The Morphometric Study for the Rolandic Fissure

OBJECTIVE : The purpose of this study was to characterize the Rolandic fissure(Rf) and was to identify the Rf using the surface bony landmarks which can be usually exposed on craniotomy. METHODS : After morphological evaluation of the Rfs using 21 Korean adult formalin fixed cadavers, craniometric measurement was carried out from the surface bony landmarks of nasion, glabella, bregma, and lambda. RESULTS : The Rfs of both hemispheres did not show the mirror image. The Rfs ran forward and downward toward the sylvian fissure keeping the mean angle of 67degrees from mid-sagittal line as elongated S-shape in left and the elongated reverse S-shape in right hemisphere. Connections between the Rf and the longitudinal fissure and between the Rf and the sylvian fissure were found in 3 (7.1%) and 2 (4.8%) of 42 hemispheres, respectively. Most Rfs extended superiorly to 2-3mm lateral to the most superomedial surface of hemispheres and extended inferiorly to 3-5mm superior to the sylvian fissures. The mean distances from the nasion, glabella, bregma, and lambda to the most superomedial aspect of the Rf were 18.8+/-0.9cm, 16.6+/-0.8cm, 5.2+/-0.6cm, and 6.9+/-1.0cm, respectively. The mean distance measured between the Rf and the nasion using traditional method was 18.4+/-0.6cm. CONCLUSION : The distance between the Rf and the nasion roughly correspond within the range of mean 4 mm compared with that measured by the traditional measurement. These data may be more helpful to delineate the Rf after the placement of drapes for craniotomy.

Comparative Clinical Analysis of Surgical and Conservative Treatment for Hypertensive Intracerebral Hemorrhage

Hypertensive intracerebral hemorrhage(ICH) is one of the leading causes of death in Korea. However, there are too many controversies regarding the pathogenesis and proper management of this disease. The author investigated the role of surgical treatment in improving the outcome of hypertensive ICH by analyzing the results of surgical and conservative therapy performed in 339 patients with hypertensive ICH during the past 8 years from 1986 to 1993. The peak age incidence of patients with hypertensive ICH was in the sixth decade(29.2%), and 88.5% of the cases occurred after the fifth decade. There was no sexual preponderance. Winter was the most prevalent season. Location of the hemorrhage was putamen in 9.2%, thalamus in 23.6%, lobular in 14.5%, cerebellum in 11.2%, caudate nucleus in 5.9%, and brain stem in 4.7%. The Glasgow coma scale(GCS) on admission was 3-5 in 17.7%, 6-8 in 2.4%, 9-12 in 20.1%, and 13-15 in 39.8%. Surgery was performed in 127 patients(37.5%) and the remaining patients were treated conservatively. The surgery rate was the highest(52.7%) for patients with 6-8 GCS, and the volume of hemorrhage was 0-45 cc. The outcome of all patients at discharge was graded as good recovery in 24.2%, moderate disability in 33.0%, severe disability in 11.8%, vegetative state in 8.6% and death in 22.4%. The mortality rate was 42.7% for patients with a 3-8 GCS, 23.5% for 9-12 GCS, and 1.5% for 13-15 GCS. The mortality rate was 9.2% in cases with a hemorrhage volume of less than 15cc, while in those over 60cc, the mortality rate was 75%. The results of surgical and conservative treatment were compared in each subgroups because the method of treatment differed according to the GCS and the volume of hemorrhage. When the GCS was less than 8, and when the hemorrhage volume was over 30cc, better results were obtained with surgery than with of conservative management(P<0.025, P<0.01, respectively).

Central Cord Syndrome after Standing of Head in a Child: A Case Report

The following report is a case of central cord syndrome in a seven-year-old girl. There was no history of major trauma except instances of standing on her head. Plain x-rays and CT myelography of the cervical spine revealed no abnormalities. Although she was apneic for 12 days and quadriparetic, the patient recovered and was able to walk on the 24th hospital day. Since central cord syndrome as a result of standing on head is unusual in children with a normal cervical spine, the arthors decided to report the above described case for medical interest.