A Clinical Study of 65 Cases in Basal Skull Fracture

65 consecutive patients with basal skull fracture admitted to Eul-Ji General Hospital, between March 1990 and March 1993 was carried out to study it's clinical and radiological presentations, complications, and outcomes. 1) Two thirds of the patients were between 20 and 40 years old and 82% were male. 2) 78% of the injuried were by traffic accidents and 17% were by fall down. 3) The outcomes of treatment were related to initial GCS(Glasgow coma scale) of the patients. 4) Clinical features were ear bleeding-54%, Racoon's eye-35%, hemotympaneum-32%, hearing loss-25%. 5) The combined lesions were skull fractures-43%, facial bone fractures-31%, subdural hematoma-19%, epidural hematoma-14%, and pneumocephalus-14%. 6) The combined cranial nerves injuried were facial nerve-32%, vestibulocochlear nerve-12%, oculomotor nerve-12%, abducens nerve-12%. 7) The location of basal skull fracture according to clinical feature and CT bone window were middle cranial fossa-54%, on anterior cranial fossa-22%, anterior and posterior cranial fossa-12%, posterior cranial fossa-2%. 8) Clinical features associated with types of petrous bone fractures were analyzed. 9) The time of onset and the degree of facial palsy had a influence on recovery of facial nerve function and the types of hearing loss had a role in recovery of hearing function. 10) CSF leakage were present in 16 cases and immediate type was more than delayed type. 11) Three patients(4.6%) developed meningitis, especially associated with CSF leakage and it's rate was higher when CSF leakage persisted over 1 week.

A Case of Intracranial Chordoma

The authors present a case of intracranial chordoma in a 53-year-old woman who presented with gradual onset of dizziness, gait disturbance. Clinical features and various diagnostic findings are described.

The Clinical Study of Chemonucleolys in Herniated Nucleus Pulposus of Lumbar Spine

Chemonucleolysis with chymopapain has been shown to be an effective alternative to surgery for the treatment of Sciatica secondary to lumbar disc herniation after failure of conservative treatment. 92 lumbar herniated disc patients had been treated by chemonucleolysis in Eul Ji General Hospital during 3 years from March 1988 to 1991 and were evaluated clinically. 1) Of 92 patients, 60 patients(65%) were between 20 and 30 years old age group and male was predominent. 2) The lesion was the most common in L4-5space(52 patients, 56.6%). 3) The results were better in the younger group and the more limited straight leg raising group. 4) The excellent and good results were obtained in 82.6%. 5) In noncompensation cases, 69 patients(88.0%) had marked improvement, but in compensation cases, 7 patients(50%) had marked improvement. 6) In conclusion, above finding suggest that chemonucleolysis is a safe and effective nonsurgical method for treatment of herniated lumbar disc before surgical intervention.

A Case of Dumbbell-Shaped Neurobibroma in Cauda Equina

A case of neurofibroma in cauda equina which had been misdiagnosed as lumbar herniated nucleus puposus 6 years ago in other hospital was presented. In January 1984, the patient had taken the operation of total laminectomy and disckectomy at L2~3 level and symtoms were relieved thereafter. However severe low back pain and right sciatic radiation recurred in April 1990. In this hospital, lumbar myelography and spin C-T examination revealed the intradural extramedullary mass shadow at L2~3 level. On surgery, the dumbbell-shaped neurofibroma at the site was removed.

Clinical Evaluation of the Traumatic Subdural Hygroma

Traumatic subdural hygroma has received little attention in the literature, the authors experienced 17 cases of traumatic subdural hygroma after introduction of Computerized Tomography(CT) since October 1977 in Kyung Hee University Hospital. Characteristics in CT of our experienced traumatic subdural hygromas were almostly bilateral and located on the anterior aspect of the interhemispheric fissure, frontal and frontotemporal side with decrease density as like cerebrospinal fluid. Subdural hygroma easily differentiated with subdural hematoma by use of the CT scan. Subdural hygroma usually respond readily to evacuation of watery yellowish or cerebrospinal fluid-like fluid through simple burr hole, conservative treatment effected only 3 cases out of 17 subdural hygromas.

Clinical Observation on the Pineal Tumors

Tumors of the pineal area are a small proportion of neoplasm of the brain and the majority of these tumor are pathologically classified as pinealoma, Until recently, ventriculography was the most useful diagnostic methods in suspected cases of pineal tumor. However, the diagnosis of posterior third ventricular tumor may be established easily with computed tomography(CT) and its size, shape, component of tumor and the direction of expansion may be visualized. Authors had experienced nine cases of the pineal tumor during about two years from October 1977 to July 1979, which were diagnosed with CT, EMI-5005 in type. We presented a clinical findings for our cases and attempted to assess clinically. The result were summarized as following; 1. The age range was from 5 months after birth to 39 years. Of 9 cases, 6 cases were below age of 20 years and 3 over age of 20 years. All but one were found in males. 2. The duration of symptoms varied from two weeks to eighteen months. The average was approximately 7 months. 3. The symptoms and signs depend on the route taken by the expanding tumors. In our series, headache found in all cases initially, vomiting in 7 cases, and papilledema in 7 cases on admission. Parinaud's sign showed in 5 cases of all patients and papillary change in 3 cases. Of 9 cases, 3 cases had a transient DI symptoms and 2 cases manifested cerebellar dysfunction in corresponding to CT findings. 4. We had performed CT scan on all cases and diagnosed pineal tumor. In pre-enhancement CT, increased density around pineal area showed in 5 cases, isodensity in 2 cases and low density in 2 cases. Among the 9 cases, 5 cases, showed well outlined a lesion by contrast enhancement. All of the cases showed symmetrical dilatation of lateral ventricles with variable degree and distortion and compression defect to the posterior third ventricle disclosed in 6 cases. 5. We had treated 8 cases with V-P shunt following irradiation therapy ranged 3000-600 Rad. in total amount for 5-6 weeks. A case of the pineal tumor had treated with V-P shunt alone because of full coma at admission. We performed biopsy through the infratentorial supracerebellar approach in one case only and confirmed pineocytoma histopathologically. 6. The result of treatment obtained as follows with excellent in 3 cases, good in 4, poor in one, and death in one case. Two cases with exellent result of treatment spend their life happily without any symptoms and follow up CT disclosed no evidence of previous tumor shadow and normal sized ventricles. A poor case developed quadriplegia during irradiation therapy due to tumor seeding to cervical cord probably.

Multiple Retrocerebellar Arachnoid Cysts Coexisted with Medulloblastoma: Case Report

Arachnoid cysts are usually classified as developmental anomaly, inflammatory and traumatic in origin. Arachnoid cyst in posterior fossa occur frequently in the midline posterior to the cerebellum. These cyst usually present symptoms and signs due to increased intracranial pressure and may be confused with cerebellar or fourth ventricular tumor. Recently we had experienced a case of multiple retrocerebellar arachnoid cysts coexisted with pathologically confirmed desmoplastic medulloblastoma in eight months lod infant and reviewed the literatures.

Clinical Analysis of Associated Injuries in Head Injuried Patients

The increase in the prevalence of head injury amongst civilian population and the provision of adequate hospital services have become matters of world-wide concern. Many present-day accidents may result in the victims receiving multiple complex injuries beside head injuries and the prognosis may become unfavorable in these patients. Therefore, the neurosurgeon must be alert to the possibility that his patients have injuries to areas outside the brain and be capable of rendering necessary, often lifesaving, treatment during the initial phase of management. We analysed associated injuries in 1523 head injured patients admitted to Department of Neurosurgery, Kyung Hee University Hospital from October, 1971 till September, 1977. The results were as follows : 1) The incidence of associated injury was 23.6% of all 1523 head injured patients. 2) In all head injuries, male outnumbered female by almost 2 to 1 and the ratio was similar in associated injury group(2.4:1). 3) The age distribution of all head injuries was 3rd, 1st and 4th decases in order, but in associated injury group it was 4th, 3rd and 5th decades in order. 4) Common causes of head injuries were traffic accidents(76.6%) and fall(11.6%), but in associated injury group traffic accident was the most frequent cause(90.8%). 5) The incidence of associated injury was higher in relation to the severity of head injury. 6) The sites of associated injuries were distributed as limbs, chest and face in order and the most frequent nature of associated injuries was fracture. 7) Single associated injury was more frequent than multiple, associated injury, about 5 to 1. 8) Overall mortality rate of all head injuries was 9.3% in contrast that of associated injuries was 17.5%. 9) Surgical mortality rate was significantly higher in associated group(40.3%) than nonassociated group(26.1%). 10) In multiple associated injuries the mortality rate was higher(21.3%) than in single associated injury(16.4%). 11) Mortality rate according to associated injured sites was as follows ; 36% for visceral injuries and 34.1% for chest injuries. 12) The mortality rate was highest in serious chest injuries such as hemo and/or pneumothorax and in hypovolemic shock on admission(60%).