Cementifying Fibroma of the Frontal Bone in Children: A Case Report

No abstract available.

Four Cases of Congenital Depressed Skull Fractures in Neonates

Depressed skull fractures in newborn babies mainly result from birth injury and rarely occurr in intrauterine life without any definable etiology. We present 4 cases of congenital intrauterine depressed skull fractures which were discovered at birth in neonates. Three babies (case 1, 2, 3) had round shallow depressions without adjacent soft tissue injury except the last one (case 4), showing sharp angulation in the center of the depression. They had neither birth trauma nor forceps applications and they were healthy without neurologic symptoms. We performed nonsurgical reduction using vacuum extractor in all cases. Three cases were reduced successfully, but the last one failed due to sharp angulation in the center of the depression. It was reduced successfully by surgical elevation using a Freer elevator. Reduction should be performed in congenital depressed skull fractures without neurologic symptoms, because brain compression by depressed fracture results in brain injury or epileptic focus. Nonsurgical reduction should be prior to surgical reduction because of its technical feasability, safety and good results, but surgical reduction should be attempted in the case of sharp angulation in the center of the depression.

Prognostic Factors in Spontaneous Thalamic Hemorrhage

OBJECT: Object of this study is to study which factors affect the prognosis in spontaneous thalamic hemorrhage treated with conservative method, stereotactic surgery and extraventricular drainage. MATERIAL AND METHODS: We analyzed 127 patients with spontaneous thalamic hemorrhage for evaluating the factors affecting prognosis. Various factors such as age, sex, location of hematoma, Glasgow coma scale(GCS) on admission, intraventricular hemorrhage(IVH), ventricular dilatation, CT classification, hematoma diameter, 4th ventricle dilatation, and treatment modality. RESULTS: The results were as follows: 1) Of the 40 patients with GCS of 3 to 8, 15 patients(37.5%) died. Of the 34 patients with GCS of 13-15, 33 patients(97%) survived 2) The 99 patients had intraventricular hemorrhage and 25 patients(25.2%) died. The 28 patients had no intraventricular hemorrhage and they all survived. 3) Of the 24 patients in whom the cerebrocaudate index(CCI) was more than 0.25, 10 patients(41.6%) died and only 2 patients had good prognosis. The 35 patients had no ventricular dilatation and all 35 patients survived 4) Of the 23 patients extending to hypothalamus or midbrain with ventricular hemorrhage, 11 patients(47.8%) died and 12 patients(52.1%) survived. 5) Of the 10 patients in whom hematoma diameter was more than 45mm, 4 patients(40%) died and 6 patients(60%) had a poor prognosis. 6) The 31 patients had hemorrhagic dilatation of the fourth ventricle and 16 patients(51.6%) died. Of the 29 patients with ventricular hemorrhage and no dilatation, 6 patients(20.6%) died. CONCLUSION: Multiple logistic regression analysis showed prognostic factors: GCS score(p<1/20.0001), extending to hypotahalamus or midbrain with ventricular hemorrhage(p<1/20.0001), thalamic hematoma with IVH(p<1/20.0001), dilated 4th ventricle hemorrhage(p<1/20.0012), hematoma diameter(p<1/20.0001), CCI(p<1/20.0001).

Acute Post-Myelographic Meningitis with Iohexol

We report a case of severe chemical meningitis complicating iohexol myelography. Cerebrospinal fluid findings include a white blood cell count of 1700(94% polymorphouse cell, 6% lymphocyte ), sugar 20mg/dl and p rotein 170mg/dl. Chemical meningitis can not be distinguished from acute bacterial meningitis on the basis of the clinical findings and cerebrospinal fluid examination. A cerebrospinal fluid gram stain and culture were the only reliable test in deciding the etiology of the meningitis. The authors report this rare complication from iohexol myelography with review of pe rtinent literature.

Culture Characteristics of Oligodendroglioma and Central Neurocytoma

OBJECTIVE: Intra or periventricular tumors of the central nervous system such as oligodendroglioma and central neurocytoma, are frequently associated with hydrocephalus and histologically share the presence of relatively uniform, small round nuclei and perinuclear halos. The two entities may be difficult to discriminate from one another from surgical specimens by a routine histologic examination. The aim of this study is to characterize and distinguish better of these two entities by examining tissue cultural characteristics. MATERIALS AND METHODS: Total of 12 oligodendrogliomas and central neurocytomas were studied. Sterile fresh tumor tissues were mechanically and enzymatically dissociated into individual cells, and seeded onto 6 well culture dish with poly-L-lysine precoated Aclar coverslips placed in a well. The oligodendroglioma cells attached to the surface of the coverslips after 4 to 5 days, and easily detached by a mechanical shaking. The growth cycle of the oligodendroglioma cells show longer lag phase and shorter log phase than central neurocytoma cells. The central neurocytoma cells attached it within 12 to 24 hours, and thin, delicate cytoplasmic processes developed by 2 to 3 days after the preparation. Immunohistochemical stains for galactocerebroside and GFAP were positive in the cultured tumor cells of oligodendroglioma, and MAP2 and synaptophysin(SYP) incentral neurocytoma, respectively. CONCLUSION: The cultural characteristics can be used as a simple and reliable method for a differential diagnosis of oligodendroglioma and central neurocytoma located in the ventricular region of the brain.

Subdural Empyema in Infants

OBJECTIVE: The goal of this study was to review the etiologies, phathophysiology, clinical presentations and to compare the results of the surgical methods of subdural empyema especially in infants. PATIENTS AND METHODS: We reviewed the clinical data of five infantile subdural empyemas experienced in our hospital from 1993 to 1998 which were all surgically treated by craniotomy or burr hole trephination. We experienced five cases of infantile subdural empyema: two males and three females. The ages ranged from 40 days to 11 months. RESULTS: The etiologies of all five cases were unproven but all five cases had meningitis before the subdural empyemas were diagnosed. The causative organism in one was streptococcus pneumoniae, and the other were unknown. Two were treated with craniotomy(one with a good outcome and the other died) and three were treated with burr hole trephination(all three had a good outcome). CONCLUSION: Subdural empyema is a rapid progressing disease and it is important to detect and treat in the early stages of disease. The choice of surgical method must be based on the stage of the disease and its location in the cranial cavity.

Terson's Syndrome due to Subarachnoid Hemorrhage after Rupture of MCA Bifurcation Aneurysm

In the literature, Terson's syndrome most commonly co-occurs with subarachnoid hemorrhage(SAH) secondary to rupture of an A-com or ICA aneurysm. It is usually observed bilaterally and the prognosis is poor. The authors report two rare cases of unilateral Terson's syndrome after rupture of MCA bifurcation aneurysm rupture. In both cases, retinal hemorrhage was noticed after early aneurysmal clipping ; after these were conservatively treated, the visual acuity of one patient improved slightly and that of the other showed no change. For early detection and proper management of retinal hemorrhage after subarachnoid hemorrhage, early and periodic fundoscopic examination appears to be important.

Clinical Analysis of Axis Fracture

This retrospective analysis describes the clinical characteristics, treatment, and long-term outcome of 30 patients with axis fracture admitted to our institution between January 1991 and December 1995. The incidence of axis fracture was 27.2% in the 110 cervical spine fractures. Among these, odontoid process fracture was the most common type, 19 cases(63%) followed by 8 hangmans fractures(27%), 3 miscellaneous fractures(10%). Hangman's fractures, odontoid type III fractures and miscellaneous fractures were treated with external immobilization devices. Remaining 11 odontoid type II fractures, and six patients with dens dislocation of 6 mm or greater were initially treated by early surgical stabilization. Individuals with dens dislocated less than 6 mm were treated by external immobilization only. Among the nonoperative group of acute axis fractures, there was no fusion failure. In the early operated group, all patients were stable clinically or radiologically. But three patients with posterior wiring and bone graft complained of their neck motion limitation.

A Comparative Analysis of Stereotactic Evacuation & Conservative Treatment in Hypertensive Putaminal Hemorrhage

We have analysed 144 patients with hypertensive putaminal hemorrhage, admitting from January 1992 to December 1993. Surgical treated group with Komai's stereotactic system was 71 patients and medical treated group was 73 patients. The results were as follows: 1) The patients with ventricular rupture were 36 cases(25%). According to the degree of ventricular rupture, the mortality was increased and the good outcome was decreased(P40ml), the outcome in both treated group was similar. 4) According to CT classification, in class II(extending to anterior limb of internal capsule), good outcome of surgical group was better than that of non-surgical group. In class V(extending th thalamus or subthalamus), the mortality in surgical group was lower than that of non-surgical group(P<0.05) .

Cavernous Hemangioma in the Fourth Ventricle

A rare case of a cavernous hemangioma located within the fourth ventricle was reported in a patient with recurrent symptomatic episodes of bleeding. With the advent of modern microsurgical technology and high-resolution imaging modalities, especially MRI, it has become possible to make a correct preoperative diagnosis and the well delineated lesion can be resected totally with good results.

A Case of Lateral Ventricle Choroid Plexus Papilloma in an Infant

Choroid plexus papillomas are uncommon neoplasms of the central nervous system, accounting for 0.4% to 0.1% of all intracranial tumors. We present a choroid plexus papilloma in the trigone of the lateral ventricle in an 8 months old infant with hydrocephalus. We successfully controlled hydrocephalus and subdural fluid collection after total removal of the mass.

A Subgaleal Hematoma Accompanying Exophthalmos

A case of subgaleal hematoma accompanying ipsilateral exophthalmos is reported. The exophthalmos is due to orbital extension of subgaleal hematoma through potential gap between orbital septum and the lateral horn of the levator palpebral aponeurosis. We must remember that exophthalmos is able to occur after subgaleal hematoma.

Vitamin K-Deficient Hemorrhagic Disease in Infants with Acute Subdural Hematoma

We had experienced 2 cases of acute subdural hematoma due to vitaimin K(vit. K) deficiency. They were 44-and 42-day-old. After the adminstration of vit.K1, prolonged prothrombin time(PT) and activated partial thromboplastin time(APTT) were corrected, so the surgical treatment ws performed. We supposed the predisposing factors were breast feeding and unknown hepatic pathology. No complication remained to one infant but the other multiple cerebral infarctions. The etiology, pathogenesis, diagnosis, prevention are discussed. We insist on neonatal administration of vit. K1 for the prevention of bleeding tendency. If intracranial hemorrhage develops, we must keep in mind that the early neurosurgical intervention may be needed.