Intracerebral Mass Lesions Presenting "Drop Attacks"

"Drop attack" is defined as sudden falling spell occurring without warning or postictal symptoms with immediate righting, and without loss of consciousness. Numerous mechanism have been proposed to explain the drop attacks. But there were no scientifically established answer for the extraordinary rapid evolution of the drop attacks. The authors report three cases of intracerebral mass lesions presenting with drop attacks. Among them, one was racemose brain abscess on the juxtaventricle of right parieto-occipital area in 3-year old girl, the another one was germinoma at genu portion of corpus callosum and pineal gland respectively in 20-year old male, and the remained one was neurocysticercosis around frontal horn of lateral ventricle in 60-year old male. The brain abscess and neurocysticercosis were almost totally removed, and conventional radio-therapy after stereotatic biopsy was carried out to germinoma of corpus callosum and pineal region. Drop attacks symptoms were abolished immediately after mass removal in brain abscess and neurocysticercosis, and gradually subsided in the germinoma case.

Intraoperative use of Real-time Ultrasonography in Neurosurgery

Recent technological advances in ultrasound instrumentation have resulted in equipment that will image in "real-time" slices of the human brain similar in quality to computerized tomography(CT). Multiple authors have attested to its usefulness in locatin, characterizing, and facilitating in the biopsy or removal, or both, of intracerebral masses. In this study, the author has examined the efficacy of intraoperative neurosurgical ultrasound in 18 patients who were admitted to the Department of Neurosurgery, Kyung Hee University Hospital. The results were as follows : 1) It can provide critical assistance in precise localization of subcortical masses, since in many instances the overlying surface of brain provides no clue for localization. 2) This technique is very useful for the identificantion of deep lesions, provding infromation about their solid and cystic components and about the shortest route of access to tumor. 3) It provides precise information to help guide biopsy needles into deep lesions, and to confirm their presence within the lesion itself. 4) The system is highly accurate in visualizing ventricular catheters during and after their placement. 5) The system is inherently safe for the patient and the operating room personnel since there is no radiation exposure.