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

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

We have experienced 17 cases of the upper brain stem compression lesions diagnosed by serial vertebral angiography and other ancillary studies from October, 1972 to August, 1975. All the cases were proven by serial vertebral angioraphy using the Seldinger catheter technique through the femoral artery and other studies such as carotid angiography, conray ventriculograpy, brain scan and pneumoencephalography. Angiographical analysis were attempted. The results were as following: 1. The location of lesion is:supratentorial lesions; 8 cases, infratentorial lesions; 5 cases, tentorial lesions; 3 cases, bilateral hippocampal herniation due to otitic hydrocephalus; 1 case. 2. We have tried to classify the upper brain stem compression lesions according to the direction of compression, i.e., (1) forward, (2) medial, (3) backward and (4) downward and analyzed their angiographic findings in detail. 3. Lesions compressed the upper brain stem forward were one case of bilateral occipital meningioma, one case of fourth ventricle tumor, two cases of medulloblastoma and one case of cerebellar hemispheric tumor. Their main angiographic findings were as follows;(1) Separation of quadrigeminal segment of superior cerebellar artery and posterior cerebral artery, (2) Compression of basilar artery against clivus and depression or elevation of bifurcation of basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward displacement of posterior mesencephalic vein and posterior displacement of precentral cerebellar vein, (5) Elevation of vein of Rosenthal. 4. Lesions compressed the upper brain stem medially were two cases of parietal ependymoma, one case of temporal meningioma, one case of bilateral hippocampal herniation and three cases of tentorial tumors. Their main angiography findings were as follows; (1) Medial displacement of posterior cerebral artery, superior cerebelar artery, bifurcation of basilar artery, distal portion of vein of Rosenthal, lateral mesencephalic vein and internal cerebral vein in Towne's view, (2) Elevation or depression of posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of crural and ambient segment of superior cerebellar artery. 5. Lesions compressed the upper brain stem backward were one case of pituitary tumor and one case of cerebellopontine angle tumor. Their main angiographic findings were as follows; (2) Posterior displacement of distal portion of basilar artery, (2) Posterior displacement of anterior pontomesencephalic vein, (3) Elevation of posterior cerebral artery and superior cerebellar artery, (4) Elevation of vein of Rosenthal and posterior mesencephalic vein, (5) Stretching and elevation of posterior communicating artery. 6. Lesions compressed the upper brain stem downward were one case of thalamic tumor, one case of thalamic hemorrhage, and one case of pinealoma. Their main angiographic findings were as follows; (1) Stretching of posterior cerebral artery and superior cerebellar artery, (2) Displacement and stretching of internal cerebral vein, vein of Rosenthal and posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of posterior cerebral artery and superior cerebellar artery, (6) Depression of internal cerebral vein, vein of Rosenthal, posterior mesencephalic vein and anterior pontomesencephalic vein. 7. We have concluded that in order to diagnosis the upper brain stem compression lesions serial vertebral angiography is the most important procedure and at the same time the analysis of the arteriographic and venographic findings in detail is important.
Angiography* ; Arteries ; Basilar Artery ; Brain Stem* ; Brain* ; Catheters ; Cerebral Veins ; Cranial Fossa, Posterior ; Depression ; Diagnosis ; Ependymoma ; Femoral Artery ; Fourth Ventricle ; Hemorrhage ; Hydrocephalus ; Medulloblastoma ; Meningioma ; Neuroma, Acoustic ; Pinealoma ; Pituitary Neoplasms ; Pneumoencephalography ; Posterior Cerebral Artery ; Rabeprazole ; Veins

The craniofacial dysostoses are due to synostosis of the basal skull sutures in the anterior cranial fossa. Patients with these abnormalities potentially have normal brains that are distorted by the misshapen skull ; shallow anterior fossa and reduction of the orbital volume, exophthalmos, and hypoplasia of the maxilla. The authors describe the operative repair and results of 9 cases of craniosynostosis. The craniofacial dysmorphic states are presumably caused by premature closure of basal skull sutures in combination with the coronary suture. In an effort to arrest and correct both the cranial and facial deformities as well as obviate the need for further radical surgery, the authors have treated 9 children with Crouzon's disease with linear suture craniectomy along the base of the skull, forehead advancement and unilateral canthal advancement techniques. A linear craniectomy along the synostotic sutures does not affect the synostotic process at the base of the skull. The advance of supraorbital margin and creating an artificial suture at the base of skull allowed for porper correction those craniofacial deformities. Following those procedure, deformity has regressed and ultimate cosmatic improvement has been obtained in 4 cases of grade III and 3 cases of the grade II and 2 cases of grade I among the 9 patients. Early neurosurgical intervention using the procedure of the forehead advancement and lateral supraorbital ridge advancement combined with linear craniectomy along the skull base suture, yields excellent results in the majority of these children.
Brain ; Child ; Congenital Abnormalities ; Cranial Fossa, Anterior ; Craniofacial Dysostosis* ; Craniosynostoses ; Exophthalmos ; Forehead ; Humans ; Maxilla ; Orbit ; Skull ; Skull Base ; Sutures ; Synostosis

The intracranial arachnoid cyst is distinctly uncommon and they have unusual clinical course. The plain skull series were usually shown bulging of the overlying skull due to progressive collection of cerebrospinal fluid in cystic cavity. Pre-operative diagnosis is unlikely to be made. The predilection sites of this lesion are usually convexity of hemisphere, cisterna chiasmaticus, especiaily forebrain along the axis of main cerebral artery. The authors report a case of intracranial arachnoid cyst arisen along the Sylvian fissure combined chronic subdural hematoma follwoing sustained mild head injury. The pathologic diagnosis was arachnoid cyst, since the removed cyst wall was normal arachnoid tissue.
Arachnoid ; Arachnoid Cysts* ; Axis, Cervical Vertebra ; Cerebral Arteries ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Diagnosis ; Hematoma, Subdural, Chronic ; Prosencephalon ; Skull

Spontaneous cerebellar hemorrhage is classically considered a rare and fatal disease because the early diagnosis is very rarely made during the life, and there is scant mention of the problems of spontaneous hemorrhage into the cerebellar hemisphere. However our opinions indicate that its frequency is greater than is generally thought although it is considered a rare lesion. The purpose of this paper is to record our present opinions concerning the possible early diagnosis and surgical management of the spontaneous cerebellar hemorrhage. We believe that it is possible by clinical examination alone to make or strongly suspect the diagnosis in life during the early stage before irreversible damage occurs and that emergency surgical intervention is strongly indicated. The patients is a 38 year old man admitted to the Department of Neurosurgery, Catholic Medical Center on Nov 3, 1976 with severe headache, vomiting, dysarthria and mental confusion. On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness. We confirmed the diagnosis under the cerebellar hemorrhage involving the cerebellar vermis and both cerebellar hemispheres by means of vertebral and carotid angiography, conray ventriculography, and cerebrospinal fluid examination. We underwent suboccipital craniectomy with the evacuation of hematoma at the vermis and both cerebellar hemispheres after 48 hours of onset of illness and his postoperative course was good except for mild cerebellar dysfunction signs and he was discharged on 45th hospital days.
Adult ; Angiography ; Cerebellar Diseases ; Cerebrospinal Fluid ; Diagnosis ; Dysarthria ; Early Diagnosis ; Emergencies ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Neck ; Neurosurgery ; Nystagmus, Pathologic ; Pupil ; Vomiting

No abstract available.
Aneurysm ; Aneurysm, Ruptured* ; Cerebral Veins* ; Veins*

A case of primary cervical intramedullary glioblastoma multiforme which is infrequently reported is presented. An 11 year old girl was admitted to the Department of Neurosurgery, Catholic Medical College in September 1976 because of flaccid paralysis of both upper extremities, neck pain and vomiting for 3 months. On admission, the patient was found to have flaccid paralysis of both arms and weakness of both legs. Sensory examination revealed hyperthesia below C2 dermatome. Babinski's toe sign was positive bilaterally and she was unable to void. Plain cervical spine revealed widening of interpedicular distance at C5 & 6. Myelogram through lumbar and cisternal route showed obstruction and widening of cord at the level of C4 & 7 respectively. Total laminectomy was performed through C3 to C6 and a purplish-blue mass was extruded out through the dorsal myelotomy. Pathologic diagnosis of the tumor was glioblastoma multiforme. Postoperatively there was marked improvement of motor power of all limbs. The patient has not shown any worsening in neurological status until this paper is submitted since she was discharged from the hospital October 1976.
Arm ; Child* ; Diagnosis ; Extremities ; Female ; Glioblastoma* ; Humans ; Laminectomy ; Leg ; Neck Pain ; Neurosurgery ; Paralysis ; Spine ; Toes ; Upper Extremity ; Vomiting

A case of primary cervical intramedullary glioblastoma multiforme which is infrequently reported is presented. An 11 year old girl was admitted to the Department of Neurosurgery, Catholic Medical College in September 1976 because of flaccid paralysis of both upper extremities, neck pain and vomiting for 3 months. On admission, the patient was found to have flaccid paralysis of both arms and weakness of both legs. Sensory examination revealed hyperthesia below C2 dermatome. Babinski's toe sign was positive bilaterally and she was unable to void. Plain cervical spine revealed widening of interpedicular distance at C5 & 6. Myelogram through lumbar and cisternal route showed obstruction and widening of cord at the level of C4 & 7 respectively. Total laminectomy was performed through C3 to C6 and a purplish-blue mass was extruded out through the dorsal myelotomy. Pathologic diagnosis of the tumor was glioblastoma multiforme. Postoperatively there was marked improvement of motor power of all limbs. The patient has not shown any worsening in neurological status until this paper is submitted since she was discharged from the hospital October 1976.
Arm ; Child* ; Diagnosis ; Extremities ; Female ; Glioblastoma* ; Humans ; Laminectomy ; Leg ; Neck Pain ; Neurosurgery ; Paralysis ; Spine ; Toes ; Upper Extremity ; Vomiting

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