Cerebral Salt Wasting Syndrome Associated with Pseudomonas Meningitis ccurred after Removal of Pituitary Adenoma: A Case Report

The authors report a case of cerebral salt wasting(CSW) syndrome followed by diabetes insipidus and meningitis after transsphenoidal approach for pituitary adenoma. Fluid and electrolyte imbalance occurs occasionally in neurosurgical patients due to DI or SIADH, however, CSW is different disease entity and the methods of treatment are different from those of DI or SIADH. A number of studies in recent years have shown that hyponatremia in many patients with intracranial disease might actually be caused by CSW in which a renal loss of sodium leads to hyponatremia and massive urinary water loss. CSW of this patient was resolved by fluid and salt replacement after 6 months.

Monostotic Eosinophilic Granuloma of the Skull: A Case Report

The authors report a case of monostotic eosinophilic granuloma which occured in the skull. A 37 year-old woman was presented with headache and soft mass in the occipital region. Plain skull X-ray showed a "punched out" osteolytic lesion in the right paramedian posterior parietal bone. Computed tomography shows a soft tissue mass and irregular bone destruction in corresponding region. On magnetic resonance image, the mass was of high signal intensity, with subgaleal extension and looks like a shirt stud or "collar button" on T2-weighted image. Total excision of the tumor and postoperative radiotherapy(1000cGy) were performed. The woman had no headache complains nor showed any focal neurologic deficit during the six months follow-up period. We report a case of monostotic eosinophilic granuloma of the skull with review of the pertinent literatures.

Results of Transpedicular Screw Fixation in Spondylolisthesis of the Lumbar Spine

The auther studied 54 lumbar spondylolisthesis patients diagnosed and treated with transpedicular screw fixation and bony fusion at our Hosptial between January 1990 and December 1994, and analysed the outcome. The results may be summarized as follows: 1) Of the 54 cases, 17 were degenerative spondylolisthesis and 37 were spondylolytic spondylolisthesis. Occurrence peaked during the fifth and sixth decades. 2) Posterolateral fusion(P.L.F) was performed in 37 cases and posterior lumbar interbody fusion(P.L.I.F) in eight ; P.L.F and P.L.I.F in combination was performed in nine cases. The mean follow-up period was 25 months. 3) In no patients was significant neurologic injury or functional root loss seen. Complications included two instrument failures and one wound infection. 4) Radiologic and clinical outcome was better in degenerative than in spondylolitic spondylolisthesis. 5) The radiologic and clinical outcome of bony fusion types P.L.F and P.L.I.F was the same. 6) The surgical result as evaluated by Mc.Nab's criteria was satisfactory in 81% of patients.

The Results of Stereotactic Evacuation of Spontaneous Large-Volume Intracerebral Hematomas

In a series of 289 patients who underwent stereotactic evacuation of spontaneous intracerebral hematoma(ICH) located in the supratentorial hemisphere from January 1990 through December 1994, the 30th day postoperative outcomes were analysed between small ICH group and large ICH group according to the initial Glasgow Coma Scale(GCS) scores. There were no significant differences found in the postoperative outcome between both groups(p=0.26), except for the finding that the small ICH group showed a better GCS score of less than 8(p=0.04) than large ICH group. In conclusion, it is suggested from these findings that stereotactic evacuation should be more readily employed for large ICH group as well as for small ICH group.

The Influence of Computed Tomographic Findings on initial Mental Status and Prognosis in Spontaneous Cerebellar Hemorrhages

The authors analyzed 53 cases with spontaneous intracerebellar hemorrhage diagnosed by brain CT scan and assessed the correlation between the mental status at admission, the outcome and the CT findings. The location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the mental status assessed by GCS at admission. The GCS score at admission, location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the outcome. We conclude that decreased GCS score at admission, large volume of hematoma, quadrigeminal cistern obliteration, presence of intraventricular hemorrhage and hydrocephalus could be considered as surgical indications and contributing factors for poor prognosis in the patients with spontaneous intracerebellar hemorrhage.