Two cases of carotico-cavernous fistula, which experienced at Dept. of Neurosurgery of Busan National University Hospital, are presented with a brief review of the literature. Because it is the very interesting disease. These were of spontaneous onset. One was 39 year-old woman who was treated with the ligations of internal and common carotid artery in the neck, another was 17 year-old boy treated with the ligations of internal and common carotid artery followed by intraluminal mascular embolization. This surgical management was successful and there was neither recurrence nor other neurologic deficit.
Adolescent ; Adult ; Busan ; Carotid Artery, Common ; Female ; Fistula* ; Humans ; Ligation ; Male ; Neck ; Neurologic Manifestations ; Neurosurgery ; Recurrence

Author has attempted to measure serial blood leucocyte and pseudoeosinophilic neutrophil counts to study the inter-relationships between blood total leucocyte levels and severity with prognostic significance of various craniocerebral injuries induced experimentally in rabbits. The experiments were performd on 31 rabbits of male sex, weighing between 1.5 and 1.7kg. On the degree of difference and severity of experimental injuries the animals were divided into the following 6 different groups;subarachnoid hemorrhage(Group I), local brain malacia(Group II), intracerebral hematoma(Group III), intraventricular hematoma(Group IV), unilateral carotid ligation(Group V), bilateral carotid ligation(Group VI). In each groups, total leucocyte and pseudoeosinophilic neutrophil counts were measured at times 1 hr., 3 hr., 6 hr., 12 hr., and 1, 2, 3, 4 day, respectively, after the injuries. The following results were obtained: 1. Mean levels of total leucocyte and pseudoeosinophilic neutrophil counts were 7263(193/mm3 and 35.1% in the control group. 2. The injured group, when compared to the control group of animals, had significantly raised total WBC and pseudoeosinophil counts at 3 hr. after the injuries, and the counts were returned to normal range at the third day after the injuries. 3. In each series of the unilateral carotid ligation, the raised total WBC and pseudoeosinophil counts did not differ significantly in the right ad left series each other. 4. Total WBC and pseudoeosinophil levels in the group of bilateral carotid ligation were progressively increased and the highest levels were seen between 6 hr. and 12 hr. after the injuries. 5. The most raised total WBC and pseudoeosinophil levels were seen in the group with bilateral carotid ligation and the next group was intraventricular hematoma, and the least raised group was subarachnoid hemorrhage. 6. It was concluded that the data showed highly significantly positive correlation between total WBC and pseudoeosinophil counts with the severity of injuries and its prognosis of craniocerebral injuries of rabbits induced experimentally. The greater increase in serial total WBC and pseudoeosinophil counts was seen in the group associated with higher degree of injuries, and the counts became to normal range at the third day with parallel to the degree of recovery after the injuries.
Animals ; Brain ; Craniocerebral Trauma ; Hematoma ; Humans ; Ligation ; Male ; Neutrophils* ; Prognosis ; Rabbits* ; Reference Values ; Subarachnoid Hemorrhage

This study was carried out to find out changes in regional cerebral blood flow(r-CBF) in relation to(i) clinical status of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms ; (ii) the degree of subarachnoid hemorrhage as indicated by brain CT scanning ; (iii) the severity of angiographic vasospasm, and (iv) other neuropathological condition. Measurement of r-CBF were performed, using 133Xe inhalation method, on 50 patients with ruptured intracranial aneurysms. Some of the major findings were as follows : 1) The degree of abnormalities of blood flow correlated well with the clinical severity of neurological deficits. 2) A marked reduction in r-CBF was found in patients with intracerebral hematoma, ischemic lesion and hydrocephalus. 3) In angiospasm area, r-CBF was found in patients with intracerebral hematoma, ischemic lesion and hydrocephalus. 3) In angiospasm area, r-CBF decreases below 30ml/100gm/min in almost all of the patients, and severity of vasospasm correlated with the decrease of CBF. 4) The measurement of CBF on patients with subarachnoid hemorrhage was thought to the useful for foreseeing the clinical outcome of the patients.
Brain ; Hematoma ; Humans ; Hydrocephalus ; Inhalation ; Intracranial Aneurysm* ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

A clinical analysis for bifrontal craniectomy had been carried out with 30 cases at Busan National University Hospital during the period from July of 1972 to June of 1973. The patient's conditions such as bilateral dilated fixed pupils, decerebrated rigidity, apneic respiration, and coma were sometimes regarded to contraindication for the department of neurosurgery to operate. This wide procedure enabled to allow identification of confused and lacerated brain, evacuation of acutely accumulated blood and necrotic brain, and decompression of swollen brain under direct visualization. The author reviews 30 cases operated, and among them, 6 were survived. Before report this technique, we did not operate on the patients who exhibiting apnea and bilaterally dilated fixed pupils. Such clinical signs are commonly preceded to death, and we have recommended conservative therapies such as hyperosmolar agents and steroids to combat brain swelling in this desperately ill patient. Our clinical impression that bifrontal decompressive craniectomy was useful for severe craniocerebral injury and swelling was unable to prove with unequivocal documentation from these cases that their survival was uniquely attributable to the bifrontal craniectomy. I presents my appraisal of the case material, not so much as proof of it's superiority over other methods, but rather as provocation for further critical appraisal of it's use.
Apnea ; Brain ; Brain Edema ; Busan ; Coma ; Craniocerebral Trauma* ; Decompression ; Decompressive Craniectomy* ; Humans ; Neurosurgery ; Pupil Disorders ; Respiration ; Steroids

Recent technological advances in ultrasound instrumentation have resulted in equipment that will image in "real-time" slices of the human brain similar in quality to computerized tomography(CT). Multiple authors have attested to its usefulness in locatin, characterizing, and facilitating in the biopsy or removal, or both, of intracerebral masses. In this study, the author has examined the efficacy of intraoperative neurosurgical ultrasound in 18 patients who were admitted to the Department of Neurosurgery, Kyung Hee University Hospital. The results were as follows : 1) It can provide critical assistance in precise localization of subcortical masses, since in many instances the overlying surface of brain provides no clue for localization. 2) This technique is very useful for the identificantion of deep lesions, provding infromation about their solid and cystic components and about the shortest route of access to tumor. 3) It provides precise information to help guide biopsy needles into deep lesions, and to confirm their presence within the lesion itself. 4) The system is highly accurate in visualizing ventricular catheters during and after their placement. 5) The system is inherently safe for the patient and the operating room personnel since there is no radiation exposure.
Biopsy ; Biopsy, Needle ; Brain ; Catheters ; Humans ; Needles ; Neurosurgery* ; Operating Rooms ; Ultrasonography*

Hemifacial spasm (HFS) is almost always induced by vascular compression but in some cases the cause of HFS are tumors at cerebellopontine angle (CPA) or vascular malformations. We present a rare case of hemifacial spasm caused by epidermoid tumors and the possible pathogenesis of HFS is discussed. A 36-year-old female patient presented with a 27-month history of progressive involuntary facial twitching and had been treated with acupuncture and herb medication. On imaging study, a mass lesion was seen at right CPA. Microvascular decompression combined with mass removal was undertaken through retrosigmoid approach. The lesion was avascular mass and diagnosed with an epidermoid tumor pathologically. Eventually, we found a offending vessel (AICA : anterior inferior cerebellar artery) compressing facial nerve root exit zone (REZ). In case of HFS caused by tumor compression on the facial nerve REZ, surgeons should try to find an offending vessel under the mass. This case supports the vascular compression theory as a pathogenesis of HFS.
Acupuncture ; Adult ; Cerebellopontine Angle ; Epidermal Cyst ; Facial Nerve ; Female ; Glycosaminoglycans ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Vascular Malformations

No abstract available.
Aneurysm* ; Arteries*

No abstract available.
Age Factors* ; Hematoma, Subdural, Chronic*

In order to study the relationship between clinical group of cervical spondylosis and electrical activity, we traced somatosensory evoked potential(SSEP) by stimulating the median nerve(MN) from the upper extremities, and the posterior tibial nerve(PTN) from the lower extremities simultaneously. The purpose of this study was to test the clinical diagnostic utility of the method, whether any consistent relationship exists between the severity and type of neurological symptoms and the results of the SSEP responses, and between neurological improved patients after operation and improved SSEP results. In this study patients were clinically divided into three groups : combined myelopathy and radiculopathy, myelopathy alone, radiculopathy alone. Over a 3-year period from 1987 to 1989, SSEP were performed on 112 patients of Korean adults and summary of the results obtained are as follows : 1) Among patients with cervical spondylosis, those with cervical myelopathy showed more abnormal SSEP than those cervical radiculopathy. 2) In the group with myelopathy, MN-cervical latensy, Ep-C2 interpeak latency. PTN-P1 latency, and N1 latency were prolonged more than MN-C2 latency, Ep-C2 interpeak latency, PTN-P1 latency, and N1 latency of the group with radiculopathy. 3) The longer the duration of the symptoms, the more abnormal were the SSEP in patients with cervical spondylosis. 4) In patient with cervical myelopathy, the latency of SSEP was prolonged not only in those with sensory deficit, but also with motor deficit. 5) Half of clinically improved patients after operation showed improved SSEP in follow-up examinations. 6) Improvement in SSEP after operation was much affected by posterior approach.
Adult ; Evoked Potentials, Somatosensory* ; Follow-Up Studies ; Humans ; Lower Extremity ; Radiculopathy ; Spinal Cord Diseases ; Spondylosis* ; Upper Extremity

We experienced the unusual C.T. finding of meningioma recently. Classical C.T. finding of meningioma reveals found homogenous high density or isodensity in the plain C.T. and homogenous marked enhancement in the postinfusion C.T. But, some of meningioma demonstrates atypical features such as irregular areas of nonenhancing mass, irregular ill-defined enhancing mass with large area of peritumoral edema, low density area within the mass representing necrosis and cystic change. C.T. finding that we experienced revealed ring-formed high density in the plain C.T. and homogenous strong enhancement in the postinfusion C.T.
Edema ; Meningioma* ; Necrosis