No shinkei geka. Neurological surgery
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In the literature, there has been no report of spontaneously growing calcified chronic subdural hematoma (C-C-SDH). The authors report a five-year-old boy with spontaneously growing C-C-SDH. The patient was admitted to author's department on July 24, 1979, because of progressive right hemiparesis, seizure and mental as well as physical retardation. ⋯ Surgical indication of C-C-SDH has to be determined on the basis of patient's age, symptoms and length of clinical course. It has been suggested that surgical treatment of C-C-SDH in children was not successful as compared with that in adults. The authors emphasize that C-C-SDH in children should be operated to encourage mental and physical development of the patients as well as to prevent hemorrhage and growth of C-C-SDH.
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We reviewed 27 patients with developmental anomalies in craniovertebral junction, and special attention was paid to computed tomography (CT) findings in congenital atlantoaxial dislocation (AAD), basilar invagination and Chiari malformations. In ADD, CT clearly demonstrated the relationships of the atlas to the axis in axial plane. Four major types were distinguished; anteroposterior (6 cases), transverse (0 case), anteroposterior-transverse (4 cases) and rotatory (5 cases) dislocations. ⋯ In Chiari malformations, plain CT scanned by high resolutional machine often makes it possible to delineate caudal migration of the cerebellar tonsils, so that it may be a choice of examination as a screening of the anomaly. In addition, metrizamide CT clearly demonstrated caudal migration both of cerebellar tonsils and medulla oblongata. Therefore, CT apparently exceeds other diagnostic modalities in evaluating this anomaly.
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Three cases of the secondary empty sella syndrome were reported. Case 1. A 57-year-old female was admitted to our clinic because of recurrent visual disturbance. ⋯ It is conceivable that the diaphragma sellae becomes weak due to 1) compression by the tumor, 2) mechanical injury during operation, 3) radiation effect. Then, these preceding factors might bring about herniation of the optic nerve and chiasm with the diaphragma sellae into the sellar cavity. Therefore, we propose that early diagnosis of pituitary tumor should be important, and that careful packing of the sellar floor at transsphenoidal surgery should be essential to prevent occurrence of the secondary empty sella syndrome.