21 Cases of the Regional Cerebral Blood Flow During Craniotomy

A new technique, the laser-doppler flowmetry. has been used intraoperatively to measure blood flow responses in the normal brain tissue, the traumatic brain tissue and so on. The flow estimate by this technique is based on the assessment of the doppler shift of the low power laser light, which is scattered by moving red blood cells.

A Case of Huge Tentorial Meningioma: Case Report

The authers describe a case of huge tentorial meningioma in 32 year old female patient. Her clinical complaints were bifrontal headache and visual impairment. CT scan revealed huge supratentorial and infratentorial enhanced tumor mass. The tumor mass was removed in one stage.

Somatosensory Evoked Potentials in Ventricular Enlargement of Experimental Hydrocephalus

We investigated the somatosensory evoked potentials(SEPs) changes and subsequent changes of the ventricular enlargement in different stages of kaolin-induced hydrocephalus. 8 week-old fifty five cats weighing 900g to 1300g, were studied in this experiment. These animals were divided into 2 groups ; a normal control(5 cats), kaolin-induced hydrocephalic groups(50 cats). The kaolin-induced hydrocephalic groups were subdivided into 5 subgroups of 10 cats each ; kaolin induced 1,2,4,6 and 8 weeks hydrocephalic groups after an intracisternal injection of the kaolin. At the each stage of the kaolin-induced hydrocephalic animals, the following parameters were obtained ; somatosensory evoked potentials(SEPs) and the size of enlargement of the ventricles at the each stage of 1,2,4,6 and 8 weeks after intracisternal kaolin injection. The results were as follows: 1) A significant elevation of the intracranial pressure(ICP) was observed in 2 weeks after kaolin injection and peak value(ICP : 10.2+/-0.9mmHg) in 4 weeks after kaolin injection. 2) The mean latencies of these wave components in somatosensory evoked potentials(SEPs) responses were 6.27+/-0.12 msec in Po, 8.41+/-0.25 msec in No, and 12.55+/-0.36 msec in P1 and the mean central conduction time(P1-P0) was 6.10+/-0.16 msec in the normal control animals. 3) Changes of amplitude and latency in SEPs were more prominent in 4 weeks after kaolin injection and progressively prolonged latencies of each wave components and CCT were resulted in 6 and 8 weeks after kaolin injection. 4) In hydrocephalic animals, the size of the ventricle(septum pellucidum (SP)-caudate nucleus(CN) distance) was moderately increased to 5.19+/-0.43mm in 1 week after kaolin injection and continued to increased in maximum size up in the 4th week after injection. However there was no further increase in ventricular size after 4th weeks. 5) A close correlation was found between SEPs and ventricular enlargement at the each stage of kaolin-induced hydrocephalic animals. In conclusion, it is assumed that the detection of SEPs in hydrocephalus is a quite valuable prognostic tool to evaluate the functional integrity of the nerve conduction system near the paraventricular area which might be involved in ventricular enlargement.

Effect on the Regional Cerebral Blood Flow and Biomechanical Factors in Ventricular Enlargement of Experimental Hydrocephalus

To evaluate the biomechanical changes and cerebral blood flow in hydrocephalic brain, this study was designed to determine the regional cerebral blood flow(rCBF; frontal cortex and periventricular area), the pressure volume index(PVI) and the resistance to the absorption of cerebrospinal fluid(Ro) in different stages of the kaolin-induced hydrocephalus. Fifty five 8 week-old cats, weighing 900g to 1300g were used in this experiment. The experimental animals were divided into 2 groups ; a normal control(5 cats), and kaolin-induced hydrocephalic groups(50 cats). The kaolin-induced 1,2,4,6 and 8 weeks hydrocephalic groups after intracisternal injection of the kaolin. The rCBF was measured by hydrogen clearance technique and the PVI and Ro were determined by the technique of bolus manipulation of CSF. A significant elevation of the intracranial pressure(ICP) was observed in 2 weeks after kaolin injection and peak value(ICP=10.2+/-0.9mmhg) was obtained in 4 weeks after Kaolin injection. The significant decrease in rCBF were revealed in both frontal cortex and periventricular area of kaolin-induced hydrocephalic cats. The PVI was significantly increased from the normal value 0.77+/-0.02ml to 1.60+/-0.16ml at 4 weeks after kaolin injection and increased to 2.12+/-0.34ml at 6 weeks after kaolin injection. Ro was significantly decreased from the normal value 90.6+/-1.3mmHg/ml/min to 36.8+/-4.3mmHg/ml/min at 4 weeks after kaolin injection and further decreased to 6.2+/-1.9mmHg/ml/min at 8 weeks after kaolin injection. In Hydrocephalic cats, the size of the ventricle(septum pellucidum-caudate nucleus distance) continued to increase in size up to 9.40+/-0.7mm at the 4th week. However, there was no further increase in ventricular size after the 4th week. This study indicated that kaolin-induced hydrocephalic cats led to dramatic changes in volume-buffering capacity expressed as PVI, coupled a reduction in the Ro. The absorptive defect and also loss of volume-buffering capacity are not sufficient to cause progressive ventricular enlargement. It is assuming that some microcirculatory impairment in the brain parenchyma is playing an important role which facilitates ventricular expansion with changes of biomechanical property of the brain.

Efficacy and Tolerability of Nimodipine in Patients with Organic Brain Syndrome

The nimodipine, calcium-channel blocker, is known to specific to brain tissue and effect on the ischemic stroke. To evaluate the efficacy and tolerability of nimodipine, we studied the 37 patients with Organic Brain Syndrome(OBS) who admitted to St. Mary's Hospital from January to August, 1989. We followed up for 12 weeks of their 18 items of neurologic outcome. The results and conclusion were as follows: 1) The pretreatment SCAG(Sandoz Clinical Assessment-Geriatric Scale) was used as a base-line measurement and the efficacy of the therapy was evaluated entirely in terms of changes in SCAG after 3, 6, 9 and 12 weeks of treatment. The total score was changed with meaningful improvement(p<0.01). 2) Among the 18 items of symptoms, the confusion, the level of alertness, the memory and the orientation were the area that have showed the most improvement. 3) No effect on heart, blood chemistry or other side effect was noted during medication. 4) We also found that those improvement has no specific relation to age, sex and causes of OBS. These result indicate that nimodipine has a possible therapeutic benefit in patients with OBS, especially who have the symptoms of confusion and impaired recent memory. These result should encouraged us to do further study such as double blind placebo in order to clarify the genuine pharmacological efficacy.

Internal Wiring Fixation of Atlantoaxial Dislocation Caused by Odontoid Fracture in a Child

Although most patients with cervical fractures have damaged the lower cervical spine, there remain a significant number whose injury involve the atlanto-axial level. Since the diagnosis of fracture of he odontoid process was initially missed frequently, it is worth emphasizing the importance of adequate radiological studies for this potentially lethal lesion in head injury patient. The treatment for fractures of the odontoid process has consisted of reduction followed by immobilization using skeletal traction, a plaster case or halo device, or internal fixation by surgical intervention. The advantages of early surgical treatment to minimize external immobilization or prolonged bed confinement are generally accepted but the surgical techniques have varied widely. The authors have managed a case of traumatic atlanto-axial dislocation in a child combined with severe brain injury by internal fixation using wire only after reduction of the dislocation was accomplished by skeletal traction. The available literature regarding this injury is reviewed.

Visual Field Defect and CT Findings in Epidural Hematoma

The evidence of infarction within the territory of the posterior cerebral artery could be diagnosed clinically using follow-up CT scan in whilt it has been pathologically well proved entity when the tentorial herniation occurred particulary in cases of head trauma with intracranial hematoma, although its incidence was generally within 10%. Visual field defects in traumatic intracranial surface hematomas have been proposed as result and directly optic tract or visual cortex. Authors experienced the infarction of occipital and temporal lobe on CT scans and the homonymous hemianopsia in 3 cases of 20 epidural hematomas after CT was available. The case histories and CT findings of the infarction were detailed and discussed. It may be stressed that the careful examination and frequent follow-up CT scan are performed even in epidural hematoma.