No abstract available.
Fracture Fixation, Intramedullary*

No abstract available.
Humans ; Pericardial Effusion*

We describe the case of a patient with symptomatic left cervical ICA stenosis and aneurysm of the left distal anterior cerebral artery. She presented with chronic headache and recurrent attack of right hemiparesis, and underwent staged operations. Using the interhemispheric approach, the intracranial aneurysm was clipped, and there was no postoperative neurologic deterioration. Two months later, a carotid endarterectomy was performed. The patient recovered without complications and angiography revealed relief of carotid stenosis and non-visualization of the aneurysm. The coexistence of symptomatic carotid stenosis and an unruptured intracranial aneurysm poses a therapeutic dilemma; correction of significant stenosis of the internal carotid artery may increase the pressure and turbulence to which the aneurysm is subjected, while the intracranial approach to an aneurysm, when blood flow is decreased by carotid stenosis, may also involve increased risk. In view of the theoretical risk of increased blood flow and turbulence after carotid endarterectomy, aneurysm neck clipping followed by this procedure either in a single stage or separate stages seems to be the another safest management strategy.
Aneurysm* ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Headache Disorders ; Humans ; Intracranial Aneurysm ; Neck ; Paresis

Spinal congenital dermal sinus (CDS) is a rare entity which supposedly results from the failure of the neuroectoderm to separate from the cutaneous ectoderm during the process of neurulation. The lesions are most frequent at the lumbosacral followed by the occipital region. CDS of the thoracic region is very rare. The patients with spinal CDS present with meningitis and/or mass effect from the associated inclusion tumor. They are usually dermoid or epidermoid cysts. Teratoma is rarely associated. The authors experienced 5 cases of spinal CDS over a 10 year period. Of the 5 cases, 2 were at thoracic and 3 were at lumbosacral levels. Dermoid cyst, epidermoid cyst and teratoma were associated in one case each. Two cases presented with neurological deficit and meningitis while an additional case presented with neurological deficit and a history of probable meningitis. Pain was present in 2 cases. Magnetic resonance imaging played an important role in the diagnosis of the lesion and planning of surgery. All the cases showed a good response to surgery even though one patient had persistent neurological deficit.
Adolescent ; Adult ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Spina Bifida Occulta/diagnosis/pathology/*surgery

Cerebral cysticercosis presents a quite variable clinical picture in its manifestation and course. This clinical polymorphism produces principal difficulties in its diagnosis and in planning therapeutic strategies as well as in evaluating therapeutic results. The author reviewed his experience with 52 cases of cerebral cysticercosis, surgically treated from 1977 to 1987 in Department of Neurosurgery, Seoul National University Hospital. The age of patients at time of diagnosis varied between 7 and 66 years(mean 43.4 years), with 75% from the fourth to the seventh decade. There was a 1.6:1 male to female ratio. The two most common residency of the patients, next to the Seoul area, were Cheju Provience(21%) and Chollanam Province(15%). The chief symptoms and signs were those of increased ICP(94%), focal neurological deficits(69%), seizure(40%), mental change(33%) and meningismus(21%). We classified 52 cases into the following groups based on the location of lesion in the brain CT scans:a) Parenchymatous(34%), b) Intraventricular(25%), c) Meningocisternal(18%), and d) Mixed type(33%). ELISA was highly reliable in making the diagnosis, this test, however, should not be regarded as a quantitative clue to evaluate the degree of curability. In cases no improvenent was achived clinically after praziquantel therapy and/or surgical treatment disappeared cysts in follow-up brain CT, a further diagnostic work-up to search for a intraventricular or mixed type is recommended. In 2 cases with a single, superficially located parenchymatous cyst, one burr hole trephination followed by aspiration using a brain needle was proved to be very effective. Surgical treatment in combination with a praziquantel therapy produced a marked improvement in 47 cases(90.4%) out of 52 cases. In the mixed type, the surgical outcome was unfavorable compared with other types.
Brain ; Cysticercosis* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Internship and Residency ; Jeju-do ; Male ; Needles ; Neurosurgery ; Praziquantel ; Seoul ; Trephining

We present a series of 42 patients with the lateral ventricular mass lesions who underwent operative removal between 1979 and 1992 at the Seoul National University Hospital. These lesions included 29 tumors, 10 benign cysts and 3 arteriovenous malformations. There were 20 lesions in the trigone, 14 in the frontal horn, 6 in the body, and 2 in the temporal horn. Together with the age of the patient, the location in the lateral ventricle and the CT or MR patterns, the range of the differential diagnosis of the lesions can be narrowed. The mass were removed by various surgical approaches;11 by the middle frontal gyrus, 10 by the superior parieto-occipital, 13 by the middle temporal gyrus, 4 by the anterior transcallosal, 2 by the posterior transcallosal and 3 by the combined approaches. The superior parieto-occipital approach left postoperative morbidities in 64% and other approaches in 20 to 25% of the cases. These morbidities included hemiparesis, hemianopsia, aphasia, memory distubance and seizure. Most hydrocephalus disappeared without the shunting procedure after removal of the lateral ventricular mass. The high frequency of postoperative complications in the superior parieto-occpital approach require meticulous consideration in the selection of this approach.
Animals ; Aphasia ; Arteriovenous Malformations ; Diagnosis, Differential* ; Hemianopsia ; Horns ; Humans ; Hydrocephalus ; Lateral Ventricles ; Memory ; Paresis ; Postoperative Complications ; Seizures ; Seoul

OBJECTIVE: A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of Labb in surgical removal of petroclival meningiomas. MATERIALS AND METHODS: The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent and equal on both sides), Type B(confluent and non-dominant on tumor side), Type C(confluent and dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of Labb was analyzed with respect to its draining point and its collaterals to other superficial veins. RESULTS: Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of Labb, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. CONCLUSION: For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of Labb.
Brain Edema ; Colon, Sigmoid ; Constriction ; Drainage ; Humans ; Infarction ; Ligation ; Meningioma* ; Phlebography* ; Postoperative Hemorrhage ; Retrospective Studies ; Veins

The authors report on 17 patients having primary central nervous system(CNS) lymphomas between January, 1981 and August, 1992. All patients were treated at Seoul National University Hospital. Only three cases underwent surgery only and fourteen cases underwent surgery and radiation theraphy with or without chemotherapy. There were no immunosuppressive patients. Sixteen patients were analyzed for survival studies, because one case was lost during follow-up. The median survival time(MST) was 26 months and one- and two-year survival rates for the 16 patients were 87.5% and 65.6% respectively. The rate of survival was analyzed according to possible prognostic factors factors;age and sex, multiplicity and location of tumors, preoperative Karnofsky performance score(KPS), pathological subclassification, type of surgery, preoperative steroid therapy, postoperative adjuvant therapy, extent of radiation, chemotherapy and the degree of response to treatment at three months follow-up. Postoperative adjuvant therapy and the degree of response to the treatment correlated with survival. Fourteen patients who underwent postoperative adjuvant therapy had a median survival time of 63 months. The one- and two-year survival rates were 100% and 75% respectively compared to the MST of 1.5 months with survival rates of 0% and 0% retrospectively for the two patients who did not. A higher long term survival rate was observed in the group with better immediate responses. In nine of 16 patients with complete responses, the MST, one-, and two-year survival rates were 63 months, 100%, and 83% respectively. The authors suggest that preoperative application of steroids may be considered in case of clinically suspected primary CNS lymphomas. It is concluded that after obtaining the tissue diagnosis of primary CNS lymphomas, radiotherapy with or without chemotherapy should be performed until the complete response.
Brain Neoplasms ; Central Nervous System* ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymphoma ; Radiotherapy ; Retrospective Studies ; Seoul ; Steroids ; Survival Rate*

No abstract available.
Drug Therapy* ; Neutropenia*

In order to determine the survival rate and prognostic factors of patients with intracranial oligodendroglioma as predictors of survival, a retrospective analysis of a total of 68 cases treated between 1982 and 1992 at our institute was performed. The 5-year and 10-year survival rates were 84.5% and 55.1% respectively while the median survival time was 116+/-5.3 months. The significant factors identified by the univariate analysis included the presence of preoperative seizure, the pre- and postoperative status, the presence of signs of increased intracranial pressure before operation and pathologic grade of the tumors. Factors such as age, types of chief complaints, blood types, the preoperative neurologic deficit, the size of tumor, the enhancement of tumor, cysts in tumor, the extent of removal and the postoperative seizure had no correlations with survival rates. The only significant prognostic factor determined by the multivariate analysis was the pathological grade(p=0.04).
Humans ; Intracranial Pressure ; Multivariate Analysis* ; Neurologic Manifestations ; Oligodendroglioma* ; Retrospective Studies* ; Seizures ; Survival Rate*