Granular Cell Myoblastoma of the Orbit: A Case Report

Granular cell myoblastoma is a relatively uncommon lesion of debatable history appearing as a small, solitary but occasionally multiple neoplasm and usually benign course. Most granular cell myoblastoma have been observed tongue, skin and subcutaneous tissue and in the breast but only rarely in the orbit and we know of only 12 well-documented orbital myoblastoma at present. We have recently seen a orbital granuloma cell myoblastoma occurring in a 39 year-old woman, the tumor was firmly attached to the muscle cone and caused exophthalmos with exodeviation of the left eye and was totally removed from the transcranial-orbital unroofing procedure.

CT-Guided Biopsy of the Paravertebral Lesion: Case Report

The accuracy of percutaneous needle aspiration and biopsies is related to localization of pathology and of the needle tip. Localization methods of percutaneous needle aspiration currently in use are fluoroscopy, ultrasound and angiography. The authors believe that localization by computed tomography is the most accurate method for performing biopsies. The authors have performed the biopsy of the paravertebral lesion under the CT-scan using EMI-5005 on Aug. 23, 1978, at the Department of Neurosurgery, Kyung Hee University Hospital.

Commissural Myelotomy: Case Report

The commissural myelotomy in the treatment of bilateral intractable pain was first reported by Armour in 1927. Used sparingly since its introduction it has recently met with renewed interest due to use of the operating microneurosurgical operating technique. We performed the commissural myelotomy in 40 years old male patient who complained of bilateral intractable pain in the lower extremities due to metastatic tumor. After total laminectomy from T10 to L1, employing with magnifying glasses we performed commissural myelotomy about 70 mm in length(T10-S2 segment) and 5 mm in depth on June 26, 1978. After operation, we had good result.

CT Brain Scan of the Subdural Hematoma: Analysis of 5 Cases

Computed tomography(CT) is a new and innovative radiologic technique, the diagnostic value of which has been well established by many reports. On account of its rapidity and non-invasiveness, CT has become the diagnostic precedure of choice for the initial evaluation of head trauma patients. The authors have performed CT scan using EMI-5005 on 5 cases of subdural hematoma during the period of 8 months from October 1977 to May 1978 at the Department of Neurosurgery, Kyung Hee University Hospital. Various attenuation coefficients of hematoma such as hyperdense, hypodense, isodense and of mixed density were observed by the CT images. One case of isodensity hematoma were clearly identifiable by delayed enhancement technique, which had been confused by ordinary, noninfused method.

A Brief Review of Computed Tomography in the Detection of Intracranial Lesions

Only a few years following its original development by the English Physicist G.N. Hounsfield at 1971, cranial computed tomography has proved to be of revolutionary importance for the diagnosis of brain disorders. This is reflected not least by the almost immediate and worldwide acceptance of the diagnostic method. First in Korea, The EMI Scanner(CT 5005/7, 160(160 matrix) was introduced at Kyung Hee University Hospital on October 1977. Since then, we reviewed 444 CT scans for 1 year. 216 representative examples of abnormal CT findings among these have been chosen from this group of cases for more detailed discussion and illustration. The results were as follows; 1) 216 abnormal CT findings were subdivided into brain neoplasm 50, orbital tumor 6, AVM 1, intracerebral hemorrhage 44, occlusive CVD 30, craniocerebral trauma 46, cerebral abscess 3, meningoencephalitis 8, hydrocephalus 13, atrophy 16, parasite 4. 2) In most brain tumor cases the tissue undergoes a change of density. Vascularized tumors were enhanced after contrast infusion. Solid tumor area are well differentiated against cystic area and necrosis, and hemorrhage in tumor is also well visualized. Tumor type is often surmised, exact classification is not possible. Thus a glioblastoma multiforme of the ring type cannot be differentiated from a metastatic tumor with central necrosis. But tumor density, appearance of contrast enhancement, predilection site of tumor, relation to adjacent structure, a degree of perifocal edema and clinical data are aid to identify the tumor type. 3) Spontaneous intracerebral hemorrhage can be identified with certainty because of high absorption values. Extent of hemorrhage and invasion of the ventricle are usually exactly visualized. Blood filling of basal cisterns and interhemispheric fissure is also well demonstrated. As opposed to spontaneous intracerebral hemorrhage, cerebral infarction shows as a region of low absorption values as early as 6 to 8 hours after ictus, which is often poorly defined with irregular borders and having mass effect during the 1st week thereafter. Sharper margins and more homogenous low density are developed 1 to 2 weeks after ictus and surrounding edema subsides with shrinking of hypodense area. Ipsilateral ventricular dilatation, homogenous low density area and sharp margins are usually found in older infarcts. 4) CT is the best method of assessing craniocerebral injuries. Since extravascular blood is set off by its high density and edematous tissue by its lower density from normal brain tissue, sequelae from injuries whose existence could only be suspected on account of the clinical symptoms but escaped detection regardless of the method used, can now be visualized directly in the CT. 5) Brain abscess has a characteristics but non specific appearance as CT, consisting of a ring configuration of the abscess capsule which shows marked enhancement after injection of contrast material. In acute stage of the meningoencephalitis, routine CT scan may be normal. During the couse of illness, diffuse enhancement of the basal cisterns and varying degree of ventricular dilatation may be found. 6) Brain atrophy is diagnosed by an enlargement of internal and external CSF spaces. Using standard sections a classification of the grade and form of the atrophy is made. The diagnosis of cysticercosis is made primarily calcification and multiple solid dense mass or cystic lesion surrounded by edema which may become enhanced following infusion of contrast media.

Multiple Retrocerebellar Arachnoid Cysts Coexisted with Medulloblastoma: Case Report

Arachnoid cysts are usually classified as developmental anomaly, inflammatory and traumatic in origin. Arachnoid cyst in posterior fossa occur frequently in the midline posterior to the cerebellum. These cyst usually present symptoms and signs due to increased intracranial pressure and may be confused with cerebellar or fourth ventricular tumor. Recently we had experienced a case of multiple retrocerebellar arachnoid cysts coexisted with pathologically confirmed desmoplastic medulloblastoma in eight months lod infant and reviewed the literatures.

Intracerebral Metastatic Choriocarcinoma Simulating Cerebrovascular Accident

Choriocarcinoma a rare malignant neoplasm of trophoblastic tissue, is characterized by early blood borne metastasis to distant organs such as lung, liver and brain. Involvement of central nervous system by metastatic choriocinoma may be manifested as acute or subacute apoplexy due to vascular invasion with tumor emboli. Therefore the diagnosis of cerebral choriocarcinoma should be suspected in women of child bearing age presenting the signs of acute or subacute intracranial pathology. We present and discuss 2 cases of intracerebral metastatic choriocarcinoma simulating cerebrovascular accident. One case, a 35 years old Korean housewife, was admitted to the department of neurosurgery, Kyung Hee University Hospital, with the chief complaints of headache, vomiting, focal seizure and right sided hemiplegia for 2 weeks duration. She had a history of irregular vaginal bleeding from 3 months before admission. On admission, there were flaccid paralysis of the right extremities with right sided facial palsy, central type and neck stiffness in moderate degree. Gynecologically, round tumor mass about 1.5cm in size at vagina was palpable and urine HCG was positive. Chest X-ray film showed scattered multiple nodular densities at both lung fields. Carotid angiogram showed vascular tumor in the fronto-parietal region. Brain scan revealed increased uptake in the parietal area. She died suddenly 3 days later at home. Another case, 39 years old housewife, was admitted to the hospital with unconscious state. Although she had and operation of hysterectomy 5 months before admission due to massive vaginal bleeding, she was quite well till several hours prior to admission when she complained of headache and vomiting followed by sudden loss of consciousness. Neurologic examination revealed deep comatose state with full dilated and fixed pupil. Chest film showed several nodular densities at both lung fields. Carotid angiogram revealed avascular space occupying lesion at right posterior partietal region. On operation, Dura was tense and scanty subdural hematoma and massive brain swelling were identified and intracerebral hematoma estimated 80cc was evacuated. Atypical trophoblast was found microscopically from biopsy material. She died on the 2nd postoperative day.

Clinical Analysis of Associated Injuries in Head Injuried Patients

The increase in the prevalence of head injury amongst civilian population and the provision of adequate hospital services have become matters of world-wide concern. Many present-day accidents may result in the victims receiving multiple complex injuries beside head injuries and the prognosis may become unfavorable in these patients. Therefore, the neurosurgeon must be alert to the possibility that his patients have injuries to areas outside the brain and be capable of rendering necessary, often lifesaving, treatment during the initial phase of management. We analysed associated injuries in 1523 head injured patients admitted to Department of Neurosurgery, Kyung Hee University Hospital from October, 1971 till September, 1977. The results were as follows : 1) The incidence of associated injury was 23.6% of all 1523 head injured patients. 2) In all head injuries, male outnumbered female by almost 2 to 1 and the ratio was similar in associated injury group(2.4:1). 3) The age distribution of all head injuries was 3rd, 1st and 4th decases in order, but in associated injury group it was 4th, 3rd and 5th decades in order. 4) Common causes of head injuries were traffic accidents(76.6%) and fall(11.6%), but in associated injury group traffic accident was the most frequent cause(90.8%). 5) The incidence of associated injury was higher in relation to the severity of head injury. 6) The sites of associated injuries were distributed as limbs, chest and face in order and the most frequent nature of associated injuries was fracture. 7) Single associated injury was more frequent than multiple, associated injury, about 5 to 1. 8) Overall mortality rate of all head injuries was 9.3% in contrast that of associated injuries was 17.5%. 9) Surgical mortality rate was significantly higher in associated group(40.3%) than nonassociated group(26.1%). 10) In multiple associated injuries the mortality rate was higher(21.3%) than in single associated injury(16.4%). 11) Mortality rate according to associated injured sites was as follows ; 36% for visceral injuries and 34.1% for chest injuries. 12) The mortality rate was highest in serious chest injuries such as hemo and/or pneumothorax and in hypovolemic shock on admission(60%).