Prognosis for patients with a malignant glioma of the brain is, up to the present time, very poor. Surgery is unlikely to be curative and the primary goals of the surgery are:(1) to make a histologic diagnosis, (2) to determine the extent of the lesion and (3) if possible, to debulk the tumor. The inclusion of radiation therapy following surgery prolonged median survival time by about 0 weeks as compared to surgery alone or surgery with chemotherapy. 50 patients with anaplastic astrocytoma or glioblastoma multiforme were treated at the Department of Neurosurgery. C.U.M.C. Mar. 1991 and Jul. 1994. All patients were treated with surgical resection, irradiation, chemotherapy with BCNU(1, 3bis(2chloroentlyl) 1nitrosourea), and immunotherapy with interferon beta(IBR therapy). Interferon beta was given in dosages of 100,000~300,000 U for 7 days and BCNU was given in doses of 200mg/sqm for 1 day, intravenously before postoperative radiotherapy and was repeated at the interval of 6 weeks. Survival rates were analyzed between our IBR therapy group and historical data of radiation therapy alone. Several prognostic factors were analyzed in the IBR therapy group. Survival curves were observed according to the Kaplan Meier method. Our observation revealed that IBR therapy showed encouraging results in some patients without stastistical significant in general. However, despite the above observtion, we believe that the statistical out come of the IBR group may change statistically if given a longer follow up period. Furthrmore, our study also demonstrated that the improved survival time gained from total resection over subtotal resection was statistically significant.
Astrocytoma ; Brain ; Carmustine* ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Glioblastoma ; Glioma* ; Humans ; Immunotherapy ; Interferon-beta* ; Interferons ; Neurosurgery ; Prognosis ; Radiotherapy ; Survival Rate

Hypertensive pontine hemorrhage usually causes profound, irreversible neurological deficits, with ominous prognosis, and is often fatal. There is controversy as to the appropriate treatment modality, but in general, surgical intervention is considered unethical. The authors report the outcome of hypertensive pontine hemorrhage in 13 patients whose Glasgow Coma Scale was 4-9, who on brain CT scan were seen to have over 10cc of hematoma and who underwent suboccipital craniectomy for hematoma removal. These patients could be divided in two groups: 'early'(9 patients), who underwent surgery within 24 hours of ictus, and 'late'(4 patients), who underwent surgery 6 to 20 days after ictus: all had shown neurological deterioration in spite of optimal medical treatment. Surgical outcome did not vary according to the extent of hematoma removal. For patients in the 'early' group, surgery was not useful, but three in the 'late' group, the GCS score improved to between 7 and 11. This study suggests that in hypertensive pontine hemorrhage, an early direct approach may not improve outcome, but for selected patients, who deteriorate during conservative treatment, surgery may be beneficial.
Brain ; Glasgow Coma Scale ; Hematoma ; Hemorrhage* ; Humans ; Prognosis ; Tomography, X-Ray Computed

No abstract available.
Meningioma* ; Proliferating Cell Nuclear Antigen*

We describe the case of a 59-year-old man whose occipital condyle was fractured in a traffic accident, resulting in severe neck pain and blurred vision. Neurological examination revealed palsy of the right side sixth cranial and ipsilateral lower cranial nerve. In fracture of the occipital condyle, persistent neck pain and lower cranial nerve palsy may be common clinical features. Conventional plain radiography may often be inadequate for the detection and evaluation of this lesion, and high-resolution CT and coronal reconstruction is the diagnostic modality of choice. The patient was treated conservatively using a Philadelphia collar, and this led to excellent clinical improvement. To demonstrate this rare form of traumatic lesion in patients with sustained post-traumatic neck pain and lower cranial nerve palsy, the authors recommend CT of the craniocervical junction.
Accidents, Traffic ; Cranial Nerve Diseases* ; Cranial Nerves* ; Humans ; Middle Aged ; Neck Pain ; Neurologic Examination ; Paralysis ; Radiography

We describe the case of a 59-year-old man whose occipital condyle was fractured in a traffic accident, resulting in severe neck pain and blurred vision. Neurological examination revealed palsy of the right side sixth cranial and ipsilateral lower cranial nerve. In fracture of the occipital condyle, persistent neck pain and lower cranial nerve palsy may be common clinical features. Conventional plain radiography may often be inadequate for the detection and evaluation of this lesion, and high-resolution CT and coronal reconstruction is the diagnostic modality of choice. The patient was treated conservatively using a Philadelphia collar, and this led to excellent clinical improvement. To demonstrate this rare form of traumatic lesion in patients with sustained post-traumatic neck pain and lower cranial nerve palsy, the authors recommend CT of the craniocervical junction.
Accidents, Traffic ; Cranial Nerve Diseases* ; Cranial Nerves* ; Humans ; Middle Aged ; Neck Pain ; Neurologic Examination ; Paralysis ; Radiography

Infantile myofibromatosis is a myofibroblastic tumor of childhood which preferentially arises in the dermis, subcutis, muscle, bone, and occasionally viscera. The disorder is usually divided into two forms, solitary and multicentric type, and the clinical course and prognosis are known to be excellent except case with visceral involvement. It is very unfamiliar in neurosurgical field. The authors present an unusual case of solitary infantile myofibromatosis occurring in right temporal bone in aafour-month-old female infant who underwent surgical excision and showed on excellent clinical course without any other adjuvant treatment. The authors propose that this disease entity should be included in differential diagnosis when neurosurgeons meet infant or child whose radiological appearance is similar to finding described.
Child ; Dermis ; Diagnosis, Differential ; Female ; Humans ; Infant ; Myofibroblasts ; Myofibromatosis* ; Prognosis ; Temporal Bone* ; Viscera

Aneurysms arising from the proximal segment(A1) of anterior cerebral artery are rare and not classified as a separate entity. This study reviewed clinical features of A1 aneurysms in four patients the authors experienced with analysis of neurological status, radiological findings, surgical management and outcome. The incidence of A1 aneurysms among 648 aneurysmal patients operated between January. 1995. and January 1998 was 0.6%. The cases were divided into two groups according to the location of aneurysm in the course of A1 segment: distal aneurysm of A1 segment arising near the anterior communicating artery(3 cases) and proximal aneurysm of A1 segment arising near the bifurcation of internal carotid artery(1 case). All three patients of distal aneurysm showed Hunt & Hess grade III-IV on admission and intraventricular hemorrhages in CT scan, on the other hand, one patient of proximal aneurysm showed Hunt & Hess grade II and no other hemorrhage except subarachnoid hemorrhage. In microsurgical fields, the domes of aneurysm of A1 segment directed superiorly in all cases, and in 2 cases of distal aneurysm, the domes were embedded within adjacent parenchyma of gyrus rectus. Distal fenestration of A1 segment which could not be detected in preoperative angiogram was found in 2 cases of distal aneurysm. The authors propose that aneurysms of A1 portion may tend to arise mainly at the distal portion of A1 segment and tend to be accompanied with distal fenestration, and also consider that, when outbreak of aneurysmal rupture, it may give rise to intraventricular hemorrhage through the frontal horn of lateral ventricle due to superior direction of aneurysm and tendency of embedding within brain parenchyma of gyrus rectus, and then it makes the patient worse than aneurysmal rupture of other common sites.
Aneurysm ; Animals ; Anterior Cerebral Artery* ; Brain ; Hand ; Hemorrhage ; Horns ; Humans ; Incidence ; Intracranial Aneurysm* ; Lateral Ventricles ; Rupture ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

In a series of 375 bilateral carotid angiographies, two accessory middle cerebral arteries, one duplication of the middle cerebral artery demonstrated on the angiography were reviewed relative to the pertinent literature. These anomalous middle cerebral arteries are very rare. We reported a case of duplication of the middle cerebral artery at 1993 which was first one to be reported in Korea. At present, we report two additional anomalous accessory middle cerebral arteries. Among these, one was accessory middle cerebral artery originated from the horizontal portion of the anterior cerebral artery, and the other originated from the A2 segment of the anterior cerebral artery. Both of these gave rise to some perforating arteries.
Angiography ; Anterior Cerebral Artery ; Arteries ; Korea ; Middle Cerebral Artery*

The neurotoxic effects of excitatory amino acids(EAAs) in the brain are well documented, but their toxicity in the spinal cord has not been thoroughly studied. Intraspinal microinjections of quisqualic acid(QA) were done to evaluate its neurotoxic effects on neurons in the adult rat spinal cord. Animals were divided into four groups based on times of post-QA injections, ranging from 7-49 days. Total volume injected in each group ranged from 0.3 to 2.0microL of QA and normal saline(vehicle) were injected in lower thoracic and upper lumbar spinal cord. Kinematic analysis of recovery process was performed using a computerized motion analysis system after intraspinal injection of QA and saline. Our results showed that unilateral injections of QA produced either unilateral or bilateral neuronal degenerations during the survival period. This was accompanied by an inflammatory reaction and initiation of pathological process leading to spinal cavitation in 23 of 25 animals. Segments affected by QA injections showed darkly stained, hypertrophied neuronal profiles, and an increased expression of glial fibrillary acidic protein(GFAP). Immunostaining for GFAP was especially intense in the areas of neuronal degeneration and around the border of spinal cavities. The kinematic analysis of locomotion in the right hindlimb showed a decrease in gait height(pre-injection level: 2.07+/-0.12cm) at post QA injection 1 week(1.53+/-0.09cm), but returned to pre-injection level at 5 weeks(1.83+/-0.15cm). There was no statistical difference in the gait distance before and after QA injections. Results of this study have shown that the intraspinal injection of QA may be a suitable model to study cellular events of EAA-induced neurotoxicity on spinal neurons and the pathological process of spinal cavitation following neuronal degeneration. Computerized motion analysis system was useful for detection of the neurological deficits from minor spinal cord injury.
Adult ; Animals ; Brain ; Gait ; Hindlimb ; Humans ; Injections, Spinal ; Locomotion* ; Microinjections ; Neurons ; Rats* ; Spinal Cord Injuries ; Spinal Cord* ; Syringomyelia*