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

The introduction of the operating microscope improved not only the immediate operative management of cerebral aneurysms, but also the knowledge of their topography. The origin and projection of an aneurysm and its relation to the arteries concerned, identification and sparing of small functionally important arteries in the vicinity of the aneurysm, and the recognition of less known anomalies of the vascular system became as important as the dissection and clipping of the neck itself. We have presented 2 patients with aneurysms arising from the carotid artery in the origin of the ophthalmic artery. The origins and projections of aneurysms were analyzed with the aid of angiography, magnification technique, operative drawing and photographs. To facilitate the surgical procedures and results in lowered morbidity we have discussed the technical considerations for medialward directing aneurysm under the optic nerve in the view point of the surgical anatomy. We emphasized preoperatively defined plans concerning the origin, direction and size of the aneurysms, as well as, constant awareness of topographic relations.
Aneurysm* ; Angiography ; Arteries ; Carotid Arteries ; Humans ; Intracranial Aneurysm ; Neck ; Ophthalmic Artery ; Optic Nerve*

We have experienced 43 cases of the hypertensive intracerebral hemorrhage who were admitted to the Catholic medical Center, Seoul from November 1969 to February 1973. All these cases were diagnosed by clinical findings and cerebral angiography and assessed the prognostic factors on the result of treatment. The results of the analysis were summarized as follows: 1. Age distribution was ranged from 26 to 67, and 79 per cent of them were in fourth and fifth decade. The ratio of male to female was about 3 to 1. 2. The most frequent site of the hypertensive intracerebral hemorrhage was in the basal ganglia in 76.7 per cent, 27.2 percent of them in the thalamic hemorrhage and 39.5 per cent in the external capsular hemorrhage. The remainder were 9.3 per cent in the subcortical hemorrhage, 11.6 per cent in the pontine hemorrhage and 2.4 per cent in the cerebellar hemorrhage. 3. In the past history, hypertension was noted in 88.3 per cent of them. Simple chest X-ray showed cardiomegaly in 58.1 per cent and left ventricular hypertrophy was found in 41.1 per cent on E.C.G. findings. 4. All of 43 cases had unconscious state with various level at the onset of illness. For 43 cases, 46.5 per cent was in transient impairment of consciousness or drowsy state and 53.6 per cent in stuporous or comatous state. Headache was experienced in 81.3 per cent and 58.1 per cent of them was associated with vomiting. 5. During hospital course improvement of conscious level to alert state was found in 25.6 per cent and drowsy state in 18.6 per cent of all cases. On the aspect of the site of hemorrhage, 81.3 % of the thalamic hemorrhage and all pontine hemmorhage cases had shown stuporous or comatous conscious level. On the other hand, 70.6 per cent of the external capsular hemorrhage and all of the subcortical hemorrhage was found in alert or drowsy state. 6. On the neurological findings, anisocoria was noted in 18.8 per cent, miotic pupil in 20.7 per cent of all cases and pin-point pupils in pontine hemorrhage exclusively. Normal extraocular movement was noted in 60.4 per cent, conjugate deviation in 9.7 per cent of all cases. Inward and downward deviation of the eye-ball was found in 50 per cent of the thalamic hemorrhage. Dissociated eye-ball movement and occular bobbing were noted in the pontine hemorrhage. Motor impairment developed in all cases except one of the subcortical hemorrhage. Hemiplegia or hemiparesis was noted in 86.1 per cent of all cases and quadriplegia in 60 per cent of the pontine hemorrhage. Speech disturbance was noted in 27.9 per cent of all cases. 7. In the hypertensive intracerebral hemorrhage 24 cases were treated surgically and 19 cases were managed conservatively. Mortality and disability rate increased steadily with deepening of level of consciousness. The result of surgical treatment was better in alert and drowsy patients. 8. In addition to conscious level, the site of intracerebral hemorrhage did strongly influence to surgical outcome. Surgical treatment of 9 cases of thalamic hemorrhage resulted 8 death and one with severe disability. On the other hand, of 17 patients of the external capsular hemorrhage 12 were treated surgically and 8 cases showed improvement. 5 patients of pontine hemorrhage was managed conservatively but resulted fatal outcome in 2 cases. 9. There is a conflict of opinion as to the optimal time to operate the hypertensive intracerebral hemorrhage. Early surgery after ictus probably increase the mortality rate. Of 10 cases who were treated with surgical intervention within 48 hours following ictus, seven cases were succumbed. On the contrary, 0f 12 cases who had received operative treatment after 72 hours following ictus, 9 showed improvement and 3 death. 10. The amount of the hematoma seem to somewhat influence to surgical result.
Age Distribution ; Anisocoria ; Basal Ganglia ; Cardiomegaly ; Cerebral Angiography ; Cerebral Hemorrhage ; Consciousness ; Fatal Outcome ; Female ; Hand ; Headache ; Hematoma ; Hemiplegia ; Hemorrhage ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Intracranial Hemorrhage, Hypertensive* ; Male ; Mortality ; Paresis ; Pupil ; Quadriplegia ; Seoul ; Stupor ; Thorax ; Unconsciousness ; Vomiting

It is established that intracranial hemorrhage is relatively common benign intracranial diseases in adult. This is very rare in children reports are limited to a few cases or to those cited in reviews of series of intracranial hemorrhage in adult group. We wish to report three cases of large intracranial hematoma in three infants. The diagnosis was greatly facilitated by the CT scan and the treatment did by the microsurgical methods.
Adult ; Cerebral Hemorrhage* ; Child ; Diagnosis ; Hematoma ; Humans ; Infant ; Intracranial Hemorrhages ; Tomography, X-Ray Computed

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

Recently microvascular decompressive approach to the hyperactive type of low cranial nerves dysfunction has been popular procedures in neurosurgical operation. The neurosurgical teams at St. Paul's Hospital, Catholic Medical College operated on 11 patients employing this technique for 2 years. The patients were diagnosed as 9 patients with hemifacial spasm, one with trigeminal neuralgia, and one with glossopharyngeal neuralgia. The results were very encouraging of the 10 patients. But remaining one patient was failed with therapy. The authors would like to share with you their experiences employing the microvascular surgical technique, the results & the prognosis.
Cranial Nerves* ; Glossopharyngeal Nerve Diseases ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Prognosis ; Trigeminal Neuralgia

A rare case of microgliomatosis(reticulum cell sarcoma) of the brain is reported. The tumor was located in the left parietal lobe and the right cerebellar hemisphere and the vermis. V-P Shunt was performed and left parietal craniotomy was done for removal of tumor. The patient received radiation therapy and chemotherapy for brain tumor with a good result Histogenesis and therapy of the microgliomatosis are briefly discussed.
Brain Neoplasms ; Brain* ; Craniotomy ; Drug Therapy ; Humans ; Parietal Lobe ; Rabeprazole

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

Orthostatic hypotension with other signs of progressive neuronal degeneration particularly affecting the autonomic nervous system has been recognized independently and is called Shy-Drager syndrome. Degenerative changes in the autonomic ganglia, loss of neurons in the intermediolateral columns and degenerative changes in the neurons of the cortex and basal ganglia have been reported on examination of this condition. The authors report a case of Shy-Drager Syndrome with symptoms of orthosatatic hypotension, dysarthria, Parkinson's features, muscle wasting, sexual impotence, atonic bladder and loss of sweating.
Autonomic Nervous System ; Basal Ganglia ; Dysarthria ; Erectile Dysfunction ; Ganglia, Autonomic ; Hypotension ; Hypotension, Orthostatic ; Male ; Neurons ; Shy-Drager Syndrome* ; Sweat ; Sweating ; Urinary Bladder