Morphometric Study of Posterior Cranial Fossa Using Computerized Tomographic (CT) Images

Introduction: The posterior cranial fossa is the largest and the deepest of the three fossae. Contents of posterior cranial fossa include occipital part of cerebral hemispheres, cerebellum, midbrain, pons and medulla oblongata. Variations in the volume of posterior cranial fossa may cause compression of these structures which may lead to various disorders. There is increasing evidence on the diagnostic potential of posterior cranial fossa measurements. The present study on morphometry of posterior cranial fossa based on CT images of patients without any clinical abnormality was undertaken for the first time in south Indian population. Subjects and Methods: To study and compare sex-wise and age-wise differences in the supratentorial and posterior cranial fossa (PF) measurements in the normal CT scan images of 62 males and 38 females who attended the Neurology department of SVIMS belonging to Rayalaseema region was undertaken. The measurements that were recorded are transverse diameter (TD) and anteroposterior diameter (APD) of supratentorial part and also posterior cranial fossa and height and volume of posterior cranial fossa. Results: The mean supratentorial TD and APD were found to be less in male but were not statistically significant sex-wise and age-wise. The mean posterior fossa APD was significant, PF height and volume were highly significantly in males. Discussion: There are no reports on supratentorial parameters in literature for comparing the results of present study. Except for one study on CT on height and volume of posterior cranial fossa there are no other studies for comparing the values of present study. Conclusion: Observations on supratentorial parameters of the present study are the first to be reported in literature.Age-wise and sex-wise observation of parameters of TD and APD of PF are the first to be reported in literature.

A Case of Asymptomatic Huge Calcified Chronic Subdural Hematoma: Case Report

Althouth the connective-tissue membrane surrounding a subdural hematoma has been described as hyalinized, calcified partially or in patches, a totally organized, calcified or ossified chronic subdural hematoma in the elderly patient is extremely rate. We report an asymptomatic case of a huge calcified chronic subdural hematoma in a 67-year-old male patient who had no previous trauma history. Computerized tomographic(CT) scan showed an oval-shaped mass with totally calcified rim at the left frontotemporoparietal region. After en-block removal of the calcified mass, postoperative CT scan showed intracerebral hematoma at the deepest portion of the calcified mass that was partially adhesive to the pia mater. The patient suffered from a transient motor aphasia after the operation. Relevant literatures are briefly reviewed.

Clinical Observation of Intracranial Meningiomas(Computerized Tomographic Findings and Pathological Correlation)

Intracranial meningioma is one of the most easily detectable tumor in the preoperative period with the brain computerized tomographic(CT) scan. Although most of them are of benign nature, they present tendency to invade surrounding brain tissue and to recur in spite of complete surgical removal. Authors analysed the clinical features of 27 cases of histologically verified meningiomas and attempted to study the correlation between CT findings and histological types to predict their clinical invasiveness and aggressiveness. Female was predominated in occurance than male in the ratio of 17:10. Mean age of occurance was 40.5-year-old. The most frequent symptoms and signs were headache, papilledema and visual disturbance in order. The most frequent histological type was meningotheliomatous type(55.6%) which was followed by transitional(18.5%), fibroblastic(18.5%) and angioblastic(7.4%) types. In the finding of the brain CT scan, perifocal brain edema was noticed in nearly almost cases and high density of the tumor mass in the precontrast CT scan was predominated in transitional and fibroblastic types. But, marked perifocal brain edema, irregular tumor margin, loss of homogeneity of the tumor density and marked contrast enhancement, which were considered to be more aggressive and invasive findings, were predominated in the meningotheliomatous and angioblastic types. So, these types seemed to be more aggressive and invasive than other types. Large cystic meningiomas were 14.8% in author's cases.

Management of Cervical Ossification of the Posterior Longitudinal Ligament

The authors treatment 35 patients with ossification of the posterior longitudinal ligament(OPLL). Sixteen of these patients had surgery during the past 3 years between 1983 and 1985. In this paper wer present a radiological and clinical analysis of these cases with a literature review. We also discuss a clinical system of grading, different types of radiological patterns, the indications of surgical treatment and the choice of operative methods. 1) The ages of the patients ranged from 31 to 79 with a mean of 55.4 years. 57.1% of the patients were in the sixth decade. The male to female ration was 28:7. 2) The cases were graded on the bases of symptoms. Grade I, no symptoms or mild neck pain, 1 case(2.9%) ; Grade II only radiculopathy, 14 cases(40.0%) ; Grade III, mild myelopathy but able to walk, 11 cases(31.4%) ; Grade IV, severe myelopathy and unable to walk alone, 7 cases(20.0%) ; Grade V, complete paralysis of one or more extremities, 2 cases(5.7%). 3) Lateral tomogram and CT scan were most useful for assesment of OPLL. 4) The pattern of OPLL was divided into a continuous type(25.7%), a multiple segmented type(31.4%), a single segmented type(20.0%), and a mixed type(22.9%). 5) In cases of a clinical grading of more than III, surgery must be considered In grade II, surgery is indicative if conservative management failed to improve the clinical symptoms. 6) Extensive total laminectomies and foraminotomies were found to be advisable in cases of OPLL involving more than two vertebrae. 7) The modified Smith-Robinson approach showed the best surgical results in cases of single segmented OPLL.