Recurrent episode of meningitis in infants and children frequently constitute a frustrating and distressing, both in determination of course and treatment. The authors are reporting a infected case of congenital dermal sinus with dermoid cyst in the subarachnoid space of cauda equina and conus medullaris which was cured after complete removal of cyst and sinus tract.
Cauda Equina ; Child ; Conus Snail ; Dermoid Cyst ; Humans ; Infant ; Meningitis ; Spina Bifida Occulta* ; Subarachnoid Space

This study was performed for the patients with benign prostatic hyperplasia who had underlying diseases which increase the risk of spinal or general anesthesia. Standard transurethral resections of prostate were done on patients with prostatic hyperplasia under local anesthesia. The selection criteria were urinary retention or below 10 ml/sec of maximum flow rate, coexist with medical problems which increase the risk of spinal and general anesthesia. Local infiltrations of 1% lidocaine were done at penoscrotal junction on each side of the corpus spongiosum, the lateral portion of the prostate and the bladder neck. This anesthesia was supplemented usually by modest dose of intravenous tranquilizers and analgesics under the continuous monitoring by an anesthesiologist. The Visual Pain Analogue Scale(VAS) was used for the evaluation of intraoperative and postoperative pain. The mean operating time, amount of the resected tissues and intraoperative and postoperative visual analogue scale were 50.2 min, 16 grams. 2.7 and 2.0. We thought that this type of anesthesia was a safe, simple and effective procedure.
Analgesics ; Anesthesia ; Anesthesia, General ; Anesthesia, Local* ; Humans ; Lidocaine ; Neck ; Pain, Postoperative ; Patient Selection ; Prostate ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate* ; Urinary Bladder ; Urinary Retention

Cervical traction has been widely used as an essential method for the treatment of cervical fracture-dislocation. This report, however, was a case in which hazardous effect of traction due to unreduced huge fragment was demonstrated only by cervical CT scan. Surprisingly plain X-rays could not demonstrated this condition. It was apparent that skeletal traction resulted in further injury of the spinal cord. Surgical removal of unreduced huge fragment was accomplished completely and interbody fusion was followed. Postoperative CT findings showed complete removal of fragment and decompression of the spinal cord as well as gratifying interbody fusion. CT scanning is imperative to evaluate the cervical fracture-dislocation and blind skeletal traction may be hazardous.
Decompression ; Spinal Cord ; Spinal Cord Injuries ; Tomography, X-Ray Computed* ; Traction

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.
Head ; Humans ; Metrizamide* ; Myelography* ; Neck ; Needles ; Operating Tables ; Prone Position ; Punctures* ; Spinal Canal ; Spinal Cord ; Spinal Cord Neoplasms ; Spinal Puncture ; Subarachnoid Space

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.
Discitis ; Diskectomy* ; Humans ; Microsurgery ; Surgical Instruments

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.
Diagnosis ; Humans ; Myelography* ; Spinal Stenosis

The authors operated 127 cases of the spontaneous intracerebral hematoma patients who were admitted via the emergency room during the recent two years. The location, timing of operation, method of approach, mortality etc. were analyzed. The results are as follows : 1) putaminal hemorrhage was 47.3%, thalamic hemorrhage was 23.6%, subcortical hemorrhage was 18.9%, cerebellar hemorrhage was 3.9%, pontine hemorrhage was 1.6%, and IVH only was 4.7%. 2) 77.2% was operated during the first 48 hours from the onset. 3) Almost all of the procedures were transcortical and trans-sylvian approach. 4) The mortality rate was 52.0%. 5) Microsurgical technique and external ventricular drainage(or ventriculoperitoneal shunt) played an important role for the good surgical outcome.
Emergency Service, Hospital ; Hematoma* ; Hemorrhage ; Humans ; Mortality ; Putaminal Hemorrhage ; Ventriculoperitoneal Shunt

Cervical cordotomy via anterior approach without bone graft which is a modified Cloward's method is an effective and simple means of relieving of intractable pain with minimal destruction of bone lower morbidity and mortality. This method consists of an anterior surgical approach to the ventral surface of the cervical cord through a simple discectomy. A transverse incision in the dura mater gives excellent exposure permitting incision of the spinothalamic tracts under direct vision. For bilateral pain both incision are made at the same level of the cord without causing impairment of motor function of the lower extremities or bowel and bladder. This procedure has also many advantages and disavantages as follows ; 1. Cervical cordotomy by the this procedure has a much lower morbidity and fewer complications than the conventional procedure by laminectomy. 2. A more complete section of the spinothalamic tract is possible under direct vision. 3. A differential section of the tract with sparing of sensation in non-painful areas is possible by this procedure. 4. An incidence of the cord trauma can be minimized because the incision is possible without distorsion and traction of the cord during the operation. 5. This procedure without bone graft is simpler than original Cloward's method. 6. An water-tight closure of the dura is difficult but successful results are obtained by using a gelfoam. 7. This procedure above the level of the C3-4 interspace is difficult but possible. 8. A relief of pain below the level of the T3 dermatome is available and there is no good operative candidate when the brachial plexus is involved.
Brachial Plexus ; Cordotomy* ; Diskectomy ; Dura Mater ; Gelatin Sponge, Absorbable ; Incidence ; Laminectomy ; Lower Extremity ; Mortality ; Pain, Intractable ; Sensation ; Spinothalamic Tracts ; Traction ; Transplants* ; Urinary Bladder

Study of 22 cases with the pseudospondylolisthesis established that it occurred more frequently in the older women, and far more frequently at the L4 level, as same results as reported by others. The slipping occurred as a result of degenerative disease of the articular process and facet joint, but it never exceeded 25% in this series. This study was performed to recognize the stability of the lumbosacral joint by the measurement of the anterior and posterior vertical heights(deformity) of the body of the L5 vertebra and lumbosacral angles in our cases. We also attempted to observe whether the facet angle changes at the involved level was meaningful or not. Result : lumbosacral angles in the our patients with pseudospondylolisthesis were increased greater than normal, so lumbar lordosis was less than normal. The body of the L5 vertebra was not as wedged anteroposteriorly as it normally was. The contour of the body of the L5 vertebra resembled rectangle shape. The pedicle-facet angles were increased at involved level, but this measurement was not correctly demonstrated on the plain roentgenograms. Conclusion : The stability of the lumbosacral joint in the patients with pseudospondylolisthesis was increased due to rectangle shape of the body of the L5 vertebra and less lumbar lordosis. The pedicle-facet angles at the involved level were increased, but not correct diagnostic values.
Animals ; Female ; Humans ; Joints ; Lordosis ; Spine ; Zygapophyseal Joint

Sturge-Weber syndrome was rare. But reported from 1860. We present a typical case of Sturge-Weber syndrome in a child and discussed the symptoms, signs, and pathological finding of various examinations in neurosurgical field such as plain x-ray, 4-vessel angiography, CT scan, EEG, IQ test, exophthamometry, opthalmometry, and fundoscopy. We find marked abnormality and asymmetry in that examination.
Angiography ; Child ; Electroencephalography ; Humans ; Sturge-Weber Syndrome* ; Tomography, X-Ray Computed