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

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

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 huge convexity meningioma close to motor area of the dominant hemisphere was resected completely without any complications and Sequelae. A 50-year-old male patient who has been suffered from dysphasia, focal seizure, recent memory impairment and weakness of the right upper extremity for about three months was admitted to our neurosurgical department on March, 1977. Before admission, he had been treated with acupuncture and conservative managements under the diagnosis of arteriosclerotic cerebral thrombosis at certain famous university hospitals. On examination, he was mentally clear but moderately dysphasic : there were central type of right facial palsy and weakness of right upper extremity with intact sense. Extensor type of plantar response on the right was noted and fundoscopic examination was impossible due to bilateral cataract. Tc-99m pertechnetate brain scan and left carotid angiogram suggested large space occupying lesion of the left parietotemporal area and so large craniotomy on the left side was performed and through this huge meningioma was resected from the left cerebral convexity adjacent motor area without any damage to the cerebral cortex and vessels. After operation, his neurological deficits were improved markedly without any seguelae and complications and he was discharged at the day of third week of operation. Repeated neurological examination on discharge day revealed slightest right facial palsy, no dysphasia, no motor weakness and no any complications and sequelae.
Acupuncture ; Aphasia ; Brain ; Cataract ; Cerebral Cortex ; Craniotomy ; Diagnosis ; Facial Paralysis ; Hospitals, University ; Humans ; Intracranial Thrombosis ; Male ; Memory ; Meningioma* ; Middle Aged ; Neurologic Examination ; Seizures ; Sodium Pertechnetate Tc 99m ; Upper Extremity

A brain abscess recurred after complete removal of encapsulated mass on the quite same spot three months later. 23-year-old woman was admitted to our hospital because of headache and vomiting for 3 months. On admission, she was mentally alert but the bilateral optic discs were markedly blurred. Left carotid angiogram and Conray ventriculogram suggested a large space-occupying lesion. At the time of operation, a large mass was removed with slightest occipital damage to the brain. On selection of the extirpated mass, thick purulent liquid came out. After operation, her neurological deficits were markedly improved except the equivocal hemiparesthesia of the right extremity. Postoperative course was quite uneventful and she was discharged. After 3 months postoperatively, she was re-admitted with recurrence of the trouble. She was comatose at this time. Pupillary light reflex was abolished. Pathologic reflexes were positive. The angiography and brain scan revealed recurrence of abscess on the just same area. Puncture for aspiration was immediately performed. Purulent materials were drained about 40ml. After abscess cavity was irrigated with physiologic saline solution, instillation of penicillin and micropaque was done within cavity. After several repeated puncture and aspiration her conditions were dramatically improved. Again, she became almost asymptomatic and was discharged days later her second admission. The results are as following ; 1. Primary focus of bacterial spreading to the brain was not found on both occasions. 2. Pathogenesis of both occasions was not clear. 3. At time of first operation, evidence of local inflammation was not found. 4. Local process and other induration was not found. These were confirmed with the operation and brain scanning. 5. Recurred brain abscess was newly developed. It seems to be hematogenous spreading in anywhere else.
Abscess ; Angiography ; Brain Abscess* ; Brain* ; Coma ; Extremities ; Female ; Headache ; Humans ; Inflammation ; Penicillins ; Punctures ; Recurrence ; Reflex ; Sodium Chloride ; Vomiting ; Young Adult

Cervical cordotomy via anterior approach without bone graft which is a modified Cloward's method is an effective and simple means of relieving of intractable pain with minimal destruction of bone lower morbidity and mortality. This method consists of an anterior surgical approach to the ventral surface of the cervical cord through a simple discectomy. A transverse incision in the dura mater gives excellent exposure permitting incision of the spinothalamic tracts under direct vision. For bilateral pain both incision are made at the same level of the cord without causing impairment of motor function of the lower extremities or bowel and bladder. This procedure has also many advantages and disavantages as follows ; 1. Cervical cordotomy by the this procedure has a much lower morbidity and fewer complications than the conventional procedure by laminectomy. 2. A more complete section of the spinothalamic tract is possible under direct vision. 3. A differential section of the tract with sparing of sensation in non-painful areas is possible by this procedure. 4. An incidence of the cord trauma can be minimized because the incision is possible without distorsion and traction of the cord during the operation. 5. This procedure without bone graft is simpler than original Cloward's method. 6. An water-tight closure of the dura is difficult but successful results are obtained by using a gelfoam. 7. This procedure above the level of the C3-4 interspace is difficult but possible. 8. A relief of pain below the level of the T3 dermatome is available and there is no good operative candidate when the brachial plexus is involved.
Brachial Plexus ; Cordotomy* ; Diskectomy ; Dura Mater ; Gelatin Sponge, Absorbable ; Incidence ; Laminectomy ; Lower Extremity ; Mortality ; Pain, Intractable ; Sensation ; Spinothalamic Tracts ; Traction ; Transplants* ; Urinary Bladder

It is the fact that parenteral antobiotics have no place in the treatment of the discitis after postoperative state because the antobiotics can not reach the focus of infection on account of the avascular zone of the intervetebral space. The author treats more extensive discitis to place an indwelling rubber catheter into the cavity to a contunuous irrigation with normal saline solution containing antobiotics. The catheter is left are as following ; 1. It is to effect the continuous direct administration of the antobiotics. 2. It is a mechnical effect by flushing out necrotic particles. 3. It is less recurrent infection. 4. The method is very simple, inexpensive. 5. The treated period is very short in contrast with immobilization and systemic antibacterial administration.
Catheters ; Catheters, Indwelling* ; Discitis ; Flushing ; Immobilization ; Rubber ; Sodium Chloride

A series of 41 patients in a vegetative state after severe head injury in presented. The patients selected were those who were in comatose state at least 2 weeks and observed more than 6 months. The vegetative state was more common before the age of 40(75.6%). The most common types of lesion causing vegetative state were subdural hematoma and epidural hematoma(56.1%). Twentyeight patients(68.1%) had a Glasgow coma score of 3 to 5. The two most frequent complications were urinary tract infections(80.5%) and bed sores(65.9%), but the most common cause of death was respiratory complication(60.0%). CT scans taken in the vegetative state showed variable evidences of cerebral atrophy, which were considered to be the results of the injury and had little value in predicting the outcome. At 6 months, the outcome was as follows : good recovery 4(9.8%) ; moderate disability 7(17.1%) ; severe disability 12(29.3%) ; vegetative state 10(24.4%) ; and dead 8(19.5%). Twenty-three patients(56.1%) came out of the vegetative state during a 6 month follow-up period. Vegetative state is not always permanent. Therefore, it seems necessary to distinguish perisstent vegetative state from vegetative state. The term, "persistent", means that the patient, if ever, came out of the vegetative state and in the event he did he usually remained in severe disability. 15 out of the 23 improved within 2 months, 14 out of the 15 improved to at least moderate disability. 8 out of the 23 improved after 2 months but all remained in severe disability. From these results we propose that the term "persitent" be applied to patients who remain in a vegetative state for more than 2 months.
Atrophy ; Cause of Death ; Coma ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Hematoma, Subdural ; Humans ; Persistent Vegetative State* ; Tomography, X-Ray Computed ; Urinary Tract

Ewing's sarcoma is an uncommon malignant neoplasm of the bone, which is rather infrequent in childhood and represented only 2% of all neoplasm under the age of 15 years. Clinical picture was that of progressive paraplegia associated with localized pain. The authors have experienced a case of primary Ewing's sarcoma of the first and second lumbar vertebrae in a 26-year-old male.
Adult ; Humans ; Lumbar Vertebrae ; Male ; Paraplegia ; Sarcoma, Ewing* ; Spine*