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

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 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

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 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

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 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*

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

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*

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