Clinical Analysis of Chronic Subdural Hematomas: Review of 69 Operated Cases

The authors analysed retrospectively, 69 cases of chronic subdural hematoma admitted to the Department of Neurological Surgery, from January 1992 to February 1995. All hematomas were operated on by one burr hole trephination and continuous closed-system cather drainage system. The results were as follows: 1) Male was more frequently involved than female with ratio of 5.3:1 and the incidence was prredominent in the patients whose ages were over 50. 2) History of head trauma was found in 52 cases(75.4%), among which habitual alcoholism was found in 6 cases(8.7%). 3) The major symptoms and signs at admission were headache(55.1%), hemiparesis(44.9%), and mental changes(30.4%). 4) On the brain CT scan, hematoma showed low, iso, mixed, and high in density, and the shapes of hematoma were crescenteric, biconvex, planoconvex, and concave in order of frequency. 5) We have found a significant relationship between the neurological grade at admission and the prognosis, and noted full recovery in 45 cases(65.2%) and no d eath as a result of 1-burr hole trephination.

A Case of Intradural Spinal Lipoma

Intradural spinal lipomas are rare, primary genign tumor of the spinal canal. A case of intradural spinal lipoma with intramedullary extension is presented. Clinical feature was slowly progressing paraparesis. A subtotal excision was performed, and pathological studies confirmed the diagnosis.

A Case of Extradural Spinal Tuberculoma

Extraosseous extradural tuberculosis of the spine is rare entity. A 21-year-old man with low back pain, left-sided sciatica & motor weakness was admitted. Simple X-ray were normal. At operation, extradural, extraosseous granuation tissue were removed, which proved upon histologic examination to be tuberculous granulomas. The authors report a rare case of extraosseous tuberculoma in the posterior extradural space of whole lumbar region with review of literatures.

Giant Serpentine Aneurysm of the Posterior Cerebral Artery: Case Report

Aneurysms of the posterior cerebral artery are rare, furthermore giant serpentine aneurysms-partially thrombosed aneurysms containing a tortuous vascular channel-of the posterior cerebral artery are extremely rare. The author et al. were able to remove 3.9cm x 2.9cm x 3.0cm sized giant serpentine aneurysm of the distal PCA totally, without any significant postoperative neurological sequela except transient ipsilateral third cranial nerve paresis and transient hemihypesthesia. Various kinds of surgical treatment were proposed by several authors in managing unclippable giant aneurysms:excision including partial excision;clipping of feeding artery and excision;trapping and excision;revascularization and excision;anastomosis only. We took subtemporal approach under the surgical microscope and trapping & excision was performed in several steps:proximal clipping of the PCA distal to the Pcom-PCA junction;reducing volume of the mass through piecemeal resection of the aneurismal wall;distal clipping of the PCA;total excision and final trapping just proximal and distal to the origin of the aneurysm. We are discussing the characteristics of the giant serpentine aneurysm, precognition of rich collateral circulation of the PCA distal to trapping and surgical management of the giant serpentine aneurysm.

Von Hippel-Lindau's Disease: Case Report

Although cases of von Hippel-Lindau syndrome are not rare, the fact that hemangioblastomans can occur at sites in the nervous system other than the cerebellum is not appreciated. We are reporting a case of VHL complex in 23-year-old male. In this case, there were multiple cerebellar hemangioblastomas, retinal angiomas, multiple spinal hemangioblastomas, syringomyelia, and papillary cystadenoma of epididymis. There was no evidence of polycythe mia or abnormality of other organs. Large cystic cerebellar hemangioblastomas were removed surgically and papillary cystadenoma of epididymis were excised, too. Total laminectomy of T2, T3 and T4 revealed abnormal meningeal varicosities, enlarged spinal cord, inra-axial hemangioblastomas, and syringomyelia.

A Case of Primary Malignant Leptomeningeal Melanoma of the Spinal Cord: Case Report

The primary malignant melanoma of spinal cord is a rare tumor cause of compression of the cord 6)7). We are reporting a case of malignant melanoma, apparently originating from leptomeninges, of with diffuse neoplastic process widely spreaded over the area of cervicothoracic spinal cord of 34-yr-old woman.