Surgical Treatment of Spontaneous Intracerebral Hematoma

The authors operated 127 cases of the spontaneous intracerebral hematoma patients who were admitted via the emergency room during the recent two years. The location, timing of operation, method of approach, mortality etc. were analyzed. The results are as follows : 1) putaminal hemorrhage was 47.3%, thalamic hemorrhage was 23.6%, subcortical hemorrhage was 18.9%, cerebellar hemorrhage was 3.9%, pontine hemorrhage was 1.6%, and IVH only was 4.7%. 2) 77.2% was operated during the first 48 hours from the onset. 3) Almost all of the procedures were transcortical and trans-sylvian approach. 4) The mortality rate was 52.0%. 5) Microsurgical technique and external ventricular drainage(or ventriculoperitoneal shunt) played an important role for the good surgical outcome.

Clinical Evaluation of Cervical Water-soluble Metrizamide Myelography via C1-2 Puncture

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.

Removal of Huge Cervical Intraspinal Fragment Demonstrated Only by CT Scan

Cervical traction has been widely used as an essential method for the treatment of cervical fracture-dislocation. This report, however, was a case in which hazardous effect of traction due to unreduced huge fragment was demonstrated only by cervical CT scan. Surprisingly plain X-rays could not demonstrated this condition. It was apparent that skeletal traction resulted in further injury of the spinal cord. Surgical removal of unreduced huge fragment was accomplished completely and interbody fusion was followed. Postoperative CT findings showed complete removal of fragment and decompression of the spinal cord as well as gratifying interbody fusion. CT scanning is imperative to evaluate the cervical fracture-dislocation and blind skeletal traction may be hazardous.

A Case of Dermoid in the Thoracolumbar Region

Dermoid and epidermoid of the spinal cord are rare and their percentage was 2.6% of spinal cord tumors. In dermoid average age of occurrence is 28.3 years. They are dysembryonic malformations. Dermoid consists of desquamated material, sebaceous material and hairs. The region of preference is lumbosacral spinal cords, especially cauda equina and conus medullaris. We are reporting a case of dermoid which has taken intracapsular enucleation and discuss about the epidemiology and pathogenesis.

Primary Malignant Lymphoma of the Brain: A Case Report

Primary malignant lymphoma is very rare and represents less than 1.5% of all intracranial neoplasms. The authors have experienced a case of primary malignant lymphoma of the brain in a 66 year-old woman who presented with presistent headache, nausea and generalized weakness. Brain CT scan demonstrated typical deep seated tumor masses in the right temporal and left frontal lobes with strong contrast enhancement. We obtained a good result after surgery followed by radiation and chemotherapy and report our case with review of the articles.

A Study of Functional Lumbar Myelography

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.

A Case of Intracerebral Tension Pneumocephalus

Tension pneumocephalus is rare while pneumocephalus is relatively common. The former has sudden or insidious deterioration in neurologic symptoms and signs comparing to self-limited pneumocephalus. This report is of a 19 years old male with tension pneumocephalus in the right frontal lobe two underwent right frontal osteoplastic craniotomy.

Modified Microsurgical and Standard Lumbar Discectomy ; Comparative Study

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.

A Case of Sturge-Weber Syndrome

Sturge-Weber syndrome was rare. But reported from 1860. We present a typical case of Sturge-Weber syndrome in a child and discussed the symptoms, signs, and pathological finding of various examinations in neurosurgical field such as plain x-ray, 4-vessel angiography, CT scan, EEG, IQ test, exophthamometry, opthalmometry, and fundoscopy. We find marked abnormality and asymmetry in that examination.

Pseudospondylolisthesis (Review of 22 Cases)

Study of 22 cases with the pseudospondylolisthesis established that it occurred more frequently in the older women, and far more frequently at the L4 level, as same results as reported by others. The slipping occurred as a result of degenerative disease of the articular process and facet joint, but it never exceeded 25% in this series. This study was performed to recognize the stability of the lumbosacral joint by the measurement of the anterior and posterior vertical heights(deformity) of the body of the L5 vertebra and lumbosacral angles in our cases. We also attempted to observe whether the facet angle changes at the involved level was meaningful or not. Result : lumbosacral angles in the our patients with pseudospondylolisthesis were increased greater than normal, so lumbar lordosis was less than normal. The body of the L5 vertebra was not as wedged anteroposteriorly as it normally was. The contour of the body of the L5 vertebra resembled rectangle shape. The pedicle-facet angles were increased at involved level, but this measurement was not correctly demonstrated on the plain roentgenograms. Conclusion : The stability of the lumbosacral joint in the patients with pseudospondylolisthesis was increased due to rectangle shape of the body of the L5 vertebra and less lumbar lordosis. The pedicle-facet angles at the involved level were increased, but not correct diagnostic values.

Two Cases of Subarachnoid - pleural Fistula Deu to Injury: Case Report

The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.

A Case of Huge Craniopharyngioma Redically Removed

A case of huge craniopharyngioma which was removed radically is presented. A 14-year-old girl was hospitalized because of the impairment of vision and a history of generalized seizures. The computed tomogram of the brain disclosed the huge mass consisting of a large cystic part extending to the frontal base and solid part medial and posterior to the cystic. Despite of the large size and adhesion to the vital structures, the tumor was removed successfully. To remove the tumor radically, it seemed to be important not to interrupt the outer structure of the mass during dissection. The postoperative course was uneventful except transient diabetes insipidus. We report this case with brief review of the references.

A Clinical Study on Patients in a Vegetative State after Severe Head Injury

A series of 41 patients in a vegetative state after severe head injury in presented. The patients selected were those who were in comatose state at least 2 weeks and observed more than 6 months. The vegetative state was more common before the age of 40(75.6%). The most common types of lesion causing vegetative state were subdural hematoma and epidural hematoma(56.1%). Twentyeight patients(68.1%) had a Glasgow coma score of 3 to 5. The two most frequent complications were urinary tract infections(80.5%) and bed sores(65.9%), but the most common cause of death was respiratory complication(60.0%). CT scans taken in the vegetative state showed variable evidences of cerebral atrophy, which were considered to be the results of the injury and had little value in predicting the outcome. At 6 months, the outcome was as follows : good recovery 4(9.8%) ; moderate disability 7(17.1%) ; severe disability 12(29.3%) ; vegetative state 10(24.4%) ; and dead 8(19.5%). Twenty-three patients(56.1%) came out of the vegetative state during a 6 month follow-up period. Vegetative state is not always permanent. Therefore, it seems necessary to distinguish perisstent vegetative state from vegetative state. The term, "persistent", means that the patient, if ever, came out of the vegetative state and in the event he did he usually remained in severe disability. 15 out of the 23 improved within 2 months, 14 out of the 15 improved to at least moderate disability. 8 out of the 23 improved after 2 months but all remained in severe disability. From these results we propose that the term "persitent" be applied to patients who remain in a vegetative state for more than 2 months.

A Clinical Analysis on the Lumbar Discectomy on the 812 Consecutive Cases

The purpose of this study on the surgical results for lumbar intervertebral disc herniation is to analyze the unique feature of the series which seems to be sufficient to represent Korean patients wuffering from these diseases. A total of 812 lumbar discectomies had been performed from May, 1971 to December, 1978 at Hanyang University Hospital. The most outstanding unique feature was the level of the lesion. The L4-L5 interspace was affected in 87.6%, while the most of the other series showed almost same incidence between L4-L5 and L5-S1 interspaces. The results of this analysis are as follows: 1) The incidence ratio of male to female was 1.3:1. 2) Most were in the 4th and 5th decade(53.5%). The duration was over one year in 64.6% of cases. 3) Traumatic origin was 37.8% of cases. Post-delivery, convulsive and unknown etiology were 2.2%, 0.7% and 59.3% of cases, respectively. 4) The level of the lesion was predilected at L4-L5 interspace with the incidence of 87.6%, while L5-S1 interspace was affected in 25.4% of cases. Single lesions were 70.8% and the multiple 29.2% of cases. 5) False positive findings of myelogram were 1.2% of cases. 6) Surgical results were gratifying in 92.3% of cases. 7) The incidence of postoperative complications was 3.3% of cases, which were mainly stitch abscesses. 8) The 7 our of 812 cases were associated with spinal tumors.

Primary Ewing's Sarcoma of the Lumbar Spine: Case Report

Ewing's sarcoma is an uncommon malignant neoplasm of the bone, which is rather infrequent in childhood and represented only 2% of all neoplasm under the age of 15 years. Clinical picture was that of progressive paraplegia associated with localized pain. The authors have experienced a case of primary Ewing's sarcoma of the first and second lumbar vertebrae in a 26-year-old male.

A Case of Tuberculous Cerebellar Abscess: Case Report

The authors describe a case of tuberculous cerebellar abscess in 21-year-old male patient with previous history of military tuberculosis and tuberculous meningitis. Verified bacteriologically and histologically was this tuberculous cerebellar abscess. In reference to the literature, tuberculous brain abscess are extremely rare among the tuberculomas of the brain.

A Case of Transitional Medulloblastoma in the Posterior Fossa of a Child

The case is reported of a 2 1/2-year-old femal with headache, vomiting and paraparesis. Clinical feature and operative findings are quite different from those of classic medulloblastoma in its lateral location, well-circumscribed tendency, non-invasiveness, no CSF metastasis, and favourable prognosis after surgical removal. Histological features are the combination of those of classic, and desmoplastic medulloblastoma. Review of literature was done.

A Clinical Analysis of the Ventriculoatrial Shunts in Hydrocephalus

The ventriculoatial shunt consists of diverting the cerebrospinal fluid from one lateral ventricle to the right atrium of the heart by means of a subcutaneous valve regulated drainage system. Of the numerous drainage systems so far devised, two, Holter and Pudenz, can be cited as having received widespread acceptance. This study is a clinical investigation of the 18 cases of ventriculoatrial shunts performed at Hanyang University Hospital between May 1972 and December 1978. Of them 17 cases and the Holter System, and one the Pudenz System. Ventricular catheter tip was placed in the frontal horn and cardiac catheter tip in the upper margin of the 6th thoracic vertebra. Postoperatively immediate neurological improvement usually took place in most instances. However, four complications developed. One of them was ventricular catheter obstruction with small brain tissue particles which was removed by revision. The other ventricular catheter obstruction was the result of thickening of the cerebral mantle and reduction in size of the ventricle. This shunt was made patient again byshortening the ventricular catheter to place inside the shrunk ventricle. The third was shunt infection. In this case, the whole shunting system was removed and reapplied into a peritoneal route, after infection subsided. The last was postoperative epidural hematoma developed due to incomplete hemostasis which required emergency surgery. Shunt obstruction was said as an inevitable complication in many instances, but it may easily restored by revision. Shunt infection was also surgically amenable. Although the necessity of revision was inevitable in some instances, ventriculoatrial shunt still seemed to be the most effective method so far devised.

Wide-Spread Benign Schwannoma Involving Multiple Cervical Vertebral Bodies

Benign Schwannoma rarely involves the vertebral bodies extensively. Two cases of widespread involvement of cervical vertebral bodies by Schwannoma are reported. Despite of huge amount of neoplastic mass and severe destructive bony changes, the neurologic deficits were minimal and postoperative result was not discouraging. Finding of plain X-rays, cervical CT scan and tumor pathology were discussed as well as surgical approach.

Therapeutic Continuous Irrigation Via Indwelling Catheter for the Neurosurgical Infections

It is the fact that parenteral antobiotics have no place in the treatment of the discitis after postoperative state because the antobiotics can not reach the focus of infection on account of the avascular zone of the intervetebral space. The author treats more extensive discitis to place an indwelling rubber catheter into the cavity to a contunuous irrigation with normal saline solution containing antobiotics. The catheter is left are as following ; 1. It is to effect the continuous direct administration of the antobiotics. 2. It is a mechnical effect by flushing out necrotic particles. 3. It is less recurrent infection. 4. The method is very simple, inexpensive. 5. The treated period is very short in contrast with immobilization and systemic antibacterial administration.