Clinical Observation upon Surgical Experience in the Douloureux

The purpose of this report is to present the results of clinical observation upon 21 surgical cases with tic douloureux (female 13, male 8) during the period from January, 1960 to August, 1972 at the Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. The average age at onset was 48 years of age ranging from 22 to 66 years. The average duration from onset to operation was 5 years. The frequency of involvement was the highest in the maxillary division, next was maxillary and mandibular division, and none in the ophthalmic division. Whole division was involved in one case. Right-sided involvement predominated by a ratio of 2 to 1 and bilateral involvement was found in only one case. Extraction of innocent teeth, ungratifying operation upon paranasal sinus had been carried out in 11 cases as consequence of misdiagnosis. Alcohol injection of peripheral branches of trigeminal nerve and medical treatment produced short-lived or none-effectiveness. Trauma to ipsilateral mandible and epidermoid cyst at cerebellopontine angle seemed to be the cause of tic doulourex in 2 cases, respectively. Major complications observed in Frazier's method group, were paresthesia, facial nerve palsy, partial paralysis of motor root, and recurrence of neuralgia. All of the peripheral nerve avulsion group developed recurrence of pin within three years. Mild decrease of cornea reflex was noted in two cases of Dandy's method group. Posterior fossa operation stands in superiority, when it is considered that some pathologic lesions are frequently found in the posterior fossa, that motor root is less frequently injured, and that the light touch is so fairly preserved in all three divisions that the least damage to the cornea is expected.

Dense Calcification in Medulloblastoma: Case Report

The medulloblastoma, a neoplastic emtity which was first identified and described in 1925 by Bailey and Cushing, is a highly malignant, rapidly growing tumor mainly confined to the first decade of life. The medulloblastoma rarely calcifies. Many investigator have reported that medulloblastoma may exhibit calcification only on microscopic examination. Roentgenographic evidence of calcification was found in one case of 54 patients with medulloblastomas by McRae, and in only one case of 96 patients with medulloblastomas by Kalan. A twelve-year-old Korean male was admitted to Seoul National University Hospital on May 1, 1972 with the complaints of severe occipital headache, vomiting, and unsteady gait of five months duration. Neurological examination revealed bilateral papilledema of 3 diopters, signs of cerebellar dysfunction on the left side including truncal ataxia, adiadochokinesia, positive Romberg test and markedlv distured tandem gait. Horizontal nystagmus with quick component directed to the left side was also found. Plain skull films showed suture separation and an abnormal calcific shadow measuring about 2 by 2.5cm in the posterior fossa. Reflux brachial angiogram showed marked bowing of anterior cerebral artery, and elevation of middle and posterior cerebral arteries suggesting a large mass in the posterior fossa causing obstruction of CFS pathways resulting in marked dilatation of ventricular system. Exploring the posterior fossa, a soft grayish tumor mass was removed partially. Microscopic diagnosis was medulloblastoma of desmoplastic type with calcification. Postoperatively CSF leakage through the incision site was encountered, but was controlled to be healed up by compression bandage. The patient showed no significant change of neurological status by the time of discharge. The patient was scheduled to undergo Co60 radiation therapy after discharge.

A Clinical Observation on Craniocerebral Injuries in Adult

In modern society, characterized by variability of daily life, complicated industrial structure and surprisingly increased traffics, the danger of unexpected accident if always threatening the people. In America, for instance, almost 0.5% of the whole population annually suffers from head injury. About two thirds of traffic accident patients have head injury of various forms. Among the head injury patients due to traffic accidents, the commonest cause of death is head injury itself in about 70%. In this study, 585 cases of adult head injury patients over 15 years of age, observed at the Department of Neurosurgery, Seoul National University Hospital during the period from January, 1966 till September, 1971 were reviewed. 1) There were 447 men and 138 women; male female ratio was 3:1.2) The commonest cause of head injury was traffic accident (57.3% of the total patients). A second common cause was "falls"(25.5%). 3) In skull fracture patients, vault fractures were twice as frequent as basal skull fracture. The incidence of simple fractures was remarkably higher than that of compound fractures, the ratio being 7:4. The incidence of linear fractures was slightly higher than that of depressed fractures, the ratio being 6:5. Most of linear fractures were simple fractures, but about 79% of depressed fractures were compound fractures. 4) Among the intracranial hemorrhagic lesion, subdural hematoma occupied about half of the total cases, most of whom were acute cases. The predilection site of subdural hematoma was the cerebral convexity (frontal, parietal and temporal areas). The epidural hematoma , of which the predilection site was temporal area, occupied about 30 % of the total intracranial hemorrhage lesions. Temporal lobe was the predilection site of intracerebral hematoma. 5) About half of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures. About 28% of the cases with skull fractures were accompanied by intracranial hemorrhagic lesions. 6) Altered consciousness was observed in about 90% of the total patients. Lucid interval was observed in 26% of the cases with intracranial hemorrhagic lesion. Vomiting occurred in a quarter of the total patients and early convulsive attacks were noticed in 5%. 7) Overall mortality rate of all the head injury patients was 12.3% and their operative mortality rate was 20.1%. The mortality rate in the patients with skull fractures was five times as high as in the patients without skull fractures. The mortality rate in the patients with intracranial hemorrhagic lesions was nearly three times as high as in those without. The mortality rate in the patients with linear skull fractures was about three times as high as in those with depressed skull fractures. 8) Sequelae were noticed in about half of the total patients. The most frequent one was postconcussion syndrome, the incidence being 36% of the total patients. 9) Associated injuries were found in about 10% of the total patients. The frequent ones were clavicle fracture, tibia/fibula fracture and mandible fracture, in order.