Although reports have been assessed to locate lesions in the frontal lobe or anterior cranial fossa, the exact localization of the lesion is invariably difficult in neurological examination. However angiographic pattern is one of the most significant clue to the diagnosis of this area. For the past 2 years, from may in 1968 to December in 1970, we have analyzed angiographic patterns of space occupying lesion in the frontal lobe and anterior cranial fossa in a total of subsequent 100 cases. It is suggested that these lesions be classified into four groups according to their characteristic patterns and, for accurate localization and practical feasibility, their surgical approach. The characteristic angiographic patterns of each group are summarized as follows: (Frontal-pole) A-P view: 1. Round shift of A.C.A. 2. Flattening of carotid fork. 3. Elongation of AI. 4. No chekrein effect. 5. Sylvian point & M.C.A.... normal / (Fronto-central) A-P view: 1. Round shift of A.C.A.-mild. 2. Checkrein effect. 3. Depression of M1. 4. Flattening or mushroom appearance of carotid-fork. 5. Sylvian point... normal. / Lateral view: 1. Posterior displacement of A.C.A. 2. Vertical stretching of A2-A3. 3. Stretching of frontopolar artery. 4. Downward displacement of M2. 5. Depression of candelabra artery. 6. Closing of carotid siphon. 7. Ophthalmic artery... normal. / Lateral view: 1. Rectangular erection of C1-M1. 2. Right angle of C1-C2. 3. Elevation of M2-M3. 4. P.C.A. & ant. Choroidal artery... better. / (Fronto-lateral) A-P view: 1. Round shift of A.C.A. 2. Infrequent checkrein effect. 3. Flattering of carotid fork. 4. Vertical stretching of C1. 5. Sylvian point... normal. / Lateral view: 1. Mild stretching of A2-A3. 2. Continuous line of C2-M2. 3. Depression of M2. 4. Stretching of candelabra artery. / (Fronto-basal) A. subfrontal; A-P view: 1. Round or angular shift of A.C.A. 2. Flattening of carotid bifurcation. 3. No checkrein effect. 4. Sylvian point... normal. / Lateral view: 1. Bowing and downward convexity of A.C.A. 2. Closing of carotid siphon. 3. Depression of sylvian artery group. 4. Enlargement of ophthalmic artery. B. Inferior frontal; A-P view and lateral view: 1. Same as subfrontal lesions. 2. Relative preservation of A.C.A. branches. 3. Enlarged ophthalmic artery... mild. 4. Depression or elevation of M2.
Agaricales ; Ants ; Arteries ; Choroid ; Cranial Fossa, Anterior* ; Depression ; Diagnosis ; Frontal Lobe ; Neurologic Examination ; Ophthalmic Artery

3 cases of pituitary adenomas, two hormone-secreting adenomas, and one non-secreting chromophobe adenoma, were treated surgically by the sublabial transsphenoidal approach with use of surgical microscope and radiofluroscopic image intensification at the Dept. of Neurosurgery, Yonsei University Medical College. The 2 cases of hormone secreting adenomas were an eosinophilic microadenoma manifestating gigantism and a prolaction secreting adenoma with amenorrhea and galactorrhea. The simplicity of this technique, criteria for the treatment of the hormone secreting and non-secreting adenomas and their biologic behaviors were described and discussed with review of literatures.
Adenoma ; Adenoma, Chromophobe ; Amenorrhea ; Eosinophils ; Female ; Galactorrhea ; Gigantism ; Neurosurgery ; Pituitary Neoplasms ; Pregnancy

3 cases of pituitary adenomas, two hormone-secreting adenomas, and one non-secreting chromophobe adenoma, were treated surgically by the sublabial transsphenoidal approach with use of surgical microscope and radiofluroscopic image intensification at the Dept. of Neurosurgery, Yonsei University Medical College. The 2 cases of hormone secreting adenomas were an eosinophilic microadenoma manifestating gigantism and a prolaction secreting adenoma with amenorrhea and galactorrhea. The simplicity of this technique, criteria for the treatment of the hormone secreting and non-secreting adenomas and their biologic behaviors were described and discussed with review of literatures.
Adenoma ; Adenoma, Chromophobe ; Amenorrhea ; Eosinophils ; Female ; Galactorrhea ; Gigantism ; Neurosurgery ; Pituitary Neoplasms ; Pregnancy

Shunting of cerebrospinal fluid into the peritoneal cavity is a well established procedure which has, over the years, enjoyed increasing popularity. A slit valve at the distal end elminated the insinuation of the omentum into the shunting tube and a spring catheter prevented kinking of the shunt tubing. However, the most common cause of failure of the shunting is from the separation, or pulling apart, of the various components of the shunt system with subsequent infection. A one piece spring catheter is sufficient to the necessity. Surgical details are illustrated for installing a one piece spring catheter for hydrocephalus. Four basic steps of surgical procedure using a subcutaneous guide, a leader, a cannula and a cuff are described; firstly passing the guide and the one piece shunt from McBurney's point to the supraclavicular space, secondly passing the guide from the parietal eminence to the supraclavicular space to thread the one piece shunt cephalad. Thirdly, inserting the cannula into the lateral ventricle and threading the ventricular end of the one piece shunt through the cuff into the lateral ventricle and fourthly inserting the peritoneal end into the peritoneal cavity.
Adolescent ; Adult ; Catheterization/methods ; Cerebrospinal Fluid Shunts/instrumentation* ; Cerebrospinal Fluid Shunts/methods ; Child, Preschool ; Human ; Hydrocephalus/surgery ; Infant ; Infant, Newborn ; Peritoneal Cavity

Spinal paragonimiasis is an uncommon ectopic manifestation of the lung fluke. In this paper eight cases of spinal paragonimiasis treated in the Severance Hospital are reported and the literature is reviewed. Differantial diagnosis is usually difficult because of the similarity of symptoms and signs with benign spinal cord tumors. positive chest X-ray findings, positive skin test and pleocytosis of the spinal fluid, especially of eosinsphils, are valuable findings in the diagnosis. The extradural space in the 1ower thoracic region is the most frequently affected area. Laminectomy with excision of the lesion supported by chemotherapy is the treatment of choice. When treated early, prognosis of this type of manfestation is usually favorable.

Deliberate hypotension in the surgery of intracranial aneurysm's used to diminish bleeding and render an aneurysmal sac slack to make clipping easy. It has been reported by Murtagh (1960) and Schettini et al. (1967) that deliberate hypotension induced with halothane anesthesia is a useful method. We are reporting clinical experience of halothane induced hypotension in 13 cases of intracranial aneurysm surgery. The results of clinical observation were as follows: 1. On the average, the systolic blood pressure lay between 60 and 80 mmHg. Hypctension by halothane was readily controllable by increasing and decreasing the inspired concentration of halothane. The use of vasopressors was not necessary to raise the blood pressure. Recovery from anesthesia was rapid. The mean of Mean Arterial Blood Pressure of 13 cases was 56.077 mmHg during the .hypotensive phase. The rate of fall of the mean arterial blood pressure was 1.862 mmHg per minute. 2. The common EKG finding was bradycardia associated with hypotension, but the pulse rate increased by raising the blood pressure. 3. The serum electrolytes, Na, K, Cl, and CO₂ combining power, checked in the pre and posto-perative period, showed no significant change. 4. Arterial blood gas study showed increased values for PaCO₂ and oxygen saturation during the hypotensive phase. The PaCO₂ was slightly lowered during hypotension. The pH was within normal limits. 5. The Hb and Hct, checked pre and postop ratively, showed lowered values in the postopertive period. During surgical clipping of the aneurysm, there were two cases of aneurysmal rupture, requiring blood transfusion; the amount of whole blood transfused was 500 ml to 1, 000 ml. 6. Urinary excretion, observed during hypoension, showed a decreased urine output at a systolic blood pressure of about 70 mmHg. 7. Postoperatively there was one death at the end of second week and the cause was thought to be cerebral infarction, not directly relnted to anesthesia.
Anesthesia ; Aneurysm ; Arterial Pressure ; Blood Pressure ; Blood Transfusion ; Bradycardia ; Cerebral Infarction ; Electrocardiography ; Electrolytes ; Halothane ; Heart Rate ; Hemorrhage ; Hydrogen-Ion Concentration ; Hypotension ; Hypotension, Controlled* ; Intracranial Aneurysm* ; Methods ; Oxygen ; Rupture ; Surgical Instruments

Multiple level laminectomies are a destructive procedure complicating kyphosis, anterior subluxation and instability of the spine in children. The surgical procedure of multiple level osteoplastic laminotomies was proposed as an alternative by Raimondi et al in 1976. The goal is preservation of the normal architecture of the spine in patients who are still developing. We have experienced a case of multiple level laminotomies(T4-T11) for removal of epidural neuroblastoma in a 3-month old baby. The technical points of surgical procedure were discussed.
Child ; Humans ; Infant ; Kyphosis ; Laminectomy* ; Neuroblastoma ; Spinal Canal* ; Spine

The authors performed occipito-cervical(C2-3) fusion in a case of atlanto-axial subluxation caused by congenital seperation of dens. At first posterior cervical fusion(C1-2-3) with rib graft was performed, but several days after the operation C1-2 subluxation developed again with cervical cord compression syndrome. In the second operation, the occiput was included in the fusion after removal of the posterior neural arch of atlas which resulted in good reduction and marked improvement in neurologic symptoms.
Neurologic Manifestations ; Ribs ; Transplants

No abstract available.
Heart Rate* ; Heart* ; Shock, Hemorrhagic*

A giant aneurysmal cerebral arteriovenous malformation in the left parieto-occipital region is described in a 4 year old child, including resolution of the alternating hemiparesis and left ventricular hypertrophy of the heart following successful removal of the malformation by microsurgical technique. This arteriovenous malformation has a large aneurysmal sac, 6x5x4cm, in size with several feeders from branches of the left middle and posterior cerebral arteries and drains directly into the straight sinus. So we have proposed to call it "a giant aneurysmal cerebral arteriovenous malformation".
Aneurysm* ; Arteriovenous Malformations ; Child ; Child, Preschool ; Heart ; Humans ; Hypertrophy, Left Ventricular ; Intracranial Arteriovenous Malformations* ; Paresis ; Posterior Cerebral Artery