No abstract available.

Since introduction of magnetic resonance imaging(MRI), six cases of multiple intracranial meningiomas without signs of neurofibromatosis were found among the forty eight cases of meningiomas. The incidence of multiple intracranial meningiomas in our series was 12.5% of all meningiomas. We analyzed six cases of multiple intracranial meningiomas that were evaluated by MRI. Two tumors were found in five patients, whereas the other one patient had more than ten tumors at different sites. The tendency of unihemispheric distribution was not seen and two cases had bilaterally located tumors and other two cases had tumors above and below the tentorium without tentorial involvement. Relatively high occurrence of meningioma in posterior fossa was observed. Half of the six cases had posterior fossa tumors and 6 tumors(28.6%) of the total 21 tumors were located in the posterior fossa. All the cases were female. Mean age on admission was 61.3 years, ranged from 44 to 77 years. All six patients were treated surgically and three of them underwent multiple staged operations. Histologically, of the 12 tumors removed, 5 were transitional, 4 were fibroblastic, 3 were meningothelial. The histological subtypes of tumors in each case were different in two cases, but identical in other three cases. The surgical results, although the follow-up periods(ranged 3 months to 2.5 years) were not long enough in some cases, were favorable.
Female ; Fibroblasts ; Follow-Up Studies ; Humans ; Incidence ; Infratentorial Neoplasms ; Magnetic Resonance Imaging ; Meningioma* ; Neurofibromatoses

To clarify possible causes, pathogenesis, and appropriate prevention method of remote intracerebral hemorrhage (RICH), we analyzed the clinical findings and the possible predisposing factors of six cases who developed RICH among the 206 surgical series of cerebral aneurysm operated in our hospital over recent 5-year period. The locations of aneurysm were anterior communicating artery in three cases and internal carotid artery in three other cases. The sites of RICH were dependent regions considering the operative position in five of six cases, con-tralateral cerebellum in three cases, bilateral cerebellum in one case, and contralateral occipital area in one case. Peripheral low density around the RICH, suggesting hemorrhagic infarction, was observed on computed tomography in four cases. No patient had preoperative hypertension; however, significant elevation of blood pressure was observed intraoperatively or postoperatively in three cases. The factors which could have induced brain shift(large amount of removed or drained cerebrospinal fluid, large amount of infused mannitol, too low PaCO2) were observed in all cases except one case. There was no case with coagulopathy or underlying occult lesion. Two patients in whom detection of RICH was delayed showed poor outcomes. The possible underlying mechanisms involved in such complication seem to be shifting of brain due to sudden decreased intracranial pressure and excessive removal of cerebrospinal fluid, and subsequent injury of blood vessels such as compression or breakdown of vein. Moreover, the sudden elevation of blood pressure may have played a role as contributing factor. Therefore, consideration should be given to the maintenance of an adequate volume of intracranial cerebrospinal fluid and the appropriate blood pressure to prevent this complication. Early detection and immediate treatment with awareness of the possibility of this complication should be borne in mind when treating these patients to prevent such complications and to obtain good results.
Aneurysm* ; Arteries ; Blood Pressure ; Blood Vessels ; Brain ; Carotid Artery, Internal ; Causality ; Cerebellum ; Cerebral Hemorrhage* ; Cerebrospinal Fluid ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Intracranial Aneurysm ; Intracranial Pressure ; Mannitol ; Veins

No abstract available.

The authors report a rare case of retroperitoneal ganglioneuroma discovered incidentally in a 47-year-old male during abdominal computed tomogaphy(CT) evaluation. The clinical features and findings of the complementary examinations, which included radiological assessment, abdomen CT and lumbar spine magnetic resonance image with contrast enhancement are presented, as well as the pathology findings. The tumor, 10x10x6cm in size, was well encapsulated and total removal was made. Histopathological diagnosis of retroperitoneal ganglioneuroma was confirmed.
Abdomen ; Diagnosis ; Ganglioneuroma* ; Humans ; Male ; Middle Aged ; Pathology ; Spine

OBJECTIVE: Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. METHODS: Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. RESULTS: In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p =0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p < 0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p < 0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. CONCLUSION: Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.
Aneurysm ; Anticonvulsants ; Craniotomy ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Neurologic Manifestations ; Risk Factors ; Rupture ; Seizures* ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

The familial occurrence of intracranial aneurysms, defined as the presence of one or more aneurysms in two or more blood relatives, is well established and is relatively rare. The pattern of inheritance in these families is not usually known. The authors report one case of familial intracranial aneurysm, without specific genetic disorder, occurring during a recent six-month period in three of five siblings. Two of these were females, aged 36 and 39, and the other was a 40-year-old male. Two of these patients had ruptured aneurysms, but in the other, the aneurysm was unruptured. All were treated successfully by clipping of the aneurysmal neck, without any neurological deficits. The authors describe their experience of a rare familial intracranial aneurysm, occurring in the absence of a specific genetic disorder, and review the literature concerning this type of aneurysm.
Adult ; Aneurysm ; Aneurysm, Ruptured ; Female ; Humans ; Intracranial Aneurysm* ; Male ; Neck ; Siblings ; Subarachnoid Hemorrhage ; Wills

Spontaneous dissection of the vertebrobasilar arterial system is less common than that of the carotid system. These dissections are usually found extracranially or in a combination of intracranial and extracranial location. Pure intracrainl involvement is uncommon. Particularly in oriental country. This vascular anomaly is one of the important causes of posterior circulation stroke in young and middle-aged adults. Lf manifested as brainstem, ischernia, the usual symptoms and signs are typically neck or occipital pain followed later by particular features of the lateral medullary syndrome. Etiology remains obscure in most cases of spontaneous dissection and management is still controversial. We present three cases of dissecting aneurysm of the intracranial portion of unilateral vertebral artery. The two patients manifested as lateral medullary syndrome with sudden neck pain and digital substracted angiogram revealed proximal narrowed segments and distal fusiform dilatation of the unilateral vertebral arter.,v. The other patient manifested as subarachnoid hemmorrhage and angiographically dilatation at the junction of vertebral artery and posterior inferior cerebellar artery was noted. In operative field, two cases were confirmed as dissecting aneurysm.
Adult ; Aneurysm, Dissecting* ; Arteries ; Brain Stem ; Dilatation ; Humans ; Lateral Medullary Syndrome ; Neck ; Neck Pain ; Stroke ; Vertebral Artery*

The safety and effectiveness of extraperitoneal C/S are controversial, so it has been performed for the purpose of training for selected cases . But we think this procedure have some benefit in selected cases. This study was based on retrospective investigation of 300 cases of extraperitoneal cesarean section among 332 cases at Eul Ji Medical hospital, during from January, 1995 to December, 1996. The results were as follows: 1. The most prevalent age distribution was seen in the age group of 26~30. 2. The indication for extraperitoneal cesarean section were dystocia(38.3%), previous cesarean section(32.6%), elderly primigravida(12.6%) in orders. 3. In the type of the anesthesia, general anesthesia was 70.7%, epidural anesthesia was 15% and spinal anesthesia was 14.3%. 4. The most common group of operation time was 36~40minute(34.3%). 5. The post operative complications and maternal morbidities were breast engorgement(21%), peritoneal opening(19.6%), endometritis(4.3%) in orders. 6. Of all cases, the blood transfusion rates was 6%. 7. The most common group of hospital stay was 5~6 days(82%). 8. In the body weight distribution of infants, the group of 3,000~3,499gm was the most common(80.7%). 9. Of extraperitoneal cesarean sections, cases of the 5minute Apgar score more than 7 were the most common(99%). 10. The most common failure factor was abdominal and pelvic 11. There was no maternal death case.
Age Distribution ; Aged ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Apgar Score ; Blood Transfusion ; Body Weight ; Breast ; Cesarean Section ; Female ; Humans ; Infant ; Length of Stay ; Maternal Death ; Methods ; Pregnancy ; Retrospective Studies

OBJECTIVE: The cytokine interleukin-6(IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants. The objective of this study is to determine whether serum IL-6 and cerebrospinal fluid(CSF) IL-6 levels were elevated at time of admission after head injury, serum IL-6 and CSF IL-6 levels related temporally to clinical improvement, severity of head injury with Glasgow Coma Scale(GCS) score and increased intracranial pressure(IICP). METHODS: All 21 patients(19 males and 2 females) with brain injury, managed in our institute between Aug 1996 and Jun 1998 were included in this study. Serum samples from all the 21 patients and CSF samples from 12 patients with low GCS score were analyzed for IL-6. IL-6 determination with enzyme-linked ELISA kits obtained from Quantikine(r). RESULTS: The values of IL-6 in serum and CSF in 21 patients with GCS score between 4 and 14(mean=9) were observed for 3-5 days after head injury. Peak elevation of serum IL-6 was observed on first day(8.2+/-4.9pg/ml) and then decreased to 4.0+/-3.6pg/ml on fifth day. Serum IL-6 levels decreased significantly faster in patients with GCS score of 8 through 11, compared with those of GCS score below 8. The patients showed markedly elevated and variable CSF IL-6 levels on admission(46.6+/-4.2pg/ml;normal, below 20.6+/-5.8pg/ml). CONCLUSION: This study demonstrates that the IL-6 level is related to the severity of traumatic brain injury.
Acute-Phase Proteins ; Adult* ; Brain Injuries ; Cerebrospinal Fluid* ; Coma ; Craniocerebral Trauma* ; Enzyme-Linked Immunosorbent Assay ; Head* ; Humans ; Interleukin-6* ; Intracranial Pressure ; Male