OBJECTIVE: Arachnoid cysts (ACs) can be cured by making the definite and wide communication between the cyst and arachnoid space using endoscopy, but often it is impossible only through the usual working-channel (intra-channel) procedures. We discuss and propose a more valuable endoscopic technique with the presentation of our series of cases. METHODS: We treated 9 patients with cortical AC in various locations with extra-channel endoscopic techniques. The patients ranged in age from 3 years to 60 years (mean age, 37.2 yrs). The follow-up period ranged from 12 to 26 months (mean follow-up duration, 17.2 months). All patients had large AC compressing the adjacent brain with clinical symptoms or signs. The authors performed extensive fenestration via single burr hole with the aid of endoscope. Being bypassed the rigid endoscope, through the space between the shaft of endoscope and guiding cannula (extra-channel method), fenestration procedures were done in the dry fields. RESULTS: Eight (88.9%) patients had been treated successfully with endoscope. One patient required shunt procedure. Among the eight patients who were treated with endoscopic procedure, 6 patients (66.7%) showed cyst reduction, and two (22.2%) showed disappearance of cyst. CONCLUSION: We suggest that extra-channel method will be simple and easy to perform using more valuable instruments with wider working area, and may promise better results compared to the conventional intra-channel endoscopic procedures.
Arachnoid ; Arachnoid Cysts ; Brain ; Catheters ; Endoscopes ; Endoscopy ; Follow-Up Studies ; Humans

Cervical traction has been widely used as an essential method for the treatment of cervical fracture-dislocation. This report, however, was a case in which hazardous effect of traction due to unreduced huge fragment was demonstrated only by cervical CT scan. Surprisingly plain X-rays could not demonstrated this condition. It was apparent that skeletal traction resulted in further injury of the spinal cord. Surgical removal of unreduced huge fragment was accomplished completely and interbody fusion was followed. Postoperative CT findings showed complete removal of fragment and decompression of the spinal cord as well as gratifying interbody fusion. CT scanning is imperative to evaluate the cervical fracture-dislocation and blind skeletal traction may be hazardous.
Decompression ; Spinal Cord ; Spinal Cord Injuries ; Tomography, X-Ray Computed* ; Traction

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.
Head ; Humans ; Metrizamide* ; Myelography* ; Neck ; Needles ; Operating Tables ; Prone Position ; Punctures* ; Spinal Canal ; Spinal Cord ; Spinal Cord Neoplasms ; Spinal Puncture ; Subarachnoid Space

Primary malignant lymphoma is very rare and represents less than 1.5% of all intracranial neoplasms. The authors have experienced a case of primary malignant lymphoma of the brain in a 66 year-old woman who presented with presistent headache, nausea and generalized weakness. Brain CT scan demonstrated typical deep seated tumor masses in the right temporal and left frontal lobes with strong contrast enhancement. We obtained a good result after surgery followed by radiation and chemotherapy and report our case with review of the articles.
Aged ; Brain Neoplasms ; Brain* ; Drug Therapy ; Female ; Frontal Lobe ; Headache ; Humans ; Lymphoma* ; Nausea ; Tomography, X-Ray Computed

Dermoid and epidermoid of the spinal cord are rare and their percentage was 2.6% of spinal cord tumors. In dermoid average age of occurrence is 28.3 years. They are dysembryonic malformations. Dermoid consists of desquamated material, sebaceous material and hairs. The region of preference is lumbosacral spinal cords, especially cauda equina and conus medullaris. We are reporting a case of dermoid which has taken intracapsular enucleation and discuss about the epidemiology and pathogenesis.
Cauda Equina ; Conus Snail ; Dermoid Cyst* ; Epidemiology ; Hair ; Spina Bifida Occulta ; Spinal Cord ; Spinal Cord Neoplasms

In the past the patients with fracture on the occipital bone involved the lateral sinus and/or the foramen magnum, were treated with the early exploratory burr hole trephination regardless of mental state. The 64 cases occipital bone fracture were evaluated used the computed tomography of the brain scan. The fracture lines involved both the transeverse sinus and the foramen magnum were 59.4%, only the transeverse sinus were 29.7% and only the foramen magnum were 10.9%. The findings of the computed tomography of the brain scan were normal 42 cases, brain edema 13 cases. The 5 cases had large hematoma on the computed tomography of the brain scan performed emergency operation. The other 59 cases were treated with only close observation and conservative treatment. The mortality rate was 20% in operative treatment and 8.5% in conservative treatment. So we concluded that the patients with significant fracture on the occipital bone but had no surgical indication on the computed tomography of the brain scan might be treated with close observation & conservative treatment and it would not be necessary to perform the exploratory craniotomy as was done in the past.
Brain ; Brain Edema ; Craniotomy ; Emergencies ; Foramen Magnum ; Hematoma ; Humans ; Mortality ; Occipital Bone* ; Transverse Sinuses ; Trephining

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 analysed ultrasonic findings of 54 brain scan cases(45 cases were performed through the anterior fontanelle and the temporoparietal thin bone and 9 through the surgical bone defect) and comparison of these pictures with those obtained in the same patients by CT scan showed prominent correlation. Ultrasonography was more sensitive to different histologic features and provided a more accurate depiction of the neuropathologic characteristics in most of cases. We conclude that ultrasonography of the brain was proven to be quite useful in the screening and follow up of neonates and infants under 15 months of age, and as a follow up method in post operative patients. It was also more accurate than CT scan in cases of abscesses and cystic lesions.
Abscess ; Brain* ; Cranial Fontanelles ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography

Tension pneumocephalus is rare while pneumocephalus is relatively common. The former has sudden or insidious deterioration in neurologic symptoms and signs comparing to self-limited pneumocephalus. This report is of a 19 years old male with tension pneumocephalus in the right frontal lobe two underwent right frontal osteoplastic craniotomy.
Craniotomy ; Frontal Lobe ; Humans ; Male ; Neurologic Manifestations ; Pneumocephalus* ; Young Adult

A rare case of surgically extirpated intra- and extracranial metastasis of hepatocellular carcinoma is reported. This dumb-bell shaped tumor simulated malignant meningioma on computerized tomography brain scan and cerebral angiography. Removal of the mass was successfully achieved by external carotid ligation and CUSA dissection. We suggest that, when investigating patient with suspected cranial secondaries particulary if there is a bony involvement, serum alpha-fetoprotein and hepatic ultrasound should be carried out as screening procedures.
alpha-Fetoproteins ; Brain ; Carcinoma, Hepatocellular* ; Cerebral Angiography ; Humans ; Ligation ; Mass Screening ; Meningioma ; Neoplasm Metastasis* ; Ultrasonography