Clinical Experience of the Primitive Neuroectodermal Tumors

Primitive neuroectodermal tumors(PNETs) are composed of undifferentiated cells resembling germinal matrix cells of the embryonic neural tube. The concept of the primitive neuroectodermal tumors is controversial due to indistinct clinicopathologic entities. While some neuropathologists believe that the PNET concept should be applied to all these tumors with the addition of qualifying terms, the opponents of this approach believe this concept to be too simplistic and that well-established diagnostic entities should not be grouped together as a single entity. Four patients with PNET were reviewed. Although the PNETs bear some differences to posterior fossa medulloblastomas, we should be grouped together as a single pathologic entity because of their primitive nature. The purpose of this study is to review the similarties and differences between two tumors from their histologic and embryologic features.

Clinical Experiences of Petrous Pyramid Fractures

A retrospective analysis of 36 cases of petrous pyramid fractures was studied clinically and radiographically during last 5 years. Of 503 patients with skull fractures admitted to the Inha University hospital, of which 7.1% involved the petrous pyramid. The most common mode of injury was a motor vehicle accident and the most common age group was the first decade. The anatomic location of fractures in the petrous pyramid were evaluated by high resolution computed tomography and it disclosed 20 longitudinal and 16 transverse fractures. The principal symptoms and signs, occurring alone or in combination, were a otologic problem, facial paralysis and CSF liquorrhea. The otologic problems were noted in almost every case. The facial palsy and CSF liquorrhea were present in 16 cases(36%) and 9 cases(25%), respectively. The anatomic type of fractures well corresponded to the principal symptoms and signs and the prognosis, the development rate of principal symptoms and signs of the transverse fracture was more higher and the prognosis of that was worse than the longitudinal fracture.

Clinical Analysis on 34 Diffuse Axonal Injured Cases Under 8 on the GCS

Thirty four patients with diffuse axonal injury, defined as post-traumatic coma for over 24 hours with Glasgow Coma Scale(GCS) score of 8 or less following nonsurgical resuscitation, admitted to Inha Hospital from January to December 1991, were studied in order to identify clinical analysis. The aim of this study was to find out the effects of barbiturates or other intensive therapy or head elevation on the intracranial pressure(ICP), arteriovenous oxygen difference(AVDO2) and outcome. The results were as follows; The ratio of male to female was about 6 to 1. 2) In clinical signs at the emergency room, abnormal pupil size was shown 17 cases(61%) under 8-5 on the GCS, but all cases under 5 on the GCS showed abnormal pupil size. 3) Ventricular compression was shown in 29 cases(85%), 17 cases(50%) was showed the ventricular compression & cisternal obliteration. 4) Post-traumatic cerebral infarction was developed 59% of DAI and occurred in 88% of ventricular compression and cisternal obliteration. 5) On admission, above 5 ml/100 ml in AVDO2 was developed in 32 cases(94%) under 8 on the GCS, but in all cases under 5 on the GCS. Recording of ICP showed above 20 mmHg in 15 cases(44%). On coagulopathy, our cases showed that decrease of platelet was involved in 5 cases(15%), prothrombin time(PT) prolongation in 11 cases(32%), activated partial thromboplastin time(APTT) in 4 cases, fibrinogen in 5 cases. 6) The mean ICP was slightly lower when the patient's head was elevated at 30 degree than at 0 degree. The mean ICP was moderately lower when the patients were taken barbiturates therapy. ICP tends to increase from the 1st to 3rd day after injury. 7) The mean AVDO2 was significantly lower when the patients were taken barbiturates therapy, especially at the 1st day. 8) On the relation between Glasgow Outcome Scale(GOS) and Neurological grading(NG), GOS IV was developed in 8 cases(NG score 3-6), GOS III in 5 cases(NG score 7-9), GOS II in 2 cases(NG score 10). Total mortality rate was 56%.

The Clinical Consideration on the Prognosis of the Pontine Hematoma

Pontine hematoma would be diagnosed and made its follow-up readily as the extent of hematoma could be clearly defined since the CT scan was available, especially with MRI in recent. Authors attemped to analyse 20 cases of pontine hematoma clinically, considering factors of influence their prognosis, admitted in Inha hospital from March 1989 to February 1992. Classification of pontine hematoma was made out according to the findings of brain CT scan taken on admission:2 cases of Type T1 to the hematoma localized in the tegmentum unilaterally, 1 case of Type T to those in the tegmentum bilaterally with some extent into the 4th ventricle, 12 in Type T to those in the tegmentum, midbrain and mostly the 4th ventricle, and 5 in Type B to those in the basis pontis mainly with tegmentum and midbrain. Of 219 spontaneous intracerebral hematoma, pontine hematoma was 9.1%. 17 hypertension and 11 previous CVA episodes including 7 cerebral infarction and 4 ICH were endountered. Age distribution was 50% in 6th decade and male to female ratio was 3:2. On admission 14 cases were under 6 in Glasgow coma scale, 6 small reactive pupils and 11 ocular bobbing. Particularly, nuclear facial paralysis was 14 in initial bilateral type, of which 7 dead within 10 days, 5 fixed in left facial paralysis and 1 case into right paralysis later. Four surgical interventions were 1 simple EVD, 1 Urokinase irrigation through EVD, 1 steretactic aspiration and 1 direct hematoma removal. Prognosis was related to various factos:GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS, Type T1 and T2, and unilateral facial paralysis in which the ratio of left to right was 2:1, while it was very poor in patients who were GCS below 6, Type B and bilateral facial paralysis. On the contrary, 7 of 20 cases were dead within 10 days, 13 patients alive for more 3 months after the hemorrhage were observed with fixed facial paralysis in nuclear type, 1 ilateral, 4 right, and 8 left side. It is suggested and requested for further careful follow-up that the hemorrhage may occur from the border zone between paramedian, short and long circumferential arteries supplying transection area of the pons unilaterally, near on around the facial nucleus, more frequent in left side.

A Clinical Observation on Head Injuries in Infants and Children

A clinical analysis was carried out with 400 cases of head injuries under 15 years of age admitted at the Department of Neurosurgery, Inha University Hospital during 4 years from 1987 to 1990. The material was classified into three groups according to main lesions, i.e. 1) simple cerebral contusion without skull fractures, 2) various types of skull fractures, 3) intracranial hemorrhagic lesions, representing such lesions as follows;a) epidural hematoma, b) subdural hematoma, c) intracerebral hematoma, intraventricular and subarachnoid hemorrhage. The results were as follows; 1) The age incidence was greatest in 7 years of age, and 188 cases(47%) were included in the age group between seven and ten. The accident occurred mostly from March to May, especially in April. 2) The head injuries were caused by traffic accident(203 cases:51%), fall down(152 cases:38%), etc. In clinical pictures, neck sprain(52.8%), nausea and vomiting(47.5%), and early epilepsy)9%) were developed. 3) The linear skull fracture was higher than other type fractures(74.6%) and the locations of skull fractures were parietal, occipital, temporal and frontal bone in order of frequency. 4) Among the intracranial hemorrhagic lesions, EDH was most common lesion, 73 cases(79%) of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures but of the patients with skull fracture, 51.4% were accompanied by hemorrhagic lesions. Lucid interval was observed in 15 of the cases with intracranial hemorrhagic lesions and contre-coup injury was developed in 19(12%). 5) In the GOS, the high scored cases on the GCS were better than the low scored cases. 4 cases of 23 people scored under 8 on the GCS died. 14 cases of them were included in the age between 6 and 10(61%). 6) Associated injuries were found in about 16% of the total patient, the most common injury was clavicle fracture and most frequent sequala was post traumatic syndrome. The late epilepsy was occurred in about 13% of the early epilepsy cases except the cases had pre-traumatic epilepsy history.