The Study on Experimental Brain Herniation

Cerebral herniations were successfully produced in experimental animals during the expansion of intracranial balloon or laminaria. Visualizing structures deep in the brain, cat's heads were instantaneously frozen with liquid nitrogen and were sectioned in the midline longitudinally. The cerebral herniations were assessed by measureing the distance between parts of various anatomical structures on the brain in mid-sagittal sectional plane. Transtentorial rostrocaudal herniation of the brain stem was evident and more marked in the group of bilateral lesions than in the groups of frontal and temporal lesions. Infratentorial lesions produced transtentorial upward herniation of a part of anterior cerebellar vermis and downward herniation of the cerebellar tonsil through the foramen magnum. The risk of brain herniation was noted to be greater in rapid expanding lesions with balloon than the more slowly developing lesions with laminaria.

A Case of Glioblastoma Multiforme of the Cerebellum

Most of glioblastoma multiforme in brain are known to be located supratentorially. On posterior fossa, they are mostly found in brain stem and cerebellar case is rare. A case of cerebellar glioblastoma multiforme is presented with the review of literatures.

A Huge Osteoma Originated From the Frontal Sinus: Case Report

On the review of literature, various cases of osteomas orginated from paranasal sinuses can be found. But osteomas which are large enough to produce ocular symptoms are not very common. Even more, various ocular and intracranial sequelae may be complicated from surgical removal of huge frontal osteoma. We present a case of huge frontal osteoma which is originated from frontal sinus and removed successfully without any complications.

Hydrocephalus In Achondroplasia: Case Report

Major neurological features of achondroplasia are attributed to premature synostoses of the pedicles of the vertebrae and of the base of the skull producing obstruction of the ventricular fluid circulation or compression of the medulla and spinal cord. Significant hydrocephalus is due to the obstruction of the cerebrosspinal fluid pathways at the level of the foramen magnum or the disturbance of CSF absorption caused by increased superior sagittal sinus pressure. In generally, the hydrocephalus in achondroplasia is of the communicating type in the pattern, so the CSF diversionary shunt may not be indicate. But, shunting procedures may be needed in patients who showed signs of severe IICP such as bulging fontanels and enlarged lateral ventricle. In this case, we experienced that the hydrocephalus in achondroplasia is prosorption following the stenosis of the foramen magnum and increased superior sagittal sinus pressure.

A Case of Spontaneous Hematomyelia

This is a report of 23 year old soldier who developed sudden onset of flaccid paraplegia and loss of all sensory modalited below the level of T4. The clinical entities of hematomyelia were sudden onset of pain, repidly developing pyramidal signs and paraplegia. The mainly involving sites of this disease were cervical and thoracic regions. The causative factors were hemorrhagic diasthesis, vascular malformation and inflammatory process as well as trauma and neoplasms affecting the spinal cord. We experienced a case of hematomyelia which did not combine with vascular anomaly, inflammatory process, hemophilia or trauma history.

Brachial Plexus Injury by Gun-Shot

Disturbances of the surrounding vascular system and the severe cicatrical entrapment of the injured plexus should be considered, with its neural damage, in brachial plexus injury by Gun-Shot. Therefore, Subclavian arteriography and Subclavian venography before operation should be essential and the correction of the deficit of the vascular system may be a factor in the determination of prognosis in relation to pain control. We have reported 2 cases of the brachial plexus injury by Gun-shot and discussed the importance of Subcalvian arteriography and Subclavian venography. External neurolysis seems to be beneficial in Causalgia caused by brachial plexus injury.

A Case of Neurilemmoma of Cauda Equina Similar to Symptoms of Herniated Lumbar Disc

A case of cystic neurilemmoma of cauda equina similar to ruptured lumbar disc herniation was brought to our attention. The patient, because of pain in lower back and in both legs, underwent acupuncture and herbal treatment without obtaining any result. In March 79, Lumbar myelography revealed meniscus sign at the level of the lower margin of L-4 body and thus total laminectomy was performed on the patient to remove the tumor. After the operation, the patient showed quick recovery.

Fibrous Dysplasia of the Skull

Fibrous dysplasia infrequently involves the cranium with wide range of variety. Recently, we have expierenced a case of diffuse sclerotic type of fibrous dysplasia which involves frontal and sphenoid bone with vault deformity. Furthermore, we stressed the diagnostic procedures such as carotid angiography, orbital venoraphy & C-T scan, are valuable in recognization of the extent of involvement and in differential diagnosis.

A Case of Intracranial Subdural Empyema

A 20-year-old male patient was admitted to this hospital because of headache and high fever on October 10, 1974. He has insidiously develope frontal headache and high fever for these 10 days, followed by vomiting, convulsions, aphasia and motor weakness on the left extremities and subsequently fell into semicomatose state. Hemogram showed marked leukocytosis, 22500/mm3, and cerebrospinal fluid cell count revealed increased leukocyte, 1210/mm3. Simple skull Roentgenograms showed no significant abnormalities except for suspicious haziness on the left frontal sinus. Carotid angiogram showed distal shift of the anterior cerebral artery, medial displacement of the middle cerebral artery and small avascular area on the left temporo-parietal area. Brain scan showed high activities on the entire left cereral hemisphere. On October 12, 1974 a large fronto-temporo-parietal osteoplastic craniotomy was done. Yellowith green, foul odored pus gushed out from the subdural space of the entire operating fields. Preteus mirabilis was isolated in pus culture. He was discharged with good recovery two months later.

Familial Bilateral Acoustic Neuroma

The familial occurrence of bilateral acoustic neuroma has rarely been reported in the literatures, and its inheritance is known to be an autosomal dominant trait in association with or without von Recklinghausen's disease. Recently, we experienced an unusual case of bilateral acoustic neuroma, which was familially occurred in mother and her son. A 18-year-old Korean boy was referred to us due to bilateral hearing disturbance and staggering gait of one year duration. There were no stigmata of von Recklinghausen's disease. Neurological examination, simple skull films and vertebral angiograms revealed various evidences of bilateral cerebellopontine angle tumors. At operation, a hen egg-sized firm mass was subtotally removed at the left cerebellopontine angle region and a peanut-sized mass was totally removed at the right cerebellopontine angle region via suboccipital craniectomy. The histological diagnosis was neurofibroma. In family history, 13 years ago his mother was operated on C6-7 neurofibroma at her age of 28 years, and again operated on bilateral acoustic tumors 2 years later. The histological diagnosis was also neurofibroma.

Effects on Respiration after the Infusion of 0.2% of Sodium Pentothal for the Treatment of Uncontrollable Seizure and Increased ICP Patients

It has ben postulated recently that Sodium Pentothal has the cerebral protective effect during hypoxia by its efficacy of decreased cerebral oxygen consumption(CMRO2) by as much as 40 to 50 per cent. It could, potentially, improve regional or total cerebral perfusion in cases of acutely elevated intracranial pressure due to cerebrovasodilation and augmentation of cerebral blood volume, although Sodium Pentothal reduces cerebral blood flow in normal persons. Our study was designed to evaluate the effects of Sodium Pentothal on respiration, which were frequently depressed with 2.5% of Sodium Pentothal as a bolus dose. 0.2% of Sodium Pentothal was administered by continuous intravenous dripping to seven aneurosurgical patients showing uncontrollable seizure and increased intracranial pressure. PH, PaCO2, PaO2, respiratory rate and minute ventilatory values before and after Sodium Pentothal infusion were evaluated. It was observed that the values of PaO2 were improved with minimal changes in pH, PaCO2, respiratory rate and minute ventilatory values.

Clinical Analysis of Intracerebral Hematoma

Seventy cases of intracerebral hematomas were analysed, forty-six of spontaneous origin and remainder of traumatic one, which had been experienced in Seoul National University Hospital between March, 1970 and June, 1975. The results were as follows: A. Among forth-six cases of spontaneous intracerebral hematomas, twenty-six cases(52%) were primary intracerebral hematomas, normotensive or hypertensive, seven aneurismal ruptures(15%), seven arteriovenous malformations(15%), two cerebral rete mirabilies, one tumor bleeding, one leukemia, one idiopathic thrombocytopenic and one due to other blood dyscrasia. 1. Among twenty-six cases of primary intracerebral hematomas, angiography was performed in all and fourteen cases were operated. The sites of hemorrhage were as follows: a. Putaminal hemorrhage:17 cases(65%)(two cases associated with intraventricular hematoma). b. Thalamic hemorrhage:5 cases(19%)(two cases associated with intraventricular hematoma). c. Subcortical hemorrhage:4 cases(16%). 2. Overall mortality among twenty-six cases was forty-six per cent;operative mortality was forty-three per cent, and non-operative, fifty per cent. 3. Age, mode of onset, level of consciousness at the time of surgery and the site of hematoma were all important factors for surgical result. Surgical intervention seemed to be most favorable in patients who had verbal communication with subcortical or localized putaminal hematoma. 4. Normotensive group was worse than hypertensive one with conservative treatment, but the former was more benefited than the latter with surgery. 5. Intracerebral hematomas due to aneurismal rupture, arteriovenous malformation and others were also influenced with above mentioned factors, but the nature of underlined disease was of prime importance. B. Among twenty-four operated cases of traumatic intracerebral hematomas: 1. Five cases(21%) showed classical lucid interval with variable duration from thirty minutes to forty-eight hours. 2. Temporal lobe was most frequently involved(63%). 3. Lateral blow was predominant than axial low, and contrecoup than coup lesion. 4. Overall mortality was twenty-nine percent. 5. Age, lucid interval, preoperative level of consciousness and associated cerebral contusion or subdural hematoma were important factors for prognosis, but the preoperative level of consciousness was of prime importance.

Significance of Temporary Occlusion of Blood Flow in the Treatment of Middle Cerebral Artery Aneurysm

After acute interruption of cerebral blood flow, various hemodynamic, morphologic and metabolic changes ensue in the occluded area. Such changes and subsequent brain damage are of great concern in the course of temporary arterial occlusion during aneurysmal surgery. Many experimental studies investigating the processes of cerebral infarction have been done through selective occlusion of intracranial vessels, and it has been known that 4 to 8 minutes interruption of cerebral blood flow results in irreversible brain damage. Cerebral resistance following vascular occlusion may be influenced by collateral circulation, hypothermia and hyperventilation. Recently we experienced two patients with right middle cerebral artery aneurysms, who were operated upon under normothermia, slight hypotension, and hyperventilation using microsurgical technique. The technique of temporary occlusion of middle cerebral artery was applied as an adjunctive method.

The Value of Various Diagnostic Studies on Sellar and Parasellar Tumors

The diagnosis of sellar and parasellar tumors have been thought as relatively easy with detailed clinical history, neurologic findings, hormonal and radiologic studies, because of their characteristic neurologic features and specific endocrine disturbances. But sometimes location, nature, size and shape of the tumors and their relationship to adjacent tissues make it difficult to be determined even with various diagnostic aids. We have experienced 89 cases of sellar and parasellar tumors, excluding aneurysm and inflammatory lesions, during the last 16 years from August, 1958 to July, 1974 at the Department of Neurosurgery, Seoul National University Hospital. Among them we have studied 54 pathologically verified cases for various diagnostic studies. The results were as follows. 1. Detailed clinical history, hormonal studies and neurologic findings were fundamental in the diagnosis. 2. Simple skull x-rays were valuable to differentiate sellar and parasellar tumors and size. Shape and calcification of sella turcica were also valuable in differential diagnosis. Double floor shadow of sella turcica on exact simple lateral skull x-ray was very important to locate the tumor. 3. Bilateral carotid angiography and retrograde brachial angiography were important to differentiate the lesion, evaluate the size, extent and nature of sellar and parasellar tumors. The findings of terminal basilar artery were more important. 4. Air studies were valuable to know the extent of tumor and conray ventriculography was much valuable in differential diagnosis especially for obstructive hydrocephalic cases.