Animal models of peripheral nerve ischemia have yielded variable results.

The question of whether postischemia re-estableshment of blood flow to the nerves auguments injury has not been examined.

To study this question, the ipsilateral common iliac and femoral arteries were occluded with arterial snares for 3 hours in rats. C14-butanol tissue distribution was then used to measure blood flow in both sciatic and posterior tivial nerve trunks during occlusion and reperfusion.

Clinical limb function was graded serially, with the undisturbed contralateral limb serving as the study control. Nerve blood flow was reduced throughout the ischemic period and was only 20% of the control value in the posterior tibial nerve. All rats had functional impairment with an average limb function score of 7.5(normal score<2). During reperfusion period, blood flow in the distal sciatic and posterior tibial nerves was approximately double that of control nerbes at 2 hours.

At 21 hours, tibial nerve blood flow was still twice that of the control nerve, but flows in the distal sciatic nerve were unchanged from control levels. Clinically, limb function improved progressively after reperfusion.

It was concluded that nerve ischemia is attended by a relatively prolonged hyperemic flow response during reperfusion.

It evaluated the efficacy of percutaneous needle aspiration(PNA) in the evacuation of supratentorial hematoma in 22 patients with spontaneous intracerebral hemorrhage. All PNA patients had hematoma volume greater than 30ml as determined by computerized tomography image analysis. All patients underwent PNA within 12 hours of presentation. No perioperative complications were noted.

In intracerebral hemorrhage patients with hematoma volume > 30ml, survival was higher in patients who underwent PNA than in unmatched medically treated controls.

Survival was significantly higher in patients with 40%, or greater reduction in hematoma volume postevacuaton.

PNA may be a simple and effective method for improving outcome in intracerebral hemorrhage. It appears that survival may be related to the amount of blood removed during PNA.

No abstract available in English.

The degenerative process of cervical spondylosis through acquired narrowing of the spinal canal or segmental hypermobility of the spinal column, either singularly or in combination, mayresult in injury to the spinal cord or supportive vasculature. The mutifactional character of cervical spondylotic myelopathy(CSM) indicates a probable onset and progression of this disease aswell as a diversity of clinical manifestations. Although it is recognized that a number of factors,mostly vascular, may contribute to the pathogenesis of CSM, surgical procedures performed forthis condition decompress the spinal cord on the premise that mechanical compression is a major, if not pirmary, causative factor.

For several decades, both anterior and posterior spinal decompressive procedures have beenperformed on CSM patients, who are generally being informed before the operation that theaim of surgery is to stabilize their neurologic condition and that actual improvement often cannot be expected.

Over the past 10 years, radical cervical cord decompression via corpectomy has been reportedas being more effective than conventional surgery for CSM.

The authors have undertaken a study of 12 patients who underwent anterior decompreuivecorpectomy procedures for CSM, which was defined as a myelopathy related to osteophyticovergrowth and ossification of posterior longitudinal ligament(OPLL) in the conical spinal canal causing impingement upon the spinal cord from Mar, 93 to Aug. 95 at Dong Dae MoonHospital, Department of Neurosurgery. The result was fo11owing : man was prevalent in allcases, prognosis was strongly correlated with age, preoperative neurological state and 7 cases(58%) resulted in excellent group.

Moyamoya diseases is an unusual vascular disorder highlighted by progressive bilateral internal carotid artery occlusion and collateralization of intracranial blood flow. To minimize the ischemic deficit, various surgical methods have been tried.

Among the 11 cases, 10 cases were associated with intracerebral and intraventricular hemorrhage and other one with cerebral infarction.

7cases with the surgical intervention were performed, 3 cases with EMS and 4 cases with EDAS. Outcome was exellent excepting 2 cases.

9 cases was survived and 2 cases was dead due to brain swelling and rebleeding.

The author has analyzed 54 cases of chronic subdural hematoma which were diagnosed by brain computerized tomography from March 1985 to February 1991.

There were 49 men and 5 women. The common incidence of age was between fifth and sixth decades. Most of the cases(76%) had a history of head injury and nearly all cases complained headache(87%).

All cases performed brain CT scan, which showed hypodense(37.1%), isodense(29.6%), hyperdense(14.8%) and mixed dense(18.5%) lesion.

Of 54 cases, 34 cases were treated with craniotomy and membranectomy. 20 cases with burr-hole and drainage. There was no difference in results in both methods and most of the cases showed good postoperative course except 2 cases.

Experience with the use of the surgibone graft in anterior cervical interbody fusion employing the Cloward technique in 15 cases of the fracture-dislocation is reported.

The surgibone, manufactured from the bone of young calves, is heterogenous material that consists only of fibrils and crystallites.

With use of surgibone, iliac osteotomy is unnecessary, and this procedure is no problem of donor site pain and infection which can be possible in interbody fusion with iliac bone and rib graft and the aims of the operations are achieved, namely removal of the disc, fixation of the spine to prevent compression of the neurak tissues and stability of the spine.

The operative procedure is simplified and the time required for the operation is diminished, comparing to autogenous bone graft.

Medulloblastomas constitute 4 per cent of all intracranial tumors and 7 to 8 per cent of all intracranial neuroepithelial tumors.

Although medulloblastomas are generally considered to be tumors of childhood, about 30 per cent of patients are at least 16 years old when first seen, Four fifths of these adult patients are between 21 and 40 years old and after the age of 50, the incidence of these tumors are extremely rare.

Herein the authors report on one case of medulloblastoma in 56 years old patient with the brief review of literatures.

The authors have studied the therapeutic effect of the combinations of mannitol, methylprednisolone(MP), phenytoin and barbiturates on the acute focal cerebral ischemia (AFCI) in cats. The experimental animals were divided into three groups. Group I was the cats with the removal of the orbital contents without occlusion of MCA. Group II was that of 2-hour recirculation after AFCI following the occlusion of MCA for 3 hours. Group C was subdivided into four subgroups as Group III-a, Group III-b, Group III-c and Group III-d. Group III-a was that of treatment of combinations of mannitol and MP, Group III-b that of combinations of mannitol and phenytoin. Group III-c that of combinations of mannitol and barbiturates, and Group III-d that of combinations of mannitol, MP (60mg/kg) phenytoin and barbiturate. As the biochemical studies cytochrome oxidase activities (COA) and the concentrations of lipid peroxidation(LP) were determined, and as the pathohistologic studies the degree of the infarcted areas, hemispheric swellings and the comparative microscopic findings of the infarcted areas were studied. In Group III-a and Group III-b no therapeutic effect on the AFCI was presented. In Group III-c the partial effect of brain protection were demonstrated only in LP and the degree of hemispheric swelling, but Group III-d provided nearly complete protection from ischemic damage. These experimental data suggested that the medical measures of the combinations of mannitol, MP, phenytoin and barbiturates can make the AFCI fully reversible and would applicable in the clinical field.

Arteriovenous malformation of the brain is a congenital abnormal communication between arterial and venous channels without the interposition of the capillary system. A retrospective clinical study was performed on 20 patients with supratentorial arteriovenous malformation during the period from September 1984 to December 1986. The 20 patients were underwent surgical treatment using the operating microscope. Followings are the results: 1) The age range of presentation of supratentorial AVM(arteriovenous malformation) was to be from 30 months to 64 years, with peak incidence of fourth decade. 2) The presenting symptoms were hemorrhage, change of consciousness, seizure, headache in order of frequency. In hemorrhage, intracerebral hematoma was the most common type. 3) The most common sites of supratentorial AVM were frontal and parietal lobe. Most of the supratentorial AVM were fed by branches of the middle cerebral artery. 4) Computerized tomographical findings of AVM were intracerebral hemorrhage and mass effect. And after injection of contrast medium, 13 out of 20 AVM showed strong enhancement. 5) After operation, 13 patients were regained nearly total function.

The purpose of this study is to investigate the effect of methylprednisolone(M.P.) on the alterations of ATP, sum of adenosine nucleotides and adenylate energy charge(E.C.) in the cats with acute focal ischemic cercbral edema. Thirty six cats were divided 3 experimental group ; The first group was induced acute experimental ischemia for 1 hour by occlusion of left middle cerebral artery(M.C.A.) applying the Heifetz clip through the transorbital approach under the operating microscope. The second and third groups were induced acute experimental ischemia for 3 hours and 5 hours respectively by the same method. Each group was also divided 3 subgroups ; The first, untreated group(4 cats) was left without any treatment after the acute ischemia. The second, recirculation group(4 cats) was recirculated for 2 hours after the acute ischemia. The third, treatment group(4 cats) was recirculated for 2 hours and injected M.P.(15mg/kg) at 30 minutes after occlusion initially and then injected at 90 minute interval, respectively. The experimental results are as follows. In 1-hour untreated group. ATP was reduced to 34.0%, sum of adenosine nucleotides reduced to 72.2% and adenylate E.C. reduced to 60.0% of the control value. In the recirculation group, ATP was reduced to 42.0%, sum of adenosine nucleotides reduced to 82.4% and adenylate E.C. reduced to 74.3%, In the treatment group, ATP was increased to 143.9%, sum of adenosine nucleotides increased to 153.9% and adenylate E.C. decreased to 92.9%. In 3-hour untreated group, ATP was decreased to 24.9%, sum of adenosine nucleotides to 22.9% and adenylate E.C. reduced to 58.6% of the control value. In the recirculation group, ATP reduced to 32.9%, sum of adenosine nucleotides reduced to 28.6% and adenylate E.C. reduced to 71.4%. In the treatment group, ATP reduced to 99.5%, sum of adenosine nucleotides increased to 103.5% and adenylate E.C. decreased to 84.3%. In 5-hour untreated group, ATP decreased to 5.3%, sum of adenosine nucleotides reduced to 9.0% and adenylate E.C. reduced to 58.6% of the control value. In the recirculation group, ATP decreased to 4.4%, sum of adenosine nucleotides decreased to 5.8% and adenylate E.C. decreased to 57.1%. In the treatment group, ATP was reduced to 11.2%, sum of adenosine nucleotides reduced to and adenylate E.C. reduced to 70.0%. As the results shown above, the therapeutic beneficial effects of M.P. were observed in cats of 1-or 3-hour occlusion of M.C.A with 2-hour recirculation.

Moya Moya disease is a rare chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. This disease has distinct angiographic features. These include 1) Either marked stenosis or complete occlusion of the distal internal carotid arteries. 2) Poorly visualized anterior and middle cerebral arteries at their proximal portions. 3) Well developed fine vascular networks at the base of the brain. These features are peculiar findings of this disease and the clue of the occlusion and its collateral circulation. Authors reported 3 cases of moya moya disease is discussed.

A 31 year old male was admitted to our hospital with severe upper thoracic pain, paraplegia and urinary difficulty. The patient have no history of infection or operation. At admission, neurologic examination revealed alert mental state, hypoesthesia below the level of T6 sensory dermatome. All deep tendon reflexes were hypoactive. Myelographic examination disclosed total blockage of T5 body level. ACT scan of the lumbar spine performed immediately after myelogram verified an intramedullary enlargement of the spinal cord. Laminectomy was performed from the T3 to T5. Yellowish discolorated pus was founded at the epidural space, and exuded out through dura perforation. Dura was incised and the abscess was removed. The intramedullary abscess was encountered and fibrous granulation tissue was partially enveloped the abscess. The abscess removed by repeated antibiotics mixed saline and suction. The organism from the abscess was identified as staphylococcus coagulase positive. Antibiotic therapy was continued for four weeks and steroid postoperatively. The patient's condition was slight improved sensory level, but motor power was still hemiplegia on discharge time

The authors report a case of tuberculoma in the posterior fossa, that developed 1 year after a procedure of ventriculo-peritonial shunt due to communicating hydrocephalus as complication of tuberculous meningitis. Brain CT demonstrated the tuberculoma at right quadrigeminal plate. Operation was done under the operating microscope at Sept.14.1984 and confirmed completely removal of tuberculomatous mass.

Giant aneurysm occures rarely and it is about 5% of intracranial aneurysm. Giant aneurysm arising from the intradural portion of the internal carotid artery proximal to the origin of the posterior communicating artery present specialsurgical problem. Most of these aneurysms arise in the relation to the origin of the ophthalmic artery from the anteromedial aspect of internal carotid artery; however, others arise from the posterolateral portion of the internal carotid artery. In some of the largest ones, the neck is so wide that the site of origin is not clear. As a group, these aneurysms can be called paraclinoid. In these cases, operative difficulty is presented and complication is well developed, so treatment is marked difficult. We experience a case of giant paraclinoid ane-urysm which was treated by common carotid artery ligation in the neck and report with brief review of the literature.

The authors report a case of large oligodendroglioma arising from the right parietal lobe in a child and review the literatures.

For the purpose of ascertaining the role and magnitude of ischemia of the spin-al cord following trauma the authors determine the lactate concentrations in cere-brospinal fluid(CSF). Laminectomies were performed at L2 under general anes-thesia with aseptic techniques. Paraplegia was produced by 400 gm-cm impact injury with impounder. Significant increases in CSF lactate levels occurring at Day 5. The prolonged elevation of CSF lactate indicates that tissue hypoxia plays a role in spinal cord damage and that there is a continuing hypoxia of metabolically active spinal cord tissue for several days post injury.

The purpose of this study is to report an experimental model for the cerebral infarction by occluding a segment of the middle cerebral artery with artificial emboli. In each dog the right common carotid artery was exposed and the internal carotid artery was catheterized selectively with a 16 gauge catheter of Intracath. The prepared embolus, a gutta percha cylinder measuring 4 mm long by 1.5mm in diameter was injected through the catheter of Intracath until backbleeding indicated the embolus had lodged intracranially, beyond the internal carotid-maxillary artery junction. The optimal material for experimental emboli should be radiopaque and easily identified in pathological specimens, and should produce cerebral lesions which resemble spontaneously occuring clinical infarction in pathophysiological mechanism. Since the gutta percha cylinder is radiopaque and its position was able to be checked in simple skull films, it was considered to an optimal embolic material. In the postoperative period the animals were extremely ill with impaired consciousness, vomiting and contralateral hemiplegia. Autopsy revealed massive hemorrhage infarction of the ipsilateral cerebral hemishpere in each of the animals and the average volume of infarction was 1.93 cu cm and also it was observed that there was no endothelial damage of the middle cerebral artey, even when the embolus was left in situ for 10 days.

The authors report a case of leptomeningeal cyst in the right parietal region, which was developed after trauma, in 3 months old male baby.

The impression gathered from the literature on epidural hematoma at the vertex is that knowledge of this hematoma is still scanty. Thest hematomas are rarely described as specific pathological entities. For this reason we thought it worthwhile to review the cases reported in the available literature. Seven cases of vertex epidural hematomas enccuntered in patients admitted over a 3-year period at the Ewha Womans University Hospital are presented. Clinical and neuroadiological findings, treatment and results are reported.

The tumor of the corpus callosum is a rare tumor with a incidence of 0.6 to 4.9% among all intracranial tumors. We report a case of astrocytoma of corpus callosum in 39 year-old man with complaints of headache, recent memory disturbance and urinary incontinence. The tumor located in the corpus callosum is soft consistency with light-grey color and the microscopic finding reveals astrocytoma in grade II.

The authors report a case of metastatic carcinoma in the skull presenting with pulsating mass of the right parietal region which was metastasized from clear cell carcinoma of the kidney.

Teratoma are probably the result of a segregated blastomere which, being totipotent, results in a jumble of tissues. It has also been suggested that they may be displacements of the coccygeal body. However, regardless of their origin they are usually present at birth or shortly there-after and are excised via perineal route. The following case of a sacrococcygeal teratoma is reported because of the histogenesis involved and the excellent result following surgical removal.

A case of a huge, densely calcified chromophobe adenoma is reported with references reviewed.

Zander, in 1940, was the first to perform a cranioplasty with methylmetacrylate, and around the same time Kleinschmidt, in experiments on rabbits, demonstrated its nonirritative character. Brain edema often forced us not to replace the skull bone flap. Under such circumstances, mostly 3 to 4 months later, we had undertaken delayed cranioplasty. Authors reviewed 62 cases of head injuries with skull defect repaired by cranioplasty using methylmetacrylate resin. The results were as follows; 1. The majority of head injuries caused in the vehicle accident. 2. The most common sites of the skull defect were in the temporal and frontal bone. 3. The interval between primary decompressive craniectomy and delayed cranioplasty was from 3 to 4 months in the majority of cases. 4. Defects may fill in spontaneously to leave no visible evidence of it's presence. 5. The syndrome of the trephined was not relieved by cranioplasty. 6. The course of the post-traumatic epilepsy was not altered by cranioplasty. 7. Headache may be refered to the site of a cranial plate. 8. Cosmetic results were excellent. 9. Postoperative complications were observed in 4 cases(6.5%)