Study on Local Cooling of the Brain in the Cat

With the purpose of avoiding the usual complications of systemic hypothermia and particularly those secondary to the lower tolerance of temperature of the cardiac neuromuscular elements as compared with tissue of the central nervous system, extravascular local cooling of the brain in cat was designed for the experiment. The experimental technique was deviced to cool the brain with cold liquid(2-3 degrees C) of physiological saline perfused or irrigated onto and with the salineice(-7 degrees C) rested on the surface of the brain. Thermocouples were introduced and placed at different depths of each 0.3cm in the brain, then the brain temperatures were measured at each depth before and during cooling every 10 minutes. Average temperature of brain surface before cooling was 35.7+/-1.7 degrees C and mean of it recorded from surface to 1.5cm depth in the brain was 36.7+/-1.1 degrees C in 20 cats. During cooling temperatures was effectively and markedly droped at extent of 0.6cm thick in the subcortical tissue, and at 20 minutes, cooling the maximal drop of temperature was recorded. During cooling with saline solution, average temperature of normal brain surface was 22.3+/-41 degrees C and mean of it recorded at different depths in brain was 28.7+/-2.5 degrees C. During cooling with saline ice, average temperature of normal brain surface was 12.2+/-2.6 degrees C, and mean of it recorded at different depths in brain was 22.0+/-1.3 degrees C. Temperature in the areas of brain injured by contusion or compression was relatively lower than in the normal brain. Temperature lowering in the injured brain during the cooling was more evident and marked in its degree than that in normal brain. Gross neurological examination failed to demonstrate any impairment of voluntary motor function after the cooling of brain for 50 minutes.

A Case of Malignant Schwannoma in the Ulnar Nerve

We have recently experienced a case of malignant schwannoma in the right ulnar nerve. A 17 years old male underwent a surgery with a total removal of malignant schwannoma of the right ulnar nerve in the elbow. The tumor mass was walnut size with infiltration to the adjacent structures. The pathological findings show the pattern of interlacing bundles of long spindle cells, plumper hypochromatic elongated or serpentile and eosinophilic nuclei with process and frequent mitosis, loss of cellular polarity and polymorphism can be seen. Pathological diagnosis was malignant schwannoma. Approximately 4 months later his initial operation, the tumor recurred at right elbow and axillary region and removed without any proper treatment.

Raeder's Paratrigeminal Syndrome

The authors report two cases of paratrigeminal syndrome. They were male and involved in the left side, and had no known hypertension. The syndrome was produced and encountered in patients who had undergone a percutaneous carotid angiography and surgery with ligation of common carotid artery for the treatment of carotidcavernous sinus fistula. The clinical manifestations were unilateral, intense, throbbing supraorbital and periorbital pain recurring regularly, accompanied by drooping of the eye lid and miosis with normal sweating on the same side as the pain. The cases were treated conservatively with diphenylhydantion and antimigraine preparations with apparent success. It is probable that the underlying pathology of the syndrome in these cases may be compression of the internal carotid sympathetic fibers due to swelling of the interal carotid arterial wall. The clinical features and courses were compatible with those of group 2 of Raeder's syndrome.

A Case of Giant-Celled Glioblastoma in the Cerebrum

A rare case of a giant-celled glioblastoma arised from the intracranial portion of the right frontal base is presented. Clinical presentation was that of increased intracranial pressure with bilateral optic papilledema. Skull X-rays showed an erosion of the right orbital roof. Right carotid angiogram confirmed the presence of a tumor in the frontal base.

A Case of Necrosis of the Brain Following Roentgen Irradiation

A case of postirradiation necrosis of the brain, clinically simulating neoplasm, is reported. A 29 years old male underwent a surgery with a partial removal of chromophobe adenoma of the pituitary gland postoperatively received deep radiation therapy with CO60. A total dose of 4,500 r. was given in 35 days. Approximately six months after the irradiation, the patient became confused and complained of frontal headache in association with signs of increased intracranial pressure and of intracranial dynamic mass lesion. Cerebral angiography and C-T scanning demonstrated findings of a large mass in the right temporal region. At operation done nine months after his initial craniotomy, tissue of the mass appeared to be a glioma and large blocks of tissue were resected. Histologically it was verified to be necrosis of the brain.

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.

A Case of the Narrow Lumbar Spinal Canal Coexisted with Lumbar Disc Herniation

A case of the narrow lumbar spinal canal was reported in which a lumbar disc herniation was coexisted at L3-L4 interspace. The patient was a 58-year-old male whose chief complaint was pain in the low back and in both legs which was intermittent in occurrence and alternative from side to side. The symptoms lated for about 7 years prior to this admission to hospital and it was initiated and aggravated by standing for minutes or walking and especially by extention of low back. No significant neurological deficits were detected in neurological examination except for signs of single nerve root compression from which L3-L4 disc herniation was suspected. Findings of simple lumbar spine radiograms and myelograms were compatible with those of narrowed spinal canal. Complete bilateral laminectomy of lumbar spine sparing articular facets were performed to get freedom of neural element or structure in the spinal canal from pressure. Hypertrophied ligamentum flavum, thickened laminae and protrusion of disc at L3-L4 interspace were the findings observed in the surgical operation. The patient became asymptomatic after the surgery.

The Treatment of Anterior Communicating Artery Aneurysms by Proximal Occlusion of the Dominant Anterior Cerebral Artery

A direct intracranial operative approach that occludes the neck of the aneurysmal sac by clipping, and excludes it from the circulation without interference with the lumen of the parent vessel, is the ideal treatment of symptomatic intracranial aneurysm. With this procedure, however, there is no assurance of complete obliteration of the aneurysmal sac. Furthermore aneurysms arising from the anterior communicating artery are particularly dangerous because of the effects produced by spasm of the important neighboring perforating vessels. Since Logue published on the treatment of anterior communicating aneurysms by proximal ligation of an anterior cerebral artery in 1956, there has been by the large number of series of cases reported by other surgeons. Tindall classified three pattern of angiographic filling in patients with anterior communicating aneurysms and in type III, each anterior cerebral artery fills from its respective side, while the aneurysm fills from one side only, proximal ligation of anterior cerebral artery was performed with good effect. Five patients with anterior communicating artery aneurysm were treated by proximal occlusion of the dominant anterior cerebral artery with no mortality or morbidity. There was also instance of recurrent hemorrhage during the follow up period for 8 months to 5 years. We thought this operative procedure, therefore, can offer a highly acceptable result if the surgeon applies strict criteria to patient selection. Technically, the procedure was simple, earlier and could be performed more quickly than the direct attack.

A Case of Osteolytic Dumb-bell Formed Meningioma

A 37-year-old Korean male was admitted to the hospital in December 1976 because of a slow growing hard mass in the right frontoparietal region near the midline. The patient had noted the mass accidentally while combing his hair six years prior to admission. Since then, the mass had grown slowly but progressively. On admission, there was a hard ovoid mass, 9 by 7 cm in size, over the right frontoparietal region, projecting 3 to 4cm above the normal level of the skull. Skull roentgenogram disclosed a large area of bone destruction and defect, 8 by 6cm, in size at the site of the tumor, accompanying sclerosis along the margin of the bony defect. A tumor located in extracalvarial portion of the head was a well circumscribed one, 9x7x4 cm in size, with no bone tissue over tissue over the tumor. A tumor located in intracranial portion was also a well circumscribed one measuring 5x4x3cm, compressing the brain but not infiltrating. Extracalvarial and intracranial portions of the tumor were interconnected by the pedicle which was a part of the tumor and passed through the defect of the dura mater, 3cm in diameter, nearly in the center of the bony defect. The tumor, dumb-bell formed in extracalvarial and intracranial growths, was completely excised. Pathological diagnosis of the specimen was fibroblastic meningioma.

A Case of Facial-Hypoglossal Anastomosis

Surgery of the facial nerve may be required for the restoration of function when the nerve is paralyzed from trauma or disease and to reduce or abolish function when the muscle it supplies are involved in severe spasm. A case of facial-hypoglossal anastomosis is reported, in which intracranial injury and destruction of the left facial nerve were resulted from the operation with complete removal of a large acoustic neurinoma in the cerebellopontine angle. The anastomosis was required for innervation of the paralyzed facial musculature following the operation. The anastomosis is preferred to the accessory-facial combination because of the extensive muscular atrophy of the upper trapezius and sternocleidomastoid muscle. Using operating microscpe, the proximal hypoglossal nerve was approximated to the distal facial nerve below the posterior belly of the digastric muscle, and the descendens hypoglossal was anastomosed to the distal hypoglossal nerve to prevent some of the glossal hemiatrophy.

A Case of Facial-Hypoglossal Anastomosis

Surgery of the facial nerve may be required for the restoration of function when the nerve is paralyzed from trauma or disease and to reduce or abolish function when the muscle it supplies are involved in severe spasm. A case of facial-hypoglossal anastomosis is reported, in which intracranial injury and destruction of the left facial nerve were resulted from the operation with complete removal of a large acoustic neurinoma in the cerebellopontine angle. The anastomosis was required for innervation of the paralyzed facial musculature following the operation. The anastomosis is preferred to the accessory-facial combination because of the extensive muscular atrophy of the upper trapezius and sternocleidomastoid muscle. Using operating microscpe, the proximal hypoglossal nerve was approximated to the distal facial nerve below the posterior belly of the digastric muscle, and the descendens hypoglossal was anastomosed to the distal hypoglossal nerve to prevent some of the glossal hemiatrophy.