Suprasellar cistern is uncommon location where the arachnoid cysts involve and only sporadic case reports are seen in the world literature. A case of suprasellar arachnoid cyst is reported, which mimicked such clinically common perisellar lesions as pituitary adenoma, empty sellar syndrome, dermoid cysts, etc., and could be differentiated from them preoperatively with C.T. scan and pneumoencephalography.
Arachnoid Cysts ; Arachnoid* ; Dermoid Cyst ; Pituitary Neoplasms ; Pneumoencephalography

The size of the cisterna magna is still detatable. Robertson13) stated that the cisterna magna varies greatly in capacity and described the large cisterna magna as a separate entity. He also found that in most cases the cisterna magna extended approximately 2.5cm above the foramen magnum and was usually 5mm deep with a variable width. Liliequist8) proposed a mean heigh of 28mm for the normal cisterna magna with a wide variation of 15 to 60mm, and a depth of 6mm at the foramen magnum with a variation of 2 to 10mm:however, he did not quote measurements for the width. Gonsette, et al.5) reported 28 cases of enlarged cisterna magna diagnosed by ventriculography and coined the phrase "mega grande citerne" or mega cisterna magna. All of these cases, however, had symptoms of posterior fossa disease. Our study of the syndrome of the mega cisterna magna without specific syndrome is presented nystagmus, transient syncope in the first & third cases were operated under suboccipital craniectomy and was confimed the large cisterna magna. This paper presents the clinical diagnosis with vertebral angiogrraphy, pneumoencephalography and computed tomography.
Cisterna Magna* ; Diagnosis ; Foramen Magnum ; Numismatics ; Pneumoencephalography ; Syncope

A new method for simple and accurate localization of stereotaxic targets around the third ventricle and thalamus was presented. In order to save the time and aim to localize the target even in non-visualized pneumoencephalogram during the stereotaxic procedure, a simple scale-Triangular measuring plate- has been devised. The plate which is based upon such landmarks as anterior notch of the frontal fossa, internal occipital proturbance and mid seller point shows the localization of Foramen of Monro, Thalamic Ventrolateral Nucleus and Ventralsi Intermedius Necleus etc. The triangular plate can easily be superimposed on routine skull X-ray film or pneumoencephalogram take before and during the stereotaixic surgery so that the target can at once be visualized or confirmable on the films. Pneumoencephalography is usually carried out three to five days before the surgery scheduled o exclude an unwilling headache by the day of surgery. One may point out the exact target desired on pneumoencephalogram by using the triangular measuring plate and this determined target can accurately be indicated on the films taken during the surgery. Further more experience and studies with the stereotaxic encephalometry will be expected in the future.
Cerebral Ventricles ; Headache ; Pneumoencephalography ; Skull ; Thalamus ; Third Ventricle ; X-Ray Film

The present study involves 30 craniopharyngioma patients who were admitted to the Department of Neurosurgery, Yonsei Medical college from April, 1965 to December, 1978. All 30 patients received surgery, the results of which were analyzed and evaluated as follows. 1. They consisted of 22 male and 8 female patients. Sixty percent of all patients were under 20 years of age. 2. Chief complaints were as follows:headache(80.0%), decreased visual acuity(80.0%), visual field cut(46.3%), nausea and vomiting(40.3%), papilledema(40.0%), optic atrophy(33.3%), diabetes insipidus(27.0%), and mental disturbance(27.0%). 3. They were diagnosed mainly by cerebral angiography until 1977, at times combined with pneumoencephalography, isotope brain scan, and Conray ventriculography. Since 1978 using the CT brain scan we have been able to reduce risk during and after neuroradiological study, and accurately determine location, size, shape and invasiveness of the tumor. 4. Surgical procedures were performed in 32 cases of craniopharyngioma using several approaches;transfrotal approaches;transfrontal approach:29 cases, transsphenoidal approach:2 cases, and sterotaxic cyst puncture:1 cases. In 8 cases(27.0%) total resection of the tumor was performed, subtotal resection in 23 cases(71.9%), and aspiration of the cyst in one case(3.1%). 5. In the above 32 surgeries, 24 cases(75.0%) of craniopharyngioma were performed by microsurgery, 8 cases involved total resection and 16 cases subtotal removal. As a result of microsurgery, it was possible to remove the tumor from the surrounding structures with less damage. 6. To manage hydrocephalus during the operation, extraventricular drainage was applied in 8 cases(27%) and in 7 cases(23.3%) ventriculoatrial or ventriculoperitoneal shunts were employed pre-or postoperatively. 7. Postsurgical radiation therapy was given to 8 patients in the dosage of 5000-7000 rad during 6 to 8 week period following surgery.
Brain ; Cerebral Angiography ; Craniopharyngioma* ; Drainage ; Female ; Humans ; Hydrocephalus ; Male ; Microsurgery ; Nausea ; Neurosurgery ; Pneumoencephalography ; Ventriculoperitoneal Shunt ; Visual Fields

Twenty three consecutive patients admitted to our department with the suspicion of juxtasellar tumor were subjected to computed tomographic examinations. The diagnostic accuracy of CT scan was compared to that of plain skull x-ray, carotid angiography, and pneumoencephalography. The characteristic CT findings of pituitary tumors, carniopharyngiomas and parasellar meningiomas were observed, including their contrast enhancement patterns. In pituitary adenomas, the author evaluated the enlargement of the sella turcica by calculating the sella turcica size index with the use of measured interclinoid distance on CT Polaroid pictures. The results were as following: 1) CT gave the highest accuracy of various diagnostic tools, indicating that CT has become the screening method of choice in the detection of juxtasellar masses along with its another advantage of noninvasiveness. 2) Pituitary adenomas showed significant enlargement of the sella turcica according to the author's sella turcica size index. Size index above 2.5 was thought to have to be interpreted as an abnormally enlaged sella turcica. 3) Suprasellar cistern was visualized in 87% of 23 normal CT scans as a pentagone(48%) or a hexagone(43%) or a tetragone(9%), but it was identified only in 51% of supratentorial mass lesions. 4) Pituitary adenomas invariably showed positive contrast enhancement(100%), but rarely contained calcification(10%) or dilatation of ventricles(8%). 5) Craniopharyngiomas generally contained large dense calcifications or partly calcified peripheral ring(83%) and cyst formation(83%). Contrast enhancement(67%) and hydrocephalus(50%) were often found, but enlargement of the sella turcica was unusual(3%). 6) As compared to the tendency of anterolateral growth in pituitary adenomas, craniopharyngiomas were often found to extend posterosuperiorly. 7) It was advantageous to perform the operation at the side of predominant location of the tumor in suprasellar cistern or at the side of the cystic portion of the tumor. 8) A case of hypothalamic glioma was operatively verified that appeared as an isodense suprasellar mass, showing marked contrast enhancement.
Angiography ; Craniopharyngioma ; Dilatation ; Glioma ; Humans ; Mass Screening ; Meningioma ; Pituitary Neoplasms ; Pneumoencephalography ; Sella Turcica ; Skull ; Tomography, X-Ray Computed

The birth of myelography was presaged by Dandy's classic description of pneumoencephalography in 1919. After then, many contrast media, such as Pantopaque, Lipiodol, Abrodil, Dimer-X, and Conray-60, were developed and myelography was achieved in widespread popularity for diagnosis in low back pain, especially on the syndrome of herniated intervertebral disc. During the past few years, the picture has changed dramatically because of the availability of Metrizamide, a new, less toxic, non-ionic, aqueous medium. So, the authors have seen and studied 165 cases of. low back pain with respect to the diagnostic classification and clinical acceptance of Metrizamide myelographic examination from May, 1982 to April, 1985 at Department of Orthopaedic Surgery, College of Medicine, Soon Chun Hyang University. The results were summerized as followings; l. Among the 165 cases, myelographic finding was classified in 4 groups and 7 types, and showed as group 1(41), group 2 and type a(46), group 2 and type b(21), group 3 and type a(9), group 3 and type 1(15), group 3 and type c(16), and group 4(17). 2. The predominent type in the 57 operative cases was group 4(46, 27.9%). 3. In clinical analysis, tenderness was predominent in most types, but sensory changes in group 4. 4. Step by step in types, anatomical changes was seen more often than funtional changes in plain X-ray. 5. Myelographic accuracy was coincided with operative findings in 75.4% and 7 cases of false negative and 5 cases of false positive. 6. In disc findings, the extruded type was seen predominently in group 4 as 29.4%. 7. Above group 3 and type a, the prognosis of operative treatment was excellent than conservative.
Classification ; Clinical Study ; Contrast Media ; Diagnosis ; Ethiodized Oil ; Intervertebral Disc ; Iophendylate ; Low Back Pain ; Metrizamide ; Myelography ; Parturition ; Pneumoencephalography ; Prognosis

We have experienced 17 cases of the upper brain stem compression lesions diagnosed by serial vertebral angiography and other ancillary studies from October, 1972 to August, 1975. All the cases were proven by serial vertebral angioraphy using the Seldinger catheter technique through the femoral artery and other studies such as carotid angiography, conray ventriculograpy, brain scan and pneumoencephalography. Angiographical analysis were attempted. The results were as following: 1. The location of lesion is:supratentorial lesions; 8 cases, infratentorial lesions; 5 cases, tentorial lesions; 3 cases, bilateral hippocampal herniation due to otitic hydrocephalus; 1 case. 2. We have tried to classify the upper brain stem compression lesions according to the direction of compression, i.e., (1) forward, (2) medial, (3) backward and (4) downward and analyzed their angiographic findings in detail. 3. Lesions compressed the upper brain stem forward were one case of bilateral occipital meningioma, one case of fourth ventricle tumor, two cases of medulloblastoma and one case of cerebellar hemispheric tumor. Their main angiographic findings were as follows;(1) Separation of quadrigeminal segment of superior cerebellar artery and posterior cerebral artery, (2) Compression of basilar artery against clivus and depression or elevation of bifurcation of basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward displacement of posterior mesencephalic vein and posterior displacement of precentral cerebellar vein, (5) Elevation of vein of Rosenthal. 4. Lesions compressed the upper brain stem medially were two cases of parietal ependymoma, one case of temporal meningioma, one case of bilateral hippocampal herniation and three cases of tentorial tumors. Their main angiography findings were as follows; (1) Medial displacement of posterior cerebral artery, superior cerebelar artery, bifurcation of basilar artery, distal portion of vein of Rosenthal, lateral mesencephalic vein and internal cerebral vein in Towne's view, (2) Elevation or depression of posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of crural and ambient segment of superior cerebellar artery. 5. Lesions compressed the upper brain stem backward were one case of pituitary tumor and one case of cerebellopontine angle tumor. Their main angiographic findings were as follows; (2) Posterior displacement of distal portion of basilar artery, (2) Posterior displacement of anterior pontomesencephalic vein, (3) Elevation of posterior cerebral artery and superior cerebellar artery, (4) Elevation of vein of Rosenthal and posterior mesencephalic vein, (5) Stretching and elevation of posterior communicating artery. 6. Lesions compressed the upper brain stem downward were one case of thalamic tumor, one case of thalamic hemorrhage, and one case of pinealoma. Their main angiographic findings were as follows; (1) Stretching of posterior cerebral artery and superior cerebellar artery, (2) Displacement and stretching of internal cerebral vein, vein of Rosenthal and posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of posterior cerebral artery and superior cerebellar artery, (6) Depression of internal cerebral vein, vein of Rosenthal, posterior mesencephalic vein and anterior pontomesencephalic vein. 7. We have concluded that in order to diagnosis the upper brain stem compression lesions serial vertebral angiography is the most important procedure and at the same time the analysis of the arteriographic and venographic findings in detail is important.
Angiography* ; Arteries ; Basilar Artery ; Brain Stem* ; Brain* ; Catheters ; Cerebral Veins ; Cranial Fossa, Posterior ; Depression ; Diagnosis ; Ependymoma ; Femoral Artery ; Fourth Ventricle ; Hemorrhage ; Hydrocephalus ; Medulloblastoma ; Meningioma ; Neuroma, Acoustic ; Pinealoma ; Pituitary Neoplasms ; Pneumoencephalography ; Posterior Cerebral Artery ; Rabeprazole ; Veins