Three patients development subdural pneumocephalus after undergoing posterior fossa surgery performed in sitting position. The mechanism for entry of air into the intracranial compartment is analogous to the entry of air into an inverted bottle. As the fluid pours out, air bubbles to the top of the container. A brow-up lateral skull radiograph with a horizontal beam provided prompt diagnosis and confirmed brain displacement as well as computerized tomography did. Tension pneumocephalus appears to be another potential complication of posterior fossa surgery in sitting position. This condition is easily diagnosed and treated, and should be considered whenever a patient fails to recover as expected following posterior fossa surgery.
Brain ; Diagnosis ; Humans ; Pneumocephalus* ; Skull

A case of Tuberculous abscess in cerebrum, in a 17 years-old male, is presented, which was confirmed Pathologically and microbiologically. At present, tuberculous infection progressively decrease, and especially occurs rarely tuberculous abscess in central nerve system. The prognosis is known to be poor. We have experienced a case of tuberculous abscess in cerebrum and obtained a good result after surgery. So, we report our case with a brief review of the articles.
Abscess* ; Adolescent ; Cerebrum* ; Humans ; Male ; Prognosis

Using Xenon inhalation method, the authers measured the rCBF's within 24 hours before and after the operation of 4 AVM patients. We found the obliteration of the cerebral steal syndrome in all cases and the loss of initial shunt peak in 2 cases after excision of AVM. We discussed these hemodynamic changes in AVM and reviewed the literatures.
Hemodynamics ; Humans ; Inhalation ; Intracranial Arteriovenous Malformations* ; Xenon

With 4 channel Nicolet-CA 1000 clinical averager and 133 Xenon inhalation method, somatosensory evoked potentials (SSEP), brainstem auditory evoked potentials (BAEP) and regional cerebral blood flow (r-CBF) were studied in 30 patients with ruptured cerebral aneurysms. 8 out of 30 patients had abnormal SSEP, 11 out of 30 patients had abnormal BAEP and 4 out of 14 patients had decreased r-CBF. The SSEP was abnormal in 6 out of 10 patients with severe vasospasm but in only 2 out of 20 patients without vasospasm or with mild and moderate spasm. The BAEP was abnormal in 5 out of 10 patients with severe vasospasm but 6 out of 20 patients without spasm or with mild and moderate spasm. Regional CBF was decreased in 3 out of 4 patients with severe vasospasm but only 1 out of 10 patients without spasm or with mild and moderate spasm. Abnormal SSEP, BAEP & decreased r-CBF in patients with severe vasospasm indicated a poor prognosis. We got the results as follows ; 1) Abnormal SSEP, BAEP and decreased r-CBF are correlated with severity of vasospasm in SAH patients. 2) Abnormal SSEP and BAEP correlated with the clinical status. 3) Brain stem transmission time (BTT) is less sensitive than central conduction time (CCT) as indicator of vasospasm.
Brain Stem ; Evoked Potentials* ; Evoked Potentials, Auditory, Brain Stem ; Evoked Potentials, Somatosensory ; Humans ; Inhalation ; Intracranial Aneurysm ; Prognosis ; Spasm ; Xenon

1210 patients with adult head injury who were admitted to the Department of Neurosurgery, Kyung Hee University Hospital during the period of 5 years from January, 1980 were analyzed clinicostatistically. The results were as follows : 1) There were 842 male and 368 females with the ratio of 2.3 : 1. 2) Higher incidence was observed on May and September of the year, and between 6:00 P.M. and 8:00 P.M. of the day. 3) The most common cause of head injury was traffic accident(58.3% of the total cases), especially pedestrian accident and the next causes were fall-down and assaults. 4) Loss of consciousness was observed in 862 cases(71% of the total cases) and the duration of unconsciousness seemed to be related with severity of clinical course. 5) Lucid interval was observed in 21.4% of the cases of intracranial mass lesion and the highest manifestated lesion was epidural hematoma. There was vomiting in 31.2% of the total cases and early posttraumatic epilepsy in 2.1%. 6) Skull fractures were identified in 375 cases ; 273 cases of linear, 50 cases of depressed, 41 cases of basal and 11 cases of diastic fractures. The most common site of linear skull fracture was temporoparietal bone. 7) 79.8% of epidural hematomas were associated with skull fractures and the most common site of hematoma was temporal area. 8) Of all cases of subdural hematoma, acute type was prevalent(59.7%) and in main involved site was frontotemporoparietal area. 9) The frequent associated injuries were mandible fracture and other facial bone fracture, chest injury and lower extrimities fracture in order. 10) The minor head injury of Glasgow Coma scale score(GCS) of 13 to 15 was 864 cases(71.4%), the moderate head injury of 9 to 12, 139 cases(11.5%), and the severe head injury of 3 to 8, 207 cases(17.1%). 11) Of 270 cases of severe head injury, the mortality was 43% and 21% had good recovery. But outcome was different according not only to GCS but also to the type of lesion. 12) Acute subdural hematoma with GCS of 3 to 5 was uniformly the worst problem(88% mortality), whereas subacute and chronic subdural hematoma had good outcome. 13) The overall mortality was 8.0% and the operation mortality in 283 cases was 19.8%. Among the 1,210 cases of head injury in adults, 80.8% showed good recovery and 11.2% remained in disabled or vegetative state.
Adult* ; Craniocerebral Trauma* ; Epilepsy ; Facial Bones ; Female ; Glasgow Coma Scale* ; Head* ; Hematoma ; Hematoma, Subdural, Acute ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Male ; Mandible ; Mortality ; Neurosurgery ; Persistent Vegetative State ; Skull Fractures ; Thoracic Injuries ; Unconsciousness ; Vomiting

Authors experienced fifteen cases of the pineal tumors during about 5 years from October, 1977 to September, 1982, which were diagnosed with brain C-T scanning. The details of clinical evaluation and follow up of 15 cases of the pineal tumors are presented. The following results were obtained. 1) The age group below age of 20 years in predominant and include 11 cases(73%) of 15 cases, and male is predominantly much than female. 2) On the neurological examination at admission, the RICP signs were showed in 15 cases, Parinaud's syndrome showed in 6 cases, cranial nerve palsy in 8 cases and DI symptom in 5 cases of all 15 cases. 3) In the follow up study, brain CT was more effective than any other conventional neuroradiologic technique. 4) 8 cases of all 15 cases have had normal life in follow up period with minium of 6 months and maximum of 6 months and maximum of 5 years, and one case with mild neurological deficit has been spent life for about 12 months. 5) Of 6 cases died within 2 years, 3 cases had insufficient treatment and 3 cases had sufficient treatment, of whom ond had tumor recurrence at primary site and dissemination to spinal epidural space and other two cases were suspected to have clinical dissemination to spinal cord. 6) On the basis of high survival rate in 9 cases of 12 cases who were treated completely, we thought that good survival rate in the patient with pinealoma will be resulted from a series of planed treatment, including early diagnosis, correction of hydrocepalus, surgical intervention and irradiation.
Brain ; Cranial Nerve Diseases ; Early Diagnosis ; Epidural Space ; Female ; Follow-Up Studies* ; Germinoma ; Humans ; Immunotherapy ; Male ; Neurologic Examination ; Ocular Motility Disorders ; Pinealoma* ; Recurrence ; Spinal Cord ; Survival Rate

Three cases of cerebral rete mirabile associated with aneurysms are presented. In two cases the aneurysms were located at the anterior communicating arteries, and in one at the peripheral portion of the middle cerebral artery. For the anterior communicating artery aneurysms, operations were performed. Based on these experiences, the difficulties and necessities of operations for the aneurysms associated with cerebral rete mirabilies are briefly discussed.
Aneurysm* ; Arteries ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mirabilis ; Moyamoya Disease*

The authors report two cases of aneurysms of basilar bifurcation approached by modified frontolateral transsylvian route: each aneurysm was clipped successfully through the space between internal carotid artery and posterior communicating artery in case 1 and the space between internal carotid artery, posterior communicating artery and oculomotor nerve in case 2. Historical background and surgical approaches are discussed.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Oculomotor Nerve

High doses of corticosteroids have been found to have beneficial effects in various shock states. It has been well recognized that ischemia is one of the important factors in shock states. This prompted us to investigate the effect of high dose methylprednisolone on tourniquet induced ischemia. The results were as follows: 1) The heart rate did not change significantly after tourniquet release in both group. 2) The mean arterial pressure decreased ignificantly at 1 minute after tourniquet release in both group. 3) The PaO2,PaCO2 and HCO-(3) did not change significantly after tourniquet release in both group. 4) The pH decreased significantly at l minute and 5 minutes after tourniquet release in control group and did not change in methylprednisolone group. 5) Base excess increased significantly at 1 minute and 5 munutes after tourniquet release in control group and did not change significantly in methylprednisolone group. In conclusion, the results of this study indicate that methylprednisolone provides a beneficial effect during tourniquet ischemia.
Adrenal Cortex Hormones ; Arterial Pressure ; Heart Rate ; Hydrogen-Ion Concentration ; Ischemia* ; Methylprednisolone* ; Shock ; Tourniquets*

Carotid cavernous sinus fistula is abnormal communication between the carotid artery and the cavernous sinus. It can be classified according to three criteria : 1) pathologically into spontaneous or traumatic ; 2) hemodynamically into high flow or low flow fistula ; 3) angiographically into direct or dural fistula. We studied the regional cerebral blood flow changes in traumatic carotid cavernous sinus fistula. Regional cerebral blood flow checked 7 times during trapping procedure. The results are as follows ; 1) regional cerebral blood flow decreased in normal side than in lesion side hemisphere in the state of carotid cavernous fistula. 2) After compression of lesion side common carotid artery over 10 minutes, cerebral blood flow increased in both side. 3) Cerebral blood flow decreased temporary after operation on both side but normalized 2 or 3 weeks later.
Carotid Arteries ; Carotid Artery, Common ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Fistula*