Correlation beteween Motor Disturbance and Involvement of the Internal Capsule in Hypertensive Intracerebral Hemorrhage

The treatment of patients with hypertensive intracerebral hemorrhage (ICH) is still controversial. Fifty-two cases with hypertensive thalamic or putaminal hemorrhage were classified into three groups on the basis of the location of the hematoma in the internal capsule on eht CT image. All the cases were confined to the anterior(Type A, 17 cases)., posterior(Type P, 25 cases) and mixed portion(Type M, 10 cases) of the posterior limb of the internal capsule, and were assigned to receive medical treatment, extraventricular drainage(EVD), or stereotactic aspiration using urokinase. This study was designed to assess the correlation between hematoma extension and the severity of motor disturbance in patients treated with stereotactic aspiration. The severity of motor weakness was found not to be related to hematoma extension, but the prognosis was frequently poor in type P and type M. The outcome was better in the stereotactic aspiration group, as compared with medical and EVD groups, especially when the hematoma was located at the posterior portion of the posterior limb of the internal capsule(p<0.05). The study suggests that stereotactic aspiration may improve the outcome of hypertensive ICH with severe motor weakness, even if the hematoma is small.

Technetium-99m-MIBI SPECT in Intracranial Lesions

Thallium(T1) has recently been used as a pharmaceutical for tumor imaging and staging. The aim of this study was to evaluate the clinical significance of the T1 analogue, 99m-Tc-MIBI(methoxyisobutylisonitrile), for imaging of intracranial lesions. The advantages of MIBI were though to be a lower radiation exposure and better image quality than with T1. 99m-Tc-MIBI SPECT studies were done in 30 patients with brain tumors(14 astrocytomas, 7 meningiomas, 2 hemangioblastomas, 2 craniopharyngiomas, 1 ependymoma, 4 metastatic tumors) and in twelve patients with non-tumorous lesions(2 abscesses, 2 granulomas, 2 cysticercosis, 3 old intracerebral hemorrages, 1 infarction. 1 postoperative gliosis, 1 unknown pathology), and semiquantitative assessment of tracer uptake was made using a ratio of radioactivity for lesion to contralateral normal brain(Lesion/Contralateral normal brains ; L/C). Twenty six of thirty tumors showed high L/C ratios(>1.5) and another four tumors low L/C ratios(<1.5). Of 12 non-tumorous intracranial lesions, 11 showed little or no uptake, but one moderate uptake. In conclusion, it appears that brain tumors show more intense focal uptake than non-tumorous brain lesions. However, further studies would be warranted to evaluate the clinical significance of MIBI SPECT in tumor staging(grading) and in differentiating necrosis from tumor regrowth more clearly.

Surgical Treatment of Spasmodic Torticollis by Microvascular Decompression with Selective Dorsal Cervical Phizotomy: Case Report

A case of spasmodic torticollis in a 48-year-old man cured by micovascular decompression of the spinal accessory nerve with selective dorsal cervical rhizotomy of the first and second cervical nerves. The 11th nerve was compressed by the posterior inferior cerebellar artery originating from the vertebral artery at the C1 level. After intraoperative identification of each posterior rootlets of C1 and C2 nerves exclusively related with the involved sternocleidomastoid muscle(SCM) using the monopolar electric nerve stimulator, microvascular decompression with selective dorsal cervical rhizotomy was done using the Teflon felt and electrobipolar coagulator. The patient was significantly relieved from symptoms 1 week after operation.

A Case of Supratentorial Hemangioblastoma Associated with Intraparenchymatous Hemorrhage: Case Report

Hemangioblastoma is a benign tumor of vascular origin that develops usually in the posterior cranial fossa and only very rarely in the supratentorial region. A case of supratentorial hemangioblastoma with spontaneous intraparenchymatous hemorrhage is reported. The neoplasm was not associated with von Hippel-Lindau syndrome nor with erythrocytosis. The hemagioblastoma was diagnosed by repeated cerebral angiography, brain CT and MRI and confirmed histologically by careful microscopic examination of the specimen which gained at the last operation.

Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report

The authors experienced 4 cases of esophageal perforations following anterior cervical spine surgery. All occurred within a few days in the postoperative period. Diagonosis was made by clinical suspision and confirmed by esophography or reexploration. This complication attributed to sharp blade penetration of a retraction during surgery, infection and use of hardware. 3 cases were successfully treated by drainage, tube feeding and parenteral antibiotics. But unfortunately, 1 case was fatality. Although conservative treatment is required prolonged hospitalization, drainage, tube feeding and parenteral antibiotics are recommended treatment.

Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report

The authors experienced 4 cases of esophageal perforations following anterior cervical spine surgery. All occurred within a few days in the postoperative period. Diagonosis was made by clinical suspision and confirmed by esophography or reexploration. This complication attributed to sharp blade penetration of a retraction during surgery, infection and use of hardware. 3 cases were successfully treated by drainage, tube feeding and parenteral antibiotics. But unfortunately, 1 case was fatality. Although conservative treatment is required prolonged hospitalization, drainage, tube feeding and parenteral antibiotics are recommended treatment.

Anatomic Variations in the Bifurcation of Common Carotid Artery in Rabbits

No abstract available.

A Clinical Analysis of 4 Cases of Arachnoid Cysts in Middle Cranial Fossa, Associated with Chronic Subdural Hematoma

Since the arachnoid cyst was first described by Bright in 1831, its natural histroy and exact incidence of arachnoid cyst associated with chronic ubdural hematoma were not well understood. Authors analyzed 4 cases of arachnoid cysts in middle cranial fossa, associated with chronic subdural hematoma. So, the following results were obtained : 1) Headche and vomiting were presenting symptoms and its symptomas were due to chronic subdural hematoma rather than that of arachnoid cyst 2) Trauma, though trivial, may have triggered the development of chronic subdural hematoma 3) All cases showed bony abnormality on plain skull X-ray. 4) CT scan is very useful for the demonstration of shape, extent of lesion, membrane enhancement, and communication between hematoma and arachnoid cyst. 5) Every case was type II arachnoid cyst. 6) Chronic subdural hematoma was most frequent intracystic type, showing rupture into the arachnoid cyst. 7) Sugery treating both the chronic subdural hematoma and arachnoid cyst produced good result.

The Effects of Selective Amygdalectomy in Experimental Epileptic Model in Rat

In order to study the effects of stereotaxic destruction of distinct epileptogenic focus, the amygdala was destroyed with radiofrequency coagulator. A total of twenty Sprague-Dawley rats were divided into two group : the control group which underwent craniectomy on the biparietal area and was instilled crytal penicillin solution into the right amygdala on the basis of stereotaxic coordinates(n=10), and the amygdalectomy group which was performed selective amygdalectomy with radiofrequency coagulator after confirmation of clinical and electroencephalographic epileptic features after proceeding same methods of control group(n=10). The experimental epileptic models in rats were obtained by selective instillation of crystal penicillin solution into the right amygdala. The effects of amygdalectomy were investigated by observation of the changes in behavior and electroencephalographic recordings. The results were as follows ; 1) A typical behavioral seizure was shown in the control group and epilepticform discharge was prominent in crystal penicillin soultion instilled side, but there was no bilateral synchronous epileptic discharges during ictal stages. 2) In comparision to two groups, the severity and the frequency of behavioral seizure were more decreased in the stereotaxic amygdalectomy group. 3) The amygdalectomy group was shwon a significant decrease in amplitude and frequency of spikes, especially during interictal stages, compared to the control group. From the results of electroencephalographic and behavioral analysis, selective amygdalectomy with radiofrequency coagulator seemed to be an effective method to treat the crystal penicillin soulution induced epileptic rats.

A Clinical Analysis of 11 Cases of Pineal Region Tumor

The authors analyzed 11 cases of pineal region tumor in young male patients who had been treated at the Capital Armed General Hospital. So, the following results were obtained. 1) Due to the army distinctiveness, all cases were young male patients. 2) An unusual large proportion of pineal region tumor(26.2%) was noted. 3) Headache and vomiting were main presenting symptoms and the duration of symptoms was short. 4) The tumors were mainly presented as a round well-enchancing masses with calcification. Also, nearly all were associated with hydrocephalus. 5) MRI was very useful for the demonstration of tumor extent. 6) Based on the classification of pineal tumor, the tumors of germ cell origin were predominant(81.9%). 7) The extrapineal metastasis was frequent. 8) The tumor marker(alpha-FP and HCG) was postive in 4 cases(36.4%). 9) Germinoma showed excellent prognosis for the irradiation following a drainage procedure.

The Clinical Analysis of 75 Patients which were Operated on MVD

A series of 75 microvascular decompression(MVD) for 23 cases of trigeminal neuralgia, 50 cases of hemifacial spasm and 2 cases of paroxysmal vertigo has been reviewed with assessment of outcome at the last follow-up examination. In hemifacial spasm, average of symptom duration was 7 years, and female had longer duration as trigeminal neuralgia. The offending site was found more frequent in right side of the trigeminal neuralgia and hemifacial spasm. Meaningfully female in hemifacial spasm and male in trigeminal neuralgia was noted more frequent in right side. The offending vessels were considered anterior inferior cerebellar artery and posterior inferior cerebellar artery in hemifacial spasm and superior cerebellar artery in trigeminal neuralgia. There were good or excellent results in 31 cases(62%) of hemifacial spasm and in 15 cases(65%) or trigeminal neuralgia. The serious complications were not occurred in both diseases except one who died of brainstem infarction.

The Effect of Fetal Mesencephalon Implants in Rats with 6-Hydroxydopamine Lesion of the Nigro-Striatum : Behavioral, Biochemical Immunohistochemical Study

Parkinson's disease most consistently involves pathologic changes in the substantia nigra, which is the major source of dopamine to the striatum. It has been shown that either fetal substantia nigra or adrenal medulla tissue implanted to the rat brain survives, produces dopamine, and improves behavioral abnormalities induced by deprivaion of the caudate nucleus of its dopaminergic innervation. Thus, grafts containing dopamine could be potential replacement for destroyed or damaged dopaminergic neurons in patients with Parkinson's disease. In the present study, authors administrated 6-hydroxydopamine into the right substantia nigra, and produced unilateral dopamine denervated Parkinson's experimental model using solid graft method and cell suspension implant, the results of these grafts were examined behaviorally, biochemically, immunohistochemically 3 months after grafting. In this study, a total of forty-five young(4 to 5 week old) rats were used and divided into three experimental groups-control group which underwent dopamine denervation without any grafting(15), solid graft group which was grafted fetal mesencephalon to the caudate-putamien(n=15) and cell suspension implant group which was grafted cell suspension fetal mesencephalon to the caudate-putamen(n=15). The apomorphine induced rotation test was performed at four weeks, eight weeks, twelve weeks after grafting. The dopamine concentration in the caudate-putamen was biochemically measured by High Performance Liquid Chromatography(HPLC) and immunohistochemically these grafts containing dopamine granules were stained by Avidin-Biotin immunoperoxidase staining with dopamine monoclonal antibody. The results were as follows ; 1) Behavioral testing was performed by apomorphine induced rotational test. A mean rotation number during the first five minutes following apomorphine injection was 40.0+/-.5 in control and 18.3+/-.9 in cell suspension implanted group at one month after grafting and these was more reduction of turning than that in solid graft group. The both graft groups demonstrated explicit reduction of turning by 58% and 55.3% when compared to the control group respectively 3 months after grafting. However the difference in reduction of turning between the two grafted groups was statistically not significant. 2) Biochemical measurements of dopamine concentration was done in pathologic and normal caudate-putamen. The concentration of dopamine was 13.5+/-3.1ng/mg of protein in normal subject and 0.6+/-0.2ng/mg of protein in the dopamine denervated caudate-putamen of the control group which was markedly reduced by 4.4% of dopamine concentration in the normal caudate-putamen. The concentration of dopamine in the cell suspension implant group was 3.2+/-1.2ng/mg of protein at three months after grafting and 3.0+/-1.1ng/mg of protein in the solid group and these values were increased in the concentration give 5 times more than those of pregrafting state. 3) In the results of immunohistochemical examination cells containing granules of dopamine were exclusively found in the grafted groups. In experimental Parkinson's disease model of Sprague-Dawley rats, it was found that the grafts of fetal mesencephalon to the caudate nucleus induced an elevation of dopamine concentration and symptomatic improvement. In the method of graft, cell suspension implant method brings faster effect, leaves less amount of damage to the host brain, and can be used in any area of the brain for the transplantation. Therefore graft of fetal mesencephalon using cell suspension grafting method might be effective treatment of patients with Parkinson's disease.

3 Cases of Coincidental Cerebral Aneurysm with Pituitary Tumor

We report three cases of coincidental cerebral aneurysm with pituitary tumor. In our hospital the incidence of such cases was 4.4% of 68 patients with pituitary tumors from March, 1970 to October, 1990. Cases No. 1 was a 47-year-old female suffering from progressive loss of visual acuity. Preoperative brain C-T scan and angiographies revealed unruptured posterior communicating aneurysm with pituitary tumor. Case No. 2 was a 39-year-old male suffering from headache after head trauma with acromegaly. Preoperative brain C-T scan and angiographies appeared unruptured anterior communicating aneurysm and pituitary tumor. Case No. 3 was a 62-year-old female suffering progressive loss of visual acuity and headache. Left middle cerebral artery aneurysm and pituitary tumor were found by preoperative brain C-T scan and angiographies. All cases were operated by transcranial route and performed tumor removal after primary clipping of aneurysm. Postoperatively remained tumor of all cases was treated by radiosurgery successfully.

A Neurenteric Cyst in Cervical Spinal Canal: Case Report

A case of neurenteric cyst within the cervical canal is reported. He has been suffered from gradual aggravated quardriparesis since 4 months. On spine C-T scan and cervical myelographic examination, intradural extramedullary mass was detected. And so total laminectomy of C4, C5 and C6 was performed. We could diagnose by the pathological findings.

Clinical analysis of 3rd Decade Male 47 Cases with Intracranial Tumors in Korea

The authors represented a clinical analysis of 3 rd decade male 47 patients with intracranial tumors who had been histologically confirmed after operation and biopsy at the department of neurosurgery of Capital Armed Forces General Hospital From Feb. 1985 to Jan, 1988. We classified the intracranial tumors according to Russell and Rubinstein's classification. The results were as follows: 1) Among the intracranial tumors, gliomas were found most frequently(40.4%), and followed by pituitary adenomas(19.2%), pinealomas(10.6%), osteomas(6.4%), medulloblastomas(4.3%), craniopharyngiomas(4.3%), blood vessel tumors(4.3%). Pituitary adenomas occupied 19.2% of all intracranial tumors and as a single entity these were the highest incidence. 2) Tumors of the pineal region constitutes 10.6% of intracranial tumors. It was relatively high incidence compared with other reports. 3) Intracranial tumors occurred more frequently in supratentorial region(85.1%). The most frequent location was sellar and parasellare region(23.4%), and followed by frontal(14.9%), parietal(12.7%), pineal gland(10.6%), temporal(8.5%), cerebellar region(8.5%) in order. 4) The most common duration of symptoms were within 3 months(42.6%). The main clinical symptoms and signs were headache(80.9%), nausea or/and vomiting(55.3%), papilledema(44.7%), so called symptoms triad of the brain tumor, and other ophthalmic symptoms, gait disturbance, motor dysfunction,cerebellar sign in order.

3 Cases of Intracranial Lipoma: Case Report

Intracranial lipomas are rare tumor which are usually found at or near the mid saggital plane, especially in the corpus callosum. 3 cases of intracranial lipomas, diagnosed by CT scanning, are presented. The first case was a lipoma involving the midline of occiput to the bilateral occipital lobes through the skull defect. There was a calcified area in this tumor. The second case presented a generalized convulsive seizure as clinical manifestation, and the lipoma was found to be located in the corpus callosum. In the third case, the lipoma was located near the third ventricle and the tumor was found incidentally after head trauma. The first case was operated and the tumor was completely removed, the others were managed with symptomatic treatment. The literature on this rare tumor is reviewed and discussed.

A Rapidly Regrowing Benign Meningioma After Total Removal: Case Report

The average interval from first operation to recurrence is about 4 years and the reported shortest interval of malignant meningioma is about 6 months. The authors reported a case of rapidly regrowing benign meningioma, located on the outer 1/3 of the right sphenoid wing. The patient was free of recurrence only at 4 months after the first surgery in spite of macroscopic complete removal of the tumor. Factors associated with recurrence of meningioma are also discussed.

Treatment of Venous Origin Hemifacial Spasm by Microsurgical Decompression: Case Report

The hemifacial spasm has been proved a state of compression usually by blood vessels to the facial nerve. The vascular compression is usually obvious at operation. Since 1980 we have operated microsurgical decompression of 42 hemifacial spasm. Recently we have experienced a case in which venous running in an anterior posterior direction across the caudal aspect of the root entry zone of the facial nerve caused the spasm was coagulated and divided. After operation the patient improved and he free of facial spasm.