We present a series of 10 Patients(Seven men and three women with an average age of 53 years) who underwent decompressive craniectomy for treatment to massive brain swelling following acute cerebral infarction. Clinical signs of cerebral herniation(anisocoria or fixed and dilated pupil, and/or hemiplegia with decerebrate righidity) were present in all patients. Computed tomography and magnetic resonance imaging showed the mass effect by cerebral edema through midline shift. All patients were treated with an extensive craniectomy and duroplasty. Among them, one recovered without neurological deficit, three were moderately disabled but functionally dependent, three remained in a persistent vegetative state and three died within 9 days after surgery(good recovery=1, moderate disability=3, persistent vegetative state=3, death=3). The results suggest that decompressive craniectomy can be an useful lifesaving procedure for massive cerebral edema following widespread hemispheric infarction.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Female ; Hemiplegia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Persistent Vegetative State ; Prognosis ; Pupil

PURPOSE: We investigated the causes and mechanisms driving acute border zone infarctions using diffusion-weighted imaging (DWI). MATERIALS AND METHODS: We analyzed DWI in 104 patients (male: 72 years, female: 32 years, age range: 44 to 84 years) with acute border zone infarction. The DWI patterns were classified as follows: pattern A- An acute border zone infarction combined with multiple small disseminated cortical infarctions, pattern B- An acute border zone infarction only. RESULTS: The most common cause of acute border zone infarctions was extracranial internal carotid artery (ICA) stenosis (45 cases, 43%). Other causes included middle cerebral artery stenosis (22 cases, 21%), intracranial ICA stenosis (14 cases, 13%), unknown, (12 cases 12%), iatrogenic (6 cases, 6%) and cardiogenic (5 cases, 5%), respectively. The most common pattern for DWI was pattern A (83 cases, 80%). We performed a transcranial Doppler in 7 of 75 cases (11%), and found at least 1 embolic pulse. CONCLUSION: The most common pattern of DWI for acute border zone infarctions was pattern A. We propose that the mechanisms driving acute border zone infarctions are emboli coupled with hypoperfusion.
Brain Infarction ; Carotid Artery, Internal ; Cerebral Infarction ; Constriction, Pathologic ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction ; Middle Cerebral Artery

A 46 year-old male with drowsy mentality and left hemiparesis had been treated. Right carotid angiogram showed a mass effect on the posterior temporal region. Preoperative CT brain scan revealed two separated hypodense masses with ring enhancement on the each hemisphere. The right-sided mass was totally removed and there was no invasion into the ventricle and meninges. The histological diagnosis was a glioblastoma multiforme. The left-sided mass was followed with the repeated CT scan, which showed the similar CT findings of a glioblastoma multiforme, and there was no evidence of commiccural extension. The above findings were consistent with the criteria of multicentric tumor.
Brain ; Diagnosis ; Glioblastoma* ; Humans ; Male ; Meninges ; Middle Aged ; Paresis ; Tomography, X-Ray Computed

OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*

To know recent research works in neurosurgical fields and to analyze neurosurgery related sites on the internet, authors have been searching sites on the web offering the neurosurgical resources. From December 1995 to October 1996 we used a modem(28.8Kbps) and thereafter connected to a LAN(local area network). Under the environment of Windows 95, we used web browsers with Netscape 2.02 and Netterm 2.89. We got an medical information with PC journals or seminars and graded the neurosurgical center/institutes from A to E according to the quality of web sites. We could use the internet resources more rapidly in the early morning than noon or evening. Best sites for neurosurgeon were MedMark(http://www.medmark.bit.co.kr/neurosur.html) and Neurosource (http://www.neurosource.com/). The more comprehensive academic neurosurgical site among all web were the Massachusetts General Hospital(http://neurosurgery.mgh.harvard.edu/) and the University North California (http://sunsite.unc.edu/Neuro/uncns/home.html). In 89 neurosurgical center/institutes, 72 sites(80.9%) couldn't supply sufficient information. In conclusion, there are many webs related to neurosurgery on the internet, but useful sites for neurosurgeon are not common. It is necessary to make an effort to find available sites offering more information in the future.
California ; Internet* ; Massachusetts ; Neurosurgery ; Web Browser

OBJECTIVE: This study was undertaken to evaluate operative results and prognosis according to preoperative clinical status and histopathological finding of spinal cord tumor. METHODS: We analyzed of clinical feature, tumor location, histopathologic finding, operative results and prognosis in 55 patients with spinal cord tumor during last 10 years. RESULTS: 1) The incidence of spinal cord tumors varies with the age of affected patients who are 2 to 75 years of age. Peak incidences were in the 5th and 7th decade of life, and the ratio of male to female was 1.2:1. 2) The most common histopathologic type was neurinoma(41.9%). 3) The tumors were located most frequently in the thoracic area(22 cases, 40.0%) and in the intradural extramedullary space(30 cases, 54.5%). 4) The most common initial clinical feature was pain in 20 cases(36.4%). For neurologic status on admission, 30 cases(54.5%) showed motor disturbance. 5) In radiologic studies, there were abnormal finding in 21 cases from plain X-rays among 37 cases. The entire 20 cases in when myelography was done showed subarachnoid blockade, either complete or incomplete. The magnetic resonance imaging, regard as the most accurate diagnostic method, revealed the exact location of the tumor and the relationship of the tumor with the adjacent anatomical structure. 6) The total removal was possible in 36 cases(65.5%), subtotal removal in 17 cases(30.9%) and biopsy in 2 cases (3.6%). Nineteen cases(90.5%) among 21 cases with preoperative radiculopathy group showed recovery or improvement, where as only 11 cases(36.7%) among 30 cases with preoperative motor weakness group showed recovery or improvement, with statistically significant difference(p<0.01). Pathologically, 26 cases(83.9%) among 31 cases of neurinoma and meningioma showed postoperative recovery or improved, but only 1 case(6.3%) among 16 cases of metastatic tumor, astrocytoma and ependymoma recovered. Postoperative complication noted in 5 cases(9.1%), and were noted postoperative hematoma, pneumonia, pulmonary edema and spinal cord infarction. CONCLUSION: Preoperative neurologic status and histopathologic finding are considered important factors of Postoperative outcome in patients with spinal cord tumor.
Astrocytoma ; Biopsy ; Ependymoma ; Female ; Hematoma ; Humans ; Incidence ; Infarction ; Magnetic Resonance Imaging ; Male ; Meningioma ; Myelography ; Neurilemmoma ; Pneumonia ; Postoperative Complications ; Prognosis ; Pulmonary Edema ; Radiculopathy ; Spinal Cord Neoplasms* ; Spinal Cord*

No abstract available.
Hematoma*

As an attempt to better understand the microanatomy during transpetrosal surgery and to determine the limitation of extradural middle fossa approach, 16 adults human cadaveric skull base speciments were dissected at the region of petroclivus and posterior cavernous sinus. The important landmarks chosen for this study included the following: a petrosigmoid intersection, arcuate eminence, foramen spinosum, foramen ovale, hiatus of greater superficial petrosal nerve (GSPN), porus acousticus internus, geniculate ganglion, cochlea and petrous portion of internal carotid artery(ICA). The resultant data are as follows: the length between the petrosigmoid intersection and the arcuate eminence was 23.1mm+/-1.9(20.1-26.5). The depth covering geniculate ganglion was 1.3mm+/-0.3(0.8-1.8). The length between the geniculate ganglion and the hiatus of GSPN as well as cochlea were 4.6mm+/-1.1(3.5-7.1) and 0.9mm+/-0.2(0.7-1.2) respectively. The whole length of the GSPN exposed the middle cranial fossa was 11.0mm+/-0.8(9.3-12.5). The diameter f the petrous portion of ICA was 5.9mm+/-0.2(5.5-6.4). The length of the horizontal segment of the petrous ICA that can be exposed for anastomosis was 10.8mm+/-0.9(9.0-12.3). The distance between geniculate ganglion and porus acousticus showed a sighificant difference in all measurements to be compared with right and left side(p<0.05). The angle between the internal acoustic meatus and GSPN correlated inversely to the length of horizontal segment of pertrous ICA(r=-0.54, p<0.05). Morphometric analysis and their correlation between bony landmarks and structures within the pyramid helped to decide the angle and direction from which bone removal could be accomplished more safely during transpetrosal surgery, including the middle fossa approach.
Acoustics ; Adult ; Cadaver ; Cavernous Sinus ; Cochlea ; Cranial Fossa, Middle* ; Foramen Ovale ; Geniculate Ganglion ; Humans ; Skull Base

A 48 year-old male with back pain and foot drop had been treated. Studies for myelomatosis were all negative. A plain lumbar spin X-ray showed an erosion of the left pedicle of the first lumbar vertebra. A myelography via lumbar and cisternal routes revealed total block with feather appearance at the upper level of the L2 and the lower level of the T12 vertebra. Pathologic evaluation confirmed the diagnosis of solitary myeloma of the bone. After undergoing almost total excision, followed by radiation, the patient was still doing well.
Animals ; Back Pain ; Diagnosis ; Feathers ; Foot ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; Myelography ; Spine*