No abstract available.
Brain Edema* ; Brain* ; Decompressive Craniectomy*

Anterior clinoid process is a small bony structure but it is very important regarding its location and relationships with neighboring neurovascular, dural, and bony structures. Removal of this process has been used in various modification of standard pterional approach. The authors have speculated how much expansion of operative window could be obtained with anterior clinoidectomy, so we measured the lengths of optic nerve, internal carotid artery, and the length and width of optico-carotid triangle(OCT) before and after extradural anterior clinoidectomy 17 times in 10 cadaveric heads. This procedure provided about two fold increase in the length of optic nerve and OCT, and over three fold expansion in the width of OCT. The results indicate that the addition of this relatively simple and easy procedure to standard approach makes the operative field more comfortable and safe than expected. We believe this procedure can be used routinely with or without combination of wide skull base exposure in cases of such lesions as belows: 1) lesions causing optic nerve or chiasmatic compression, 2) lesions encircling/covering the optic nerve and internal carotid artery, 3) lesions arising from or extending into the optic canal, orbital apex, and paraclinoid region, 4) suprasellar/parasellar lesions with limited operative windows(e.g. prefixed chiasm, infra-optic or subchiasmatic locations or adherence).
Cadaver* ; Carotid Artery, Internal* ; Head ; Optic Nerve* ; Orbit ; Skull Base

No abstract available.
Adenocarcinoma* ; Optic Nerve*

OBJECTIVE: The purpose of this study was to evaluate the reproducibility of measurements representing asymmetry of the mandible and to identify which landmarks would be more useful in 3-dimensional (3D) CT imaging. METHODS: Facial CT images were obtained from forty normal occlusion individuals. Eighteen landmarks were established from the condyle, gonion, and menton areas, and 25 measurements were constructed to represent asymmetry of the mandible; 8 for ramus length, 12 for mandibular body length, 1 for condylar neck length, 2 for frontal ramal inclination, and 2 for lateral ramal inclination. Inter- and intra-examiner reproducibility of the measurements was evaluated. RESULTS: Inter-examiner reproducibility of the measurements proved to be high except for 3 measurements. Intra-examiner reproducibility also proved to be high except for 2 measurements. Inter- and intra-examiner reproducibility of the measurements including Gonion proved to be low. CONCLUSIONS: The results of the present study indicate that the landmarks and measurements constructed in 3D CT images can be used for the diagnosis of facial asymmetry.
Facial Asymmetry ; Mandible ; Neck

Usually, acute subdural hematomas (ASDHs) result from head trauma and require urgent surgical treatment. However, there have been many reports of rapid spontaneous resolution of ASDHs since 1986. Recently, we experienced a case of a massive ASDH that resolved spontaneously within 1.5 days. A 76-year-old man was admitted to a local hospital after a head injury. According to his clinical records, his initial neurologic status was good (Glasgow Coma Scale score of 14). However, his head computer tomography (CT) scan demonstrated a massive ASDH to the right, with a significant midline shift. Based on his neurological status and general condition, surgery was not considered, and the patient was closely monitored in the intensive care unit. The next day, the patient was transferred to our hospital as requested by his family, after which his neurological state stabilized, and the customary follow-up brain CT was performed. It was about 32 hours after the patient's head injury, and it revealed an unexpected finding, near-total resolution of the ASDH. Herein, we review previously reported similar cases and relevant mechanisms of rapid resolution of the ASDH. We believe that neurosurgeons should comprehensively assess the patient's condition and CT findings and provide appropriate treatment, especially when surgical intervention is unnecessary.

Cysticercosis is a relatively common disease in Korea. Racemose cysticercosis, a peculiar form of the neurocysticercosis usually occurs as meningeal forms and rarely involves the cerebral parenchyme. The authors present a case of cerebral parenchymal racemose cysticercosis in a 55 year-old man with generalized seizure. Brain CT and MRI showed a large multilobulated cyst in the right frontal lobe. At surgery, we removed cyst covered by milkish white, multiple septated membranes completely. Histological dignosis of surgical specimen was racemose cysticercosis without scolex.
Brain ; Cerebrum ; Cysticercosis* ; Frontal Lobe ; Humans ; Korea ; Magnetic Resonance Imaging ; Membranes ; Middle Aged ; Neurocysticercosis ; Seizures

Primary appendiceal adenocarcinoma is a rare neoplasm, which constitutes less than 0.5% of all gastrointestinal neoplasms. Very few cases of primary tumors of the appendix have been reported in the literature; and no prior case reports of surgical resection of appendiceal adenocarcinoma with liver metastasis have been published. In this study, we report for the first time a case of the surgical resection of liver metastasis from a case of adenocarcinoma of the appendix. (Case) A 53-year-old man was admitted complaining of intermittent abdominal pain. The patient's CEA level was mildly elevated, at a level of 30.8 ng/ml; the AFP was 1.93 ng/ml, and all additional blood tests were normal. Abdominal CT revealed a 9 cm sized malignant-appearing peripheral enhancing mass in the right lobe of the liver. In an effort to rule out metastatic cancer originating from the GI tract, we conducted gastroendoscopy and colonoscopy. However, we were unable to detect any malignant lesions. Therefore, we conducted a whole body fusion PET scan, which revealed a hot uptake of FDG at the right lobe of the liver, as well as a terminal ileum. We concluded with a diagnosis of primary small bowel malignancy with liver metastasis; the patient underwent surgery. During surgery, we detected a very large malignant-appearing tumor in the right lobe of the liver, and an appendix which appeared suspicious for malignancy, and measured 8.0 cm in length and 1.5 cm in diameter. The frozen biopsy of the appendix at surgery confirmed a malignant adenocarcinoma of the appendix, coupled with vascular invasion. Thus, we conducted a right hemihepatectomy and a right hemicolectomy. The post-operative course was uneventful; the patient was discharged at POD #21 after the application of systemic chemotherapy. We detected no evidence of recurrence five months after surgery.
Abdominal Pain ; Adenocarcinoma* ; Appendix* ; Biopsy ; Colonoscopy ; Diagnosis ; Drug Therapy ; Gastrointestinal Neoplasms ; Gastrointestinal Tract ; Hematologic Tests ; Humans ; Ileum ; Liver* ; Middle Aged ; Neoplasm Metastasis* ; Positron-Emission Tomography ; Recurrence ; Tomography, X-Ray Computed

Rathke's cleft cysts are believed to be derived from remnants of Rathke's pouch, a dorsal invagination of the stomodeum. Although these cysts are characteristically small, asymptomatic and intrasellar in location, they occasionally provoke symtoms with enlargement to compress surrounding structures. It is characteristically lined by stratified squamous epithelium with keratinization on a layer of connective tissue. The cells of the anterior pituitary lobe, from which pituitary adenomas develop, are also formed by the proliferation of the anterior wall of Rathke's pouch. Thus, Rathke's cleft cyst and pituitary adenomas are considered to have a common ancestry. We report a rare case in which the preoperative diagnosis was pituitary adenoma, but the pathologic diagnosis was a combination of a Rathke's cleft cyst and a coincidental pituitary adenoma.
Adenoma* ; Central Nervous System Cysts ; Connective Tissue ; Diagnosis ; Epithelium ; Pituitary Neoplasms*

Cranioplasty has long been performed by many physicians with different materials from the prehistoric era. Among the materials, methyl methacrylate has been known to be the superior to any other substitutes since 1940s in biologic, chemical and physical characteristics and its availability. So the authors review 72 patients who underwent cranioplasty with methyl methacrylate at out hospital from 1985 to 1989. The clinical analyses were as follow : 1) There was male predominance and epidural hematomas, compound, comminuted depressed fractures by traffic accidents or fall down injuries were the main causes of craniectomy. 2) The location of defects was mainly frontal and/or parietal area and average size of defects was 17cm2 in plain skull film measurements. 3) The cosmetic results were satisfactory. 4) Complication rate was 6% and there was no mortality.
Accidents, Traffic ; Hematoma ; Humans ; Male ; Mortality ; Rabeprazole ; Skull

Schwannomas of the small bowel are very rare, accounting for fewer than 1% of all neoplasm of the gastrointestinal tract, and appendiceal schwannoma is extremely rare. We report a case of appendiceal schwannoma arising in the mid portion of the appendix. A 46-year-old woman was admitted due to intermittent nausea, vomitting and right flank pain via emergency room. Preoperative abdominal ultrasonogram, CT, MRI scan demonstrated 3.5 cm sized, round intraperitoneal mass in right lower quardrant of abdomen. Appendectomy was done and the mass was diagnosed as schwannoma on immunohistochemical stain. The patient followed up and no evidence of specific complication or recurrence was noted.
Abdomen ; Appendectomy ; Appendix ; Emergency Service, Hospital ; Female ; Flank Pain ; Gastrointestinal Tract ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Nausea ; Neurilemmoma* ; Recurrence ; Ultrasonography