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

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.
Discitis ; Diskectomy* ; Humans ; Microsurgery ; Surgical Instruments

The authors experienced on the use of bovine bone in 3 cases of interbody fusion employing the Cloward technique. Two patients were cervical fracture-dislocation and one patient was a case of lumbar spondylolysis. With use of bovine bone, iliac osteotomy is unnecessary, and this procedure is no problem of donor site pain and infection which can be possible in interbody fusion with iliac bone and rib graft. With the use of bovine bone the additional advantages are. 1) The operative procedure is simplified. 2) The time required for the operation is diminished. 3) Patient meralgia is eliminated completely. 4) The surgeon can have uniformly sized bones of a proven hardness on hand. 5) The epidural bleeding is showed through lattice of bovine bone.
Hand ; Hardness ; Hemorrhage ; Humans ; Osteotomy ; Ribs ; Spondylolysis ; Surgical Procedures, Operative ; Tissue Donors ; Transplants

The mean values of the height, depth and lateral shifting of the spinous processes and the height of the intervertebral disc spaces of 100 patients were measured in the lumbar region. The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduced the overall surgical trauma suffered by patient, but the spinous process might disturb the insertional course and multidirectional activities of the pituitary forceps due to a very small skin incision. The purpose of this study was to prove the relationships between intervertebral disc space and spinous process in the lumbar region. The results were as follows; 1) The height of the intervertebral disc space from L3-4 to L5-S1 intervertebral disc space was 12.63mm, 12.57mm and 11.71mm respectively. 2) The depth of the spinous process from L3 to L5 was 28.87mm, 27.87mm and 23.97mm respectively. 3) The lateral shifting of the spinous process from midline to the right side was 4.39mm, 4.35mm and 4.01mm at L3, L4 and L5 spinous process respectively and to the left side was 3.61mm, 3.70mm and 3.69mm at L3, L4 and L5 spinous process respectively. Conclusively, the lower part of the spinous process was overlapped above the intervertebral disc space at L3-4, L4-5 and L5-S1 intervertebral disc space. About 4mm of the lateral shifting of the spinous process was protruded to both right and left side in the insertional course(about 2-3cm) of the pituitary forceps. The spinous process might disturb the multidirectional activities and perpendicular insertion of the pituitary forceps. So, the removal of the spinous process to the midline was recommended to perform the complete removal of disc materials in microlumbar discectomy.
Diskectomy ; Humans ; Intervertebral Disc* ; Lumbosacral Region ; Skin ; Surgical Instruments