Clinical Studies of the Occipital Bone Fracture

In the past the patients with fracture on the occipital bone involved the lateral sinus and/or the foramen magnum, were treated with the early exploratory burr hole trephination regardless of mental state. The 64 cases occipital bone fracture were evaluated used the computed tomography of the brain scan. The fracture lines involved both the transeverse sinus and the foramen magnum were 59.4%, only the transeverse sinus were 29.7% and only the foramen magnum were 10.9%. The findings of the computed tomography of the brain scan were normal 42 cases, brain edema 13 cases. The 5 cases had large hematoma on the computed tomography of the brain scan performed emergency operation. The other 59 cases were treated with only close observation and conservative treatment. The mortality rate was 20% in operative treatment and 8.5% in conservative treatment. So we concluded that the patients with significant fracture on the occipital bone but had no surgical indication on the computed tomography of the brain scan might be treated with close observation & conservative treatment and it would not be necessary to perform the exploratory craniotomy as was done in the past.

Extirpated Intra- and Extracranial Metastasis of Hepatocellular Carcinoma: Case Report

A rare case of surgically extirpated intra- and extracranial metastasis of hepatocellular carcinoma is reported. This dumb-bell shaped tumor simulated malignant meningioma on computerized tomography brain scan and cerebral angiography. Removal of the mass was successfully achieved by external carotid ligation and CUSA dissection. We suggest that, when investigating patient with suspected cranial secondaries particulary if there is a bony involvement, serum alpha-fetoprotein and hepatic ultrasound should be carried out as screening procedures.

Diagnostic Value of Ultrasonographic Brain Scan

We analysed ultrasonic findings of 54 brain scan cases(45 cases were performed through the anterior fontanelle and the temporoparietal thin bone and 9 through the surgical bone defect) and comparison of these pictures with those obtained in the same patients by CT scan showed prominent correlation. Ultrasonography was more sensitive to different histologic features and provided a more accurate depiction of the neuropathologic characteristics in most of cases. We conclude that ultrasonography of the brain was proven to be quite useful in the screening and follow up of neonates and infants under 15 months of age, and as a follow up method in post operative patients. It was also more accurate than CT scan in cases of abscesses and cystic lesions.

Surgical Experience on directly treated 18 Intracranial Aneurysm

Eighteen intracranial aneurysm were operated upon with direct approach under the surgical microscope. The aneurysms arising in the anterior communicating artery(8) were most common, followed by internal carotid artery(6), middle cerebral artery(2), posterior communicating artery(1), anterior cerebral artery(1) in order. We preferred pterional approach. And the timing of operation was scheduled as soon as possible if other conditions permitted. Mannitol administration, hypotensive anesthesia, Sugita clip, biobond or aneurysmostat were utilizes during the operation. The aneurysmal neck was clipped with Sugita clip mostly, but wrapping was also carried out in certain condition. The elasticity of the Sugita clip is seemed to be better than others. In even Sugita clip, however, overopening at the time of clipping made it weak and resulted in incomplete occlusion of the aneurysm neck. To obtain successful aneurysmal surgical result, following surgical care should be taken. 1) lesser brain retraction, 2) complete removal of subarachnoid clots, 3) Meticulous hemostasis of micro-oozing from bridging vein and internal dural surface. Uneventful two surgical cases were found to be fatal due to hidden post-operative oozing clots from the internal surface of the dura.

A Case of Cervical Intramedullary Huge Solitary Cyst due to Cysticercosis

Spinal cystcercosis is extremely rare. But recently was have experienced cervical intramedullary solitary huge cyst, which was confirmed as intramedullary cysticercosis pathologically. Neurological deficits were left hemiparesis, hypoesthesia on the left lower extremity, hyperactive muscle stretch reflex and voiding and defecation difficulty, in spite of its huge size and surgical removal was easy as compared with other intramedullary tumor. There was no adjacent granuloma, granulomatous tissue, not combined with intracranial cysticercosis. Following surgery the patient's symptom were cleared up.

Plain Radiological Measurement of Relationships Between Intervertebral Disc Space and Spinous Process

The mean values of the height, depth and lateral shifting of the spinous processes and the height of the intervertebral disc spaces of 100 patients were measured in the lumbar region. The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduced the overall surgical trauma suffered by patient, but the spinous process might disturb the insertional course and multidirectional activities of the pituitary forceps due to a very small skin incision. The purpose of this study was to prove the relationships between intervertebral disc space and spinous process in the lumbar region. The results were as follows; 1) The height of the intervertebral disc space from L3-4 to L5-S1 intervertebral disc space was 12.63mm, 12.57mm and 11.71mm respectively. 2) The depth of the spinous process from L3 to L5 was 28.87mm, 27.87mm and 23.97mm respectively. 3) The lateral shifting of the spinous process from midline to the right side was 4.39mm, 4.35mm and 4.01mm at L3, L4 and L5 spinous process respectively and to the left side was 3.61mm, 3.70mm and 3.69mm at L3, L4 and L5 spinous process respectively. Conclusively, the lower part of the spinous process was overlapped above the intervertebral disc space at L3-4, L4-5 and L5-S1 intervertebral disc space. About 4mm of the lateral shifting of the spinous process was protruded to both right and left side in the insertional course(about 2-3cm) of the pituitary forceps. The spinous process might disturb the multidirectional activities and perpendicular insertion of the pituitary forceps. So, the removal of the spinous process to the midline was recommended to perform the complete removal of disc materials in microlumbar discectomy.

Spinal Interbody Fusion with Bovine Bone: A preliminary report

The authors experienced on the use of bovine bone in 3 cases of interbody fusion employing the Cloward technique. Two patients were cervical fracture-dislocation and one patient was a case of lumbar spondylolysis. With use of bovine bone, iliac osteotomy is unnecessary, and this procedure is no problem of donor site pain and infection which can be possible in interbody fusion with iliac bone and rib graft. With the use of bovine bone the additional advantages are. 1) The operative procedure is simplified. 2) The time required for the operation is diminished. 3) Patient meralgia is eliminated completely. 4) The surgeon can have uniformly sized bones of a proven hardness on hand. 5) The epidural bleeding is showed through lattice of bovine bone.

A Clinical Trial of Iopamidol Myelography in 27 Cases

27 Myelographies with Iopamidol and 27 myelographies with metrizamide were performed in order to compare adverse reactions, radiographic quality and effects on vital signs of the two contrast media after injection into the spinal subarachnoid space. Headache and nausea were less severe using Iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities which were noted in 7.4% of the metrizamide group but were not seen with the use of Iopamidol. Iopamidol was more stable than metrizamide in CSF. Image quality and diagnostic accuracy of Iopamidol myelography was equivalent to metrizamide for intrathecal application.

Evaluation of Carcinoembryonic Antigen and Alpha-Fetoprotein in Neurologic Lesions

Carcinoembryonic antigen(CEA) in blood and CSF was reported to be increased in cases of nervous system neoplasms by some investigators. To evaluate the oncological diagnostic value of CEA in the neurosurgical conditions, this study has been performed on 24 nervous system neoplasms and 8 non-nervous system as well as 49 controls. In addition, alpha-fetoprotein was also measured on the same conditions because of its close oncologic nature and recent diagnostic application on the general surgical conditions. The CEA concentration in blood and CSF were determined by CEA Radioimmunoassay kit, and the alpha-fetoprotein in blood and CSF were determined by GammaDab kit. The result showed that concentration of CEA and alpha-fetoprotein was higher and seemed to diagnostic in Extra-CNS neoplasma. In nerovous system, however, these were the lower than we expected, although were higher than control. Moreever, these levels were not unique on same oncologic condition and rather somewhat variable. From these results, increased concentration of these itself may be considered suggestive of existence of nervous system neoplasm, but it does mean neither degree of malignancy nor its origin.