The authors analyzed the radiographs(brain CT and cerebral angiograms) and medical & surgical records of 54 cases of ruptured anterior communicating artery aneurysms resulted in operations at our hospital from January 1991 to December 1995. The results were summarized as follows: 1) The rate of incidence was found to be highest in sixth decade and the ratio of male to female was 1:1. 2) On the preoperative brain CT, ventricular or cerebral hemorrhage combined cases had high Hunt-Hess and Fisher grades. 3) Of 54 cases, hypertension was observed in 20 cases(37%). Hypertension had no effect on the admission Hunt-Hess and Fisher grades. 4) Classification of the anterior communicating artery aneurysms according to its directions were as follows; anterior direction in 57.4%, superior direction in 18.5%, posterior direction in 13%, inferior direction in 11.1%. 5) The afferent artery of anterior communicating artery aneurysms were as follows; left A1 in 38 cases(70.4%), right A1 in 12 cases(22,2%), bilateral A1 in 4 cases(7.4%). 6) The ranges of diameters of the aneurysm was as follows;6-10mm in 57.4%, below 5mm in 22.2%. 7) The posteriorly directing aneurysms showed less favorable preoperative state, and preoperative hydrocephalus was most common on the posteriorly directing aneurysms. 8) There was no significant relationship between direction of aneurysm and prognosis. However, better Hunt-Hess grades seem to correlate better prognosis. 9) The operation was performed by pterional approach in all cases, the approach side was selected for the presence of dominant feeding artery in 50 cases(92.6%). 10) Overall mortality rate was 1.8%, the patients who died are of the older age group and the cause of death was medical complication in 6 cases.
Aneurysm ; Arteries ; Brain ; Cause of Death ; Cerebral Hemorrhage ; Classification ; Female ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Prognosis

Bilateral hypoplasia of the internal carotid arteries is a rare condition. The authors experienced two cases of bilateral hypoplasia of the internal carotid arteries. In one case, a 46-year-old female patient, presented with subarachnoid hemorrhage. Internal carotid angiograms showed right hypoplastic internal carotid artery and left agenetic internal carotid artery. An aneurysm, believed to be the source of the subarachnoid hemorrhage, took origin from the trunk of the basilar artery. In another case, a 48-year-old male, presented with semicomatous mentality. Brain CT demonstrated intracranial hemorrhage on the parasylvian area, and high density on the basal cistern, quadrigerminal cistern and temporal horn of left lateral ventricle. Initially, aortic arch injection did not visualized the origin of the common carotid arteries. It revealed only the vertebral arteries and both external carotid artery originating from each vertebral artery. A selective left vetebral artery study demonstrated a communication between the hypertrophied basilar artery and the posterior cerebral arteries. The anterior and middle cerebral vessels, in turn, were opacified through the circle of Willis, via the posterior communicating arteries. In addition, an aneurysm, believed to be the sourse of the subarachnoid hemorrhage, took origin from the posterior cerebral artery. The cases of the bilateral hypoplasia of internal carotid artery with intracranial aneurysm are reported as above, together with literature review.
Aneurysm ; Animals ; Aorta, Thoracic ; Arteries ; Basilar Artery ; Brain ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal* ; Circle of Willis ; Collateral Circulation ; Female ; Horns ; Humans ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Lateral Ventricles ; Male ; Middle Aged ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage ; Vertebral Artery

Anterior cervical microforaminotomy is the one of surgical options for treating cervical spondylotic lesions manifested by radiculopathy or myelopathy. This minimally invasive surgical procedure is gaining popularity due to the recent trends of avoidance of spinal fusion resulting in loss of the physiologic spinal motion and developing a future adjacent segment syndrome. Although the spinal fusion still remains a gold standard procedure for degenerative cervical spinal diseases, the eager for maintaining the function of the motion segment is another issue for contemporary spinal surgeons. Anterior cervical microforaminotomy is a target-oriented operation that decompresses the nerve root or spinal cord without destruction of the spinal anatomical functional unit. Unlike to other procedures including total or partial resection of the intervertebral disc, this surgical procedure removes only a small part of the uncovertebral joint or vertebral body. Through this narrow corridor, adequate decompression of the nerve root or spinal cord can be achieved while preserving functional motion. Technical variations of the original anterior cervical microforaminotomy have been continuously developed to minimize the concerns for the postoperative disc height loss and instability. As of now, the anterior cervical microforaminotomy and its technical variations have been proved to be an excellent procedure for treating the cervical spondylotic radiculopathy from literatures review. But the long-term clinical results and the efficacy of the procedure for cervical myelopathy still remain to be seen.
Decompression ; Intervertebral Disc ; Joints ; Radiculopathy ; Spinal Cord ; Spinal Cord Diseases ; Spinal Diseases ; Spinal Fusion

Injection of the tissue adhesive Histoacryl (N-butyl-2-cyanoacrylate, enbucrilate) has been more effective than conventional sclerosants in the treatment of active upper G-I bleeding. Histoacryl is an effective sclerosant that is polymerized immediately after contact with blood, and has been used for the treatment of bleeding gastric and esophageal varices. We present here a case of infarction of the caudate lobe that developed after an injection of a Histoacryl -Lipiodol mixture for the hemostasis of duodenal ulcer bleeding.
Duodenal Ulcer* ; Enbucrilate* ; Esophageal and Gastric Varices ; Hemorrhage* ; Hemostasis ; Infarction* ; Liver* ; Polymers ; Sclerosing Solutions ; Tissue Adhesives

The authors reviewed the radiographs and medical records of 134 consecutive patients who underwent chemonucleolysis and automated percutaneous lumbar discectomy(APLD) between March 1990 and December 1994 at our institute. Among the 34 consecutive patients, 90 patients underwent chemonucleolysis and the other remaining patients underwent APLD using a nucleotome. The results are summarized as follows: 1) In both groups, predominent patients were of young age and males. 2) The most common lesion was in L4-5 interspace in both groups 3) The posteior lateral type showed high incidence in APLD group. 4) The results were better in the younger age group and when spinal CT demonstrated posterior lateral type in both groups. 5) The results showed relatively good success rate of 84.4% in chemonucleolysis group and 88.6% in APLD group. 6) Better results can be anticipated when patients are carefully selected and operated on with a higher skillful technique.
Diskectomy* ; Humans ; Incidence ; Intervertebral Disc Chemolysis ; Male ; Medical Records ; Spine*

We have analysed 111 cases of subdural hygroma that were development after various neurosurgical conditions including head injuries. The results were summarized as follows. 1) The peak incidence was the age of 50's and occured most frequently in male. 2) Causes were head injuries(91 cases), traumatic intracranial hematoma removal(10 cases), operation for intracranial aneurysms(4 cases), hypertensive intracerebral hemorrhage evacuation(2 cases), ventriculoperitoneal shunt(2 cases), brian tumor removal(1 cases), arachnoid cyst excision(1 cases), and cerebral infarction(1 cases). 3) Acute subdural hematoma was most often associated with complex subdural hygrom. 4) Clinical manifestations were headache, altered mental state, disorientation, nausea in order. 5) Operation were underwent in 27 cases and surgical complications were reaccumulation and pneumocephalus in order. 6) Mortality rate was 6.3%. 7) The prognois of the simple hygroma was very good, but the complex was not.
Arachnoid ; Craniocerebral Trauma ; Head ; Headache ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Intracranial Hemorrhage, Traumatic ; Lymphangioma, Cystic ; Male ; Mortality ; Nausea ; Pneumocephalus ; Subdural Effusion*

The authors encountered two cases of Langerhans' cell histiocytosis. One, a three-year-old male, had persistent epiphora and showed exophthalmos of the left eye. A mass was detected in the left orbit and was removed subtotally; pathologic examination revealed Langerhans cell histiocytosis. The other case, a 24-year-old male, presented with a gradually growing palpable mass in the parietal area; the skull defect was punched out in shape. The mass, which was tightly attached to the outer layer of the dura mater, was completely removed. On the basis of pathologic findings, Langerhans' cell histiocytosis was diagnosed, and the patient subsequently underwent radiotherapy.
Dura Mater ; Exophthalmos ; Histiocytosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Lacrimal Apparatus Diseases ; Male ; Orbit ; Rabeprazole ; Radiotherapy ; Skull ; Young Adult

The authors have experienced a case of an arachnoid cyst within the cervical canal. The patient suffered from right upper extremity pain and numbness for 1 month. On cervical MRI, intradural extramedullary mass was detected. A total laminectomy of C5, C6 and C7 was performed. We could diagnose by radiological and pathological findings.
Arachnoid* ; Humans ; Hypesthesia ; Laminectomy ; Magnetic Resonance Imaging ; Spinal Canal* ; Upper Extremity

The authors have experienced a case of an arachnoid cyst within the cervical canal. The patient suffered from right upper extremity pain and numbness for 1 month. On cervical MRI, intradural extramedullary mass was detected. A total laminectomy of C5, C6 and C7 was performed. We could diagnose by radiological and pathological findings.
Arachnoid* ; Humans ; Hypesthesia ; Laminectomy ; Magnetic Resonance Imaging ; Spinal Canal* ; Upper Extremity

The authors encountered a case of gliosarcoma with hemorrhage arising in the left frontotemporal lobe of a 34-year old woman who five months previously had undergone surgery for an ICH in the same lobe. On CT brain scan, we could a slight hyperdense tumor with irregular enhancement could be detected, and perilesional edema and obvious mass effect were also noted. The tumor was firm and surgically,its margine was somewhat poor. On pathologic and histochemical study, the presence of a gliosarcoma was confirmed.
Adult ; Brain ; Brain Neoplasms ; Edema ; Female ; Gliosarcoma* ; Hemorrhage* ; Humans