Two cases of carotico-cavernous fistula, which experienced at Dept. of Neurosurgery of Busan National University Hospital, are presented with a brief review of the literature. Because it is the very interesting disease. These were of spontaneous onset. One was 39 year-old woman who was treated with the ligations of internal and common carotid artery in the neck, another was 17 year-old boy treated with the ligations of internal and common carotid artery followed by intraluminal mascular embolization. This surgical management was successful and there was neither recurrence nor other neurologic deficit.
Adolescent ; Adult ; Busan ; Carotid Artery, Common ; Female ; Fistula* ; Humans ; Ligation ; Male ; Neck ; Neurologic Manifestations ; Neurosurgery ; Recurrence

Author has attempted to measure serial blood leucocyte and pseudoeosinophilic neutrophil counts to study the inter-relationships between blood total leucocyte levels and severity with prognostic significance of various craniocerebral injuries induced experimentally in rabbits. The experiments were performd on 31 rabbits of male sex, weighing between 1.5 and 1.7kg. On the degree of difference and severity of experimental injuries the animals were divided into the following 6 different groups;subarachnoid hemorrhage(Group I), local brain malacia(Group II), intracerebral hematoma(Group III), intraventricular hematoma(Group IV), unilateral carotid ligation(Group V), bilateral carotid ligation(Group VI). In each groups, total leucocyte and pseudoeosinophilic neutrophil counts were measured at times 1 hr., 3 hr., 6 hr., 12 hr., and 1, 2, 3, 4 day, respectively, after the injuries. The following results were obtained: 1. Mean levels of total leucocyte and pseudoeosinophilic neutrophil counts were 7263(193/mm3 and 35.1% in the control group. 2. The injured group, when compared to the control group of animals, had significantly raised total WBC and pseudoeosinophil counts at 3 hr. after the injuries, and the counts were returned to normal range at the third day after the injuries. 3. In each series of the unilateral carotid ligation, the raised total WBC and pseudoeosinophil counts did not differ significantly in the right ad left series each other. 4. Total WBC and pseudoeosinophil levels in the group of bilateral carotid ligation were progressively increased and the highest levels were seen between 6 hr. and 12 hr. after the injuries. 5. The most raised total WBC and pseudoeosinophil levels were seen in the group with bilateral carotid ligation and the next group was intraventricular hematoma, and the least raised group was subarachnoid hemorrhage. 6. It was concluded that the data showed highly significantly positive correlation between total WBC and pseudoeosinophil counts with the severity of injuries and its prognosis of craniocerebral injuries of rabbits induced experimentally. The greater increase in serial total WBC and pseudoeosinophil counts was seen in the group associated with higher degree of injuries, and the counts became to normal range at the third day with parallel to the degree of recovery after the injuries.
Animals ; Brain ; Craniocerebral Trauma ; Hematoma ; Humans ; Ligation ; Male ; Neutrophils* ; Prognosis ; Rabbits* ; Reference Values ; Subarachnoid Hemorrhage

A clinical analysis for bifrontal craniectomy had been carried out with 30 cases at Busan National University Hospital during the period from July of 1972 to June of 1973. The patient's conditions such as bilateral dilated fixed pupils, decerebrated rigidity, apneic respiration, and coma were sometimes regarded to contraindication for the department of neurosurgery to operate. This wide procedure enabled to allow identification of confused and lacerated brain, evacuation of acutely accumulated blood and necrotic brain, and decompression of swollen brain under direct visualization. The author reviews 30 cases operated, and among them, 6 were survived. Before report this technique, we did not operate on the patients who exhibiting apnea and bilaterally dilated fixed pupils. Such clinical signs are commonly preceded to death, and we have recommended conservative therapies such as hyperosmolar agents and steroids to combat brain swelling in this desperately ill patient. Our clinical impression that bifrontal decompressive craniectomy was useful for severe craniocerebral injury and swelling was unable to prove with unequivocal documentation from these cases that their survival was uniquely attributable to the bifrontal craniectomy. I presents my appraisal of the case material, not so much as proof of it's superiority over other methods, but rather as provocation for further critical appraisal of it's use.
Apnea ; Brain ; Brain Edema ; Busan ; Coma ; Craniocerebral Trauma* ; Decompression ; Decompressive Craniectomy* ; Humans ; Neurosurgery ; Pupil Disorders ; Respiration ; Steroids

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.
Biopsy ; Biopsy, Needle ; Brain ; Catheters ; Humans ; Needles ; Neurosurgery* ; Operating Rooms ; Ultrasonography*

This study was carried out to find out changes in regional cerebral blood flow(r-CBF) in relation to(i) clinical status of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms ; (ii) the degree of subarachnoid hemorrhage as indicated by brain CT scanning ; (iii) the severity of angiographic vasospasm, and (iv) other neuropathological condition. Measurement of r-CBF were performed, using 133Xe inhalation method, on 50 patients with ruptured intracranial aneurysms. Some of the major findings were as follows : 1) The degree of abnormalities of blood flow correlated well with the clinical severity of neurological deficits. 2) A marked reduction in r-CBF was found in patients with intracerebral hematoma, ischemic lesion and hydrocephalus. 3) In angiospasm area, r-CBF was found in patients with intracerebral hematoma, ischemic lesion and hydrocephalus. 3) In angiospasm area, r-CBF decreases below 30ml/100gm/min in almost all of the patients, and severity of vasospasm correlated with the decrease of CBF. 4) The measurement of CBF on patients with subarachnoid hemorrhage was thought to the useful for foreseeing the clinical outcome of the patients.
Brain ; Hematoma ; Humans ; Hydrocephalus ; Inhalation ; Intracranial Aneurysm* ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

Extradural hematomas are usually acute and rapidly progressing and the lucid intervals generally varies from a few moments to several hours. However, not uncommonly, an epidural hematoma may have a lucid interval lasting weeks, months or even years, which may present as a chronic epidural hematoma. Two cases have recently come under our care, demonstrating a paucity of objective neurologic abnormalities, but with extensive compressive extradural hemorrhage, which were found incidentally during the screening examination with the CT scanning.
Hematoma* ; Hemorrhage ; Mass Screening ; Tomography, X-Ray Computed

No abstract available.
Carpal Tunnel Syndrome* ; Humans

No abstract available.
Microsurgery* ; Radiosurgery* ; Trigeminal Neuralgia*

The authors analyzed 60 cases of ruptured internal carotid artery(ICA) aneurysms admitted and operated at Department of Neurosurgery in Kyung Hee University Hospital during the period from July 1983 to June 1988. The results of analysis were summarized as follows; 1) Mean age of patients was 51 years. ICA aneurysms occurred more frequently in female(47) than male(13). 2) Distribution of ICA aneurysms were ophthalmic aneurysm 8 cases(13.3%), posterior communicating aneurysm 40 cases(66.6%), anterior choroidal aneurysm 7 cases(11.6%), bifurcation aneurysm 5 cases(8.3%). 3) Most common direction of aneurysmal dome in ophthalmic, anterior choroidal and posterior communicating aneurysm was posterior-inferior-lateral and in bifurcation aneurysm was posterior-superior. 4) Multiple aneurysm was 23 cases(38%). 5) Incidence of clinical vasospasm was 48.3% and that of rebleeding was 20%. 6) Clipping was done in all cases, 2 cases combined with wrapping and 2 cases with trapping. 7) Mortality rate was 21.6%.
Aneurysm* ; Carotid Artery, Internal* ; Choroid ; Humans ; Incidence ; Mortality ; Neurosurgery

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time ; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical center for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ration was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhage had brought about a high licidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade I-II, and also decreased the frequency of Grade III, but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment. 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.
Academic Medical Centers ; Blood Loss, Surgical ; Cause of Death ; Classification ; Consciousness ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive* ; Korea ; Middle Aged ; Mortality ; Neurosurgery ; Putamen ; Seasons