Vascular lesions involving the upper extremities have been treated by different route of upper thoracic sympathectomy with varying success. More recently, the anatomic and physiologic interest for autonomic nervous system has been progressively mounted but the surgical attack has plateau. It may be worthy for academic interest and clinical practice to estimate and to compare with the different surgical method. This paper concerns the treatment of a case suffering from atherosclerotic occlusion whom were treated by upper thoracic sympathetic ganglionectomy through the transaxillary transpleural route. This operation seems to be simpler than other surgical methods with lower morbidity, fewer complication and satisfying results.
Autonomic Nervous System ; Ganglionectomy ; Sympathectomy* ; Upper Extremity

Trigeminal neurinomas are relatively rare tumors that arise from the sheath of Schwann and constitute 2.9% of intracranial neurinomas and 0.26% of all brain tumors. The most cases are confined to the middle fossa and arising from the Gasserian ganglion. In slight fewer cases the tumor occupy the cerebellopontine angle. In minority it is an hourglass form both situations. By reason of their rarity, the complex clinical problems which may present and the difficult technical aspects involved in their removal, neurinomas of the Gasserian ganglion are of extreme interest. We are reporting a case of trigeminal neurinoma which was arised from the right Gasserian ganglion and located in both situations of middle and posterior cranial fossas. A 37 year-old female was admitted to our department with characteristic symptoms and signs involving many cranial nerves, cerebellum and cerebral peduncle. We chose temporal craniotomy and approached to and exposed the mass by extradural and intradural techniques. Complete removal of the tumor occupying the middle and posterior cranial fossas are accomplished satisfactorily.
Adult ; Brain Neoplasms ; Cerebellopontine Angle ; Cerebellum ; Cranial Fossa, Posterior ; Cranial Nerves ; Craniotomy ; Female ; Humans ; Neurilemmoma* ; Tegmentum Mesencephali ; Trigeminal Ganglion

Chordomas are congenital tumor which develop from remnant of the notochord. Most of them arise at the clivus Blumenbachii, at the junction of the sphenoidal and occipital bones or sacrococcygeal region. Rarely chordomas arise at the thoracic spine, which compress the spinal cord epidurally and sometimes invade the substance of the spinal cord. The authors report a case of chordoma at T9-T10 vertebral level in which the characteristic "physaliferous" cells were found in the slides of operative specimen. The tumor was compressing the spinal cord and extending into body and lamine of the vertebra, which resulted the patient, 52 year-old Korean male, in paraplegia.
Chordoma* ; Cranial Fossa, Posterior ; Humans ; Male ; Middle Aged ; Notochord ; Occipital Bone ; Paraplegia ; Sacrococcygeal Region ; Spinal Cord ; Spine*

We have recently managed three cases of cerebellar hemangioblastomas in adult male in which the vertebral angiograms and C-T scan led us to diagnose the vascular mass lesions involving the right, left lobe and superior vermis respectively. Polycythemia, angiomatosis retinae and familial incidence were not detected but signs of increased intracranial pressure and of cerebellar dysfunction in varying degrees were common to all three cases. The duration of symptoms and signs ranged from weeks to years. The lesion in the right lobe was a fairly large mass harboring multiple small cysts in it and able to removed completely. The mass in the left lobe was paramedian in location and obstructing the 4 th ventricle. It was also large and entirely cystic accompanying a mural nodule in it and easily removed completely. The lesion occupying the cerebellar vermis was a large solid one and extending diffusely up to posterior third ventricle region and could only be removed partially.
Adult ; Cerebellar Diseases ; Hemangioblastoma* ; Humans ; Incidence ; Intracranial Pressure ; Male ; Polycythemia ; Third Ventricle ; von Hippel-Lindau Disease

Eosinophilic granuloma, Hand-Schuler-Christian and Abt-Letterer-Siwe syndrome are considered to be different manifestations of one and the same disease of the reticulohistiocytic system, and are included under the term histiocytosis X, clinical and morphological manifestations are variable. The syndromes can be differentiated according to their course and extent of spread. Eosinophilic granuloma of bone is the mildest form, usually restricted to one or a few foci. This occurs chiefly in children but may occur at any age. The male sex is affected almost twice as often as the female. Cranial vault is most commonly affected site and jaw, humerus, rib and femur are also often affected. Recently we have experienced 2 cases of eosinophilic granuloma of the skull bone. One was 10 years old male with protruding mass on the right frontal bone, and the other was a mass on right parietal bone in 12 years old male. On admission, the patients had headache and local tenderness without any abnormal neurological signs. Histopathologic findings show the fibrocartilagenous tissue and bone. The soft tissue is densely replaced by infiltrations of histiocytes, eosinophils, lymphocytes, plasma cells and multinucleated giants cells. Bone tissue is also infiltrated with identical cells. The differential diagnosis distiction between the cerebral granulomatosis is difficult.
Bone and Bones ; Child ; Diagnosis, Differential ; Eosinophilic Granuloma* ; Eosinophils* ; Female ; Femur ; Frontal Bone ; Headache ; Histiocytes ; Histiocytosis, Langerhans-Cell ; Humans ; Humerus ; Jaw ; Lymphocytes ; Male ; Parietal Bone ; Plasma Cells ; Ribs ; Skull*

Recently, motor evoked potential(MEP) using cortical surface of transcranial stimulation have been used to monitor the integrity of motor pathways and map motor cortex in human and animal. The primary concept using motor evoked potentials(MEPs) for test of motor pathways was based on the assumtion that pyramidal neurons in the motor cortex are activated by electrical stimulation applied on the cerebral cortex and synchronized compound action potentials are conducted mainly along the corticospinal tracts in the spinal cord. However, the origins and the descending pathways of these MEPs in small animals may be different from those of potentials evoked by intracortical microstimulation because of current spread. Our previous study revealed that the origns of the MEPs in rats differed from those previously believed and may be reticular nuclei. To further clarify those results and localize the intraspinal pathways conduction MEPs, consecutive vertical and/or horizontal sections of the spinal cord were performed at T9 cord level in twelve rats. MEPs were recorded at T2/3 and L2/3 before and after each section and sequential alterations of MEPs were observed. In six rats, the stimulation was alternated between the right and left cortex and the lateralities of conduction pathways were compared. All six cases showed no differences of MEPs and pattern of wave abolition after each section between right and left brain stimulation. The alteration of MEPs after each consecutive section was categorized by analyzing latency shift, amplitude change, and disappearance of waves. We divided a cross section of T9 spinal cord into forty-six squares. If one of the categorized changes occurrd after cutting an area, the appropriate score was given for the area since more change of waves meant more significant contribution of the cut area to conduction of MEPs. The score of twelev rats were summed in each forty-six spots and map showing the distribution of MEPs was constructed. The map revealed that MEPs were conducted along the wide area of ventral and lateral funiculus of the spinal cord but mainly along the medial portion of the ventral funiculus of the spinal cord but mainly along the medial portion of the ventral funiculus and ventral portion of the larteral funiculus through which reticulospinal and vestibulospinal tracts pass. No conduction of MEPs along the corticospinal tracts was confirmed. This finding supports the result of our previous study. However, this extrapyramidal MEP conducted along ventral spinal cord in addition to somatosensory evoked potential(SSEP) which is conducted along posterior funiculus can be useful to monitor the integrity of the whole spinal cord. Moreover, the extrapyramidal MEP can be more useful than pyramidal MEP in rats because the reticular formation plays a more important role in motor function and pyramidal tract is located in posterior funiculus.
Action Potentials ; Animals ; Brain ; Cerebral Cortex ; Efferent Pathways ; Electric Stimulation ; Evoked Potentials, Motor* ; Extrapyramidal Tracts ; Humans ; Motor Cortex ; Neurons ; Pyramidal Tracts ; Rats* ; Reticular Formation ; Spinal Cord

Motor evoked potential(MEP) produced by cortical surface or transcranial stimulation has evolved as a new clinical and experimental tool to monitor the integrity of motor pathways and to map motor cortex. Clinical assessment of motor system using MEP has further advanced with recent development of the magnetic stimulator. The primary concept using MEPs for test of motor pathways was based on the assumption that pyramidal neurons in the motor cortex are activated by electrical stimulation applied on the cerebral cortex and synchronized compound action potentials are conducted mainly along the corticospinal tracts in the spinal cord. However,recent studies indicated that the origins of the Meps in non primates may differ from those previously believed. In order to use MEPs as a clinical or experimental tool, it is essential to clarify the origin of MEPs. Therefore, goals of this study were : (1) to investigate the origin of MEPs, and (2) to design the most reliable but simple method to evoke and monitor MEPs. In a total of fifteen rats, MEPs were produced by cortex to cortex stimulation and were monitored using a pair of epidural electrodes. Using varying stimulus intensities, the amplitudes and latencies of MEPs were statistically analyzed. The latencies and amplitudes of the MEPs in these animals showed surprisingly large standard deviations, which were partially resulted in these animals showed surprisingly large standard deviations, which were partially resulted from convergence of neighboring waves during high stimulation intensities. Wave forms of MEPs were also varied greatly depending on the position of recording electordes. At low stimulus intensities, most consisten MEPs were obtained when the stimulating electrodes were placed on the hard palate and the temporal muscle, not on the motor cortex. This observation indicates that the primary source of MEPs is not the motor cortex in the rat. When the potentials generated by direct stimulation of motor cortex and those generated by reticular nuclei were monitored epidurally in the same preparation using the same electrodes, these potentials generated by different sources actually identical in their latencies and wave forms. However, the threshold stimulus intensities evoking these potentials were quite different in the two metholds. The threshold was much lower to evoke potentails by reticular nuclei stimulation. It suggests that MEPs are geneated by the reticular nuclei or brain structure located in the brain stem. The observation that the motor cortex play no major roles in generating MEPs was confirmed by sequential sections of neural axis from the motor cortex to brain stem in three rats. All these findings suggested that neither direct motor cortex stimulation not transcranial stimulation did evoke MEPs originating from the motor cortex in rat. These stimulating methods activate reticular nuclei by stimulus current spread to the brain stem. Since the reticular formation plays an important role in motor function in rats, MEP originated from reticular nucleus can be an important testing of the motor function in rats. Moreover, transcranial stimulation of the brain is technically easy. This technique producing MEPs originated from reticular nucleus can be useful to monitor the integrity of motor pathways.
Action Potentials ; Animals ; Axis, Cervical Vertebra ; Brain ; Brain Stem ; Cerebral Cortex ; Efferent Pathways ; Electric Stimulation ; Electrodes ; Evoked Potentials, Motor* ; Extrapyramidal Tracts ; Motor Cortex ; Neurons ; Palate, Hard ; Primates ; Pyramidal Tracts ; Rats* ; Reticular Formation ; Spinal Cord ; Temporal Muscle

PURPOSE: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. MATERIALS AND METHODS: We performed a dorsal closing wedge 1st metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-1st metatarsal, calcaneus-1st metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. RESULTS: Talo-1st metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of 21degrees and 25degrees to 12degrees and 19degrees, respectively, at last followup. Also, calcaneus-1st metatarsal angle was increased from the mean 114degrees to 144degrees. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. CONCLUSION: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.
Achilles Tendon ; Adult ; Animals ; Ankle ; Cerebral Palsy ; Charcot-Marie-Tooth Disease ; Collateral Ligaments ; Congenital Abnormalities ; Displacement (Psychology) ; Follow-Up Studies ; Foot ; Hoof and Claw ; Humans ; Joints ; Male ; Metatarsal Bones ; Organic Chemicals ; Osteotomy ; Poliomyelitis ; Sural Nerve ; Weight-Bearing

A case has been reported in which stereotaxic percutaneous cordotomy has been performed for the treatment of an intractable pain in the arm. The 60-year-old male was admitted to this hospital because of right arm pain which was persistant, so severe and intractable to various medical treatment for 2 months prior to admission. The pain in association with right Horners' syndrome has been produced by the involvement of carcinoma in the right apex of the lung to the cords of brachial plexus and superior cervical ganglion. Since the patient was so emaciated and distressed with the pain, the percutaneous cordotomy was indicated for him to cure the pain. Under the local anesthesia the patient was maintained in the supine position with his head held lightly on the head holder. And unilateral high cervical cordotomy by the percutaneous stereotaxic method was performed on the left through C-C2 interlaminar space under radiographic and impedance measurements, which relieved the pain completely with no development of significant postoperative complications. It was simple, safe and effective for the patient who has poor general condition because it does not require a general anesthesia or a period of wound healing and the cooperation of the alert patient eliminates the possibility of paralysis and enhances the changes of securing the desired sensory loss.
Anesthesia, General ; Anesthesia, Local ; Arm ; Brachial Plexus ; Cordotomy* ; Electric Impedance ; Head ; Humans ; Lung ; Male ; Middle Aged ; Pain, Intractable ; Paralysis ; Postoperative Complications ; Superior Cervical Ganglion ; Supine Position ; Wound Healing

Author report a case of neurocysticercosis that involved the right cerebral hemisphere subcortically. The subject was 38-year-old Korean male. The headache, epileptiform seizures and left sided motor weakness were the symptoms. Simple skull X-rays showed no significant pathological findings. Right carotid angiogram disclosed the signs of a large mass in the centrosylvian region. CT scan also demonstrated large, multiple and round cystic lesions within the substance of the brain itself in the right frontoparietal region. At operation cyst wall and cysticercus in the fluid content of a mass were obtained. Postoperatively with the aids of occurrence of cysticercrus in the skin and positive serologic test, the diagnosis again confirmed.
Adult ; Brain ; Cerebrum ; Cysticercosis* ; Cysticercus ; Diagnosis ; Headache ; Humans ; Male ; Neurocysticercosis ; Seizures ; Serologic Tests ; Skin ; Skull ; Tomography, X-Ray Computed