We have experienced a rare case of leukemic lesion(chloroma) in the lower spinal canal which was confirmed by the surgery and histologic examination of the tumor. A farmer, aged 39, was admitted to the Department of Neurosurgery, St. Paul Hospital in December 1974 with chief complaints of low back pain with radiating pain in the right lower extremity and voiding difficulty for one month. On admission, neurologically, the patient exhibited weakness of the right anterior tibialis, extensor hallucis longus and peroneus longus and brevis muscles and sensory involvement of the right third, fourth and fifth sacral dermatomes. He was disclosed the positive signs of the Naffziger's and Lasegue's and severe tenderness on the spinous process of the fifth lumbar and first sacral vertebrae. Lumbar myelogram demonstrated a total block at lower level of the fifth lumbar vertebra and a filling defect of the right fifth lumbar root area. Through the laminectomy of fourth lumbar to first sacral lamina, an extradural greenish soft mass located at the ventral aspect of the right fifth lumbar to upper sacral roots, and the mass was removed. The biopsy specimen disclosed chloroma with leukemic infiltration of the meninges.
Biopsy ; Humans ; Laminectomy ; Leukemic Infiltration ; Low Back Pain ; Lower Extremity ; Meninges ; Muscles ; Neurosurgery ; Sarcoma, Myeloid ; Spinal Canal* ; Spine

Plasma levels of growth hormone(GH), luteinizing hormone(LH) and cortisol were determined by radioimmunoassay following radiofrequency(RF) stimulation or coagulation of various nuclei in thalamus and hypothalamus. RF stimulation or coagulation of many nuclei in thalamus and hypothalamus consisted of pulvinar and dorsomedial nucleus in thalamus and anterior and posterior hypothalamic nuclei in hypothalamus. Anterior thalamic stimulation resulted in highly significant increase of plasma LH, GH, cortisol and TH levels. However thalamic stimulation resulted no change in the level of various plasma hormones. Hypothalamic lesion produced significantly decreased plasma LH, GH and cortisol levels. Plasma cortisol and LH levels were highest 2 hours after stimulation while GH levels did not increased until 6 hours and TH until 72 hours respectively after stimulation. The significant difference in latency for beginning of hormone secretion suggests that GH, cortisol and LH may be controlled by several separate neuronal networks. Plasma GH and cortisol levels were lowest 72 hrs after coagulation of the anterior hypothalamic area, while GH, cortisol and LH levels did not change following stimulation or coagulation of posterior hypothalamic nucleus and thalamic nucldi. It was also noted that the anterior hypothalamic stimulation or coagulation caused increased or decreased in GH, cortisol, and LH than that observed from stimulation or coagulation of other hypothalamic and thalamic nuclei respectively.
Anterior Hypothalamic Nucleus ; Hydrocortisone ; Hypothalamus* ; Lutein ; Mediodorsal Thalamic Nucleus ; Neurons ; Plasma ; Pulvinar ; Radioimmunoassay ; Thalamic Nuclei ; Thalamus*

We have experienced a case of suprasellar germinoma metastasized to the lumbar spinal canal. A 22-year-old man was admitted to St. Mary's Hospital May, 1975 with complaints of low back pain, progressive weakness of both lower extremities and voiding difficulty for about one month. About 7 months ago he received craniotomy and irradiation therapy for suprasellar germinoma. Neurological examination revealed foot drop on the left side with sensory change and atonic neurogenic bladder. Pantopaque myelogram showed a total block at the level of the 3 rd lumbar vertebra suggestive an epidural mass compressing dural sac posteriolaterally. Total laminectomy of lumbar first to fifth vertebrae disclosed a firm, rubbery hard and vascular mass in the epidural space, which was not adherent to the dura. Histological examination of the tumor revealed typical germinoma. Pathogenesis of geminoma and possible mode of epidural metastasis are discussed.
Craniotomy ; Epidural Space* ; Foot ; Germinoma* ; Humans ; Iophendylate ; Laminectomy ; Low Back Pain ; Lower Extremity ; Neoplasm Metastasis ; Neurologic Examination ; Spinal Canal* ; Spine ; Urinary Bladder, Neurogenic ; Young Adult

A case of infantile multiloculated brain abscess diagnosed by computerized tomography and enhancement with intravenous contrast material is introduced. In this case, patient was successfully treated by repeated needle aspiration and lesions were observed by means of serial computerized tomography and intracapsular microbarium injection. The abscess cavities were punctured stereotaxically on measuring the lesions of the plain skull film with consequence C.A.T scan.
Abscess ; Brain Abscess* ; Brain* ; Humans ; Needles* ; Skull

We performed experiments to study the effects of acutely increased inracranial pressure on cereral gas metabolism. The results and findings were reported to The Journal of Catholic Medical College,(Vol. 24) 1973. We thereafter evaluated cerebral gas metabolism of fifty patients with acute cerebral lesions. Cerebral gas metabolism was measured by determining the pO2, pCO2, and pH values of arterial and venous blood and of the cerebrospinal fluid. Samplings of venous blood were obtained from the internal jugular vein. In the determination of the pH, pO2 and pCO2 of arterial and venous blood and cerebro-spinal fluid, the "Radiometer BMS 3 with Digital Acid-Base Analyser PHM 72" was used. These 50 patients had their gas metabolism measured at interval of 2 or 3 days, from the time of their admission to the time of either their recovery or death. The following observations were made 1. The 50 patients studied and observed included. a) Brain contusion 13 cases. b) Epidural or subdural hematoma 11 cases. c) Skull fracture 10 cases. d) Intracerebral hemorrhage 5 cases. e) Scalp laceration 1 cases. f) Arteriovenous malformation or cerebral rete 5 cases. g) Traumatic subarachnoid hemorrhage 1 cases. h) Intracranial aneurysm 4 cases. 2. There 50 patients have been subdivided according to level of consciousness as follows: a) Group A-Those who were alert with no neurological deficit. b) Group B-Those who were drowsy with mild neurological deficit. c) Group C-Those who were stuporous with severe neurological deficit. d) Group D-Those who were in coma. 3. It was observed that the pH, pO2, and pCO2 content of the arterial and venous blood and cerebrospinal fluid of those in Group A were within normal ranges. 4. Many cases classified under Group B had respiratory alkalosis of the arterial blood. However those who recovered or became worse revealed no noticeable changes in the cerebral gas metabolism studies. 5. Many cases classified under Group C had respiratory alkalosis in their arterial blood but only a few showed metabolic acidosis in the cerebrospinal fluid. However the patients who became worse manifested a marked metabolic acidosis in the cerebrospinal fluid. 6. Several patients in Group D had severe respiratory alkalosis as well as metabolic alkalosis in their arterial blood and marked metabolic acidosis in the their cerebrospinal fluid. 7. "Luxury perfusion syndrome" was not seen in any of the fifty cases studied. 8. Only a few cases manifested arterial hypoxemia in the all group. We believe this was due to the fact that tracheostomy and hyperventilation were done in the early stages with the aim of reducing the raised intracranial pressure.
Acidosis ; Alkalosis ; Alkalosis, Respiratory ; Anoxia ; Arteriovenous Malformations ; Brain Injuries ; Brain* ; Cerebral Hemorrhage ; Cerebrospinal Fluid ; Coma ; Consciousness ; Hematoma, Subdural ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Intracranial Aneurysm ; Intracranial Pressure ; Jugular Veins ; Lacerations ; Metabolism ; Perfusion ; Reference Values ; Scalp ; Skull Fractures ; Stupor ; Subarachnoid Hemorrhage, Traumatic ; Tracheostomy

Ninety three patients, who sustained craniocerebral injuries were studied and followed up for detection of syndrome of inappropriate secretion of antidiuretic hormone from their admission to the time of their recovery. Their electrolytes in serum and urine, and fluid balance were examined at frequent intervals. Ten cases have manifested. "The Syndrome of the Inappropriate Secretion of Antidiuretic Hormone"(S.I.S.A.D.H.). 1. For the detection of the presence of S.I.S.A.D.H., body weight, fluid balance, central venous pressure, sodium, potassium, chloride, B.U.N. and creatinine content of the serum as well as sodium, potassium, chloride, B.U.N. and creatinine content of the serum as well as sodium, potassium, chloride and 17-ketesteroid content of 24 hours urine specimen had been measured every 2 or 3 days interval, from their admission. 2. To establish the diagnosis of S.I.S.A.D.H., the following conditions were observed. First, there was no evidence of dehydration, second, the level of the sodium content of the serum was decreased below 125mEq/L and third, the amount of urinary sodium was persistently increased. However the functions of the kidney and adrenal gland were normal. 3. In the cases of S.I.S.A.D.H. among Korean craniocerebral injuries, the amount of sodium excreted in the urine was above 110mEq/L. On the other hand, 27 Koreans without craniocerebral injury or pulmonary complication, who had hospital diet which contained about 15gms. of NaCl, the average value of sodium excreted in the urine was 95mEq/L although there had been great individual differences. 4. Out of 33 patients with brain contusion, 4 manifested S.I.S.A.D.H., 27 with epidural hematoma there were 4 cases, of 15 cases of subdural hematoma, there was one case and also one cases of S.I.S.A.D.H. was found among the 11 cases of compound comminuted depressed fracture of the skull. 5. Among the 93 cases of craniocerebral injuries, 10 of them which is equivalent to 10.8% developed S.I.S.A.D.H. In there cases, improvement of the syndrome was observed in a few days by limitation of daily in take to 600cc. The patient who has shown rather severe hyponatremia, the condition was improved by parenteral injection of 3% saline solution with fluid restriction. 6. Among the cases with S.I.S.A.D.H. it was discovered that 3 of them had infection or complications of the lung. 7. Clinical findings among these patients with S.I.S.A.D.H. were:Three cases had mental disturbance, two with anorexia, one had vomiting and one with convulsions. In all the cases consciousness and muscular activity were somewhat impaired. 8. Aside from the patients with craniocerebral injuries, S.I.S.A.D.H. was observed in one case of aneurysm of the anterior communicating artery.
Adrenal Glands ; Aneurysm ; Anorexia ; Arteries ; Body Weight ; Brain Injuries ; Central Venous Pressure ; Consciousness ; Craniocerebral Trauma ; Creatinine ; Dehydration ; Diagnosis ; Diet ; Electrolytes ; Hand ; Hematoma ; Hematoma, Subdural ; Humans ; Hyponatremia ; Individuality ; Kidney ; Lung ; Potassium ; Seizures ; Skull ; Sodium ; Sodium Chloride ; Vomiting ; Water-Electrolyte Balance

The authors report a case of pterional meningioma invading the sphenoid bone, orbital roof and lateral orbit, and temporal bone with hyperostosis, which extended into temporal muscle. Extensive removal of orbital, sphenoid and basal skull bone was carried out with total excision of tumor mass in and out of the cranium. Preoperative exophthalmos still remained postoperatively. The mode of extension, result of surgery and CT findings are discussed.
Exophthalmos ; Hyperostosis ; Meningioma* ; Orbit ; Skull ; Sphenoid Bone ; Temporal Bone ; Temporal Muscle

The arteriovenous malformations(AVMs) of the corpus callosum are distinct anatomical and surgical entities. The AVMs of the corpus callosum are supplied by the pericallosal arteries if the malformations are located in the anterior and middle portion of the callosum and the AVMs of the splenium are usually fed by the pericallosal and posterior cerebral arteries. Radical excision of the callosal AVMs became successful with microsurgical techniques since a few years ago. The authors report a case of the callosal AVM, who had subarachnoid hemorrhage twice prior to this admission, and the studies with angiography and computed tomography revealed an AVM involing the middle portions of the corpus callosum. Radical excision of the AVM was accomplished by microsurgical techniques without neurologic sequela.
Angiography ; Arteries ; Corpus Callosum* ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

Since the turn of the century surgeons were proposed many procedures for exposure of the hypophysis cerebri of the operations proposed, two pricipal routes have been selected to reach the sella, first the intracranial, and second, the extracranial transsphenoidal. A variety of transnasal approaches have been used to gain access to the sella turcica. Each of these approaches requires crossing the sphenoid sinus, hence the transsphenoidal designation of these methods. Since the growth and refinement of microsurgery as a distinct surgical discipline there has been a coincidental maturation of transsphenoidal microsurgical techniques for the management of the hormone secreting microadenoma. The present paper reviews the historical events leading to the current methods of transsphenoidal pituitary surgery. Detailed descriptions of each method are given, with advantages and disadvantages of each. The author's experience in the management of 2 acromegalic patients with the transethmoidal approach are presented. The purpose of this paper is to focus recount the historical events leading to author's present method of pituitary surgery and to present the advantages and disadvantages as well as a procedural description for the transethmoidal approach to the sella turcicaz.
Acromegaly ; Growth Hormone ; Humans ; Microsurgery ; Pituitary Gland ; Sella Turcica ; Sphenoid Sinus

The anterior communicating artery(Acomm) is one of more common sites of intracranial aneurysms. Surgery of anterior communicating aneurysm has been considered difficult because it is deep, and proximity to the vital diencephalic centers and it projects in various directions and its parent artery is thin or thourgh the sac, sometimes having vascular anomalies. Successful treatment of aneurysms by intracranial surgery requires careful planning of the surgical approach. The gyrus rectus approach to anterior communicating aneurysms is based on the belief that since aneurysms rupture at their fundus they can most safely be approached at their base because premature rupture of an aneurysm is deleterious to appropriate surgical treatment. From January to October 1982, 20 cases with ruptured aneurysms of the Acomm have been operated on using microsurgical procedures. We have presented 2 patients of Acomm aneurysms with certain difficult in clipping neck. The double aneurysms were obliterated with two clips and the other aneurysm was clipped with the long length clip and also the inclusion of adjacent vital nerves and vessels in the clips were avoided. Technical problems associated with the application of the clips are discussed.
Aneurysm* ; Aneurysm, Ruptured ; Arteries ; Humans ; Intracranial Aneurysm ; Neck ; Parents ; Rupture