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*

Spontaneous hematomyelia is an acute expanding lesion by the hemorrhage within the substance of the located primarily in the gray matter. It is necessary to have urgent operation to preserve the remainding cord function. We are reporting a rare case of spontaneous hematomyelia extending from T-8 to T-10 of unknown cause of which transverse symptoms have largely subsided after surgical evacuation of the liquefied hematoma.
Hematoma ; Hemorrhage ; Spinal Cord Vascular Diseases*

Intracerebral metastatic choriocarcinoma is characterized by acute apoplexy bue to vascular invasion with tumor emboli. We experienced 3 cases of intracerebral metastatic choriocarcinoma having such a apoplexy and rebleeding.
Choriocarcinoma* ; Female ; Pregnancy ; Stroke*

Seventy-five patients with moyamoya disease were admitted at Kyung Hee University Hospital from 1978 to 1993. Of these, we followed up fourty-five cases who had been treated conservatively for the study of the natural history of moyamoya disease. Seven operated cases and six dead patients during admission were excluded in this study and sixteen cases were lost to follow-up. There were 16 males and 29 females. The hemorrhagic group was twenty-three cases and the non-hemorrhagic group was twenty-two cases. On angiographic findings, the typical type was twenty-eight cases and the atypical type was seventeen cases. Twenty-one cases(91%) of the hemorrhagic group were over twenty years old and sixteen cases(73%) of the non-hemorrhagic group were under twenty years old. The mean follow-up period was 66 months(range 6 months to 15 year 4 months). Nineteen cases had reattack, but most of them had good result except only two cases who died due to huge intracerebral hematoma. Of the sixteen cases, who were under twenty years old and manifested as transient ischemic attack, fifteen cases were improved only with conservative management. The good result of fourty-one cases out of fourty-five with conservative management. suggests that spontaneous collateral circulation had developed well to restore the function of ischemic brain in the natural course of moyamoya disease. Moyamoya disease seems to be not so worse in natural course than expected and further study about natural history will be necessary.
Brain ; Collateral Circulation ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Ischemic Attack, Transient ; Lost to Follow-Up ; Male ; Moyamoya Disease* ; Natural History*

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

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

A case of mucocele of the sphenoid sinus having diplopia and headache is presented. This rare disorder is benign and curable by simple intranasal procedure. But it is often misdiagnosed as malignant or pituitary tumor, and unnecessary treatment such as radiotherapy or craniotomy has been performed. We removed it by sublabidal trans-septal trans-sphenoidal approach without difficulties and postoperative complications.
Abducens Nerve Diseases ; Craniotomy ; Diplopia ; Headache ; Mucocele ; Pituitary Neoplasms ; Postoperative Complications ; Radiotherapy ; Sphenoid Sinus*

We have experienced 480 cases of Cerebrovascular Disorder confirmed by C. T. Brain scan, who admitted to the Kyung hee Medical Center from January 1979 to December 1980. The authors have analyzed the clinical aspects of Cerebrovascular Disorder. The following results are obtained. 1) Intracranial hemorrhage group is more commoner than occlusive group. The sixth decade is most frequently involved. Male is more affected. 2) Headache is most frequent initial symptom and next sequence is paresis. 3) The prognosis is correlated with the initial consciousness level, initial CSF pressure and hematoma volume. 4) In the intracranial hemorrhage group, the prognosis is somewhat better in the operative cases than in the non-operative cases.
Brain* ; Cerebrovascular Disorders* ; Consciousness ; Headache ; Hematoma ; Humans ; Intracranial Hemorrhages ; Male ; Paresis ; Prognosis ; Subarachnoid Hemorrhage