The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.
Accidents, Traffic ; Cerebrospinal Fluid ; Diagnosis, Differential ; Drainage ; Fistula* ; Pleural Cavity ; Pleural Effusion ; Punctures ; Subarachnoid Space ; Sympathectomy

A 48-year-old male patient is presented in whom huge cystic cerebellar astrocytoma simulated cerebellopontine angle tumor. Surprisingly enough, the symptoms started only 20 days prior to admission and expired before opening the dura. The neurological manifestations were of throbbing suboccipital headache, right hemiparesis, slurred speech and ataxia associated with acute increased intracranial pressure. The vertebral angiogram revealed downwardly displaced inferior posterior cerebellar artery without tumor blush. There was no evidence of increased uptake of radioactive isotope in brain scan. Suboccipital craniectomy and total laminectomy of the first and second cervical spine was performed but intradural manipulation was postponed because of tensely bulged dura, excessive bleeding and unstable vital signs to tolerate general anesthesia. The patient died of respiratory arrest 5 hours after the operation. The huge size of cystic astrocytoma on the right cerebellar hemisphere and tremendous cerebellomedullary herniation were found at the time of postmortem examination. Various pathophysiological mechanism which caused this unusual regrettable clinical outcome are briefly considered.
Adult* ; Anesthesia, General ; Arteries ; Astrocytoma* ; Ataxia ; Autopsy ; Brain ; Headache ; Hemorrhage ; Humans ; Intracranial Pressure ; Laminectomy ; Male ; Middle Aged ; Neurologic Manifestations ; Neuroma, Acoustic ; Paresis ; Spine ; Transcutaneous Electric Nerve Stimulation ; Vital Signs

Interbody fusion was performed on eight cases of lumbar instability;five spondylolisthesis and three spondylolysis. Five cases were operated by anterolateral approach through the retroperitoneal space, and posterior approach on three cases after Cloward. Symptomatic improvement was obtained in almost all cases and complete fusion was observed on the roentgenogram three months later. Ambulation was possible from the immediate postoperative day without external support. While posterior approach has an advantage to observe the nerve root under direct vision, anterolateral approach has the following advantages;It is less destructive to the spinal structures, It can be performed without teasing the neural elements, anterior slipping of the vertebral body can be reduced easily, and its was applicable to the upper lumber level where neural elements qre compact. We believe interbody fusion has definite advantage to obtain strong weight bearing stability than fusion of any other parts of the spine because it has rapid recovery, low morbidity and high percentage of complete cure without disability.
Retroperitoneal Space ; Spine ; Spondylolisthesis ; Spondylolysis ; Walking ; Weight-Bearing

27 Myelographies with Iopamidol and 27 myelographies with metrizamide were performed in order to compare adverse reactions, radiographic quality and effects on vital signs of the two contrast media after injection into the spinal subarachnoid space. Headache and nausea were less severe using Iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities which were noted in 7.4% of the metrizamide group but were not seen with the use of Iopamidol. Iopamidol was more stable than metrizamide in CSF. Image quality and diagnostic accuracy of Iopamidol myelography was equivalent to metrizamide for intrathecal application.
Contrast Media ; Headache ; Iopamidol* ; Metrizamide ; Myelography* ; Nausea ; Strikes, Employee ; Subarachnoid Space ; Vital Signs

A case of huge craniopharyngioma which was removed radically is presented. A 14-year-old girl was hospitalized because of the impairment of vision and a history of generalized seizures. The computed tomogram of the brain disclosed the huge mass consisting of a large cystic part extending to the frontal base and solid part medial and posterior to the cystic. Despite of the large size and adhesion to the vital structures, the tumor was removed successfully. To remove the tumor radically, it seemed to be important not to interrupt the outer structure of the mass during dissection. The postoperative course was uneventful except transient diabetes insipidus. We report this case with brief review of the references.
Adolescent ; Brain ; Craniopharyngioma* ; Diabetes Insipidus ; Female ; Humans ; Seizures

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.
Discitis ; Diskectomy* ; Humans ; Microsurgery ; Surgical Instruments

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.
Diagnosis ; Humans ; Myelography* ; Spinal Stenosis

We have reported our experience with 5 cases, each of whom had tardy ulnar palsy, which was treated by medial epicondylectomy without anterior transplantation of ulnar nerve, and each of whom had good result in 2 years follow-up study. All patients had cubitus valgus deformity which was followed to the fracture-dislocation of the elbow region. The operative procedure employed in this series is carried out with the patient spine, the humerus abducted and externally rotated, and the elbow flexed so that the extensor surface of the forearm may rest comfortably on a padded arm board. A skin incision 5 to 6 cm long made parallel to the ulnar nerve but a centimeter or more in front of it. Centered on the prominence of the condyle. After fully exposing the medial epicondyle and the supracondylar ridge subperiosteally, they are removed with rongeurs. No sharp edge should be left and the bone should be removed sufficiently checking X-ray during the operation for the evaluation of bone shape hidden in the soft tissues. Following epicondylectomy, all patients gained relief from pain and had gradual return of motor function. Because of less risk to traumatize to nerve branches, to interfere with blood supply, and to adhere the neighboring tissues, and of ability to move the elbow through a full range immediately, we believe this method gives results superior to anterior transplantation operation.
Arm ; Congenital Abnormalities ; Elbow ; Follow-Up Studies ; Forearm ; Humans ; Humerus ; Paralysis* ; Skin ; Spine ; Surgical Procedures, Operative ; Ulnar Nerve

Study of 22 cases with the pseudospondylolisthesis established that it occurred more frequently in the older women, and far more frequently at the L4 level, as same results as reported by others. The slipping occurred as a result of degenerative disease of the articular process and facet joint, but it never exceeded 25% in this series. This study was performed to recognize the stability of the lumbosacral joint by the measurement of the anterior and posterior vertical heights(deformity) of the body of the L5 vertebra and lumbosacral angles in our cases. We also attempted to observe whether the facet angle changes at the involved level was meaningful or not. Result : lumbosacral angles in the our patients with pseudospondylolisthesis were increased greater than normal, so lumbar lordosis was less than normal. The body of the L5 vertebra was not as wedged anteroposteriorly as it normally was. The contour of the body of the L5 vertebra resembled rectangle shape. The pedicle-facet angles were increased at involved level, but this measurement was not correctly demonstrated on the plain roentgenograms. Conclusion : The stability of the lumbosacral joint in the patients with pseudospondylolisthesis was increased due to rectangle shape of the body of the L5 vertebra and less lumbar lordosis. The pedicle-facet angles at the involved level were increased, but not correct diagnostic values.
Animals ; Female ; Humans ; Joints ; Lordosis ; Spine ; Zygapophyseal Joint

Sturge-Weber syndrome was rare. But reported from 1860. We present a typical case of Sturge-Weber syndrome in a child and discussed the symptoms, signs, and pathological finding of various examinations in neurosurgical field such as plain x-ray, 4-vessel angiography, CT scan, EEG, IQ test, exophthamometry, opthalmometry, and fundoscopy. We find marked abnormality and asymmetry in that examination.
Angiography ; Child ; Electroencephalography ; Humans ; Sturge-Weber Syndrome* ; Tomography, X-Ray Computed