We have experienced a rare case of leukemic lesion(chloroma) in the lower spinal canal which was confirmed by the surgery and histologic examination of the tumor. A farmer, aged 39, was admitted to the Department of Neurosurgery, St. Paul Hospital in December 1974 with chief complaints of low back pain with radiating pain in the right lower extremity and voiding difficulty for one month. On admission, neurologically, the patient exhibited weakness of the right anterior tibialis, extensor hallucis longus and peroneus longus and brevis muscles and sensory involvement of the right third, fourth and fifth sacral dermatomes. He was disclosed the positive signs of the Naffziger's and Lasegue's and severe tenderness on the spinous process of the fifth lumbar and first sacral vertebrae. Lumbar myelogram demonstrated a total block at lower level of the fifth lumbar vertebra and a filling defect of the right fifth lumbar root area. Through the laminectomy of fourth lumbar to first sacral lamina, an extradural greenish soft mass located at the ventral aspect of the right fifth lumbar to upper sacral roots, and the mass was removed. The biopsy specimen disclosed chloroma with leukemic infiltration of the meninges.
Biopsy ; Humans ; Laminectomy ; Leukemic Infiltration ; Low Back Pain ; Lower Extremity ; Meninges ; Muscles ; Neurosurgery ; Sarcoma, Myeloid ; Spinal Canal* ; Spine

We have experienced 17 cases of the upper brain stem compression lesions diagnosed by serial vertebral angiography and other ancillary studies from October, 1972 to August, 1975. All the cases were proven by serial vertebral angioraphy using the Seldinger catheter technique through the femoral artery and other studies such as carotid angiography, conray ventriculograpy, brain scan and pneumoencephalography. Angiographical analysis were attempted. The results were as following: 1. The location of lesion is:supratentorial lesions; 8 cases, infratentorial lesions; 5 cases, tentorial lesions; 3 cases, bilateral hippocampal herniation due to otitic hydrocephalus; 1 case. 2. We have tried to classify the upper brain stem compression lesions according to the direction of compression, i.e., (1) forward, (2) medial, (3) backward and (4) downward and analyzed their angiographic findings in detail. 3. Lesions compressed the upper brain stem forward were one case of bilateral occipital meningioma, one case of fourth ventricle tumor, two cases of medulloblastoma and one case of cerebellar hemispheric tumor. Their main angiographic findings were as follows;(1) Separation of quadrigeminal segment of superior cerebellar artery and posterior cerebral artery, (2) Compression of basilar artery against clivus and depression or elevation of bifurcation of basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward displacement of posterior mesencephalic vein and posterior displacement of precentral cerebellar vein, (5) Elevation of vein of Rosenthal. 4. Lesions compressed the upper brain stem medially were two cases of parietal ependymoma, one case of temporal meningioma, one case of bilateral hippocampal herniation and three cases of tentorial tumors. Their main angiography findings were as follows; (1) Medial displacement of posterior cerebral artery, superior cerebelar artery, bifurcation of basilar artery, distal portion of vein of Rosenthal, lateral mesencephalic vein and internal cerebral vein in Towne's view, (2) Elevation or depression of posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of crural and ambient segment of superior cerebellar artery. 5. Lesions compressed the upper brain stem backward were one case of pituitary tumor and one case of cerebellopontine angle tumor. Their main angiographic findings were as follows; (2) Posterior displacement of distal portion of basilar artery, (2) Posterior displacement of anterior pontomesencephalic vein, (3) Elevation of posterior cerebral artery and superior cerebellar artery, (4) Elevation of vein of Rosenthal and posterior mesencephalic vein, (5) Stretching and elevation of posterior communicating artery. 6. Lesions compressed the upper brain stem downward were one case of thalamic tumor, one case of thalamic hemorrhage, and one case of pinealoma. Their main angiographic findings were as follows; (1) Stretching of posterior cerebral artery and superior cerebellar artery, (2) Displacement and stretching of internal cerebral vein, vein of Rosenthal and posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of posterior cerebral artery and superior cerebellar artery, (6) Depression of internal cerebral vein, vein of Rosenthal, posterior mesencephalic vein and anterior pontomesencephalic vein. 7. We have concluded that in order to diagnosis the upper brain stem compression lesions serial vertebral angiography is the most important procedure and at the same time the analysis of the arteriographic and venographic findings in detail is important.
Angiography* ; Arteries ; Basilar Artery ; Brain Stem* ; Brain* ; Catheters ; Cerebral Veins ; Cranial Fossa, Posterior ; Depression ; Diagnosis ; Ependymoma ; Femoral Artery ; Fourth Ventricle ; Hemorrhage ; Hydrocephalus ; Medulloblastoma ; Meningioma ; Neuroma, Acoustic ; Pinealoma ; Pituitary Neoplasms ; Pneumoencephalography ; Posterior Cerebral Artery ; Rabeprazole ; Veins

The authors describe the case of a 57-year-old female who developed subrachnoid hemorrhage secondary to rupture of posteriorly projecting, high placed aneurysm of the proximal posterior cerebral artry. This aneurysm was treated easily and successfully with the zygomatic temporopolar approach which was modification of the temporopolar approach proposed by Sano by detaching the zygomatic arch to get a wide and flexible operating field.
Aneurysm* ; Female ; Hemorrhage ; Humans ; Middle Aged ; Rupture ; Zygoma

A synophthalmia, another form of cyclopia, in which the element of the two eyes are partially fused to form an apparently single eye in the middle of the forehead. The synophthalmia is a result of complex, neural plate misdevelopment syndrome involving the eye, brain, skull and face. It is well known that synophthalmia is due to heterogenous causes, most of which chromosomal imbalances. We experienced a case of synophthalmia associated with proboscis, alobar holoprosencephaly and chromosomal anomaly 46, XX, -15,t (15 q, 21 q). Diagnosis was confirmed by brain MRI and autopsy, The patient died about 20 hours of age and autopsy was done. A brief review of the literatures was also presented.
Autopsy ; Brain ; Diagnosis ; Forehead ; Holoprosencephaly ; Humans ; Magnetic Resonance Imaging ; Neural Plate ; Skull

We have experienced 20 cases of the cerebral rete mirabile from 1969 to 1975. All were proved by bilateral carotid angiography, and clinical assessment and angiographical analysis were attempted. The results were summarized as follows: 1. Age distribution was ranged from 5 to 55. The majority of 20 cases were age over 20 as 15 cases who were distributed evenly in each decade and 5 cases were age below 20. 12 cases were male and 8 female. 2. Authors classified the cases as the group of subarachnoid hemorrhage and non-subarachnoid hemorrhage conveniently. All cases of age below 20 comprised in the group of non-subarachnoid hemorrhage while majority of subarachnoid hemorrhage group were age over 20. 3. There were no contributory factors to cerebral rete mirabile with regard to past history and family background. 4. There were considerable differences in the symptoms and signs between the groups of subarachnoid hemorrhage and non-subarachnoid hemorrhage. Clinical manifestations were mainly headache and impairment of consciousness with meningeal sign in the group of subarachnoid hemorrhage. On the other hand, motor disturbance such as hemiparesis or monoparesis was occurred in the majority of non-subarachnoid hemorrhage and the minority showed speech impairment, seizure and choreiform movement. 5. All cases showed the characteristic angiographic findings of cerebral rete mirabile, which are occlusion or stenosis at the supraclinoid portion of internal carotid artery with abnormal fine vascular network around the base of brain and poor or non-visualizing anterior cerebral and middle cerebral arteries. The interesting picture was rete formation of ophthalmic artery in the orbit of 2 cases. There were no abnormal angiographic findings on the vertebral angiogram except retrograde filling to anterior cerebral and middle cerebral arteries through collateral channel from the posterior cerebral artery. 6. The prognosis of the cerebral rete mirabile seem to be favorable with regard to mortality. There were no death in our 20 cases during the period of observation.
Age Distribution ; Angiography ; Brain ; Carotid Artery, Internal ; Chorea ; Consciousness ; Constriction, Pathologic ; Female ; Hand ; Headache ; Hemorrhage ; Humans ; Male ; Middle Cerebral Artery ; Mortality ; Ophthalmic Artery ; Orbit ; Paresis ; Posterior Cerebral Artery ; Prognosis ; Seizures ; Subarachnoid Hemorrhage

Recently, brainstem auditory evoked potential is very important for the evaluation of functions of the 8th nerve & brainstem. Especially, it appears that waves I, III, and V primarily represent volume- conducted electrical activity from the acoustic nerve, pons and midbrain, respectively, and that latencies between these three potentials indirectly reflect neural conduction in the corresponding segments of the central auditory pathway. For example, wave I to wave III interpeak latency(I-III IPL) is a measure of conduction in the more caudal segment of the brainstem auditory pathway-acoustic nerve and potomedullary portion-while the III-V IPL is a measure of conduction in the more rostral pontine and midbrain portions of the pathway. This study was undertaken to identify the normal measurements of the waves I, III and V and I-III IPL, III-V IPL in order to for provide basic data for clinical use in diagnosis, monitering in operation and management of patients with brainstem lesions. The literature is reviewed and results compared to the current study.
Auditory Pathways ; Brain Stem* ; Cochlear Nerve ; Diagnosis ; Evoked Potentials, Auditory, Brain Stem* ; Humans ; Mesencephalon ; Neural Conduction ; Pons

Recently for 2 years, 24 cases of microabscesses have been experienced and treated at St. Paul's Hospital, Catholic Medical College. Investigations had been made & analyzed to characteristic clinical symptoms and signs, typical CT findings and therapeutic management and prognosis. The CT scan is most choice of and early and accurate diagnosis and has made feasible the follow up of the evolution and eventual resolution of abscess lesions. In the authors opinion and experience, when microabscess is diagnosed at it early stage, it could be treated in 2week with the administration of antibiotics & not need any other surgical interventions.
Abscess ; Anti-Bacterial Agents ; Diagnosis* ; Follow-Up Studies ; Prognosis ; Tomography, X-Ray Computed

CT guided stereotactic biopsies were carried out in 41 patients with tumorous CT findings during past 2 years. In 27 tumorous CT conditions impressed glioma, meningioma, metastatic ca, chondroma, germinoma and craniopharyngioma, 16 cases were disclosed correctly in preoperative cinicalradiological diagnosis comparing with pathological diagnosis confirmed by means of stereotactic biopsy, but other 11 cases, showed the preoperative diagnostic error which pathological diagnosis were infarction, cryptical AVM, abscess, granuloma, and tumors such ad lymphoma, oligodendroglioma, GBM, chordoma. Among 12 granulomatous CT lesions 3 cases showed preoperative diagnostic error, which were, confirmed infarction, multiple sclerosis by pathological diagnosis. The pathological findings of 2 vascular lesions that were impressed as infarction and old hematoma were confirmed as granuloma and GBM. The error of preoperative clinical - CT diagnosis was 39% of total 41 patients. The advantage of preoperative stereotactic biopsy is to confirm the correct histological diagnosis, while it can help the patient and surgeon for the planning of further proper therapy.
Abscess ; Biopsy* ; Chondroma ; Chordoma ; Craniopharyngioma ; Diagnosis ; Diagnostic Errors ; Germinoma ; Glioma ; Granuloma ; Hematoma ; Humans ; Infarction ; Lymphoma ; Meningioma ; Multiple Sclerosis ; Oligodendroglioma

Japanese neurosurgeons have recently reported number of disorder having typical angiographic findings, which showed abnormal cerebrovascular network at the base of the brain related with the occlusion of the internal carotid arteries in Japanese race. Since the authors have observed five cases of the similar vascular abnormalities in Korea by cerebral angiography from 1969 to 1971, the clinical findings and angiographic features of these cases were presented. The results were summarized as follows; 1. Of the 5 patients, 4 cases were over 20 years of age and one 5-year-old child. 4 cases were male and one female. 2. There were considerable differences in the initial symptoms of these patients. Authors classified these as the group of subarachnoidal hemorrhage and non-subarachnoidal hemorrhage. The former was 3 cases and later 2. The most frequent clinical manifestations in the hemorrhagic group was headache, impairment of consciousness and sings of meningeal irritation, while hemiparesis and speech disturbance was mainly seen in the nonhemorrhagic group. Similar clinical pictures were reported in Japanese cases. 3. Characteristic cerebral angiographic findings of these cases were; 1) Narrowing of the cervical portion of both internal carotid arteries. 2) Occlusion or stenosis of bilateral internal carotid arteries at the supraclinoid portion. 3) Abnormal vascular network at the base of the brain around the occlusive area. 4) Anterior and middle cerebral arteries were no visualized in all cases and superficial temporal arteries or ophthaemic artery was prominent in a few cases. The etiological possibility of these disorder, radiological features and symptomatology were discussed.
Arteries ; Asian Continental Ancestry Group ; Brain* ; Carotid Artery, Internal* ; Cerebral Angiography ; Child ; Child, Preschool ; Consciousness ; Constriction, Pathologic ; Continental Population Groups ; Female ; Headache ; Hemorrhage ; Humans ; Korea ; Male ; Middle Cerebral Artery ; Paresis ; Temporal Arteries

Recently microvascular decompressive approach to the hyperactive type of low cranial nerves dysfunction has been popular procedures in neurosurgical operation. The neurosurgical teams at St. Paul's Hospital, Catholic Medical College operated on 11 patients employing this technique for 2 years. The patients were diagnosed as 9 patients with hemifacial spasm, one with trigeminal neuralgia, and one with glossopharyngeal neuralgia. The results were very encouraging of the 10 patients. But remaining one patient was failed with therapy. The authors would like to share with you their experiences employing the microvascular surgical technique, the results & the prognosis.
Cranial Nerves* ; Glossopharyngeal Nerve Diseases ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Prognosis ; Trigeminal Neuralgia