Traumatic Cirsoid Aneurysm of the Scalp Diagnosed by Doppler Ultrasonography: Case Report

The authors report a patient with a small traumatic cirsoid aneurysm of the scalp, diagnosed by duplex doppler ultrasonography. This 15-year-old boy was diagnosed as a cirsoid aneurysm by duplex doppler ultrasonogram which revealed an ovoid cystic lesion at left temporal area of scalp containing vascular flow mapping. The gross appearance showed an aneurysm with arteriovenous fistula, consisting of two feeding arteries and two draining veins. Total removal of mass was made and the histological examination revealed an aneurysm which showing irregular contour of inner surface and thickened fibrotic vascular wall without normal arterial layers. Noninvasive duplex doppler ultrasonography before surgical excision or direct puncture embolization of cirsoid aneurysms of the scalp could be recommended as an alternative management option.

Effects of B-16 Melanoma Cells and Mycoplasma pneumoniae on the Induction of IL-1 beta, IL-2, IL-6, IL-10, IL-12, and TNF - alpha from Mouse Astrocytes

No abstract available.

Retrospective Outcome Evaluation of Cervical Chemonucleolysis with Digital Infrared Thermographic Imaging

The diagnostic efficacy and comparability of digital infrared thermographic imaging(DITI), computerized tomographic(CT) scan and magnetic resonance imaging(MRI) in the assessment of outcome of chemonucleolysis for herniated soft cervical disc patients with ce rvicobrachial neuralgia were evaluated. Forty seven patients of herniated cervical discs who were treated with nucleolysis using chymopapain for last 2 years were assessed by each studying modality and clinical examinations. All the cases received DITI, CT scan and/ or MRI, and the thermal difference of each patient between symptomatic and asymptomatic limb was analyzed pre- and post-operatively. The diagnostic efficacy of each technology was similar, and inter-rater comparability did not differ significantly. DITI showed significantly good correlation with clinical outcome although there existed a considerable inaccuracy in assessing individual subjects. Digital infrared thermographic imaging was shown to be very useful method in the outcome evaluation of cervical chemonucleolysis.

A Study on the Selection Criteria of Surgical Approaches to Vestibular Schwannomas

This study was carried out in order to clarify the selection criteria of the surgical approaches and validate their efficacy in patients with vestibular schwannoma. The evolution and modification of the transpetrosal approach was evolved into combined approaches to vestibular schwannomas. These approaches have been advocated to reduce the mortality and morbidity as well as to improve the surgical results especially in large acoustic neurinoma. Having been stimulated with the fascinating preliminary surgical results of the suboccipital and combined transpetrosal approaches, we have builded up a decision making policy based on the tumor size and the preoperative hearing status for the surgical approaches to vestibular schwannomas. Between May 1996 and September 1997, 21 patients with vestibular schwannoma including one case of NF II underwent either suboccipital or various transpetrosal approaches. There was no surgical mortality. Gross total removal was achieved in 20 patients(95%). Facial nerve function was preserved in 19(90%) and hearing function in 6(46%) among the 13 patients who underwent hearing preservation surgery. The authors confirmed the validity of various transpetrosal approaches in this study and conclude that our policy on the surgical approaches to vestibular schwannomas is quite reasonable.

Chondroitinase ABC Chemonucleolysis on Normal Rabbit's Lumbar Discs

OBJECTIVE: This study is aimed to evaluate the effect of chondroitinase ABC on normal rabbit lumbar discs. MATERIALS AND METHODS: A series of intradiscal injections of chondroitinase ABC was performed in 9 young adult rabbits. A control series of intradiscal injections of iodine contrast medium was performed in 6 young adult rabbits. Roentgenograms were taken preoperatively and were repeated at one, three, five, seven days after injection of chondroitinase ABC. Roentgenograms also were taken preoperatiely and at seven days after injection of contrast dye. Magnetic resonance imagings(MRI) scan was performed pre-operatively and at seven days after injection. Light microscopic examination of both groups was done at 7 days postinjection. RESULTS: Roentgenographic evidence of disc space narrowing showed significant correlation with time course in the series of intradiscal injections of chondroitinase ABC compared with the control series. T2 weighted MRI of disc space demonstrated significantly decreased signal intensity in the series of intradiscal injections of chondroitinase ABC at seven days after injection, as compared with the control series. Histologic evaluation revealed the stainability of nucleus pulposus and annulus to toluidine blue which was quite decreased. The cytoplasm of notochordal cells of nucleus pulposus appeared to be shrunken, and the large cytoplasmic vacuoles in hematoxylin-eosin stain were decreased in the series of intradiscal injections of chondroitinase ABC, which were not evident in the control series. CONCLUSION: Intradiscal injections of chondroitinase ABC on normal rabbit lumbar disc proven to have chemonucleolytic effects.

Comparison between Acetazolamide and Dipyridamole Activated SPECT for Cerebral Vascular Reserve Capacity Measurement

Object of this study was to make comparison between acetazolamide and dipyridamole activated SPECT for measurement of cerebral vascular reserve capacity. This study was also carried out to evaluate response in acetazolamide and dipyridamole activated SPECT in relation to clinical parameters, such as Glasgow Coma Scale, Hunt & Hess grade, Fisher grade and Glasgow Outcome Scale. It is concluded from study that. Acetazolamide and dipyridamole activated SPECT study proved to be valuable for cerebral vascular reserve capacity. Dipyridamole activated SPECT study was somewhat equivocal because of systemic vascular dilatation effect, but this problem could be resolved by Gamma Count Ratio. Although there were minimal transient side effect of dipyridamole such as dizziness, no complication.

The Modular Concept in the Lateral and Posterior Skull Base Approaches: Anatomico-clinical Study

OBJECTIVE: Despite advance in the surgical treatment of the skull base lesions, reaching the ventral brain stem is not familiar to us yet. No traditional complex skull base approaches have a value not only in treating complex and unusual skull base pathology but also in providing a better and safer exposure to traditional pathology. However, a more widespread use of these complex skull base approaches is predicated on a clear understanding of the topographical areas of the skull base exposed and on how these complex approaches can improve the exposure afforded by more conventional surgical routes. PATIENTS AND METHODS: The study was performed on 43 surgical dissection with 20 embalmed cadevaric heads in which the cephalic vascular system had been injected with colored silicone material. RESULTS AND CONCLUSIONS: This paper provides an visual anatomical understanding of the areas of the skull base exposed by the approaches examined using the same cues(CT and MRI) that the surgeons use in selecting an approach when confronted with a real lesion and makes them to apply to the clinical situations properly and intimately for the optimal treatment. In addition, with the modular concept, the neurosurgeon may better understand how complex skull base approaches are derived and modified from, and improve the exposure of basic, well known conventional neurosurgical approaches as building block.

A Case of Adrenal Neuroblastoma Presented with Late Brain Metastasis

Intracranial metastasis from primary extracranial neuroblastoma is rare and parenchymal involvement is even rarer. Its pathogenesis is uncertain and the outcomes from the previous reports during the past several decades indicate a uniformly poor. The operative findings of this case suggest that the neural crest derived tissues providing the appropriate "soil" to support CNS-metastasizing neuroblastoma. We report a case of cerebral metastatic neuroblastoma which has relapsed in adrenal gland and discuss its pathogenesis with review of the literature.

Partial Posterior Canal Labyrinthectomy for Pontine Cavernous Angioma

The transpetrosal approach to the anterior portion of a brain stem lesion with intact hearing is often limited by portions of the labyrinth. The technique of partial labyrinthectomy, by which the posterior and superior semicircular canals, maximizes surgical exposure while preserving hearing. We report the case of a patient who underwent a modified partial labyrinthectomy involving resection of the posterior semicircular canal only in the area of the labyrinth. Technical modification of the partial labyrinthectomy approach simplifies tumor removal while preserving hearing.

The Role of CT/Discography in Assessing Postoperative Disc Herniation

Successful management of patients with persistent or recurring pain after lumbar disc surgery requires comprehensive evaluation to accurately localize the anatomic sources of pain. The results of reoperation for recurrent disc herniation are uniformly good, whereas those of reoperation for scar tissue are poor. There have been few studies comparing the ability of enhanced MRI and CT/discography to distinguish between scar tissue and recurrent disc herniation. We evaluated 23 patients with recurring pain after lumbar disc surgery. Two neurosurgeons independently reviewed CT/discography and MRI of each patient before and after gadolinium enhancement. To determine the accuracy, sensitivity, and specificity of each test, responses were compared with surgical findings and CT/discography was found to be more sensitive and specific in distinguishing between scar and recurrent disc herniation. Characteristics associated with recurrent disc herniation include nonenhanced or rim-enhanced abnormality surrounding a low signal on enhanced MRI. and extension of contrast into the epidural space on CT/discography. For determining the need to repeat open disc surgery, combined MRI and CT/discography is more accurate and sensitive than either test alone.

Influence of Mycoplasma Pneumoniae Infection on the Growth, Phagocytie Activities and Induction of Nitric Oxide Production of the Microglial Cells of Mice

In this study, the distribution and reisolation of Mycoplasma pneumoniae(Mp) were observed from the various tissues of BALB/c mice which were intraperitoneally pre-inoculated with Mp. In addition, the effect of Mp on the growth, phagocytic activities and nitric oxide production of microglial cells were also examined. The results were as follows; 1) Mp was reisolated from the various tissues such as lymph node, spleen, liver, kidney, brain and blood from one hour through 48 hours after intra-peritoneal inoculation of Mp in mice by the cultural method. Furthermore, it could also be confirmed from those tissues up to 72 hours by the indirect immunofluorescent antibody method. 2) There was no difference in the phagocytic activities between the control microglial cells and Mp stimulated microglial cells. 3) The growth of microglial cells in the medium was significantly increased by the stimulation with Mp compared with that of the control. 4) Nitric oxide production of mouse microglial cells was increased by the combined treatment if IFN-r and LPS or IFN-r and Mp or IFN-r, LPS and Mp, whereas, no increase was observed by either LPS or Mp alone. 5) Nitric oxide production of microglial cells primed with IFN-r was closely related with the dose of LPS and Mp in the dose dependent manner rather than that of the IFN-r. These results suggest that; i) Mp spreads to the various tissues of mice within one hour after intraperitoneal inoculation, ii) the growth of microglial cells increases by the infection of Mp, iii) microglial cells have phagocytic activities to C.albicans and iv) nitric oxide production of microglial cells was augmented by the infection of Mp. Increased nitric oxide production of microglial cells is regarded as an increase of the intracellular bactericidal activiteis of microglial cells. It is suggested, nonetheless, that the inflammatory response of the Mp infected tissues is augmented by the increase of nitric oxide.

Can DITI Predict a Sequestered Lumbar Disc?

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.

99m Tc HMPAO Brain SPECT in Patients with Diffuse Axonal Injury

This study was performed in order to compare the functional imaging by 99m Tc-HMPAO brain SPECT with structural neuroimaging by CT or MRI. Eighteen patients with diffuse axonal injury underwent HMPAO brain SPECT(18), CT(9) and MR(14), and neurological status were then evaluated. Seventeen patients(94%) were revealed abnormal SPECT whereas nine patients(50%) demonstrated abnormal CT compared with ten patients(71%) demonstrated abnormal MRI. The neurololgical deficits correlated well with abnormal SPECT lesion except in one case. It is therefore concluded that brain perfusion SPECT is not only more sensitive than CT or MRI, it is also more cost effective and clinically well correlated in diffuse axonal injury patient.

Subcortical Intracerebral Hemorrhage:Clinical Analysis of 42 Patients

Forty two patients were diagnosed as having subcortical(lobar) intracerebral hemorrhage among 407 consecutive patients presenting with spontaneous intracerebral hemorrhage. Brain CT and MRI or angiography were performed in 39 patients. The authors analyzed clinical features, brain CT, etiological factors, and outcome. Headache(69%) and vomiting(55%) were most common symptoms. The incidence of seizure was 14%. The volume of hematoma on CT was below 20cc in 21 patients, between 20cc and 40cc in 16 patients, and aove 40cc in 5 patients. The most common site of hemorrhage was parietal lobe in 32 of 42 patients. The mortality rate was 9.5% and the functional outcome of the patients was generally better than in other forms of intracerebral hemorrhage. Thirty one patients had arterial hypertension which was the leading cause. Two patients had AVMs and two patients had blood dyscrasias. Unknown etiology occurred in 7 patients. Neither brain MRI nor cerebral angiography showed abnormal vascular lesion in all of the pa tients who had arterial hypertension. We conclude that no further evaluation if recommended in patients with subcortical hemorrhage who were definitely diagnosed as having arterial hypertension.

Clinical Analysis of the Factors Affecting the Growth or Rebleeding of Spontaneous Intracerebral Hemorrhages

The growth or rebleeding of the spontaneous ICH is catastrophic so that prevention of them is critical in management. We reviewed 233 cases of spontaneous ICH from Jan. 1990 to Dec. 1994 to evaluate the factors associated with the hematoma enlargement. The relationship among the admission time from hematoma onset, the systolic BP at admission, hemostatic parameter, liver dysfunction with rebleeding incidence were assessed. Also, hematoma shape, density, site, volume, and operation tiem from hematoma onset were evaluated. Hematoma growth was oserved at 26 patients(11.6%). Incidence of rebleeding was significantly associated in patients with shorter admission time from hematoma onset, high systoic BP at admission, inhomogenous, irregular-shaped hematoma at CT and liver dysfunction. The incidence of hematoma growth was higher in the early operation group but there was no significant relationship in statistic analysis. Patients admitted within 6 hours of hematoma onset, with irregular-shaped, inhomogenous hematoma on CT, and liver dysfunction should be observed closely for the enlargement of hematoma. The operation time might be delayed at least 6 hours after hematoma onset.

Spontaneous Resolution of Chronic Subdural Hematoma in Children: Case Report

Presented here in are two cases of chronic subdural hematoma in children which were spontaneously resolved. The first case has developed as the complication of a ventriculoperitoneal shunt in bilateral cerebral convexities of a 14-year-old boy while in the other case, the hematoma was developed in the posterior fossa of a 19 days-old neonate are complication of delivery. The etiology, clinical couse, treatment and mechanism of spontaneous resolution of chronic subdural hematomas in children and adult are discussed.

Exophthalmos in Chronic Epidural Hematoma: Case Report

A case of chronic epidural hematoma in the left frontal region is presented. The patient presented with a unique neurologic sign, exophthalmos, which was not a result of the injury but of in-growth of granulation tissue of the hematoma capsule into the orbit through the orbital roof defect. The time interval between head injury and the operation was about 25 years. Our case represent the second most longest time interval among the reviewed literatures.

Morphological Changes in Skeletal Muscle Following Experimental Colchicine Toxicity: Electron Microscopic Study

To investigate the morphological changes in skeletal muscle produced by colchicines toxicity, 42/rats were given a single intraperitoneal dose(0.4mg/Kg) of colchicines, and the animals were killed at daily intervals up to 7 days. The results of light microscopic and electron microscopic observations are summarized as follows; 1) At the light microscopic level, colchicines treated arts show non-inflammatory, nonspecific scattered degeneration or necrosis of myofibers irrespective of location of the skeletal muscle. No significant pathologic changes in peripheral nerve fibers distributed in affected muscles are seen. 2) The general ultrastructural changes are dilation of sarcoplasmic reticulum, swelling and pleomorphism of mitochondria, and appearance of membraneous bodies characterized by a single or multiple concentric layers of membranes in subsarcolemmal zones and intermyofibrillar zones, and focal necrosis or loss of myofibrils. The incidence and severity of these changes show gradual increase and reach maximal peak 3 days after colchicines administration, and then they show gradual decrease. Nerve fibers and motor-end plates show no difference compared with the control. 3) The observations are consistent with the opinion that the muscle weakness or paresis produced by toxic dose of colchicines is not of neuropathic, but of myopathic alterations. 4) The membraneous bodies are classified into the following 3 types;Type I is those bodies outlined by a few concentric membranes with osmiophilic granules, small vesicles, free ribosomes, and mitochondria in central zone. Type II is those outlined by several concentric layers of membranes with osmiophilic granules, small vesicles, free ribosomes, and mitochondria in center. Type III is those outlined by multilayered or thick concentric membranes with osmiophilic granules, small vesicles, free ribosomes, and mitochondria in central zone, frequently with complicated lamellar structures. 5) The skeletal muscle lesions produced by colchicines toxicity may be categorized into those degenerative changes characterized by the appearance of membraneous bodies. And, morphologically, it is presumed that the membraneous bodies are heterogenous in origin, alterations of subcellular structures such as sarcoplasmic reticulum, mitochondria, and lysosome.

Paraganglioma of the Cauda Equina

Paraganglioma of the cauda equina or filum terminale is rare tumor and was first described in 1970. The authors present a case of paraganglioma of the cauda equina in a 55 year-old-man with nonspecific back pain. To our knowledge, there has been only a few report of MRI of a paraganglioma of the cauda equina. Diagnosis can be made with immunohistochemical study and electron microscopy after surgical removal. Because of frequent recurrence, total excision is mandatory.

A Case Report of Recurrent and Disseminated Cerebellar Hemangioblastoma

The authors present a rare case of recurrence and dissemination following total removal of solitary cerebellar hemangioblastoma. A 48-year-old male patient who had been diagnosed as having cerebellar hemangioblastoma was admitted to our hospital. After two consecutives successful removal of the tumor, there were several years in which he was free from symptoms, but recurrence and dissemination was found on both cerebellar hemispheres and brain stem. Using previous reports, we will demonstrate the clinical and pathological factors which are responsible for recurrence or dissemination of cerebellar hemangioblastoma. So we suggest that in cases the possibility of recurrence and dissemination are associated with the preidictors, it may be necessary to have follow up examinations routinely for a prolonged period.