59 Consequtive patients with cervical disc disease were treated with single or multilevel anterior discectomy and fusion using a modified Smith-Robinson procedure from Sep. 1993 to Dec. 1996.

There were 36 single-level fusions, 19 two-level fusions and 4 three-level fusions.

The most common presenting complaint was radiating pain to upper extremity and the most frequent site was the C5-6 in single level, C5-6-7 in two level, and C3-4-5-6 in three level. Immediate postoperative complications were encountered in 11 cases : graft extrusion in three, hardware failure and loosening in two, donor site pain and hematoma in four, and transient hoarseness in two cases. With an average follow-up of 1 year, the fusion rate was 96.5%(83 of 86 levels). The single-level fusion rate was 100%, the two-or three-level was 94%. Results by clinical examination revealed 32(54%) excellent, 23(39%) good, 1 fair and 3 poor.

There were no significant graft collapse or exrusion and wound infection or neurologic complications. The modified Smith-Robinson procedure for anterior cervical discectomy and fusion has led to the successful treatment of cervical disc disease with improved results and few complications in long-term follow up.

Cysticercosis is the most frequent parasitosis of the central nervous system. Often medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the occurence of complications, such as hydrocephalus. So a considerable group of patients require surgical procedures, especially in cases of neural compression or intracranial hypertension or epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocy-sticercosis using the stereotatic endoscopic system.

We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF)analysis, enhanced com-puterized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all patients, partial sensory type in 3 cases who had reciprocal intraparenchymal lesion, generalized type in 1 case who had obstructive hydrocephalus by multple ventricular cysts.

For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser and suction. Cystic forms were removed successfully but in solid form additional transgyral microscopic removal was needed. In intraventricular lesions, we first placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway patheter. Through the peelaway catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions were removed without specific complications except transient chemical meningitis in one case.

Stereotactic endoscopic surgery make it possible to operate cystic lesions without dege-neration(vesicular stage)wherever they locate.

The assessment of the vasoreactivity measured with transcranial doppler(TCD) provides information regarding to the reserve capacity of the cerebral circulation in patients with acute head injuries, which has important therapeutic consequencies because it allows for the diagnosis of impending ischemia and for the control of the effect of initiated corrective measures.

The authors performed TCD study to measure the CO₂ reactivity to the entire basal cerebral arteries in 30 cases of control group and 14 cases of head inury group between the 3rd and the 7th day after insult. All patients were examined by single photon emission computed tomography and their results were compared to CO₂ reactivities at 8 basal cerebral arteries. All of these results were analyzed by statistical analysis system(SAS).

The increase of MBFV(mean blood flow velocity) and decrease of PI(pulsatility index)were noted in the cerebral arteries with decreased CO₂ reactivity. It meant that the arterial walls were dilated. There was no close relationship between region of interest(ROI) index and CO₂ index but CO₂ reactivity was remarkably decreased in the region which showed abnormal regional cerebral blood flow in SPECT(single photon emission computed tomogram)(P=0.04). In the relationship between the variables, ROI increased as the clinical status worsen(r=0.5, P=0.0008), the prognosis of the patients had positive correlation with CO₂ index(r=0.32, P=0.04) or clinical status had negative correlation with ROI index(r=0.40, P=0.0094).

The doppler CO₂ test in patients with head injury provides useful information regarding hemodynamic state, prognosis and determination of beneficial effects of specific therapy, especially during subacute stage. In the various TCD parameters CO₂ index was correlated well with prognosis.

The authors report 16 cases of large cranial base meningiomas operated on during the 7-year period from August 1986 through August 1994.

These minigiomas were 4 cases of olfactory groove, 4 cases of tuberculum sellas, 1 case of cavernous sinus, 2 cases of sphenoid ride(medial), 3 cases of tentorium, 1 case of intratemporal fossa and 1 case of petroclival area. These were 14 women(87%) and 2 men(13%) with a mean age of 48 years(mage 17 to 65 years).

Microsurgical technque with recent advance sugical approach assisted in removal of tumor tissues with preservation of vital structures. The grading of tumor removal by Simpson grading system were followings ; grade I 4 grade II 8 cases, grade III 2 cases grade IV 2 cases. There were 4 deaths(25%) ; one from pulmonary edema, one from myocardiac ischemia, one from sepsis and from brain swelling. Only one patient died from the cause related to his tumor. Overall 6(44%) of patients are doing well and 5(31%) have significant disability.

While odontoid fractures are common injuries, disagreement exists regarding treatment. Because of the high risk of nonunion in type II odontoid fractures, surgical fusion should be considered in the initial treatment of odontoid fractures, surgical fusion should be considered in the initial treatment of odontoid fractures.

Surgical fusion of odontoid fractures has usually been carried out by posterior C1-2 arthrodesis rather than fracture fixation. The former approach has been associated with significant mortality and morbidity. In addition, it results in a decreased range of motion, particularly lateral rotation and requires postoperative external immobilization. Recently several authors aors have advocated anterior scrow fixation of the fracture as an alternative to posterior cervical fusion.

This paper presents a descuddion of different fusion methods and a limmited experience of screw fixation method.

Direct anterior odentoid screw fixation can be used for the successful treatment of selected odontoid fractures and nonunions.

The author reports the experiences of the transcondylar approaches to five meningiomas in the low clivus and foramen magnum, two aneurysms of the posterior inferior cerebellar artery and one cavernous angioma in the pontomedullary area. The results show that there, was no operative mortality and minimal operative morbidity was noted ; one patient has temporary oropharyngeal dysfunction. The main advantage of this approach of offers the best direct view of the ventral structures to low clivus and foramen magnum without additinal retraction or manipulation of the brain stem.

The author has reviewed the results of microsurgical management in 56 patients with pituitary adenoma, In a series of 56 pituitary adenomas, 10(18%) were nonsecreting and 46(82%) produced hypersecretion syndrome : prolaction(34), human growth hormone(6), mixed prolactin and growth hormone(1), adrenocortcotropic hormone(5). The number of microadenomas were 6 cases. In the aspects of operative procedures the trans-sphenoidal procedure approach were given in 38(69%) cases and the transcranial approach in 18(31%) cases. In anatomic(radiographic and operative) classification, non-surprasella extension(5), occupies surprasellar cistern(27%), recesses of third ventricle obliterated(11), third ventricle grossly displaced(7) and parasellar extension(5) were observed. The overall morbidity and mortality were 3.6% and 10.7% respecterely.

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.

For the purpose of the study of severity of the chronic vasospasm after subarachnoud hemorrhage(SAH), SAH was induced in dogs by injections of fresh unheparinized autologous arterial blood into the cisterna magna. The experimental groups were devided into two groups. Group I was that of the only one 5ml injection of subarachnoid blood, and Group II was that of the double-hemorrhage canine model; secondary injection of 3ml at 24hours after initial injection. Selective left vertebral angiograms were performed 5 days before and 7 days after the initial SAH and were compared to determine the percentage of reduction in basilar artery diameters. The reductions in basilar artery diameter of Group I and II were 33.0%±0.90 and 45.3%±1.99 respectively.

This result suggest that the severity of spasm is related to the volume of hemorrhage and rebleeding episode.

A consecutive series of fifty-six patients with ruptured aneurysms were operated upon within 24 to 72 hours after subarachnoid hemorrhage (SAH). All operations were performed by the author.

The clinical grading (Hunt and Hess) was I to II in 21, III in 11 and IV to V in 24. In 24 patient the internal carotid complex and in 18 it arose from the middle cerebral artery. The SAH as determined by computerized tomography was minor in 14, moderate in 5 and severe in 24. 15 patients habored intracranial hematomas (subdural, intracerebral or intraventricular hematoma). Of the patients preoperatively grade I or II, 86% had good neurological recovery, of the grade III patients good neurological recovery and of grade IV-V 75% had died. The mortality of the grade I-II patients operated upon within 24 hours, 24~48 hour and 72 hours were 11.1%, nil and 13.3% respectively. These results suggest that acute surgical repair of the ruptured cerebral aneurysms within 3 day of the ruptures in the grade I to III, is useful in preventing recurrence of hemorrhage and vasospasm through the removal of the subarachnoid clot.

It is the purpose of the this experimental study to investigate the protective effect of pretreatment of mannitol and methylprednisolone(MP) on the changes of the high-energy metabolites(nucleotides ; derivatives of adenosine, guanosine, uracil and cystosine) and adenylate energy charge in the brain tissue of the cats. The experimental animals were divied into three groups. Group I was the sham control groups that the postorbital approach was performed but no occlusion of MCA. Group II was the recirculation group that of 2-hour recirculation after the occlusion of the middle cerebral artery(MCA) via the postorbital approach. Group III was that of pretreatment of the combination of mannitol(29mg/kg) and MP(3mg/kg) at 30 minutes before occlusion of the MCA and then every one and a half hours during the 5-hours occlusion and 2-hours recirculation. The experimental results are as follows. 1) Adenosine derivatives : In group III ATP was significantly increased to 622.9%, ADP significantly increased to 154.81%, AMP reduced 68.05% and total adenosine nucleotides increased to 103.63% of the values of group III. 2) Adenylate energy charge(E.C.) : In group III E.C. was recovered to 82.66% and increased to 206.66% of the values of group II. 3) Guanosine derivatives : In group III GTP was significantly increased to 554.03%, GDP increased to 96.61% and GMP reduced to 62.71% of the group II. 4) Uracil derivatives : In group III UTP and UDP was significantly increased to 470.37%, and 300.64% respectively and UMP was reduced to 91.7% of values of group II. 5) Cystosine derivatives : In group III CTP was increased to 133.33%, CDP reduced to 90.0% and CMP increased to 119.03% of values of group II. These above results suggested that pretreatment of mannitol and MP have a protective effect on the acute focal cerebral ischemia when given prior to the onset of the ischemia by the stabilization of the energy regulation and maintenance of a higher level of adenylate E.C.

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.

The introcuction of computed tomography and improvements in the surgical techniques have made the diagnosis of hypertensive intracerebral hematoma (HICH) easy and simple at early stage and lead neurosurgeons to operation in the acute phase of the ictus. For the purpose of the assessment of the prognostic factors(age, sex the preoperative consciousness level, location of hematoma, initial blood pressure, blood sugar level and history of hypertension) influencing the surgical mortality, the author reviewed the 52 cases of HICH operated on within 24 hours of the appopletic attack. The overall operative mortality was 57.7%, and the preoperative consciousness level and the location of the hematoma were very significantly and initial blood pressure was significantly correlated with the surgical outcome of the patients. Therefore, it was suggested that the preoperative consciousness level and the location of the hematoma were the most important factors influencing the prognosis in surgical treatment of HICH. However, the other various factors contributing the prognosis need to be studied further.

It is the purpose of this study to evaluate the therapeutic effect of methylprednisolone(M.P) in the acute phase of focal cerebral ischemic stroke. Acute focal cerebral ischemia was produced by transorbital occlusion of the left middle cerebral artery (MCA) with Heifetz clip under the operating microscope. The Experimental animals were divided into 3 groups. The occlusion group was that the acute focal ischemia was induced for 4-hour of the occlusion of the MCA only. The circulation group was that of 2-hour recirculation after acute focal ischemia. The treatment group was that of M.P. (15mg/kg) injection at 30minutes after dcclusion initially and at 90 minute interval. The sham control group was the cats with removal of the orbital contents without occlusion of MCA. Cytochrome oxidase activity(COA) and the lipid peroxidation LP were concentration determined. The results obtained were as the following. In the occlusion group, COA was reduced to 60.6% and LP increased to 167.0% of the sham control value, in the recirculation group COA reduced to 63.5%. LP increased to 140.6% of the sham control value. In the treatment group, COA was increased to 154.9% and LP decreased to 88.7% of the sham control value. Ultrastructures of the mitochondria were studied by electron microscopy in all group. In comparison with the other experimental groups the shapes and numbers of the mitochondrial cristae and the whole mitochondria were preserved well relatively. The above results indicate that MP has beneficial effect in the management of the acute focal ischemia in the cat model of 4-hour occlusion of MCA with 2-hour recirculation.

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.

It is the purpose of this investigation to study the effect of methylprednisolone(M.P.) on the alterations of glucose and lactate in the acute focal ischemic cerebral edema of the cats. The acute occlusion of left middle cerebral artery(MCA) of forty cats for 1, 3 and 5 hours respectively were accomplished by applying the Heifetz clip through the transorbital approach under the operating microscope. Twelve cats were not recirculated as a untreated group, twelve cats were recirculated for 2 hours as a recirculation group and twelve cats were recirculated for 2 hours and given M.P.(15mg/kg) at 30 minutes after occlusion initially, and then every one and a half hour as a treatment group. In 1-hour untreated group glucose was reduced to 67.3% and lactate increased to 156.6%, of the sham control, in the recirculation group glucose was increased to 552.7% and lactate decreased to 79.8%, in the treatment group glucose was increased to 3334.5% and lactate decreased to 74.6% of the sham control. In 3-hour untreated group, glucose decrease to 45.5% and lactate increased to 161.3% of the sham control, in the recirculation group glucose rose to 520.0%, lactate to 135.3% of the sham control. in the treated group glucose rose to 1187.3%, lactate to 101.2% of the sham control. In 5-hour untreated group, glucose decreased to 25.5% and lactate increased to 187.9% of the sham control. In the recirculation group glucose drecreased to 12.7% and lactate increased to 196.0%, in the treated group glucose rose to 103.6%, lactate to 157.2% of the sham control. Our experimental studies of the therapeutic beneficial effects of M.P. were observed in cats of 1-or 3-hour occlusion of MCA with 2-hour recirculation. Therefore, it was suggested that MP will prolong the period of potential reversibility of cerebral ischemia following reperfusion within 3 hours of ischemia.

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

No abstract available.

Focal cerebral ischemia initiates a series of event from the regional development of ischemic edema, loss of neural function and culminating in eventual infarction. The purpose of this study is to determine the effect of recirculation in acute focal cerebral ischemia. Sixty adult mongrel cats of either sex underwent production of focal ischemia by transorbital occlusion of the left middle cerebral artery with a Heifetz clip. The duration of ischemia was 1, 3 and 5 hours. In 5 animals in each group, the ischemic brain was reperfused for 1, 4 and 7 hours by removing the clip from the artery. It was observed that provided the restoration of cerebral blood flow in cats can be accomplished within 1 hour in cats or at least within 3 hours of the insult, the reversal of the neurological deficits and prevention of irreversible cerebral infarction can be expected. Therefore the prevention of cerebral infarction must first be directed toward improving blood flow during the insult as rapidly as possible to-minimize the time that cerebral blood flow is below threshold for the formation edema.

The object of this investigation was to study the effects of mannitol and high dose of methylprednisolone(MP) upon evolution of cerebral infarction in cats after acute left middle cerebral artery(MCA) occlusion and following reperfusion. The acute occlusion of left proximal MCA of thirty cats for 2, 4 and 6 hours respectively were accomplished by applying the Heifetz clip through the retro-orbital extradural approach and followed by 2 hours of recirculation. Fifteen cats were untreated as a control group and the fifteen cats were given a combination of mannitol(2g/kg) and MP(15mg/kg) at 30 minutes after occlusion initially, and then every one and half hour. Results of morphologic examination of the brain demonstrated that in treated cats undergoing 2-hour or 4-hour occlusion mannitol and MP improved the ischemic edema and infarction, but in treated cats undergoing 6-hour occlusion they had little protective effect in ischemic brain injury(swelling, neuronal damage and hemorrhagic infarction). Electroencephalography(EEG) in cats undergoing 2- or 4-hour occlusion showed more increasing activities and voltage than in untreated groups, but in cats undergoing 6-hour occlusion low voltage and slow waves with poor activity, i.e, generally suppressed pattern, were observed and were not significantly different between treated and untreated groups. Our experimental studies of the therapeutic beneficial effects of mannitol and MP were observed in cats of 2- or 4-hour occlusion of MCA with 2 hour recirculation Therefore, it was suggested that mannitol and MP will prolong the period of potential reversibility of cerebral ischemia following reperfusion within 4 hours of ischemia.

Acute experimental occlusions of the left middle cerebral artery of cats were accomplished by applying the Heifets zlip through the retro-orbital extradural approach with operating microscope. The most striking neurologic signs were disturbance of consciousness, paresis of the right limbs(especially fore limb), and tonic deviation of the head neck toward the side of the occluded artery. The size and severity of the infarcts generally were related to the severity of the neuro logic disorders. 4 cats died within 48 hours of the occlusion of artery and 5 cats improved somewhat after the initial stage. However, the disturbance of the consciousness and the motor weakness persisted until the end of the period of observation. The severity of persistence of the neurological deficits may depend upon the effectiveness of reperfusion through collateral channels and the variability of anatomical pattern of the cerebral structures. A disturbances of consciousness may be related to the generalized decreases of neuronal activity or to focal neuronal dysfunction. Ischemic edema secondary to brain ischema increases the intracranial pressure and aggravates the impairment of neurological deficits. Finally cerebral herniation may produce the irreversible brainstem damage and death. Therefore, early reperfusion of ischemic brain before ischemic edema develops may improve the neurological deficts and prevent the occurrence of the secon-dary neuronal dysfunction.

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.

This study was undertaken in order to define the beneficial action of methylprednisolone sodium succinate on the lactate metabolism in injuried spinal cord. The spinal cord was exposed by dorsal laminectomy from L2 to L5 under the operating microscope. A 400gm - cm injury was produced at the L2 vertebral level of the cord. The lactate content peaked at 2 ours of the injury, and remained significantly elevated for 8 hours compared to uninjuried normal cord. The changes of tissue lactate in the spinal cord following injury are consistent with marked reduction in blood flow in the injuried spinal cord tissue following blunt contusion trauma. The elevation in lactate observed at 1 hour, 2 hour and 4 hour after the injury were prevented by intravenous administration of single 30 mg/kg dose of menthylprednisolone at 30 minutes after the injury. The results suggest that the beneficial effect of the intravenous administration of a 30 mg/kg dose of methylprednisolone may improve blood flow to the injuried tissue of spinal cord.

The pathological lesion in spinal injury is usually more severe in the central gray matter and spreads centrifugally to surrounding white matter. Opiate antagonists, naloxone, by blocking the pathophysiologic effect of endorphins, should increase both mean arterial pressure and spinal cord blood flow and limit neurologic injury. Naloxone produce increase of lateral column blood flow and ameliorate the central gray matter ischemia. We have investigated to thoracic cord confusion. The spinal cord of naloxone-treated cats has less tissue damage than would be observed in time-matched standards.

It is purpose of this study to determine the benificial effect of treatment with methylprednisolone on the enhancement of Na⁺·K⁺-ATPase activity and the increased ATP level during the 4 hours after a 400gm-cm injury to the spinal cord of cat. These results demonstrate that high dose(30mg/kg) of methylprednisolone can benificially enhance the activity of neuronal Na⁺·K⁺-ATPase during the first 4 hour after spinal cord injury. But the enharrcement of this enzyme activity is not significantly increased with mega dose(60mg/kg) of methylprednisolone. Tissue level of ATP in the high dose-treated cat at 1 hour after trauma was significantly elevated, but those in high dose-treated cat at 4 hour and the 1 and 4 hours with mega dose-treated groups were not significantly increased. The protective effects of methylprednisolone in experimental spinal cord trauma are the enhancement of Na⁺·K⁺-ATPase, inhibition of the free-radical reaction and the lipid peroxidation, the increment of neuronal activity and ATP utilization. High dose(30mg/kg) of methylprednisolone is required in order to produce the acute effect in the early phase experimental spinal cord injury.

The author measured the activities of the membrane-bound enzyme, Na⁺·K⁺-ATPase, and ATP as a part of an attempt to define the major cellular alterations in the initial 4-hour period of the feline spinal cord following experimental impact injury with 400gm-cm. The activities of Na⁺·K⁺-ATPase were significantly decreased at post-injury 1-hour and between the 1-hour and 4-hour period. But for these same samples, the activities of Mg²⁺-ATPase did not change appreciably. Contents of ATP were significantly depleted in the same period. These changes suggested that this model of the spinal cord trauma results in a severe irrevirsible injury to the affected tissues.

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 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.

The authors describe a case of facial myokymia which was considered as an isolated event. SUMMARY A case of facial myokymia which was considered as an isolated event was reported and the clinical and EMG features described.

The authors describe a case of syndrome of progressive bulbar palsy in amyotorphic lateral sclerosis which was diagnosed by electromyography.

Citations

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• A Case Report on the Use of Korean Medicine Treatment for a Patient with Dysarthria Caused by Progressive Bulbar Palsy (PBP)
  Jae Hyun Ahn, Sung Yoon Kim, Jun Hyeong Park, Jeongjae Cho, Do Young Choi, Seung Hoon Lee, Jae Dong Lee
  The Acupuncture.2017; 34(1): 49.     CrossRef

The authors describe a case of the brain abscess in the left temporal lobe which was accurately diagnosed by computerized tomography brain scan and complete surgical excision of abscess capsule was accomplis with great success. SUMMARY The case presented by authors was otogenic in origin and diagnosed accurately by the computerized tomographic scan, and total excision of the abscess capsule was performed by two stage operation.

Ependymal tumors are usually classified with the glial neoplasms of the nervous system. Ependymomas are the most frequent intramedullary tumors of the spinal cord and filum terminale. The authors describe a case of ependymoma arising in the conus medullaris and filum terminale.