The purpose of this study was to investigate the morphological changes(using magnetic resonance imaging(MRI))of 5 patients with lumbar disc herniation. All of these patients suffered from lower back and leg pain and were conservatively treated. The results were correlated with clinical outcomes to determine what kind of lumbar disc herniation had the capacity for spontaneous regression and how long it would take until such regression might occur. These patients were examined more than twice using MRI during conservative therapy. Lumbar disc herniation is classified into 3 types, using T1-weighted sagittal views. The patients were re-examined on the same MRI scanner. The herniated disc material of these 5 patients showed a high intensity on T2-weighted MRI study. It took about 4 months on average for the lumbar disc herniation symptoms to improve. About 17 weeks after the initial MRI scan, the disc material had clearly decreased in size for all patients. Regarding the mechanism of lumbar disc resolution ; the exposure of the herniated disc material to the vascular supply may have an affect although many other factors may also be involved.

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This report present the histological findings of 2 ruptured aneurysms treated by embolization using interlocking detachable coils. After embolization, a 82-year-old woman with a right middle cerebral artery aneurysm died from acute renal failure, and a 69-year-old woman with a basilar top aneurysm from acute pulmonary edema. The embolized aneurysms were resected and fixed. After embedding in polyester, these aneurysms together with the coils were sliced using diamond cutter, ground to 20 μm, and stained. Histological evidence showed that connective tissue had formed in the circumference of the coils. A large number of neutrophils and lymphocytes were present in the connective tissue and a few neutrophils and lymphocytes in the clot. No evidence of endothelialization of neck was found. The authors believe that thrombus began to develop on the circumference of the coils due to an inflammatory reaction.

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The ophthalmic artery has the highest incidence of variations and anomalies among the intracranial arteries, although these are usually asymptomatic. The authors present a rare case of anomalous ophthalmic artery arising from the anterior cerebral artery and stress the importance of recognizing abnormal origins of the ophthalmic artery. They have classed the various anomalous origins of the ophthalmic artery into 3 categories ; (1)those associated with the abnormal development of vascular anastomoses in the embryonic stage, (2)agenesis or aplasia of the internal carotid artery, and(3)abnormal development of the primitive ophthalmic arteries. During angiography, we should always check the origin and course of the ophthalmic artery. The absence of filling of the ophthalmic artery on internal carotid angiograms strongly suggests an abnormal origin of the ophthalmic artery in this case, external carotid angiography is essential for detection. During surgery on patients with possible anomaly, special care must be taken not to injure the surrounding structures, or an alternative surgical approach might be considered, as appropriate.

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This case of pituitary apoplexy occurred a few days after a road accident. A 66-year-old man was referred the hospital with occipital neck pain a road accident. A CT scan revealed no apparent traumatic changes. On the seventh day after the accident, the patient noticed a narrowing of his visual field. He was diagnosed with pituitary apoplexy on the evidence of a CT scan. On the ninth day after accident the tumor was removed by the transsphenoidal approach. A full visual recovery was made after the operation. Once diagnosed, pituitary apoplexy is easily treatable and its symptoms readily reversed.

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A rare case of kissing aneurysms arising from the ophthalmic segment of the left internal carotid artery and the anterior communicating artery is reported. A 60-year-old man was suspected of multiple aneurysms based on brain MRA performed as a screening examination. Although the follow up angiography revealed the 2 aneurysms described above, we did not recognize kissing aneurysms because the image of intraaneurysmal contrast medium seemed to overlap each other despite being close together on the every view. Thus, we decided initially to perform surgery on the aneurysm of the anterior communicating artery with irregular wall which seemed to be liable to repture. Surgical findings demonstrated 2 aneurysms pressing against each other at the dome and adhering with fibrous tissue. Aneurysmal adhesion was so tight that we had to run the risk of dissecting the kissing point sharply to mobilize the aneurysmal complex before fully exposing the neck. The aneurysm of the anterior communicating artery was clipped uneventfully. Seven months later, the residual internal carotid-ophthalmic segment aneurysm was clipped. We emphasize that in a case of multiple aneurysms in close proximity to each other, it is necessary to consider the possibility of kissing aneurysms.

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The authors report a case of longitudinal fracture of the clivus associated with cerebrospinal fluid(CSF)rhinorrhea. The patient, a 58-year-old man, sustained an industrial accident in which he was hit in the occipital region. Initial computed tomography(CT)demonstrated an occipital skull fracture and acute subdural hematoma in the left frontal region as well as in the posterior fossa. his condition rapidly deteriorated, and an emergency craniotomy allowed the removal of both subdural hematomas. The patient regained consciousness a few days later and 6 days after his initial craniotomy, he experienced massive CSF rhinorrhea. CT, especially three-dimensional(3D)CT, revealed a longitudinal fracture of the clivus and fluid collection in the sphenoid sinus. The CSF leak ceased following trans-sphenoidal surgical repair. The longitudinal fracture of the clivus should be taken into consideration in patients with traumatic CSF fistula. This case appeared to be rare in that the traumatic CSF rhinorrhea was caused by a longitudinal fracture of the clivus.

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We experienced a case with a ruptured aneurysm at the origin of azygos anterior cerebral artery(azygos ACA), and multiple aneurysms arising from the azygos trunk, which were not located at the vessel branching site. This case was also associated with hypoplasia of corpus callosum and a lipoma in the same part. This dysgenetic lesion, assumed to have formed in the patient's natural development suggests that aneurysms on the azygos ACA trunk may not necessarily result from the usual causal factors such as defect or hemodynamic stress, but instead develop due to the influenece of such development factors as dysgenesis of corpus callosum or the malnutrition of the vessel wall due to the presence of a lipoma.

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It is well known that neurofibromatosis type 2(NF 2)has bilateral acoustic schwannomas and lack genes on chromosome 22. We presented 26-year-old man diagnosed as NF 2 by radiological and chromosomal examination. We found multiple tumors both in cranial and spinal region, and resected the symptomatic lumbar schwannomas and the thoracic ependymoma. Recent reports also showed that NF 2 has characteristically associates multiple tumors both in cranial and spinal portion. Reviewing of literatures, 40 cases have been reported about intramedullary spinal cord tumor associated with NF 2. Surgical results of spinal scwannoma and ependymoma are almost good. Because the tumors with clear margin are either ependymoma or schwannoma, most of them could be totaly removed. We conclude that the symptomatic intramedullary tumors with clear margin have also good operative indication even if they are associated with NF 2.

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A patient with a large unruptured vertebral arterial aneurysm had been treated by endovascular proximal occlusion of the parent vertebral artery(VA). The aneurysm regrew however 6 months after the treatment. The 64-year-old male suffered from truncal ataxia in the pulses, came from seventh and eighth cranial nerves on the right side. Neuroradiological evidence revealed a very large, partially thrombosed VA aneurysm on the right side. Endovascular proximal occlusion of the VA was performed using an interlocking detachable coil(IDC)and a vortex proximally to the exit of the posterior inferior cerebellar artery(PICA). He recovered from the operation most successfully, with no sign of the aneurysm in the angiogram. Six months after the occlusion, however, the cerebellar symptoms reappeared. CT and three-dimensional CT angiography clearly demonstrated the aneurysmal enlargement. The patient then died abruptly of respiratory distress, probably due to compression of to the medulla. The authors discussed the hemodynamic mechanism of aneurysmal enlargement. The PICA flow and the distance between the aneurysm and the vertebral union are important factors to consider for successful VA occlusion therapy.

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For anesthetic management of patients with a ruptured cerebral aneurysm, oxygen saturation of the jugular bulb(SjO_2)was monitored in 42 patients. Preoperative SjO_2 was reduced(54.4±8.2%, mean±SD)and increased until end of microsurgery. Cardiac index in preoperative period was within the normal range(3.5±0.7L/min/m^2). The reduced preoperative SjO_2 in subarachnoid hemorrhage(SAH)patients may be due to impaired vascular reactivity. In anesthetic management of SAH cases, it is necessary strictly to control systemic circulation.

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Aneurysms of the distal anterior cerebral artery(ACA)are uncommon and the number of cases experienced by each surgeon is small. The present paper deals with surgical techniques of distal ACA aneurysms by use of marking in DSA study and described our cases. Between April, 1992 and December, 1995, 4 cases of distal ACA aneurysms were managed in our hospital. All cases presented with subarachnoid hemorrhage(SAH). Patients' age ranged from 68 to 77 years. Preoperative conscious level ranged form 6 to 15 points on the Glasgow Outcome Scale. In the DSA study, we set a pean on the patient's head for marking. The setting point was on the midline of the patient's head where the external auricular hole connected with the distal ACA aneurysm. Under these conditions, we took DSA in A-P and lateral views. parasagittal craniotomy was performed, and a scalp incision, 4 to 5 cm in width, which exceeded the midline, was made centering around the above mentioned marking. Under the microscope, we operated by the interhemispheric approach and performed neck clipping. Operators can predict the location of aneurysms from the marking during DSA. The preoperative marking makes it easier and safer to approach the aneurysm neck and to shorten the operative time.

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