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 object of this investigation was to study the effects of Naloxone on histopathological changes in cats subjected thoracic cord contusion. Twenty cats were divided 4 groups : The first group was sham control(3 Cats). The second group was the impact group that was induced by T₉ cord injury without treatment(6 Cats). The third group was the saline group that was induced by T₉ cord injury and treatment with Saline(6 Cats). The fourth group was the Naloxone group that was induced by T₉ cord injury and treatment with Naloxone(6 Cats). The histopathological evaluation of the injured spinal cords in Naloxone-treated Cats had less tissue damage than would be observed in time-matched standards. The histopathology in Saline-treated group had slightly better than typical of what we would expect in impact group.

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 object of this investigation was to study the effects of methylprednisolone (M.P.) on the pathological change in the acute focal ischemic cerebral edema in cats. Forty cats were divided 4 groups : The first group was sham control group (4 cats). The second 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 (12 cats). The third and the fourth groups were induced acute experimental ischemia fro 3 hours and 5 hours respectively by the same method (respectively each 12 cats). Each group except sham control group was also divided 3 subgroups : The first, untreated 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 cats undergoing 1 or 3 hours of occlusion, treatment with methylprednisolone and recirculation show suppressive effects for subsequent edema and ischemia, but after 5 hours of occlusion, those have little positive or no effect. The effect of treatment with methylprednisolone and recirculation is dependent upon the degree of the ischemic insult and duration of ischemia. The present experimental results suggest that early medical treatment and recirculation within at least 4 hours protect the cerebral tissue from the injurious effect of ischemia. It would be considered that M.P. is used practically in the treatment of acute thromboembolism prevention the irreversible ischemic cerebral edema.

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

Twelve cases of delayed traumatic intracerebral hematoma(DTICH) were found retrospectively among 826 patients with closed head injuries admitted to the Department of Neurosurgery, College of Medicine, Ewhe Womans University in a 2-year period. All cases had severe head injuries sustained with the head in motion. The interval from cranial injury to diagnosis of DTICH by computerized tomography(CT) varied from 15 hours to 11 days. The diagnosis was made on repeat CT scans obtained because of the development of focal findings, lack of improvement and/or general neurological deterioration. One patient had initially negative CT scans. Six patients demonstrated only extracerebral hematoma on initial CT scans. Two patients showed acute intracerebral hematoma on the initial scan followed by new hematomas on repeat study. Ten patients were treated surgically, and eight had fair & good results. The cases presented are discussed in the light of pertinent literature.

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.

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.

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.

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.

We have experienced 61 cases of hypertensive intracerebral hemorrhage who were admitted to the Department of Neurosurgery of Ewha Womans University Hospital from January 1981 to October 1983.

We analyzed the result of the treatment of hypertensive intracerebral hemorrhage and assessed prognostic factors affecting the result of treatment of hypertensive intracerebral hemorrhage.

The following results were obtained.

1) The age distribution was ranged from 36 to 74, and the fifth decade was most frequently involved, 22 among 61 patients(36.1%).

2) The ratio of male to female was about 1.8:1 and the age of the patient did not significantly influence on the result of operative cases in all age group, but in the non-operative cases increased mortality above fifth decade was noted.

3) The most frequent site of hypertensive intracerebral hemorrhage was putamen in 50.8%; followed by thalamic 19.7%, subcortical 11.5%, pontine 9.8% and cerebellar hemorrhage 8.2%. Intraventricular hemorrhage occurred in 27.2%.

4) Calculated amounts of hematoma based on CT scans ranged from 5 to 150cc roughly. The amount of hematoma did not directly related to the outcome of operated cases if the hematoma was less than 65cc, while the mortality was considerably increased if the hematoma was more than 65cc.

5) In correlation between arterial blood pressure and outcome, the mortality of below systolic BP 150mmHg was 20%, of above BO 150mmHg was 41.3%.

6) The operative mortality of the hypertensive intracerebral hemorrhage was 27.8%, and 48% in non-operative cases.

7) The surgical treatment obtained better result than non-operative treatment in the cases showing progressive change in consciousness following intracerebral hemorrhage and the conservative treatment obtained relatively good result in the cases showed progressive improvement of conscious level following intracerebral hemorrhage.

8) The interval from the attack to surgical intervention did not constantly influence on the result of surgery and it might be wise to decide the time of surgical intervention according to the progressive changes in conscious level and neurological status after bleeding.

No abstract available in English.

No abstract available in English.

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.