Spontaneous Cervical Epidural Hematoma: Case Report

Spontaneous cervical epidural hematoma is an infrequent entity that usually requires emergency decompression on account of impending neurologic deficit. We present a case of a 36-year-old man who visited our emergency room complainng of severe neck pain with progressive weakness of both upper extrmities. On cervical MRI, fusiform epidural hematoma was found extending from the fifth to the seventh cervical vertebrae. Emergency surgical evacuation was performed. The patient was fully recovered and discharged uneventfully.

Minimaly Invasive Spinal Surgery: Cinical analysis of Chemonucleolysis & Percutaneous Automated Lumbar Discectomy

The authors retrospectively analized the radiographs and medical records of 135 consecutive patients who underwent minimaly invasive spinal surgery from January, 1990 to December, 1994 at our institution. Among these, 72 patients have had chemonucleolysis and others percutaneous automated lumbar discectomy(PALD). The success rate was similar in both groups, ie, 75% in chemonucleolysis and 74.6% in PALD by Macnab's criteria. The higher success rate could be obtained in 1) younger age below 30, 2) predominant sciatica than lower back pain, 3) eccentric bulged disc with minimal degeneration, 4) abscent or minimal neurologic deficits. In conclusion, provided patients are carefully screened, minimal invasive spinal surgery is more preferable over conventional surgery, providing a safe and effective therapeutic alternative to many patients suffering from herniated lumbar disc.

Streotactic Evacuation and Urokinase Irrigation in the Management of Spontaneous Intracerebral Hemorrhage

The best treatment modality of spontaneous intracerebral hematoma is still controversial. But stereotactic surgery can minimize the brain damage and be performed under local anesthesia. Recently we experienced 46 cases of spontaneous intracerebral hematoma which were operated using ZD(Zamorano-Dujovny) stereotactic system and urokinase irrigation from November 1990 to April 1993. Before operation, computerized tomographic scanning was done to locate the hematoma, assess the amount, and to determine the stereotactic coordinates. The silastic tube was inserted after stereotactic evacuation of hematoma and urokinase irrigation was repeated every 6 to 8 hours until the hematoma was cleared up. The results were analysed and we concluded that we can substitute open craniectomy or conservative treatment for stereotactic evacuation of spontaneous intracerebral hematoma combined with urokinase irrigation in certain instances and can minimize the brain damage regardless the patient's general condition or past history.

Surgical Removal of a Large Distal Posterior Inferior Cerebellar Artery Aneurysm: Case Report

The authors report a rare case of right distal posterior inferior cerebellar artery(PICA) aneurysm arising from just distal to its vermian brance. A 36-year-old female patient presented with a sudden onset of headache, nausea, dizziness and ataxia without any other neurologic deficit. On brain computerized tomographic(CT) scan and magnetic resonance imaging(MRI), a well-defined round mass was detected just behind the fourth ventricle. On transfemoral vertebral angiogram(TFVAG), it was confirmed as a saccular aneurysm arising from the vermian brance of the right PICA. The aneurysm was initially directly clipped through bilateral suboccipital approach. Postoperative follow up angiogram after two weeks revealed a more enlarged aneurysm and an incompletely clipped neck. After making sufficient exposure of the aneurysm, the neck was reclipped and the sac removed. Postoperative results were uneventful.

A Case of Histiocytosis-X

The authors have experienced a case of histiocytosis-X. A 7-year-old male patient had three tender masses, one on the right parietal region, another on the left parietal region, the other on the left occipital region and revealed exophthalmus on his left side. Plain skull films showed multiple punched out skull defects and on lumbar spine films, collapse of body of second lumbar vertebra was detected. Among the masses, the largest right parietal one was excised totally. The final diagnosis revealed histiocytosis-X on pathologic basis and he was given subsequent chemotheraphy.

Akinetic Mutism from Obstructive Hydrocephalus;Successful Treatment with Bromocriptine and Ephedrine

The authors report one case of akinetic mutism with obstructive hydrocephalus. The patient suffered from multiple shunt failures and shunt revision. After multiple shunt revision, the patient fell into an akinetic-mute state. She appeared awake but was no response to painful somatosensory, loud auditory or threatening visual stimuli and she required total nursing care. This behavioral syndrome was no response to shunt revision but we were able to successfully treat a case of akinetic mutism after combination theraphy of Bromocryptine and Ephedrine.