Changes in the individual symptomatology were analyzed on twenty-nine patients with Parkinson's disease who underwent thirty-five stereotaxic thalamotomies to evaluate the influence of each symptom on the surgical results. The thalamotomy could obviously improve and prevent progression of tremor and rigidity but not bradykinesia and axial symptoms. Long-term follow-up wtudy with statistical analysis suggested that progressive worsening after surgery was due not to recurrence of tremor and rigidity but aggravation of bradykinesia and axial symptoms in the natural course of the disease. We believe that timely surgical treatment should be encouraged in patients presenting symptoms of tremor and rigidity.
Follow-Up Studies ; Humans ; Hypokinesia ; Parkinson Disease* ; Recurrence ; Tremor

The herniated lumbar intervertebral disc, a common affliction in man, had been diagnosed with myelogram and treated with laminectomy. Recently, the application of CT scan and chemonucleolysis markedly changed the mode of management in lumbar disc diseases. High resolution CT scan of lumbar spine became the most popular diagnostic tool to detect herniations of lumbar discs and discolysis with chymopapain an alternative to surgery in a large number of patients. We performed CT scan and discography in 131 discs of 100 patients prior to chemonucleolysis and there were too many ruptured discs not found on CT scan but discography. Of the 5 patients who failed in chemonucleolysis severe dye leakage was seen in 4 cases. Extradural leakage of contrast medium was not a contraindication to the injection of chymopapain. However, when this occured the precaution was taken of injecting more quantity of chymopapain slowly. This report presents our experience with lumbar discography and comparative analysis of CT scan and discography. We think discography is very important diagnostic tool to detect rupture of discs prior to chemonucleolysis and may aid our gradually increasing understanding of the pathophysiology of the disc diseases.
Chymopapain ; Humans ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Laminectomy ; Rupture ; Spine ; Tomography, X-Ray Computed*

The authors treatment 35 patients with ossification of the posterior longitudinal ligament(OPLL). Sixteen of these patients had surgery during the past 3 years between 1983 and 1985. In this paper wer present a radiological and clinical analysis of these cases with a literature review. We also discuss a clinical system of grading, different types of radiological patterns, the indications of surgical treatment and the choice of operative methods. 1) The ages of the patients ranged from 31 to 79 with a mean of 55.4 years. 57.1% of the patients were in the sixth decade. The male to female ration was 28:7. 2) The cases were graded on the bases of symptoms. Grade I, no symptoms or mild neck pain, 1 case(2.9%) ; Grade II only radiculopathy, 14 cases(40.0%) ; Grade III, mild myelopathy but able to walk, 11 cases(31.4%) ; Grade IV, severe myelopathy and unable to walk alone, 7 cases(20.0%) ; Grade V, complete paralysis of one or more extremities, 2 cases(5.7%). 3) Lateral tomogram and CT scan were most useful for assesment of OPLL. 4) The pattern of OPLL was divided into a continuous type(25.7%), a multiple segmented type(31.4%), a single segmented type(20.0%), and a mixed type(22.9%). 5) In cases of a clinical grading of more than III, surgery must be considered In grade II, surgery is indicative if conservative management failed to improve the clinical symptoms. 6) Extensive total laminectomies and foraminotomies were found to be advisable in cases of OPLL involving more than two vertebrae. 7) The modified Smith-Robinson approach showed the best surgical results in cases of single segmented OPLL.
Equidae ; Extremities ; Female ; Foraminotomy ; Humans ; Laminectomy ; Longitudinal Ligaments* ; Male ; Neck Pain ; Paralysis ; Radiculopathy ; Spinal Cord Diseases ; Spine ; Spondylosis ; Tomography, X-Ray Computed

No abstract available.
Radiosurgery*

A retrospective analysis was done on twenty-nine patients with Parkinson's disease who underwent thirty-five stereotaxic thalamotomies during the past 21 years. Eighteen patients received unilateral surgery, and six received two-staged bilateral surgery. Five had second stage operation after contralateral operation at other hospitals. Thirteen patients were followed-up for a period of six months to 12 years but the remainder were lost to follow-up. Parkinsonism scoring scale was designed and used to investigate postsurgical results and progress of patients. Clinical symptoms improved in 94.7% immediately after surgery. Only one patient had permanent neurological deficit resulting from the operation. A long-term follow-up study, with statistical analysis, suggested that progressive worsening after surgery was not ue to recurrence of tremor and rigidity but aggravation of bradykinesia and axial symptoms in the natural course of the disease. After unilateral surgery, 53.3% of patients had progressive aggravation of symptoms in contralateral side. It is believed that surgical treatment should be considered in patients presenting symptoms of tremor and rigidity. Bilateral surgery is indicated in patients who have bilateral symptoms or contralateral aggravation of symptoms after an initial operation.
Follow-Up Studies ; Humans ; Hypokinesia ; Lost to Follow-Up ; Parkinson Disease* ; Parkinsonian Disorders ; Recurrence ; Retrospective Studies ; Thalamic Nuclei ; Tomography, X-Ray Computed ; Tremor

This study presents seven patients with hypothalamic hamartomas diagnosed on the basis of MRI. Histological confirmation was performed in one patient who underwent surgery. Four patients presented with epilepsy, including gelastic seizures. Other symptoms were behavior abnormalities in 3 patients and precocious puberty in 4 patients. We classify hypothalamic hamartomas into four subgroups according to MRI finding: Types la lesions were less than 100mm in lesions less than 10mm and mammillary body. Type lla lesions were more than 100mm in diamenter and sessilely attached to hypothalamus with slight hypothalmic displacement and Type llb lesions more than 10mm and with marked displacement of hypothalamus. We could achieve good result with surgical resection in one patient with Type llb hamartoma associated with gelastic seizure that was unresponsive to medical treatment. We performed gamma knife radiosurgery in three patients with gelastic seizue(2 patients with Type lla and 1 patient with Type llb) and three patients with precocious puberty(2 patients with Type la and 1 patient with Type lla 1 patient with Type llb) and three patients with precocious puberty(2 patients with Type la and 1 patient with type lb). The authors propose direct surgery as a treatment for this progressive syndrome and gamma knife radiourgery is alternative treatment for high risk patients.
Epilepsy ; Hamartoma* ; Humans ; Hypothalamus ; Magnetic Resonance Imaging ; Mamillary Bodies ; Puberty, Precocious ; Radiosurgery ; Seizures

OBJECTIVE: The purpose of this study are to evaluate the effectiveness of Gamma Knife radiosurgery(GKS) as a treatment of craniopharyngioma and to investigate the proper dose planning technique in GKS for craniopharyngioma. METHOD: Between May 1992 and March 1999, seven Gamma Knife radiosurgical procedures were done for residual tumor mass of 6 patients with craniopharyngioma after microsurgical resection. Conventional radiation therapy was not performed. In this study, their clinical, radiological and radiosurgical data were analyzed and the radiation dosage to the optic pathway, hypothalamus, pituitary stalk, and cavernous sinus were calculated and correlation with clinical outcome was evaluated. The mean follow-up period was 33.5 months(12.3-55.2 months). RESULT: The mean tumor volume was 4.4cc(0.4-18.0cc) and the maximum radiation dose ranged from 14 to 32 Gy(mean 20.9Gy). The radiation was given with isodose curve, 50-90% and the marginal dose varied within 8-22.4Gy(mean 12.7Gy). The mean number of isocenter was 4.3(1-12). The tumor was well controlled in all cases. In 5 of 7 cases, the size of tumor decreased to 10-50% of pre-GKS volume and remaining two showed no volume change. The mean dose to optic pathway was 5.7Gy(5.1-11.2Gy) and there were no complications. CONCLUSION: GKS seems to be effective for control of craniopharyngioma as an adjuvant treatment after microsurgical resection and even suboptimal dose for tumor margin is considered to be enough for tumor control. It is safe with careful dose planning to protect surrounding important structures, especially optic pathway. We believe conventional radiation therapy should be avoided because it has limitation for dose planning of additional treatments such as radiosurgery or intracystic instillation of radioisotope in case of recurrence.
Cavernous Sinus ; Craniopharyngioma* ; Follow-Up Studies ; Humans ; Hypothalamus ; Neoplasm, Residual ; Pituitary Gland ; Planning Techniques ; Radiation Dosage ; Radiosurgery* ; Recurrence ; Tumor Burden

No abstract available.
Head* ; Humans ; Leukoencephalopathy, Progressive Multifocal* ; Lymphoma, T-Cell* ; Neck*

No abstract available.
Central Nervous System*

No abstract available.
Animals ; Evoked Potentials* ; Rats*