Two Bilateral Symmetrical Cases of 4 Multiple Intracranial Aneurysms

Two cases of 4 Multiple Intracranial Aneurysms are presented. The author believes that patients who have had a subarachnoid hemorrhage should have four-vessel arteriography to identify all aneurysms, and that all surgically accessible aneuryms should be treated. Surgery of multiple aneurysms should be performed at the same craniotomy if they are within reach. Hower, if the asymptomatic or incidental aneurysm is in the opposite side or cannot be reached in the initial surgical procedure, it should be treated at a lager craniotomy.

A Case of Pituitary Tuberculoma: Case Report

The authors describe a case of pituitary tuberculoma in 45 year old female patient with previous history of tuberculous meningitis. Her clinical complaints were headache, visual field defects and amenorrhea. Endocrinological studies showed hypopitutitarism. Radiological studies including CT showed tumor mass in the sella turcica and suprasella area & paietal lobe. Ramamurthi and Varadarajan described the two types of the intracranial tuberculoma ; 1) A superficial and vascular type requires operation only in selected cases and it responds favoratly to treatment. 2) A deep and avascular type accompanied by increased intracranial tension and a spaecoccupying lesion, which does not respond to medical treatment and requires operation. Removal of the pituitary tuberculoma by T.S.A. followed by antituberculous treatment resulted in resolution of her neurological symptoms and signs.

Postoperative Evaluation of Lumbar Disc Herniation Using Digital Infrared Thermographic Imaging

Digital infrared thermographic imaging system is noninvasive, easy to reading, objective and physiologic instrument by measuring and imaging infrared energy emitted from skin surface. The authors present the result of digital infrared thermographic images of 83 patients of operated lumbar disc herniation from October, 1990 to March, 1991. 46 patients have received discectomy and the other 37 patients have received chemonucleolysis. We have done digital infrared thermographic imaging preoperatively and postoperatively. In preoperative digital infrared thermographic imaging, diagnostic sensitivity is about 76%, In postoperative digital infrared thermographic imaging, clinical results were well correlated in discectomy group. But in chemonucleolysis group, clinical results were not correlated with digital infrared thermographic images.

Regional Cerebral Blood Flow and Brain Edema Responses to Continuous Versus Intermittent Brain Retraction

Retraction of any part of the brain may damage the cortex as well as the parenchyma, so it is advisable to retract the brain with the least force necessary and for the shortest time as possible. The purpose of this study was to examine in cats the damage caused by retraction of the brain by measuring the regional blood flow and brain edema, and to determine which of two methods, continuous or intermittent brain retraction, is less harmful to the brain. Twenty five adult cats weighting 2.5 to 4.0Kg, were used in this study. The twenty five cats were divided into three groups ; control (n=5), continuous retraction (n=10) and intermittent retraction groups (n=10) respectively. The brain retraction was produced by applying the lead weight with the stainless retractor on the right frontal lobe through a craniectomy at the right frontal bone. The weight (20g) was supported throught the pulley so that its long axis was perpendicular to the cortical surface. In the continuous retraction group, the brain was retracted for 180 min with a retraction force of 20g and in the intermittent retraction group, a 15 min period of retraction was applied, followed by a 5 min release, repeated nine times. The regional cerebral blood flow (rCBF) and brain specific gravity measurements were carried out in each animal before and immediately after brain retraction, at the 30th min, 60th min, 90th min, 120th min, 150th min and 180th min after retraction. The rCBF was measured by hydrogen clearance method and the brain edema was measured by gravimetric technique. The results were as follows : 1) After the brain retraction, there were rise in blood pressure and bradycardia in 60 min. 2) Normal control cerebral blood flow (rCBF, ml/100g/min) were 38.7+/-1.9 in right frontal, 38.7+/-1.7 in left frontal, 38.6+/-2.3 in right parietal and 38.2+/-2,3 in left parietal lobes. 3) A considerable reduction in rCBF at the retraction site, has been demonstrated with continuous brain retraction in 60 min after retraction. A reduction in rCBF to 30% of control (RF ; 28.2+/-2.1ml/100g/min) in 180 min after continuous retraction of the right frontal lobe, however, intermittent retraction resulted in a reduction of flow to 12% of control(RF ; 37.5+/-2.9ml/100g/min) at retraction site in 180 min after retraction. 4) The changes of brain specific gravity relatively began to notice at rCBF less than 23.0ml/100g/min. It might be inferred from these that intermittent retraction was less harmful to the brain, which indicate adequate arterial blood flow under the retractor was vital for the preservation and return of the neuronal function following brain retraction.

Cerebral Blood Flow and Somatosensory Evoked Potentials Following Cerebral Hemispheric Injury and Effect of Mannitol: An Experimental Cat Model

Since every component of the evoked responses are considered to be related to topographically specific neural structures, it is possible that the location and severity of brain dysfunction could be accurately defined by careful analysis of evoked responses. The main objective of this experiment was to replicate some of the mechanisms involved in human brain injuries in cat and observe the effect of focal hemispheric brain injury on regional cerebral blood flow(rCBF) and somatosensory evoked potential(SEP) and to evaluate the effects of mannitol on them. Thirty adult cats weighing 2.5 to 4.2kg, were used in this study. The animals were divided into 3 groups of 10 cats each:(1) mild injury, (2) severe injury and (3) mannitol treated severe injury group. A mild injury was produced by moving the drill along a predetermined pathway through the right parietal hole at 50 cycle per minute for 2 seconds and a severe injury was produced in a similar fashion at 200 cycle per minute for 3 seconds. A mannitol treated group was produced in a same method as the severe injury group. The rCBF and SEP measurements were performed immediately after injury in each animal, at 30 minutes, 60 minutes and the final flow at 90 minutes by Pasztor(1973) hydrogen clearance technique. The results obtained were as follows. 1) After focal cerebral hemispheric injury, there were rapid rise in intracranial pressure, bradycardia, changes in blood pressure and marked alteration in respiration which are neurogenically mediated. 2) Normal control flows(rCBF, ml/100g/min) were 30.7+/-5.9 in right frontal, 35.2+/-6.7 in right parietal, 27.9+/-6.8 in left frontal, and 35.2+/-7.3 in left parietal lobes. 3) Sequential changes of the rCBF after focal cereral hemispheric injury were as follows. (1) Mild focal hemispheric injury resulted in a reduction of flow to 30% of control flow(RF:18.8+/-3.7, RP:25.0+/-7.8ml/100g/min) at injury resulted in a reduction of flow to 30% of control folw(RF:18.8+/-3.7, RP:25.0+/-7.8ml/100g/min) at injury site after immediate injury. (2) Severe focal hemispheric injury resulted in a reduction of flow to 50% of control flow(RF:20.4+/-10.9, RP:18.8+/-7.6ml/100g/min) at injury site after immediate injury. (3) Mannitol-treated severe injury resulted also in a reduction of flow to 50% of control flow at the injury site after immediate injury, but at 90 minutes the flow was 75% of the control flow. 4) A close correlation was found between cortical-evoked potentials and flow, suggesting a threshold relationship both on injury and non-injury areas. (1) The SEP was present shortly after injury though markedly altered in shape and the early components(No, N1) of the SEP were suppressed first. (2) It was also noted that the amplitude of the SEP was much smaller, perhaps due to direct ijury on the injured area. (3) The SEP disappeared if the rCBF in either hemisphere fell below 15ml/100gm/min. 5) It might be inferred from these results that adequate flow was vital for the preservation and return of electrical activity following brain injury.