patient presented with gradually enlarged palpable mass on the occipital area. The occipital skull was defected in a punched out fashion. The mass was completely removed. The pathologic findings revealed Histiocytosis-X and the patient was given chemotherapy.

Microsurgical and Standard Removal of Protruded Lumbar Disc;Clinical Analysis and Comparative Study

Today, lumbar disc surgery has been considerable refined from that performed by Mixter and Barr less than 50 years ago, but there is still room for improvement. The addition of the microsurgical technique may be the most recent means to refine the process of lumbar discectomy. Magnetified vision and brillant illumination have allowed neurosurgeons to refine many standard operations and to devise new ones for hitherto inaccessible areas. Small incisions, meticulous hemostasis, and precise removal of diseased tissue are the contributions of microsurgery to an ideal operation. 37 cases of microsurgical discectomy weer compared to the same number of standard operations. The total patient profiles were the same with other studies. The results demonstrated a 72.9% marked improvement in the standard discectomy category and a 83.9% marked improvement in the microsurgical discectomy group. Also, the mean time until their return to work was 7.3 wks in the microsurgical discectomy group, while 10.8 wks in the standard operation group.

Intraventricular Hemorrhage due to Aneurysm of the Distal Posterior Inferior Cerebellar Artery: Case Report

A case of ruptured aneurysm of the distal PICA presenting with isolated intraventricular hemorrhage is presented. The diagnosis of distal PICA aneurysm should be considered if isolated intraventricular hematoma is found without obvious parenchymal hemorrhage or subarachnoid blood in the basal cisterns. Complete vertebral arteriography is a requiste for the recognition of this condition. The outcome in patients with these aneurysms should be good if surgical repair is performed before rebleeding occurs.

Paraganglioma of the Cauda Equina: Case Report

A case of paraganglioma of cauda equina is presented. This was first described in 1972, since when over 50 cases of this tumor have been described in the world literature. The patient's symptoms were relieved by decompressive laminectomy and subtotal removal of mass with radiotherapy. The pathological examination revealed paraganglioma.

A Case of Epidermoid Cyst with Intractable Trigeminal Neuralgia

The authors report a cases of the epidermoid cyst which manifested neuralgia on the 2nd and 3rd brances of the trigeminal nerve. The tumor was located in the cerebelloponitine angle, Lt. The cyst content and tumor capsule surrounding the trigeminal nerve were removed. After surgery, the chief complaint disappeared and other complications were absent. In the patient, the computed tomography scan demonstrated a hypodense tumor not enhanced by contrast material. With magnetic resonance imaging, the tumor showed a intermediate signal intensity between the brain and CSF on the T1-seighted image and an increased signal intensity relative to brain CSF on T2-weighted image. In the patient with trigeminal pain, we have to evaluate the causes of the pain radiologically.

A Case of Iatrogenic Pseudoaneurysm of the Superficial Temporal Artery

The authors report a case of false aneurysm of the superficial temporal artery which manifested after operation for FCCD. An aneurysm of the superficial temporal artery is a rare disease. In collected literature, the incidence of superficial temporal artery aneurysms ranged from 0.5 to 2.5 percent of all aneurysms for which surgery was performed. False aneurysm should be suspected when a mass, which may or may not be pulsatile, appears in the scalp region after recent trauma. Troublesome(but not life-threatening) bleeding may occur if the lesion is unrecognized, and an attempt is made to "shell it out" as though it were an epidermal inclusion cyst.

Clinical and Pathological Study After Ligation of Common Carotid Artery in the Rat

This study examined the late pathological finding, clinical manifestation, and mortality in thirty-two rats with cerebral infarction induced by common carotied artery ligation. Thirty-two rats were divided into three group : Group A-a unilateral common carotid artery ligation group of twelve animals, Group B-a total common carotid artery ligation one side and partial common carotid artery ligation another side of eighteen animals, and Group C-bilateral common carotid arteries ligation of two animal. All animals surviving for 3 weeks were sacrified by intracardial injection of 2 M KCI 5cc and 2.5cc of 2% T.T.C. solution was infused into each common carotid arteries. The brain was rapidly rmoved and sectioned coronally and examined with the aid of a stereoscopic microscope for degree of T.T.C. stain and infarction. Brain was fixed and examined histologically. The results were as follows : 1) Mortality rate of each group : a unilateral common carotid artery ligation group was 16.67%, a total. Common carotid artery ligation on side and partial common carotid artery ligation another side group was 77.78%, and bilateral common arteries ligation group was 100%. 2) Clinical manifestation was showed as follows : hemiparesis, circling movement, abnormal seizure like activity, and ptosis. 3) Percent hemispheric volume infarction(%HVI) was 40%(mean value) in unilateral total common carotid artery ligation and 60% in total ligation one side and 46.25% in partial ligation another side. 4) The pathological change was signigicantly visible in bilateral ligation group.

The Experimental Study for the Reaction of the Hemostatic Agents to the Surrounding Brain Tissue

In a series of 20 young rats, three cortical lesions were made in each hemisphere. Two of these lesions were filled with avitene and gelfoam, while the third was left empty as a control. The animals were killed successively on weeks 1, 2, 4 and 8 after the operation. The results were as follows : 1) Although there was no difference in the type of tissue reactions, avitene was more rapid and profound than gelfoam in the process and degree of inflammatory reaction at the same periods. 2) Avitene biodegradaded more rapidly than gelfoam. 3) The extent of fibrosis and adhesion to the surrounding brain tissues were not grossly different between these two agents but more profound histopathologically in avitene at the same periods. With these results, we could conclude that the avitene was superior to the gelfoam as the hemostatic agent in neurosurgical area.