We have experienced a case of suprasellar germinoma metastasized to the lumbar spinal canal. A 22-year-old man was admitted to St. Mary's Hospital May, 1975 with complaints of low back pain, progressive weakness of both lower extremities and voiding difficulty for about one month. About 7 months ago he received craniotomy and irradiation therapy for suprasellar germinoma. Neurological examination revealed foot drop on the left side with sensory change and atonic neurogenic bladder. Pantopaque myelogram showed a total block at the level of the 3 rd lumbar vertebra suggestive an epidural mass compressing dural sac posteriolaterally. Total laminectomy of lumbar first to fifth vertebrae disclosed a firm, rubbery hard and vascular mass in the epidural space, which was not adherent to the dura. Histological examination of the tumor revealed typical germinoma. Pathogenesis of geminoma and possible mode of epidural metastasis are discussed.
Craniotomy ; Epidural Space* ; Foot ; Germinoma* ; Humans ; Iophendylate ; Laminectomy ; Low Back Pain ; Lower Extremity ; Neoplasm Metastasis ; Neurologic Examination ; Spinal Canal* ; Spine ; Urinary Bladder, Neurogenic ; Young Adult

The intracranial arachnoid cyst is distinctly uncommon and they have unusual clinical course. The plain skull series were usually shown bulging of the overlying skull due to progressive collection of cerebrospinal fluid in cystic cavity. Pre-operative diagnosis is unlikely to be made. The predilection sites of this lesion are usually convexity of hemisphere, cisterna chiasmaticus, especiaily forebrain along the axis of main cerebral artery. The authors report a case of intracranial arachnoid cyst arisen along the Sylvian fissure combined chronic subdural hematoma follwoing sustained mild head injury. The pathologic diagnosis was arachnoid cyst, since the removed cyst wall was normal arachnoid tissue.
Arachnoid ; Arachnoid Cysts* ; Axis, Cervical Vertebra ; Cerebral Arteries ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Diagnosis ; Hematoma, Subdural, Chronic ; Prosencephalon ; Skull

The arteriovenous malformations(AVMs) of the corpus callosum are distinct anatomical and surgical entities. The AVMs of the corpus callosum are supplied by the pericallosal arteries if the malformations are located in the anterior and middle portion of the callosum and the AVMs of the splenium are usually fed by the pericallosal and posterior cerebral arteries. Radical excision of the callosal AVMs became successful with microsurgical techniques since a few years ago. The authors report a case of the callosal AVM, who had subarachnoid hemorrhage twice prior to this admission, and the studies with angiography and computed tomography revealed an AVM involing the middle portions of the corpus callosum. Radical excision of the AVM was accomplished by microsurgical techniques without neurologic sequela.
Angiography ; Arteries ; Corpus Callosum* ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

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

Authors experienced the myelotomy for the syringomyelia in 3 cases. Moreover a recent case who underwent the craniovertebral decompression with myelotomy was associated with Arnold-Chiari malformation. Post-operative courses were uneventful in two but a case with the thoracic myelotomy became paraparetic after 5 years of follow up due to the spinal arachnoiditis. It seems that the careful studies, including the ventriculography and/or C-T scan are necessary to find the hind-brain malformation and to give the appropriate management.
Arachnoid ; Arachnoiditis ; Arnold-Chiari Malformation ; Decompression ; Follow-Up Studies ; Syringomyelia*

Epilepsy can be defined as a paroxysmal, neuronal discharge within the brain originating from either corticalor sugcortical regions. The incidence of epilepsy is increasing possibly due to the survival of persons who shouldhave died of brain injuries or other cerebral abnormalities acquired in earlylife. the use of abtibiotics andimprovement in the medical care have saved many children who might have died of meningitis, brain abscess,encephalitis, severe head injuries, etc. CCT scan is new radiologic procedure for defining cranial andintracranial structures and also an useful procedure for evaluation and follow-up(FU) of patient with focalseizure disorder. Recently we experienced nodules which were isodense or hypodense on initial noncontrasted CT(NECT) and scans became hyperdense of the enhancement in 4 cases of focal epileptic seizures. Nearly completedisappearance or regression of the epileptic foci occurred on the FU CT scans in 2 cases. Operation was performedin 2 cases. The tissue specimen obtianed from the CT nodule revealed cerebral edema in one case and localizedgliosis and congestion in the other. All the patients showed marked clinical improvement when the CT noduleimporved. Review of literature failed to disclose any previous report on such observation.
Brain ; Brain Edema ; Brain Injuries ; Child ; Craniocerebral Trauma ; Epilepsy ; Estrogens, Conjugated (USP) ; Humans ; Incidence ; Meningitis ; Neurons ; Tomography, X-Ray Computed

A case of carotico-cavernous fistula was managed by intravascular occlusion using a Fogarty catheter and ligation of the carotid artery. The fistula was obliterated by the procedure and neurologic deficits improved progressively without further recurrence. The radiological feature, symptomatology and surgical management were discussed.
Carotid Arteries ; Catheters ; Fistula* ; Ligation ; Neurologic Manifestations ; Recurrence

Attention has been called to the sudden expansion of a pituitary tumor by hemorrhage within it, causing sudden loss of vision. Management of the pituitary apoplexy should be regarded as a neurological emergency. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, opthalmoplegia, meningismus and signs of compression of the optic nerve or chiasm. The authors report two cases of pituitary apoplexy, one was chromophobe adenoma and pathological diagnosis was not obtained in the other. The first case was 45-year-old man admitted to the Department of Neurosurgery, Catholic Medical Center on June 20, 1977, with headache, double vision and impared left side visual acuity. On April 26, 1977, he experienced sudden severe headache and diplopia then became drowsy. The headache and impairment of consciousness improved subsequently. He was admitted to a university hospital following the onset. The work up at the hospital revealed an enlarged sella with hazy dorsum sellae on plain skull films. The carotid angiogram revealed an elevation of the A1 segments bilaterally and cisternal pneumogram revealed an evidence of suprasellar extension of the pituitary tumor. He was advised to have immediate surgery. The patient, however, refused the surgery and noticed the impaired visual acuity and diplopia were persisting. The studies in this hospital revealed marked impairment of left side vision and oculomotor nerve palsy of the left eye. The carotid angiogram and cisternal pneumogram revealed the no evidence of sellar mass or suprasellar extension of the tumor. The second case was 59-year-old woman admitted to the neurosurgical ward on September 30, 1977, after a sudden onset of severe bifrontal headache, vomiting, bilateral ocular pain and drowsy mental state. She was drowsy with panopthalmoplegia of the right side, and spinal fluid was xanthochromic. Skull X-ray, carotid angiogram and air study revealed an evidence of pituitary tumor with minimal suprasellar extension. Removal of pituitary tumor through the trans-sphenoidal approach was performed, and the tumor was proved to be chromophobe adenoma. Panopthalmoplegia was progressively improved postoperatively.
Adenoma, Chromophobe ; Consciousness ; Diagnosis ; Diplopia ; Emergencies ; Female ; Headache ; Hemorrhage ; Humans ; Meningism ; Middle Aged ; Neurosurgery ; Oculomotor Nerve Diseases ; Optic Nerve ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Visual Acuity ; Vomiting

The size of the cisterna magna is still detatable. Robertson13) stated that the cisterna magna varies greatly in capacity and described the large cisterna magna as a separate entity. He also found that in most cases the cisterna magna extended approximately 2.5cm above the foramen magnum and was usually 5mm deep with a variable width. Liliequist8) proposed a mean heigh of 28mm for the normal cisterna magna with a wide variation of 15 to 60mm, and a depth of 6mm at the foramen magnum with a variation of 2 to 10mm:however, he did not quote measurements for the width. Gonsette, et al.5) reported 28 cases of enlarged cisterna magna diagnosed by ventriculography and coined the phrase "mega grande citerne" or mega cisterna magna. All of these cases, however, had symptoms of posterior fossa disease. Our study of the syndrome of the mega cisterna magna without specific syndrome is presented nystagmus, transient syncope in the first & third cases were operated under suboccipital craniectomy and was confimed the large cisterna magna. This paper presents the clinical diagnosis with vertebral angiogrraphy, pneumoencephalography and computed tomography.
Cisterna Magna* ; Diagnosis ; Foramen Magnum ; Numismatics ; Pneumoencephalography ; Syncope

Congenital dermal sinuses are dermal tubes which extended inward from the surface for varying distances and frequently connect the central nervous system or its covering with the surface of the body. The inner end of the sinus may be expanded to form a dermoid or epidermoid cyst. They are the results of incomplete separation of the epithelial ectoderm from the neuroectoderm at the fourth week of fetal development. As cystic expansion of a congenital sinus which is located within the cranium or spinal canal may act as any other mass lesion to interrupt neurologic function by local compression or it may obstruct the normal circulation of spinal fluid. In addition, because of its persistent communication with the skin surface, it serves as a constant potential port of entry for infection into the central nervous system. Since the first report in 1926 by Moise of staphyloccus meningitis secondary to a congenital sacral sinus, numerous reports have appeared of infection secondary to congenital sinuses along the craniospinal axis, particulary in the suboccipital region. Authors report a case of congenital dermal sinus associated with dermoid cyst of posterior fossa which was successfully removed and discuss the pathegenesis of it in embryology, and surgical management of it's complications.
Axis, Cervical Vertebra ; Central Nervous System ; Dermoid Cyst* ; Ectoderm ; Embryology ; Epidermal Cyst ; Fetal Development ; Meningitis ; Neural Plate ; Skin ; Skull ; Spina Bifida Occulta* ; Spinal Canal