No abstract available.
6-Cyano-7-nitroquinoxaline-2,3-dione* ; Cycloheximide* ; Dizocilpine Maleate*

In recent years there has been a tendency to abandon repeat cerebral angiography in patients with subarachnoid hemorrhage(SAH) if the initial angiogram is normal because prognosis is said to be excellent. Our experiences does not support such a conclusion. In 291 cases with subarachnoid hemorrhage(SAH), four vessel cerebral angiography was performed to investigate a source of the hemorrhage. The first four vessel study on admission revealed 234 cases(80.4%) of ruptured cerebral aneurysms. Fifty-five of 291 patients with primary subarachnoid hemorrhage(SAH) did not show vascular lesion in initial pan-angiography studies. In order to define the benefit of control angiography these patients were reviewed. Among 41 patients who underwent repeat angiography, a second angiography showed an aneurysm in 24(58.5%). Twelve of the twenty-four cases had aneurysms in the anterior communicating artery. But the age, sex, initial clinical grade and CT grade of patients with aneurysm in repeat angiography were indistinguishable from thoses of patients without aneurysm. Even in the patients who showed angiographic vasospasm in intial angiography, probability of revealing an aneurysm was not different from those without spasm. We conclude that repeat angiography is necessary in the cases of SAH with normal initial angiogram regardless of the CT findings and the presence of vasospasm.
Aneurysm ; Angiography* ; Arteries ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Prognosis ; Spasm ; Subarachnoid Hemorrhage*

Atrial natriuretic factor(ANF) is a diuretic natriuretic peptide hormone produced by both the heart and brain. It has been postulated to play a role in the hemodynamic and sodium instability that frequently follows subaracthnoid hemorrhage(SAH). Electrocardiographic(EKG) abnormalities is known to occur frenquently after cerebrovascular accident, especially subarachnoid hemorrhage. A prospective study was undertaken to evaluate the relation between the changes of ANF and EKG findings and clinical findings. Thirty-five nonselected patients with SAH were followed with serial measurements of plasma ANF, plasma antidiuretic hormone(ADH), serum sodium, serum osmolarity, and electrocardiography(EKG) at 2nd, 5th, and 7th day after hemorrhage. Mean plasma ANF values at 2nd, 5th, and 7th day of hemorrhage were 202.3+/-109.6 pg/ml, 134.6+/-83.5 pg/ml, and 123.3+/-69.9 pg/ml, respectively. Mean plasma ADH values were within normal limits(3.2-4.4 pg/ml). At a later stage, 9 patients showed hyponatremia and hypoosmolarity, among whom 8 patients had elevated ANF and 1 patient elevated ADH. The delayed and persistent rise of plasma ANF was correlated with the development of hyponatremia. One or more EKG abnormalities were found in 13 patients. Mean ANF values of patients with normal EKG(131.8+/-48.7 pg/ml) were significantly different from those with abnormal EKG(272.2+/-107.5 pg/ml). The changes of plasma ANF appeared unrelated to age, sex, clinical grade, CT grade, and bleeding site. The results of this study indicate that elevated plasma ANF is closely related with electrophysiological changes of myocardium and that the transitory myocardial ischemia might be the source of plasma ANF sfter SAH.
Atrial Natriuretic Factor* ; Brain ; Electrocardiography* ; Heart ; Hemodynamics ; Hemorrhage ; Humans ; Hyponatremia ; Myocardial Ischemia ; Myocardium ; Osmolar Concentration ; Plasma ; Prospective Studies ; Sodium ; Stroke ; Subarachnoid Hemorrhage*

The authors describe a technique consisting of subfascial temporalis dissection and performing a pedicled bone flap in pterional craniotomy. This technique provides reliable preservation of the frontalis nerve, does not necessitate the reconstruction of the temporalis muscle at the end of the surgery, and does not compromise the operative exposure.
Craniotomy

No abstract available.
Conus Snail* ; Hemangioblastoma*

No abstract available.
Conus Snail* ; Hemangioblastoma*

The author has performed an experimental study in order to investigate the effect of nimodipine on the production of CSF in 12 cats. The cats were divided into 2 groups, one for nimodipine intravenous infusion and the other for its vehicle infusion group. Using ventriculo-cisternal perfusion method, nimodipine and its vehicle were examined for their effects on CSF formation rate respectively. Baseline CSF formation rate was 22.5+/-2.9 microliter/min(S.E.) and it gradually reduced to 17.0+/-3.4 microliter/min(S.E.) after final infusion of nimodipine at 60 microgram/kg/min. Vehicle infusion revealed no significant change in CSF formation rate. Although the nimodipine insuion revealed declining tendency in CSF formation rate along with increment of nimodipine concentration, it was not statistically different from that of vehicle infusion group. Systolic blood pressure was significantly reduced after nimodipine infusion(133+/-31.8mmHg at baseline, 93.9+/-19.1mmHg at the end of the experiment) on oneway ANOVA test and it was significantly different from that in vehicle infusion group(p<0.01).
Animals ; Blood Pressure ; Cats ; Infusions, Intravenous ; Nimodipine* ; Perfusion

OBJECTIVE: Hemangiopericytoma is known as a malignant tumor originating from pericytes and rarely occurs in the central nervous system. We present 6 cases of pathologically confirmed meningeal hemangiopericytoma. METHODS: Retrospective study was done based on patient's recordings including radiological studies. Each case of tumors was treated surgically and postoperative radiotherapy was done. RESULTS: There were 5 cases of intracranial and 1 case of spinal hemangiopericytomas. Three of 5 intracranial hemangiopericytomas were located at tentorial region. Total tumor removal was done in 4 cases and postoperative local recurrence (or regrowth) was noted in 3 cases despite of postoperative external radiation therapy, 2 of which had died. CONCLUSION: Our cases show more frequent tentorial locations and poor clinical outcomes of hemangiopericytomas compared with meningiomas.
Central Nervous System ; Hemangiopericytoma* ; Meningioma ; Pericytes ; Radiotherapy ; Recurrence ; Retrospective Studies

OBJECTIVE: This paper describes our experience and implant technique for cranioplasty of a large cranial defects using a porous polyethylene implant(Medpor) and compares the results with polymethylmethacrylate(PMMA). METHODS: Sixteen cranioplasties were performed using Medpor(n=10) and PMMA(n=6) implants between June 2003 and January 2005. The criterion for patient enrollment was a defect larger than 10cm in diameter. This study compared the operation times and complications. RESULTS: The operation times ranged from 105 to 250minutes(Mean 180 degrees +/-44minutes) in Medpor and from 185 to 460minutes (mean 128minutes) in PMMA. The absolute operation times were shorter using the Medpor implant and the differences were statistically significant(P=0.030). Satisfactory cosmetic results were obtained in all cases using the Medpor implant and with no implant-related complications. Bone ingrowth to the medpor implant was presumed to be the result on an increase in Houndsfield units of the implant, particularly at the marginal areas in the serial follow-up brain computed tomography images. CONCLUSION: It is believed that the properties of a Medpor implant make this implant an good alternative to the existing methods of a cranial contour correction. However, a further follow-up study will be needed.
Brain ; Follow-Up Studies ; Humans ; Polyethylene* ; Polymethyl Methacrylate

A retrospective review was performed of all patients with craniopharyngioma treated over a 6-year period. Of the 19 patients, 10 were males and 9 were females, with a mean age of 29 years(range 4 to 65 years). Their clinical follow-up periods ranged from 8 to 73 months, with a mean of 33.4 months. Eight patients(42%) were less than 18 years of age. In children, the most common symptoms were relared to increased intracranial pressure(100%), followed by short stature(50%), whereas visual disturbance(63.6%) was most common in adult. Obstructive hydrocephalus was observed in 7 patients(36.8%), and was more frequently developed in cases with larger tumor size and retrochiasmatic location. All patients were underwent for surgical removal and the most of the surgical procedures were carried out by the pterional or subfrontal approach. Total removal of the tumor was achieved in 8 patients(42.1%), and in 6 subtotally removed. Surgical outcome was favorable in 16 patients(84.2%), but 2 patients(10.5%) died in the postoperative period due to the hypothalamic dysfunction. Persistent diabetes insipidus requiring hormonal replacement therapy occurred in 8 patients(42.1%). Recurrence or regrowth of the tumor was observed in 5 patients(29. 4%). Recurrence was related with the extent of surgical resection.
Adult ; Child ; Craniopharyngioma* ; Diabetes Insipidus ; Female ; Follow-Up Studies ; Humans ; Hydrocephalus ; Male ; Postoperative Period ; Recurrence ; Retrospective Studies