Treatment of Hypertensive Intracerebral Hematoma

212 cases of hypertensive intracerebral hematoma were treated and followed for more than 3 months. The outcome was analysed in point of comparison between conservative treatment and operative treatment. The precipitating factors on prognosis depend on size and site of hematoma, level of mental deterioration, and blood pressure on admisson. Operative treatment showed better outcome than conservative treatment in cases of severly mentally deteriorated patients, large hematoma, and pontine hematoma.

Treatment of Pontine Hemorrhage

Most of untreated pontine hematoma are known to be fatal. Even though the patient may survive, the sequelae of pontine hematoma is serious. Fourteen cases of pontine hematoma who were treated either surgically or conservatively were analysed. Among nine cases treated surgically, three showed good recovery, three died postoperatively, and moderate to severe disability remained in three cases. On the other hand, conservative treatment resulted in one good recovery, one moderate disability, and four deaths. We hope to emphasize the efficacy of surgical treatment on pontine hematoma.

The Early Diagnosis and Treatment in Cerebellar Infarction

Cerebellar infarction may be rapidly fatal when the patient is not diagnosed and treated promptly. Since 1980, we have encountered five patients of cerebellar infarction and here we analysed the cases and reviewed the literature. All patients were treated by means of the posterior fossa decompression with mortality rate of 20%. By the mode of onset and progression of symptoms and signs, the patient of cerebellar infarction could be divided into two groups;The patients who took the benign course showed the initial symptoms of headache, nausea, vomiting, dizziness and lack of balance, and were usually recovered spontaneously with the conservative treatment. On the contrary, the patients who took the progressive course showed rapidly progressive deterioration of the initial symptoms and signs and mental state. They could be recovered by the early posterior fossa decompression. The emphasis should be given to the early diagnosis and treatment for the purpose of recover in the patient of cerebellar infarction.

Clinical Observation of Medulloblastoma

The authors represented a clinical analysis on 31 patients with medulloblatoma who had been treated surgically at the Department of Neurosurgery, Yonsei Medical Center and Wonju Christian Hospital from Sept. 1967 to Aug. 1981. The results were summarized as follows ; 1) Among 31 patients, 19 were male and 12 were female. About 73% of cases were found under the age of 16 and male was predominant in this age group. 2) The most common clinical symptom was that of increased intracranial pressure(84%). Gait disturbance, generalized seizure and mental change were also found and duration of symptom of symptom was average 2.2 month. Neurological signs showed papilledema, cerebellar signs and lower cranial palsies. 3) Plain skull X-rays, carotid and vertebral angiography and conray ventriculography were useful diagnostic methods but brain CT scan was thought to be the most accurate, noninvasive and helpful method which showed size and location of tumor and relationship with surrounding structures. In brain CT scan hydrocephalus and compression 4th ventricle were found in 94%, and 88% revealed contrast enhancement. 4) Considering 1 year survival rate which was possible follow up in this study, microsugical total excision of tumor followed by radiation therapy disclosed the best result for reducing recurrence and seeding of tumor among the current therapeutic methods.

Surgical Treatment of Pontine Hematoma

Three cases of pontine hematoma accompanied by serious neurological symptoms with coma were treated surgically. All patients underwent suboccipital craniectomy with removal of hematoma and subsequently ventriculoperitoneal shunts were needed in all cases. Postoperatively all cases showed improvement with some neurological sequelae remained. Most of untreated pontine hematoma may be fatal, whereas surgical evacuation of the hematoma is safe and promising. We emphasize surgical treatment of pontine hematoma should be considered in any cases though they show serious neurological deficits.