The surgical technique for removal of ruptured lumbar intervertebral disc has changed very little since it was introduced by Mixter and Barr in 1934. The technique of the interlaminar operation used by most neurosurgeons was used successfully in early cases to relieve the sciatica, but many patients were unable to return to heavy work because of low back pain. Cloward described a different surgical technique for removal of a ruptured lumbar intervertebral disc. The operation utilizes a transverse skin incision and a wide bilateral stlipping and retraction of fascia and muscles. The ligamentum flavum is not removed but detached and reflected medially in a flap. Only the bone margins of the adjacent facets are removed. A complete laminectomy is never done except for spondylolisthesis when the separate neural arch is disarticulated and removed. Using a "Vertebral Spreader", and interlaminar exposure is developed two to three times larger than that obtained y the "standard" technique. The advantages are obvious: 1. Both operations were done through a single transverse incision. A wider lateral exposure for the skin wound, being made parallel to the lumbar operation was possible and the normal skin lines, heals better with less scar. 2. The entire ligament is preserved, by separating its attachments from the lamina and reflecting in a flap, a larger opening into the spinal canal is obtained and the replaced flap protects the dura and prevents scarring. 3. Cloward recommends the use of a narrow, sharp chisel and hammer, but we used the spinal rongeurs including the Kerrison punch to remove part of the laminal edge. We leave the articular facets of the lumbar disc surgery because the articular facets are considered important major elements in the articulation of the vertebral joints, and as an essential bony surface to be used in posterior spinal fusion operation. 4. The routine use of intrathecal cortisone after lumbar disc operation has not been used in our cases because of increased pressure of the cerebrospinal fluid in modified prone position of the patient.
Cerebrospinal Fluid ; Cicatrix ; Cortisone ; Fascia ; Humans ; Intervertebral Disc ; Joints ; Laminectomy ; Ligaments ; Ligamentum Flavum ; Low Back Pain ; Muscles ; Prone Position ; Sciatica ; Skin ; Spinal Canal ; Spinal Fusion ; Spondylolisthesis ; Wounds and Injuries

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

Meningioma en plaque are extremely rare, not only dose it form a thin layer on the inside of the dura but also infiltrates it an invades the adjacent bone. Painless, slowly developing exophthalmos with palpable swelling in the ipsilateral temporal region, and later impairment of vision and ocular motility indicate menigioma "en plaque" in the temporal region. The authors report a case of meningioma "en plaque" arisen from the outer third of sphenoid ridge.
Exophthalmos ; Meningioma*

Congenital dermal sinuses result from a failure of separation of the cutaneous epithelial ectoderm from the neuroepithelial ectoderm along the dorsum of the embroy during the first month of intra-uterine life. These sinus tracts can occur at any level of the cerebro-spinal axis, but are located predominantly in the occipital and lumbosacral regions and occasional cases involving the cervical and thoracic regions. The dermal sinus tract is lined by stratified squamous epithelium and extends from the surface through the deeper tissues into the cranial or spinal cavity, usually ending on the dura or within the dura in conjunction with a terminal epidermoid or dermoid cyst. An intra-medullary epidermoid or dermoid with a dermal sinus is an unusual association. We have been able to find a previously reported coincidence of these malformations although there are many definitive papers on these uncommon entities. We are experienced in one case who are 14 months old boy with a intra-medullary dermoid cyst associated with a congenital dermal sinus at the T4 level, and reviewed related reports.
Axis, Cervical Vertebra ; Dermoid Cyst* ; Ectoderm ; Epithelium ; Humans ; Infant ; Lumbosacral Region ; Male ; Spina Bifida Occulta*

Technetium 99 M pertechnetate has become a valuable for the radioisotopic brain scan. This was introduced by Haper in 1963 and is now widely used in the medical field. The advantages are easy administration, high count rate with potential for high speed scanning, absence of beta radiation and decreasing time for test. We used Siemens Scintimat 2 Scanner with a 3x2 inch Na(T1) crystal and 151-hole collimator in our study. 10 mci Technetium 99 M was injected intravenously and obtained both lateral, anterior and posterior view in 80 cases of brain lesion from Mar. 75 to Sep. 76. The scans were classified as positive, negative and suspicious. The overall detection rate in 40 cases of brain tumors was 60%, especially high uptake in mengioma, malignant pituitary tumor, astrocytoma, metastatic brain tumor and acoustic neuroma. But in nontumors diseases of the brain including CVA, head injury and hydrocephalus the uptake rate was a little value.
Astrocytoma ; Beta Particles ; Brain Neoplasms ; Brain* ; Craniocerebral Trauma ; Hydrocephalus ; Neuroma, Acoustic ; Pituitary Neoplasms ; Sodium Pertechnetate Tc 99m ; Technetium

An analysis of recent experiences for the brain stem glioma with surgery and autopsy established confirmation of the characteristic symptoms and signs, and of diagnostic criterias of Conray-ventriculogram and vertebral-angiogram. The cases consisted of 2 cases of exophytic brain stem glioma and 4 cases of pontomedullary glioma, and 5 of 6 patients had the signs of the increased intracranial pressure in this cases. A resurgence of interest in the Conray ventriculogram has been produced by cut-off sign of aqueduct of Sylvius in 2 cases of the exophytic brain stem glioma. The survival period in adults (1-3 years) were longer than that in children (less than 3 months) in this series.
Adult ; Autopsy ; Brain Stem* ; Brain* ; Cerebral Aqueduct ; Child ; Glioma* ; Humans ; Intracranial Pressure

Malignant peripheral nerve tumors are very rare and derived from the neurofibromatosis in about 13%. There are two classes of malignant tumors in the peripheral nerve, one those of mesoblastic origin, is far most common and made up of malignant neurofibroma and much common fibrosarcoma, and metastasis in 20% of fibrosarcoma, and the other is neuroepithelial origin. These are characterized by increased cellularity, atypical form of cells, mitoses and invasiveness. The choice treatment is radical removal of the tumor, and not affected the prognosis by radiation or chemotherapy. We have been recently experienced of one case of malignant schwannoma on the cervical roots in a case of von Recklinhausen's disease.
Drug Therapy ; Fibrosarcoma ; Mitosis ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibroma ; Neurofibromatoses ; Peripheral Nerves ; Peripheral Nervous System Neoplasms ; Prognosis

Since oligodendroglioma was first described by Bailey & Cushing in 1926, there have been numerous studies reporting detailed description of the clinical and pathological characteristics of the tumor. It is a slow growing tumor usually in adults, with the highest frequency between 30 and 50 years, and affect the cerebral hemispheres, particularly the frontal lobes. Of all brain tumors the oligodendroglioma is the most likely to contain calcareous deposits which can be demonstrated radiologically in 40% to 50%. It consists of a continous sheet of uniformed small, round & densely packed cells interruptedly only by remarkably regular network of small blood vessels in histology. We have been recently experienced of a case of typical oligodendroglioma and reviewed the literatures.
Adult ; Blood Vessels ; Brain Neoplasms ; Cerebrum ; Frontal Lobe ; Humans ; Oligodendroglioma*

The authors present 2 cases of malignant pituitary adenoma. One case has remote metastases to the right frontal lobe, and the other case has invasion into the adjacent temporal lobe and malignant features histologically. Malignant pituitary adenoma constitute less than 1% of the large reported series of pituitary adenoma, which defined as (1) it burst its capsule to invade the adjacent nervous structures or bone, (2) it shows malignant features histologically, such as frequent mitoses, anaplasia with hyperchromatic pleomorphic cells, loss of alveolar arrangement, and (3) presence of distant metastases.
Anaplasia ; Frontal Lobe ; Mitosis ; Neoplasm Metastasis ; Pituitary Neoplasms* ; Temporal Lobe

The ovarian hyperstimulation syndrome is a rare but serious complication of ovulation induction therapy with gonadotropin. The clinical manifestations are generalized edema, ascites with pleural effusion and may become life-threatening in severe cases. The pathophysiology is still unknown therefore, the treatment should be symptomatic and conservative. We report a case of severe OHSS with massive right pleural effusion in excess of ten liters after human menopausal gonadotropin therapy because of secondary infertility. Fluid and electrolyte imbalances were corrected and albumin was administered. A right chest tube was placed for a total of sixteen days, draining eleven liters of pleural effusion totally, resulting a dramatic decrease of pleural effusion and improvement of symptoms.
Ascites ; Chest Tubes ; Edema ; Female ; Gonadotropins ; Humans ; Infertility ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction ; Pleural Effusion*