The parathyroid cyst is a relatively uncommon disease and usually identified during the operation for a presumed thyroid mass. Thirteen cases of parathyroid cyst (2 males, 11 females) treated from 1981 to 1993 were reviewed. Ages ranged from 17 to 59 years(mean, 41 years). Gross measurement of the tumor size varied from 1.0 to 10.0 cm in diameter with a mean of 4.8cm. All of the 13 patients presented with a chief complaint of painless anterior cervical mass. Only one complained of mild symptom of dyspnea and voice change due to huge cyst in paratracheal space. No functional cyst was identified. Diagnostic studies included ^99mTc thyroid scan (n=11), ultrasonography (n=10), computerized tomography (n=4) and fine needle aspiration(FNA) (preoperative, n=4; intraoperative, n=3). All diagnostic precedures but needle aspiration were nonspecific. Cysts were found in right inferior parathyroid(n=4), left inferior parathyroid (n=7), or anterior superior mediastinum (n=2). The FNA of the cyst contents revealed watery clear fluid with elevated parathyroid hormone level and was diagnostic in each cases. Four patients were treated initially with needle aspiration, of which only one patient was successful, and 3 patients who were unsuccessful to needle aspiration and the remaining 9 were effectively treated with surgical extirpation. Our experience suggested that needle aspiration may be of significant help in diagnosis and treatment of parathyroid cyst, but most of the patient could be treated successfully by surgical extirpation with an excellent chance for curability.
Biopsy, Fine-Needle ; Diagnosis ; Dyspnea ; Humans ; Male ; Mediastinum ; Needles ; Parathyroid Hormone ; Thyroid Gland ; Ultrasonography ; Voice

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.
Fingers ; Hand ; Hand Strength ; Humans ; Methods ; Paralysis ; Radial Nerve ; Radial Neuropathy ; Rupture ; Tendon Transfer ; Tendons ; Thumb ; Upper Extremity ; Wrist

Using a rat model, this study examined the cerebral protective effect of moderate hypothermia and evaluated the effect on early local metabolic change of permanent focal cerebral ischemia. The middle cerebral artery(MCA) of the rat was approached subtemporally and was occluded, and its surface was cooled. Cerebral infarct size was measured at 1, 4 and 7 days after MCA occlusion in non-treated(n=27), 2-hour hypothermia(n=27) and 3-hour hypothermia(n=27) group, respectively, and regional cerebral glucose uptake(rCGU) was determined at 1 and 4 hour after MCA occlusion in the non-treated(n=8) and 3-hour hypothermia(n=8) group, respectively. Infarct size measured at 1, 4 and 7 days after MCA occlusion was 22.2%+/-4.4%, 14.3%+/-6.6%, 13.7%+/-5.3% in the non-treated group, 19.6%+/-10.0%, 12.5%+/-6.2%, 12.0%+/-6.9% in the 2-hour hypothermia group and 12.9%+/-5.6%, 8.3%+/-3.3%, 8.2%+/-2.3% in the 3-hour hypothermia group. In the 2-hour hypothermia group, no significant size reduction was seen, but in the 3-hour hypothermia group, infarct size had decreased to half of that of the non-treated group(p<0.05). This protective effect was observed untill 1 week after MCA occlusion. rCGU in the non-treated group measured at 1 hour after MCA occlusion had increased in the periphery of the ischemic core, but at 4 hours, periischemic hypermetabolism had disappeared and the area of low metabolism in the center had become larger. rCGU in the 3-hour hypothermia group measured at 1 hour after MCA occlusion(BT 26degreesC) showed a uniform decrease in all regions, supressing temporary periischemic hypermetabolism, and at 4 hours(BT 37degreesC) after occlusion, hypermetabolism was not prominent and the area of low metabolism in the center had narrowed. This study indicates that 3 hour moderate hypothermia immediately after MCA occlusion significantly reduces infarct size, and that this protective effect was associated with suppression of periischemic hypermetabolism occurring around 1 hour after MCA occlusion.
Animals ; Brain Ischemia* ; Glucose* ; Hypothermia* ; Metabolism ; Models, Animal ; Rats*

The authors reviewed forty cases of acoustic neurinomas operated on from July 1974 to June 1984, analyzing our data obtained during 10 years in the following three periods: 1974 to 1978, 1978 to 1981, 1981 to 1984. A suboccipital approach was used for the removal of acoustic neurinomas in all cases. 1) A peak in the age distribution was seen at 40-50 years of age and no sexual difference was present. 2) The earliest symptoms were hearing loss(50%), headaches(25%), tinnitus(15%) in order of frequency. The time between onset of complaints and admission was mostly within 5 years(83%). 3) Most of the patients had large tumors(78%), greater than 3cm, of whom 4 patients were free of cerebellar and brain stem dysfunction. 4) Total removal was carried out in 27 out of 40 patients(67%) and particularly in 8 out of 14 patients(57%) with large tumors greater than 5cm. The total mortality was 7.5%. 5) In the last 3 years with the advance of microsurgical technique and CT scan, 25 patients were operated on only with a single death and total removal was carried out in 20 out of 25 patients. 6) In total removal, the total mortality was 7.4% and the mortality was 8% in patients with 3-5cm sized tumors and 13% in patients with tumors greater than 5cm, particularly 5% in the recent 3 years. 7) Preservation of the facial nerve following total removal was achieved in 59%. In the recent 3 years, the facial nerve was preserved in 65%. In the large tumors, 3-5cm sized and greater than 5cm, the rates of 75% and 37% were obtained.
Acoustics* ; Age Distribution ; Brain Stem ; Facial Nerve ; Hearing ; Humans ; Mortality ; Neuroma, Acoustic* ; Tomography, X-Ray Computed

Authors report on the general features of postoperative central nervous system infection in patients undergoing neurosurgical procedures. The postoperative central nervous system infection was defined was defined as 1) emergence of purulent material from any site that had been exposed to surgical field, and/or 2) development of meningitis during postoperative recovery period. The materials were obtained from 50 cases of postoperative central nervous system infection out of 1,232 cases of operations that had been performed in neurosurgical department of Seoul National University Hospital during the last three years. Various predisposing factors, associated problems, and therapeutic aspects are discussed. General features of hospital infection are also considered.
Anti-Bacterial Agents ; Causality ; Central Nervous System Infections* ; Central Nervous System* ; Cross Infection ; Humans ; Meningitis ; Neurosurgical Procedures ; Seoul ; Wound Infection

Pituitary apoplexy is defined as a complex series of clinical events occurring as a consequence of the fulminant expansion of the pituitary tumor by infarction, hemorrhage, or hemorrhagic infarction of the tumor and the adjacent pituitary tissue. It is one of the entities which need neurosurgical emergency care. Its incidence was, however, reported variously in many literatures due to different diagnostic criteria. We reviewed 150 histologically proven pituitary adenoma cases, operated from January 1980 to September 1986, to select 30 cases which showed clinical or operative findings compatible with pitultary apoplexy('pituitary apoplexy in a broad sense'). Authors analyzed their incidence, presidposing factor, clinical feature, diagnosis and treatment, especially in those who showed major attack with evident enurologic deficits('pituitary apoplexy in a strict sense'). The conclusions are as follows; 1) Among the 150 cases of pituitary tumor, 30 cases (20.0%) were diagnosed as pituitary apoplexy in a broad sense. Eleven cases (7.3%) out of them showed major attack. 2) The symptoms and signs of the 11 cases with major attack were sudden headache(11 cases), visual impairment (9 cases), cavernous sinus compression signs (7 cases), nausea and vomiting (6 cases), depressed consciouness (4 cases), and meningismus (3 cases). 3) In the clinical diagnosis of pituitary apoplexy, findings of plain skull radiologic view were very helpful. 4) With the medical treatment and surgery, good results were achieved in all cases except one patient showing visual impairment. 5) As the method of surgical treatment, the transsphenoidal approach is highly recommended.
Cavernous Sinus ; Diagnosis* ; Emergency Medical Services ; Hemorrhage ; Humans ; Incidence ; Infarction ; Meningism ; Nausea ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Stroke ; Vision Disorders ; Vomiting

In this article author attempts to find out the typical angiographic findings of the space occupying lesions of the supratentorial and posterior fossa regions, which are relatively constant and pathognomonic signs for the accurate diagnosis of the space occupying lesions. in the vertebral angiograms. 43 cases of vertebral angiogram of the space occupying lesions of the supratentorial and posterior fossa regions studied at Seoul National University Hospital from June 1974 to September 1976 were subjected. Some obtained results will be presented.
Angiography* ; Diagnosis* ; Seoul

Authors studied the hemodynamical and angionatomical structures of the anterior cerebral artery complex in one hundred normal adult angiograms and thirty angiograms demonstrating anterior communicating artery aneurysms, which were admitted to the Department of Neurosurgery, Seoul National University Hospital in recent three years. The results are as following : 1. Observation of anterior cerebral artery complex in 100 normal adult angiogram show : Symmetrical anterior cerebral artery complex ; 77%, Asymmetrical ; 16%, Hypoplastic or aplastic : 7%. 2. Observation of anterior cerebral artery complex in 30 anterior communicating artery aneurysm angiogram shows : Symmetrical ; 40%, Asymmetrical ; 23%, Hypoplastic or aplastic : 37%. 3. Type classification of anterior cerebral artery complex in anterior communicating artery aneurysms show : Type I; 40, Type II; 13%, Type III; 47%. 4. In normal adult angiograms with cross compression test visualized portion of contralateral cerebral blood vessels is as following : A1; 7%, M1; 4%, M2; 9%, M3 or M4 ; 80%.
Adult ; Anterior Cerebral Artery* ; Blood Vessels ; Classification ; Humans ; Intracranial Aneurysm* ; Neurosurgery ; Seoul

In a consecutive series of 100 patients with ruptured saccular aneurysm, 69% of them under-went surgery and 31% did not. Of those who did not have surgery, half refused surgery and the other half had too high risk factors to be operated. Sixty seven percent of surgical cases under-went direct neck clipping, while 14% of them had wrapping or proximal clipping of anterior cerebral artery and 19% of them, carotid ligation. The mortality rate of non-microsurgery group was 14% and that of microsurgery group was 6%. The morbidity rate of non-microsurgery group was 19% and that of microsurgery group was 11%. The use of operating microscope brought about the significant reduction in the incidence of surgical mortality and morbidity.
Aneurysm* ; Anterior Cerebral Artery ; Humans ; Incidence ; Ligation ; Microsurgery ; Mortality ; Neck ; Risk Factors

The management of the patient undergoing posterior fossa surgery meets with various difficulties during and after the surgery due to the anatomical characteristics of the posterior fossa. Sitting position has been used popularly for its advantage of proper exposure of the posterior fossa lesions, but this position presents disastrous complications such as hypotension and air embolism not infrequently. Hydrocephalus, frequently complicating the posterior fossa lesions, also presents many problems during and after surgery. Postoperative brain swelling, CSF leakage and infection are other important problems of the posterior fossa surgery. The authors obtained following results with analysis of surgical results in 71 posterior fossa lesions. 1) The posterior fossa lesions are frequently present hydrocephalus and signs of increased intracranial pressure due to blockade of CSF flow. Their proper management such as steroid, diuretics and preoperative shunt made the operative manipulation easier and improved the postoperative course. 2) The major intraperative problems were air embolism and postural hypotension which were mainly related to th4 sitting position. To avoid these complications, the author propose lateral position for very old patients and those with cardiopulmonary disease or in surgery for CP angle lesion and cerebellar hemispheric lesion which can be exposed adequately with this position. 3) It way easy to detect and manage possible postoperative problems such as brain swelling, hematoma and persistent hydrocephalus with aid of CT scan and their serious outcome could be reduced.
Brain Edema ; Diuretics ; Embolism, Air ; Hematoma ; Humans ; Hydrocephalus ; Hypotension ; Hypotension, Orthostatic ; Intracranial Pressure ; Tomography, X-Ray Computed