The authors report a case of intradural myxopapillary ependymoma of the cauda equina that was clinically similary to herniated lumbar disc disease. The tumor was totally removed under microsurgical condition and the diagnosis was confirmed pathologically.
Cauda Equina* ; Diagnosis ; Ependymoma*

The eight patients of neurocysticercosis have been diagnosed from 1985 to 1987 in the department of neurosurgery at The Baptist Hospital. Six patients had parenchymal cysts, one had a racemose cyst and the other one had a mixed cyst. The blood serum and CSF ELISA on six patients had a positive reaction for cysticercosis but the follow-up ELISA titers were variable three months later on these four. The racemose and mixed cysts were removed surgically due to mass effect and followed by praziquantel therapy. The parenchymal cysts were treated with praziquantel only. Praziquantel was given daily at 50mg/kg of body weight for two weeks or 30mg/kg of body weight for three weeks. The common side effects of praziquantel were headache, dizziness, nausea, seizure and focal neurological deficits. These side effects could be prevented or minimized by corticosteroid. The result of praziquantel therapy was excellent in all the patients except the mixed cyst.
Body Weight ; Cysticercosis ; Dizziness ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Headache ; Humans ; Nausea ; Neurocysticercosis ; Neurosurgery ; Praziquantel* ; Protestantism ; Seizures ; Serum

The eight patients of neurocysticercosis have been diagnosed from 1985 to 1987 in the department of neurosurgery at The Baptist Hospital. Six patients had parenchymal cysts, one had a racemose cyst and the other one had a mixed cyst. The blood serum and CSF ELISA on six patients had a positive reaction for cysticercosis but the follow-up ELISA titers were variable three months later on these four. The racemose and mixed cysts were removed surgically due to mass effect and followed by praziquantel therapy. The parenchymal cysts were treated with praziquantel only. Praziquantel was given daily at 50mg/kg of body weight for two weeks or 30mg/kg of body weight for three weeks. The common side effects of praziquantel were headache, dizziness, nausea, seizure and focal neurological deficits. These side effects could be prevented or minimized by corticosteroid. The result of praziquantel therapy was excellent in all the patients except the mixed cyst.
Body Weight ; Cysticercosis ; Dizziness ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Headache ; Humans ; Nausea ; Neurocysticercosis ; Neurosurgery ; Praziquantel* ; Protestantism ; Seizures ; Serum

To understand the pathophysiology of the intracranial pressure changes, the Monro-Kellie doctrine has been to be a useful concept. By recent reports it has possibly been suggested that prostaglandins may pathophysiologically contribute to the inherent response of intracranial pressure. Although the cardiovascular effects of several postaglandins have well been studied, little is known about their effects on cerebral blood vessel and cerebrospinal fluid pressure. The author observed the effect of prostaglandins injected intra-arterially and intravenously on the intracranial pressure and systemic blood pressure and compared with those of norepinephrine or 5-hydroxytryptamine. The result were summarized as the follows : 1. The intra-arterial and intravenous injections of a single dose of norepinephrine increased not only the intracranial pressure but also systemic blood pressure with dose-dependant response. 2. The intra-arterial injection of PGA2 caused the increase in the intracranial pressure, but on the contrary, the blood pressure was decreased. The intra-arterial injection of PGE1 and PGE2 caused the increase in the intracranial pressure, which was not related to the used doage. 3. The intra-arterial and intravenous injections PGF2 alpha decreased the intracranial pressure but increased the blood pressure, both of which were not related to the dosage used.
Alprostadil ; Blood Pressure ; Blood Vessels ; Cerebrospinal Fluid Pressure ; Dinoprost ; Dinoprostone ; Injections, Intra-Arterial ; Injections, Intravenous ; Intracranial Pressure* ; Norepinephrine ; Prostaglandins* ; Rabbits* ; Serotonin

The report of basilar bifurcation aneurysm accompanying carotid-ophthalmic aneurysm is extremely rare and some technical dexterity must be needed on surgical treatment for each of two aneurysms. Authors report a case of basilar top aneurysm accompanied with a carotid- ophthalmic aneurysm clipped successfully in one stage operation with review of literatures concerning basilar bifurcation aneurysm, carotid-ophthalmic aneurysm and multiple aneurysms.
Aneurysm*

The immune system contributes to body defence mechanism, but sometimes show unfavorable immune disease. Cerebral vasospasm is a major problem in aneurysmal subarachnoid hemorrhage(SAH), but the pathogenesis is poorly understood. Some authors suggest cerebral vasospasm is one type of autoimmune vasculitis. In 35 patients(male 20, female 15) with aneurysmal SAH. the levels of serum immunoglobulin(Ig) G, A, M, E and complement C3(C3) were determined to analyze the relation among Igs, C3, cerebral vasospasm and clinical grade. The results were as follows : 1) Highly significant correlation presented between C3 level and cerebral vasospasm(p<0.001). 2) Highly significant correlation presented between IgA level and cerebral vasospasm(p<0.001). 3) Significant correlation showed IgA with admission grade(p<0.001) and outcome(p<0.01). 4) Significant correlation showed C3 with admission grade(p<0.05) and outcome(p<0.01). 5) Among the 4 groups(SAH without vasospasm, SAH within vasospasm, hypertensive intracranial hematoma(HICH), herniated intervertebral disc(HIVD)), significant statistical difference at the level of IgA and C3 with others is observed in the group 2. 6) In serial determination of C3 levels performed in 8 patients(group 1 and group 2), correlative alteration between C3 level and cerebral vasospasm was observed. From the above results, these findings suggest that IgA and C3 levels not only might be reflected the severity of the neurological insult but also provide the usefulness as a predictable marker of cerebral vasospasm in aneurysmal SAH.
Aneurysm* ; Complement C3* ; Complement System Proteins* ; Female ; Humans ; Immune System ; Immune System Diseases ; Immunoglobulin A ; Immunoglobulins* ; Subarachnoid Hemorrhage* ; Vasculitis ; Vasospasm, Intracranial*

The reports of epidural vascular tumors are rare however dumbbell-shaped epidural cavernous hemangioma is exceedingly rare. The reported incidence of epidural hemangiom is 4%of all spinal epidural tumors and 12% of all intraspinal hemangioma. In the majority of cases, hemangiomas of spinal epidural space represent the secondary extension of a vertebral hemangioma but the occurance of pure epidural cavernous hemangioma is relatively rare. In this report, authors present two cases of epidural cavernous hemangioma including one dembbell-shaped in the thoracic spine with review of other reports.
Epidural Neoplasms ; Epidural Space ; Hemangioma ; Hemangioma, Cavernous* ; Incidence ; Spine*

GDC embolization has been performed selectively since 1991 in patients with intracranial aneurysms and made remarkable technical and clinical advances in recent years. But until now, this procedure lacks an adequate long-term follow-up study. Also, clear mechanism and evidence of electrothrombosis and endothelialization of aneurysm neck, the incidence of vasospasm after GDC embolization are still controversial. Here we critically reviewed the published literatures pertaining to the GDC embolization in order to gain a comprehensive understanding and knowledge of forementioned controversies. Also from November 1997 to April 1999, we treated 12 patients of intracranial aneurysms with GDC embolization. In conclusion, although certain shortcomings and controversies are still remain, the GDC embolization can be an alternative, supportive and attractive therapeutic modality in the treatment of intracranial aneurysms. Not only to improve outcome of intracranial aneurysms but also fulfill the patient's requirement, we need cooperations and cross-training with the interventional neuroradiology and rigorous academic evaluation on anatomy of cerebral vasculature and pathophysiology of cerebrovascular disorders.
Aneurysm ; Cerebrovascular Disorders ; Embolization, Therapeutic* ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Aneurysm* ; Neck

Aneurysms arising from the posterior circulation are 5-19% of total intracranial aneurysms. Althought many neurosurgeons have challended with various innovations but the confinned surgical space, complicated anatomical structure and many small perforators to vital organ of brain were remained the barrier that we we have to overcome. From July 1987 to December 1994, we have been operated on 23 cases of posterior circuation aneurysms among 409 cases of surgically treated all intracranial aneurysms. The present 5.6% of all intracranial aneurysms, the average age of these patients was 49 years old. The ratio of male to female was 1 : 1.8. The number of basilar bifurcation artery aneurysms(BBAA) were 14(61%), the posterior cerebral artery(PCA) aneurysms 3(13%), the upper basilar trunk aneurysm 1, posterior inferior cerebellar artery(PICA) aneurysm 3(13%), anterior inferior cerebellar artery(AICA) aneurysm 1 and vertebral artery aneurysm 1. Five patients had accompanined with anterior circulation aneurysm and one patient had concomitant arteriovenous malformation. We have successfully clipped 12 cases and wrapped 2 cases of BBAA aneurysms through modified pterional approach and subtemporal approach according to the hight of basilar bifurcation and the other posterior circulation aneurysms are all clipped through most available approaches including lateral, far-lateral suboccipital and interhemispheric approach. Surgical outcome was good in 15 cases, fair in 4 cases, poor in 3 cases and one patient expired.
Aneurysm* ; Arteries ; Arteriovenous Malformations ; Brain ; Female ; Humans ; Intracranial Aneurysm ; Male ; Middle Aged ; Vertebral Artery

Since Yasargil's report, most neurosurgeons operate on middle cerebral artery(MCA) aneurysms through frontotemporal(pterional) bone flap under large skin incision which could result avoidable complications of facial nerve damage, temporal muscle atropy, paresthesia along incision scar and cosmetic bony defect. After careful review of detailed facial nerve anatomy, the author has developed a less invasive approach involving 8cm mini skin incision starting from 1.5cm above zygomatic arch, 1.5cm inside the anterior temporal hair line to upward 4-5cm and then curving forward 3cm length around 2cm above supraorbital ridge. Then, about 2.5cm mini-bone flap centered on pterion is made. After reflection of round dural flap, dissection of sylvian fissure was proceeded from just lateral end of limen insula, where middle cerebral artery(MCA) bifurcation or M2 segment was deeply located. The author has operated on consecutive 18 cases of MCA aneurysms using this minicraniotomy from 1996 to 1998 which provided sufficient working area enough not only for surgeon's free hand motion including multiple temporary clippings at one field but also inspection for other anterior circulation and posterior circulation systems. Hunt-Hess Grade for these patients were 17 cases of Grade II and 1 case of Grade I. Mean age of patients was 52.9 years old. There were 15 males and 3 females. Excellent postoperative neurological conditions were achieved without any morbidity or mortality. This approach is especially recommendable for patients with good neurological status for being less invasive and more convenient method.
Aneurysm ; Cicatrix ; Facial Nerve ; Female ; Hair ; Hand ; Humans ; Intracranial Aneurysm* ; Male ; Middle Cerebral Artery* ; Mortality ; Paresthesia ; Skin ; Temporal Muscle ; Zygoma