A Case of Primary Malignant Melanoma in the Occipital Region

There is a current tendency to believe that malignant melanoma originate from epidermal melanocyte rather than from pigmented cell of the upper dermis. Approximately 15% of all malignant melanoma in the body occur in head and neck regions. The majority of the patients were in the sixth & seventh decade. A case of malignant melanoma in the occipital region in a 2-year-old girl is reported. Physical and X-ray studies showed a large brownish pigmented mass with ulcerated surface and small bony defect in the occipital region.

A Clinical Study of Severe Head Injury

This report is made to investigate clinical outcome in 144 patients with severe head injuries. The result was as follows: 18% made a good recovery, 25% were moderately disabled, 11% were left vegetative, and 44% died. The outcome from severe head injuries seemed to become worse with advancing age. It was observed that the prognosis for head injury in general worsens in the group older than 30 years and the apparent increased morbidity and mortality with a surgical hematoma relate more to age than to the presence of the hematoma.

Experimental Penicillin-Induced Seizure

The penicillin produces seizures when applied directly to cerebral cortex and, in some instances, when given systemically in large amounts. Most studies with this agent have had as their goal the elucidation of neurophysiological mechanisms underlying seizure activity. The present study was undertaken to explore the biochemical events which take place in the presence of an epileptogenic agent and, in particular, to see whether this agent has a direct effect on passive or active cation transport or an effect on energy production within neural tissues. The penicillin-induced seizure activity has been produced by direct injection of an aqueous penicillin G sodium into the cerebral subarachnoid space in rat. It is assumed that penicillin-induced seizure results from the leakage of potassium ions from intracellular compartment and alteration of firing properties of neurons with prolonged depolarization, and disturbances in activities of enzyme involved in glutamine metabolism. Diphenylhydantoin may stimulate cation pumping with activation of (Na+-K+)-ATPase enzyme system and this action may be relevant to its anticonvulsant activity.

Experimental Microneurosurgical Cerebral Embolectomy:A Time Limit for Cerebral Embolectomy

Acute cerebral embolism continues to be a major cause of stroke morbidity in children and young adults. A variety of drugs including steroids, dextran, barbiturates, and anticoagulants are used in the management of cerebral ischemia, despite controversy over their benefits in clinical and experimental situations. The operative treatment includes microsurgical cerebral embolectomy and cerebral revascularization. Middle cerebral artery embolectomies which have been carried out in human with variable results, have been reported by different authors. In order to define a time limit for cerebral embolectomies before irreversible brain damage has been incurred, the canine middle cerebral artery was embolized by means of a gutta percha cylinder, 4 mm long by 1.5 mm in diameter, via the internal carotid artery. It was observed that embolectomy of the middle cerebral artery performed between 4 and 5 hours postembolism could prevent the expected cerebral infarction effectually. Middle cerebral artery embolectomy beyond 5-hour periods invariably resulted in severe hemorrhagic infarction with concomitant neurological impairment.

Intradural Spinal Schwannoma: Case Report

The authors report a case of intradural schwannoma of the cauda equina that was totally removed by microsurgical operation.

Intradural Spinal Schwannoma: Case Report

The authors report a case of intradural schwannoma of the cauda equina that was totally removed by microsurgical operation.

The Ventriculoperitoneal Shunting in Pseudotumor Cerebri: Report of 2 Cases

The authors report 2 cases of pseudotumor cerebri in which ventriculoperitoneal shunting procedures have been performed to relieve intracranial hypertensions, and satisfactory results have been obtained.

Cirsoid Aneurysm of the Scalp: Case Report

The authors report a case of cirsoid aneurysm in which diagnosis is reached by carotid angiography. To clarify the confusion regarding this rare lesion, the definition, origin and pathogenesis of the lesion are discussed.

A Case of Encephaloclastic Porencephaly

Although a great deal has been written about porencephaly during the past 100 years, there is much that remains obscure. The clinical recognition of porencephaly is important because it occurs with sufficient frequency to require consideration in the differential diagnosis of focal cerebral lesions. The authors considered and discussed to fulfill the pathogensis for this case.

A Case of Huge Reticulum Cell Sarcoma of the Brain

The authors report a rare case of reticulum cell sarcoma-microgliomatosis which was extended into the leptomeninges, the Virchow-Robin spaces and choroid plexus invading the cerebral parenchyma in the left temporal area. Histogenesis of this tumor is briefly discussed.

A Study on the Mortality Factors of Extradural Hematoma

Of all the potentially lethal complications of the head injury, extradural hemorrhage is the most readily diagnosed and remediable, yet the mortality rate remains distressingly high. The authors report on 58 consecutive patients with extradural hematoma. The mortality was 31%. The classical clinical course with a lucidal interval was seen in three patients only. The classical neurological signs of an extradural hematoma, contralateral hemiparesis, and ipsilateral third nerve palsy were seen in 9 patients(15.5%). The main factors associated with increased mortality were concomitant brain injury, rapid development of the hematoma and unconsciousness at the time of operation. In almost half of the fatal cases, there was a delay in the diagnosis and operation. Consequently better results are possible with better organization of the supervision and treatment of brain injured patients.

A Surgical Experience of Congenital Atlantoaxial Dislocation: A Case of Ossiculum Terminale

The authors describe a case of ossiculum terminale in which a new technique of posterior cervical fusion for the reduction of atlantoaxial dislocation has been attempted, and satisfactory stabilization and restoration of normal contour of the cervical spine have been obtained by double wiring technique.

A Clinical Study of Complication in Skull Fracture

The authors analyze arbitrary 100 cases of skull fractures and compare with the incidence and character of the complication of head injuries associated with a skull fracture. Age, sex, cause of injury, skull fracture, intracranial hemorrhage, mortality rate and sequelae are discussed.

A Case of Malignant Brain-Stem Glioma : Microsurgical Decompression and Biopsy: Case Report

The authors report a case of malignant brain-stem glioma with typical clinical signs in which successful surgical decompression and biopsy were obtained under the surgical microscope, and factors favoring surgical removal of such lesion are discussed.

A Case of Tuberculous Epidural Granuloma: Case Report

The authors describe a case of tuberculous epidural granuloma at the level of the 4th thoracic spine in a 27-year-old woman. Extraosseous origin of tuberculous granuloma has been rarely reported. With the references reviewed, the pathogenesis of Pott's paraplegia is discussed.

A Case of Tuberculoma in Cerebral Hemisphere

The authors report a case of tuberculoma of the cerebral hemisphere, which has been excised under the operating microscope. With the references reviewed, this case is interesting one in supratentorial location.

A Case of Large Dermoid Cyst

The authors describe a case of large dermoid cyst of the scalp which removed surgically and cosmetically. Dermoid cyst is derived from epiblastic cells predestined to form skin which become detached from their neighbours and included in mesenchyme at about third to the fifth week of feral life, when the neural tube is closing. The contents of the cyst are thus mixtures of keratin, sebum, and hair, according to the proportionate development of these elements. It is usually a single tumor and may develop almost anywhere in the subcutaneous tissue, being of variable size.

A Technique of Posterior Fusion for the Atlanto-axial Dislocation with Odontoid Process Fracture: Technical Note

The authors describe a new technique for the reduction and wiring of atlanto-axial dislocation. More strong supporting effect has been achieved by double wiring of the posterior arch of the cervical vertebrae. Various techniques for the fixation of the atlanto-axial dislocation have been discussed.olved.

Reduction and Fusion in Cervical Fracture Dislocation

With the establishment of the anterior cervical approach as the procedure of choice for cervical fracture-dislocation, attention has now turned to refinements of Cloward technique. The purpose of application of the Cloward technique is to achieve early stabilization of the fracture-dislocation, to shorten the recumbency period, and to promote rehabilitation. Recently the authors have experienced with the Cloward technique in the treatment of cervical fracture-dislocation. Our results indicated that anterior interbody fusion has been a satisfactory method for stabilizing one or more segment of the cervical fracture-dislocation. The prevention of dowel fracture or extrusion following fusion has been a important factor in the success. Another advantage obtained is to use the operating microscope for decompression of nerve roots. The chronic locked facets have not been reduced by the application of Cloward technique, but have been managed to achieve stabilization with Smith-Robinson technique. The lateral cervical pucture technique(C1-C2) for pantopaque myelography has been shown to be a valuable adjunct of acute injuries of the cervical spinal cord. A new technique for wiring and fusion of atlanto-axial dislocation has been performed with satisfactory results.

A Study on the Fracture Pattern of Posterior Fossa

This study has been made to stress the importance of fracture pattern of the posterior fossa for recognition of traumatic lesions in the posterior fossa. Included in the series are all the cases of clinically significant verified lesions in the posterior fossa due to posterior fossa fractures. The classification of posterior fossa fractures introduced here by author has been based on the linear fracture involving the transverse sinus groove and/or the foramen magnum in Towne's projection. Five types of pattern have occurred. In type I, a linear fracture involves the transverse sinus groove and the foramen magnum. In type II, a linear fracture involves the transverse sinus groove but not the foramen magnum. In type III, a linear fracture involves the lambdoid suture, the transverse sinus groove and the foramen magnum. In type IV, a linear fracture involves the lambdoid suture and the transverse sinus groove, but not the foramen magnum. In type V, a linear fracture of the suboccipital bone involves the foramen magnum, but not the transverse sinus groove. In a total of 33 cases of posterior fossa fracture, 13 cases(39.3%) are of type I, 7 cases(21.2%) are of type II, 5 cases(15.2%) are of type III, 5 cases(15.2%) are of type IV, 3 cases(9.1%) are of type V. It has been shown that the cerebellar hematomas have been verified in type I, epidural and subdural hematomas verified in all the types without regard to the fracture patterns, and subdural hygromas verified in type I, III and V.