The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.
Accidents, Traffic ; Cerebrospinal Fluid ; Diagnosis, Differential ; Drainage ; Fistula* ; Pleural Cavity ; Pleural Effusion ; Punctures ; Subarachnoid Space ; Sympathectomy

OBJECTIVE: Arachnoid cysts (ACs) can be cured by making the definite and wide communication between the cyst and arachnoid space using endoscopy, but often it is impossible only through the usual working-channel (intra-channel) procedures. We discuss and propose a more valuable endoscopic technique with the presentation of our series of cases. METHODS: We treated 9 patients with cortical AC in various locations with extra-channel endoscopic techniques. The patients ranged in age from 3 years to 60 years (mean age, 37.2 yrs). The follow-up period ranged from 12 to 26 months (mean follow-up duration, 17.2 months). All patients had large AC compressing the adjacent brain with clinical symptoms or signs. The authors performed extensive fenestration via single burr hole with the aid of endoscope. Being bypassed the rigid endoscope, through the space between the shaft of endoscope and guiding cannula (extra-channel method), fenestration procedures were done in the dry fields. RESULTS: Eight (88.9%) patients had been treated successfully with endoscope. One patient required shunt procedure. Among the eight patients who were treated with endoscopic procedure, 6 patients (66.7%) showed cyst reduction, and two (22.2%) showed disappearance of cyst. CONCLUSION: We suggest that extra-channel method will be simple and easy to perform using more valuable instruments with wider working area, and may promise better results compared to the conventional intra-channel endoscopic procedures.
Arachnoid ; Arachnoid Cysts ; Brain ; Catheters ; Endoscopes ; Endoscopy ; Follow-Up Studies ; Humans

A series of 41 patients in a vegetative state after severe head injury in presented. The patients selected were those who were in comatose state at least 2 weeks and observed more than 6 months. The vegetative state was more common before the age of 40(75.6%). The most common types of lesion causing vegetative state were subdural hematoma and epidural hematoma(56.1%). Twentyeight patients(68.1%) had a Glasgow coma score of 3 to 5. The two most frequent complications were urinary tract infections(80.5%) and bed sores(65.9%), but the most common cause of death was respiratory complication(60.0%). CT scans taken in the vegetative state showed variable evidences of cerebral atrophy, which were considered to be the results of the injury and had little value in predicting the outcome. At 6 months, the outcome was as follows : good recovery 4(9.8%) ; moderate disability 7(17.1%) ; severe disability 12(29.3%) ; vegetative state 10(24.4%) ; and dead 8(19.5%). Twenty-three patients(56.1%) came out of the vegetative state during a 6 month follow-up period. Vegetative state is not always permanent. Therefore, it seems necessary to distinguish perisstent vegetative state from vegetative state. The term, "persistent", means that the patient, if ever, came out of the vegetative state and in the event he did he usually remained in severe disability. 15 out of the 23 improved within 2 months, 14 out of the 15 improved to at least moderate disability. 8 out of the 23 improved after 2 months but all remained in severe disability. From these results we propose that the term "persitent" be applied to patients who remain in a vegetative state for more than 2 months.
Atrophy ; Cause of Death ; Coma ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Hematoma, Subdural ; Humans ; Persistent Vegetative State* ; Tomography, X-Ray Computed ; Urinary Tract

Ewing's sarcoma is an uncommon malignant neoplasm of the bone, which is rather infrequent in childhood and represented only 2% of all neoplasm under the age of 15 years. Clinical picture was that of progressive paraplegia associated with localized pain. The authors have experienced a case of primary Ewing's sarcoma of the first and second lumbar vertebrae in a 26-year-old male.
Adult ; Humans ; Lumbar Vertebrae ; Male ; Paraplegia ; Sarcoma, Ewing* ; Spine*

The purpose of this study on the surgical results for lumbar intervertebral disc herniation is to analyze the unique feature of the series which seems to be sufficient to represent Korean patients wuffering from these diseases. A total of 812 lumbar discectomies had been performed from May, 1971 to December, 1978 at Hanyang University Hospital. The most outstanding unique feature was the level of the lesion. The L4-L5 interspace was affected in 87.6%, while the most of the other series showed almost same incidence between L4-L5 and L5-S1 interspaces. The results of this analysis are as follows: 1) The incidence ratio of male to female was 1.3:1. 2) Most were in the 4th and 5th decade(53.5%). The duration was over one year in 64.6% of cases. 3) Traumatic origin was 37.8% of cases. Post-delivery, convulsive and unknown etiology were 2.2%, 0.7% and 59.3% of cases, respectively. 4) The level of the lesion was predilected at L4-L5 interspace with the incidence of 87.6%, while L5-S1 interspace was affected in 25.4% of cases. Single lesions were 70.8% and the multiple 29.2% of cases. 5) False positive findings of myelogram were 1.2% of cases. 6) Surgical results were gratifying in 92.3% of cases. 7) The incidence of postoperative complications was 3.3% of cases, which were mainly stitch abscesses. 8) The 7 our of 812 cases were associated with spinal tumors.
Abscess ; Diskectomy* ; Female ; Humans ; Incidence ; Intervertebral Disc ; Male ; Postoperative Complications

Tension pneumocephalus is rare while pneumocephalus is relatively common. The former has sudden or insidious deterioration in neurologic symptoms and signs comparing to self-limited pneumocephalus. This report is of a 19 years old male with tension pneumocephalus in the right frontal lobe two underwent right frontal osteoplastic craniotomy.
Craniotomy ; Frontal Lobe ; Humans ; Male ; Neurologic Manifestations ; Pneumocephalus* ; Young Adult

A rare case of surgically extirpated intra- and extracranial metastasis of hepatocellular carcinoma is reported. This dumb-bell shaped tumor simulated malignant meningioma on computerized tomography brain scan and cerebral angiography. Removal of the mass was successfully achieved by external carotid ligation and CUSA dissection. We suggest that, when investigating patient with suspected cranial secondaries particulary if there is a bony involvement, serum alpha-fetoprotein and hepatic ultrasound should be carried out as screening procedures.
alpha-Fetoproteins ; Brain ; Carcinoma, Hepatocellular* ; Cerebral Angiography ; Humans ; Ligation ; Mass Screening ; Meningioma ; Neoplasm Metastasis* ; Ultrasonography

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.
Diagnosis ; Humans ; Myelography* ; Spinal Stenosis

We analysed ultrasonic findings of 54 brain scan cases(45 cases were performed through the anterior fontanelle and the temporoparietal thin bone and 9 through the surgical bone defect) and comparison of these pictures with those obtained in the same patients by CT scan showed prominent correlation. Ultrasonography was more sensitive to different histologic features and provided a more accurate depiction of the neuropathologic characteristics in most of cases. We conclude that ultrasonography of the brain was proven to be quite useful in the screening and follow up of neonates and infants under 15 months of age, and as a follow up method in post operative patients. It was also more accurate than CT scan in cases of abscesses and cystic lesions.
Abscess ; Brain* ; Cranial Fontanelles ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography

A case of huge craniopharyngioma which was removed radically is presented. A 14-year-old girl was hospitalized because of the impairment of vision and a history of generalized seizures. The computed tomogram of the brain disclosed the huge mass consisting of a large cystic part extending to the frontal base and solid part medial and posterior to the cystic. Despite of the large size and adhesion to the vital structures, the tumor was removed successfully. To remove the tumor radically, it seemed to be important not to interrupt the outer structure of the mass during dissection. The postoperative course was uneventful except transient diabetes insipidus. We report this case with brief review of the references.
Adolescent ; Brain ; Craniopharyngioma* ; Diabetes Insipidus ; Female ; Humans ; Seizures