Staged Treatment of High Flow, Large Cerebral Arteriovenous Malformation with a Combination of Preoperative Embolization and Microsurgery

Surgical treatment of cerebral arteriovenous malformations(AVM's) that are high flow and large remain particularly difficult to manage. It has been reported that normal perfusion pressure breakthrough(NPPB) syndrome occur more frequently in such AVM's and managing such AVM's by staged treatment may help to avoid the occurrence of this complication. The authors report our experience with one case of high flow, large AVM that would pose a great operative difficulty if it was to be managed by surgical resection alone. The patient was treated by a staged procedure in which a preoperative embolization was followed by a complete microsurgical excision. The staged, complementary approach proved to be quite useful and safe for the treatment of high flow, large AVM.

Results of Stereotactic Evacuation of Hematoma and External Ventricular Drainage in Comatose Patients with Hypertensive Supratentorial Intracerebral Hemorrhage

The purpose of this study was to analyze and evaluate therapeutic results of stereotactic evacuation of hematoma, urokinase irrigation and external ventricular drainage(EVD) in comatose patients who had hypertensive supratentorial intracerebral hemorrhage. The authors carried out stereotactic evacuation of hematoma and external ventricular drainage in the consecutive 45 cases who were admitted to the Department of Neurosurgery, Chosun University Hospital. from Sep. 1990 to Jun. 1993. The therapeutic results were as follows : 1) The peak age incidences were 6th to 7th decades. The incidence was higher in female than male. The age was not related to the prognosis. 2) The hematoma was located at the basal ganglia in 37 cases, and the thalamic area in 8 cases. The prognosis was poorer as the area of hematoma extended more wider and deeper. 3) The volume of hematoma ranged from 8 to 155 ml. The prognosis of the patient was unfavorable in large volume of hematoma. 4) Intraventricular hemorrhage(IVH) occured in forty cases(89.9%) and mortality rate was 45%. The mortality rate was increased in cases with IVH than in case without it. 5) The mortality rates based on the Glasgow coma scale(GCS) on admission were 50% in GCS score 4 group, 50% in GCS score 5 group, 40% in GCS score 6 group, 27% in GCS score 7 group. Cases of low Glasgow coma scale on admission showed high mortality rate. 6) The overall mortality rate was 42%. These results suggest that stereotactic evacuation of hematoma and EVD decreased the mortality rate when compared with conservative treatment and conventional craniotomy in the literatures.

Posterior Stabilization with Interlaminar Clamps in Unstable Cervical Spine Injures

Conventional methods for stabilization of unstable cervical spines caused by flexion injury are sublaminar wiring and palte and screw fixation. These methods, however, carry the risk of damage to the cervical cord and or vertebral artery. We have used interlaminar clamps for the stabilization of sixteen cases of unstable cervical spine, including for cases of odontoid process fracture. There was suecessful fusion in all cases, no slippage of clamp and no deterioration of neurological function. Advantages of this method include the fact the there is no need for bone graft and that it is technically easy and inexpensive. Good stabilization allows early ambulation and so prevents complications such as pneumonia and decubitus ulcer.

Isolated Loculations of the Lateral Ventricle

Isolated hydroceohalus is an uncommon entity wihch results from obstruction of the level of the foramen of Monnro. We have recently expierience three cases of isolated loculations of the lateral ventricle cause by intraventricular hemorrhage and ventriculitis. All patients were treated sucessfully using one or multiple shunts.

Isolated Loculations of the Lateral Ventricle

Isolated hydroceohalus is an uncommon entity wihch results from obstruction of the level of the foramen of Monnro. We have recently expierience three cases of isolated loculations of the lateral ventricle cause by intraventricular hemorrhage and ventriculitis. All patients were treated sucessfully using one or multiple shunts.