Experimential Brain Stem Compression

Patterns of brain-stem compression and secondary brain-stem evoked postentials were investigated to correlate with expanding mass volume and location in mass-induced supratentorial brain compression in cats in which the subjects were divided into four experimental group i.e., frontal, temporal, parietal, and occipital brain-compressed groups. Postmortem insepection of the brain-stem showed either unilateral or bilateral dorsal herniation of the brain in frontal and temporal brain-compressed groups and dorsolateral herniation in parietal and occipital brain-compressed groups, respectively. Microscopic examination revealed that the secondary brain-stem hemorrhages were mostly caused by venous bleeding secondary to venous congestion, the bleeding being more severe in occipital brain-compressed group. As the intracranial pressure was raised by expansion of a supratentorial balloon, the late components of the BSEP were suppressed first, followed by the suppression of the early components. In BSEP recording a significant change was observed in Vth wave with prolongation of latency and decrease in amplitude. This finding suggests that the midbrain is the most vulnerable to compression ischemia. In parietal group, the Vth wave started to be prolonged at 0.4ml of balloon expansion and totally disappeared at 1.8ml of expansion.

A Case of Primary Melanoma in the Spinal Cord

A case of primary melanoma of the spinal cord in 20 year-old male is presented. The symptoms and signs were those of cervical cord compression caused by the melanoma, for which underwent laminectomy and was histologically verified.

Evaluation of the Effect of Myelotomy on Experimental Acute Spinal Cord Injury with Spinal Evoked Potentials

Direct spinal epidural surface of spinal evoked potentials have been made in 16 adult cats with acute spinal cord injuries produced experimentally in which myelotomy was performed in 8 cats 1 hour after the injury. The remaining 8 animals served as control. The spinal cord injury with 20gm - 20 cm was inflicted over the entire dorsal surface of the spinal cord at L2-3 interspace by Allen's weight-drop method which was improved by placing a curved steel plate anterior to the spinal cord to provide a smooth, hard surface for the receipt of posterior cord impact. Under the operating microscope, a median posterior longitudinal myelotomy approximately 10mm to 15mm in length was made at the injury site 1 hour after the injury. Animals were evaluated electrophysiologically either from preinjury state to postinjury 4 hours(control group) or from preinjury state to post myelotomy 3 hours(myelotomy group). The component waves of the spinal somatosensory evoked potentials(SSEP) of control group disappeared sequentially after the injury in the following order : N4, N3, N2, N1. In myelotomy group, N4 and N3 wave also disappeared, but N1 and N2 wave remained. The latencies of the component waves increased & its amplitudes decreased sequentially after the injury. In myelotomy group, as com-with the control group, post-traumatic latency rate increase as well as amplitude were both reduced.

A Case of Incomplete form cf Sturge-Weber Syndrome

Sturge-Weber syndrome is a neurocutaneous syndrome characterized by portwine nevus of the face with angiomatosis of the ipsilateral cerebral leptomeninges and extensive calcification in the underlying cerebral cortex. Associated features include mental retardation, generalized or focal seizures, hemiparesis, choroidal angioma, & buphthalmos or glaucoma. We experienced a case of incomplete form of Sturge-Weber syndrome in a 12 year-old boy, who had generalized seizure, a homonymous hemianopsia, intracranial calficication and leptomeningeal angiomatosis without facial nevus or mental retardation. So we presented a case with a brief review of related literatures.

Usage of Laminaria Embolization Procedure for the Treatment of Carotid-Cavernous Fistula: Case Report and Technical Note

Many different type of embolic material, such as muscles Gelfoam, porcelain, and detachable balloon, etc, has been used for the treatment of carotid-cavernous fistula. In an effort to achieve better results the authors used laminaria, a sea-weeds root, as a newly-tried embolus which has a unique characteristic of expanding gradually within 4 hours 3-4 times from its original width, but not in length, when in contact with any type of fluid. A very special feature of the laminaria is that the initial hard and coarserness is slowly transformed while expanding into a rounded softness as to allow no menhanical injury to the surrounding vessels of tissue. The laminaria was formed into a reversed bowling-pin shape measuring 8x1.5mm with tapered tail and a round head in which contains a sliver clip as a radiographic marker. An extension of standard angiographic technique ahs been used to complete an alternative method of treatment. This technique involves introducing the cather harboring the laminaria by the percutaneous route either transfemoral or directly transcarotid and releasing the terminal internal carotid artery at the site of the fistula. Releasing a few of the shaped laminaria piece from the catheter tip has resulted in a successful obliteration of the fistula in 7 cases out of total 8 of carotid-cavernous fistula.

Parasellar Germinoma a form of Ectopic Pinealoma: Case Report

A case of parasellar germinoma is reported in a 13-year-old boy whose complaints were headache, polydipsia, polyuria and right visual disturbance. Neurosurgical diagnostic procedures including brain CT scan revealed a large lobulated mass in and around the pituitary fossa. right craniotomy was done and the mass removed totally under the operating microscope. Diagnostic and therapeutic procedures for the management of this lesion was discussed.

Experimental Study on the Occlusion of Arterio Venous Fistula

A variety of therapeutic maneuvers of the arteriovenous or carotidcavernous fistulas has been tried and mainly discarded as inadequate because of complicated factors such as an anatomical situation of the fistula, and embolus of predetermined size and configuration, and introducing method. The fistulas have been embolized by a variety of materials with no gain of wide acceptance. One of the major problems inherent in the procedure is the inability to control the ultimate location of the embolus, which is closely related to predetermined size and shape of the embolus. To get around this difficulty, a piece of the laminaria stalk shappen into a small columnar bar was used as an embolus in this experiment. The laminaria, sea weed used for a slow dilatation of the uterine cervical orifice in gynecological practice, has specific nature of gradual increase in its volume on contact with water or tissue fluids, expanding only in width, radial direction, but not in length. It expanded gradually with maximal increase of 3.3 times the original width by 12 hours of the contact and with increase of more than 80% of its maximal expansion by three to four hours contact. In a series of experiments, arteriovenous fistulous lesions have been created in albino rats, using a portion of jugular vein implanted on the cervical carotid artery, and it has been tried to occlude the excluded fistulous segment with the help of the laminaria stalk. A stalk of laminaria with diameter of one third of vascular lumen could easily reached to the fistulous point by the arterial pulse and thrust because the stalk was fairly smaller relative to the size of the vessel, and it occluded the lumen of the vessel near totally by a slow expansion of it into as large as the luminal size of the vessel within a couple of hours after lodging in the vessel.

A Case of Diencephalic Syndrome

Authors report a case of diencephalic syndrome which was observed in the patient with astrocytoma in the region of anterior hypothalamus and optic chiasm. An enlarged head, emaciation and hyperactive response were the symptoms. The subject, 8-month-old female infant, was bright and alert and had a history of failure to gain weight for months in spite of the fact that the child had eaten well. Skull X-rays showed no significant pathological findings but for enlarged head with suture separation. Conray ventriculography and CT scanning disclosed signs of presence of tumor in the suprasellar region. Craniotomy for removal of the tumor was followed by ventriculoperitoneal shunt.

A Case of Large Cystic Cerebral Cysticercosis

Author report a case of neurocysticercosis that involved the right cerebral hemisphere subcortically. The subject was 38-year-old Korean male. The headache, epileptiform seizures and left sided motor weakness were the symptoms. Simple skull X-rays showed no significant pathological findings. Right carotid angiogram disclosed the signs of a large mass in the centrosylvian region. CT scan also demonstrated large, multiple and round cystic lesions within the substance of the brain itself in the right frontoparietal region. At operation cyst wall and cysticercus in the fluid content of a mass were obtained. Postoperatively with the aids of occurrence of cysticercrus in the skin and positive serologic test, the diagnosis again confirmed.

A Case of Cervical Disc Herniation Complicated by Central Cord Syndrome

We have recently managed a patient, 31-year-old male, who has been in the state of inferior paraparesis due to cervical disc herniation. The centrally herniated disc material was removed through the posterior approach to the lesion under the general anesthesia in left lateral position. Two days after the operation with removal of herniated disc at C5-6interspace, the subject developed quadriparesis and difficulty in urination in which the weakness of upper extremities were more severe that of the lower extremities. The signs developed postoperatively were very much compatible with those of central cord syndrome, There was improving after the removal of the hematoma and of additional herniated material at second operation which was forced to be done due to development of central cord syndrome in severe degree following the primary surgery. Recovery from neurological dysfunction in order of good and better improvement was of leg, arm, voiding and finger.

A Case of Intramedullary Ependymoma in the upper Thoracic Spinal Cord

We have recently experienced a case of intramedullary ependymoma in the upper thoracic spinal cord. A 46 years old man was admitted to our Department of Neurosurgery because of spastic paraplegia and disturbance of urination since 6 years ago when the disability developed rather abruptly. Myelogram showed a subtotal block of the dye column at the level of T-3 intervertebral space about where a fusiform enlargement of the cord was shadowed. Opening the duramater after total laminectomy performd through C7 to T3, a markedly swallen and enlarged spinal cord was under a great pressure. Spinal cord was paper thin and fully filled with a massive tumor inside of it. The intrameduallary tumor was mushroomed out on dorsal myelotomy. Histological study was verified to be ependymoma. The patient has not shown any improvement of neurological deficits in postoperative period.

Solitary Eosinophilic Granuloma of the Skull Bone

Eosinophilic granuloma, Hand-Schuler-Christian and Abt-Letterer-Siwe syndrome are considered to be different manifestations of one and the same disease of the reticulohistiocytic system, and are included under the term histiocytosis X, clinical and morphological manifestations are variable. The syndromes can be differentiated according to their course and extent of spread. Eosinophilic granuloma of bone is the mildest form, usually restricted to one or a few foci. This occurs chiefly in children but may occur at any age. The male sex is affected almost twice as often as the female. Cranial vault is most commonly affected site and jaw, humerus, rib and femur are also often affected. Recently we have experienced 2 cases of eosinophilic granuloma of the skull bone. One was 10 years old male with protruding mass on the right frontal bone, and the other was a mass on right parietal bone in 12 years old male. On admission, the patients had headache and local tenderness without any abnormal neurological signs. Histopathologic findings show the fibrocartilagenous tissue and bone. The soft tissue is densely replaced by infiltrations of histiocytes, eosinophils, lymphocytes, plasma cells and multinucleated giants cells. Bone tissue is also infiltrated with identical cells. The differential diagnosis distiction between the cerebral granulomatosis is difficult.