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*

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

The treatment of brain tumors metastasizing from lung cancer though the outcome has been unsatisfactory. Through an examination of the prognosis in patients treated with varying modalities, this study aims to determine which gives the best results. We analyzed 110 of 124 cases, histologically diagnosed between 1985 and 1994, in which lung cancer had meta-stasized to the brain. Radiotherapy, chemotherapy and conservative management had been implemented. The patients' mean age was 58(range 23 to 76) years: the M: F ratio was 74: 36. The histological diagnosis was squamous cell carcinoma in 25 cases, adenocarcinoma in 50, small cell carcinoma in 24, and large cell carcinoma in 11. The median metastatic period between the lung cancer and metastatic tumor was 11.5 months: the longest duration was 42 months(one case). In 63 cases primary lung cancer and brain metastasis were diagnosed simultaneously. Of the total cases, 47 involved solitary metastasis and 63, multiple. The chief complaints were headache in 38 cases, hemiparesis in 48, cognitive function defect in 16, and seizure in eight. Metastasis to other organs at the time of diagnosis was as follow: adrenal gland, 6: bone, 9: liver, 4: lung, 3: leptomeninges, 1. Four patients had undergone craniotomy, two, only chemotherapy; and 41, radiotherapy. Seven patients underwent gamma knife radiosurgery: 43 were treated with a single modality: and 53, by combined therapy. The median survival period in cases of surgery alone, radiotherapy, chemotherapy and gamma knife radiosurgery was 17 months, 5.7 months, 3.5 months and 8.0 months, respectively. In cases of combined therapy, this period was 19.2 months for conventional surgery and gamma knife radiosurgery, 14.0 months for surgery and radiotherapy, and 7.0 months for radiotherapy and chemotherapy. For those with adenocarcinoma, the median survival period was 7.7 months: those with large cell carcinoma had the shortest median survival period(4.6 months). Combined therapy proved most effective, but survival periods did not lengthen.
Adenocarcinoma ; Adrenal Glands ; Brain Neoplasms ; Brain* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Craniotomy ; Diagnosis ; Drug Therapy ; Headache ; Humans ; Liver ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Paresis ; Prognosis ; Radiosurgery ; Radiotherapy ; Seizures

Three patients with complex partial seizures had dysembryoplastic neuroepithelial tumor (DNET) in temporal lobe. In all cases, longterm video-EEG monitoring showed epileptogenic focus in left temporal lobe where small mass lesion was located. For further seizure localization and functional mapping, subdural grids were placed on left temporal lobe including lesions. Lateral temporal lobectomy with lesionectomy was performed in two cases. Lateral temporal lobe resection and amygdalohippocampectomy was done in one case. The pathological findings of all lesions were characterized by intracortical location, multiple nodular architecture, foci of dysplastic cortical disorganization and the presence of a specific glioneuronal element. All patients have been seizure free.
Epilepsy, Temporal Lobe* ; Humans ; Neoplasms, Neuroepithelial* ; Seizures ; Temporal Lobe*

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time ; or 3) lack of proper classification of hematomas for comparison of results from different institutions. The authors analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical center for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ration was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhage had brought about a high licidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade I-II, and also decreased the frequency of Grade III, but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment. 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.
Academic Medical Centers ; Blood Loss, Surgical ; Cause of Death ; Classification ; Consciousness ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive* ; Korea ; Middle Aged ; Mortality ; Neurosurgery ; Putamen ; Seasons

The authors analyzed 60 cases of ruptured internal carotid artery(ICA) aneurysms admitted and operated at Department of Neurosurgery in Kyung Hee University Hospital during the period from July 1983 to June 1988. The results of analysis were summarized as follows; 1) Mean age of patients was 51 years. ICA aneurysms occurred more frequently in female(47) than male(13). 2) Distribution of ICA aneurysms were ophthalmic aneurysm 8 cases(13.3%), posterior communicating aneurysm 40 cases(66.6%), anterior choroidal aneurysm 7 cases(11.6%), bifurcation aneurysm 5 cases(8.3%). 3) Most common direction of aneurysmal dome in ophthalmic, anterior choroidal and posterior communicating aneurysm was posterior-inferior-lateral and in bifurcation aneurysm was posterior-superior. 4) Multiple aneurysm was 23 cases(38%). 5) Incidence of clinical vasospasm was 48.3% and that of rebleeding was 20%. 6) Clipping was done in all cases, 2 cases combined with wrapping and 2 cases with trapping. 7) Mortality rate was 21.6%.
Aneurysm* ; Carotid Artery, Internal* ; Choroid ; Humans ; Incidence ; Mortality ; Neurosurgery

The presnt study was carried out to find out any difference in terms of the rate of rebleeding, mortality and of the occurrence of vasopasm and hydrocephalus between the two groups of patients with subarachnoid hemorrhage : a group of 225 cases which were administered with epsilon aminocaproic acid(EACA) (antifibrinolytic agent) and the other a group of 221 cases without EACA treatment. Both groups were chosen from 476 patients admitted to the Department of Neurosurgery, Kyung-Hee University Medical Center within 7 days after the onset of subarachnoid hemorrhage during a period from January 1982 to December 1987. The clinical observation was done during acute period following subarachnoid hemorrhage. The major findings obtained were as follows : 1) The occurrence of rebleeding was higher within 3 days after the onset of subarachnoid hemorrhage. The rate of rebleeding was 8.4% in treated group whereas the rate was 13.1% in control group. This may suggest that administration of EACA is effective to prevent rebleeding. 2) the occurrence of vasopasm was higher within on the 7th and 8th day after the onset of subarachnoid hemorrhage. The rate of vasospasm was 28.9% in treated group whereas the rate was 12.4% in control group. This means that the rate of occurrence of vasospasm was two times higer in EACA treated group. 3) the rate of occurrence of hydrocephalus was 18.3% in treated group whereas the rate lower in control group(11.6%). 4) Within-two-weeks mortality and within-one-month mortality were 14.7% and 22.2% respectively in treated group whereas the two rates in control group were 15.1% and 24.1% respectively. No significant difference between the two groups was observed. 5) The causes of death in treated group were found to be vasospasm(55.5%) and rebleeding(28.0%) in order, whereas in control group the causes of deaths were rebleeding(40.2%) and vasospasm(21.3%). In other words, the main cause of death was vasospasm in treated and that in control group was rebleeding.
Academic Medical Centers ; Cause of Death ; Humans ; Hydrocephalus ; Mortality ; Neurosurgery ; Subarachnoid Hemorrhage*

No abstract available.
Aneurysm* ; Arteries*

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

No abstract available.
Carpal Tunnel Syndrome* ; Humans