Prediction of Prognosis by Acetazolamide Brain Perfusion SPECT in Patients with Arteriovenous Malformation / 대한핵의학회잡지

After surgical operation in patients with arteriovenous malformation (AVM), normal pressure perfusion breakthrough (NPPB) is one of the major complications. Brain perfusion SPECT with acetazolamide stress was known to be useful to evaluate the vascular reserve in several neurological and neurosurgical conditions. The authors performed acetazolamide brain perfusion SPECT in patients with AVM and compared the brain perfusion in the post-operative clinical courses. The acetazolamide brain perfusion SPECT was helpful in defining the prognosis of the patients with AVM. We describe 4 patients with AVM who had acetazolamide brain perfusion SPECT to examine the prognosis.

Clinical Outcome of Surgical Treatment with Instrumentation and Fusion in the Management of the Thoracolumbar Injured Patients

The goals of operation for unstable thoracolumbar spine injuries are decompression of any neural canal compression, restoration of normal anatomic contour of the spine and stabilization. A retrospective analysis on 64 thoracolumbar injured patients treated with internal instrumentation and fusion was performed from January 1991 to December 1996. The purpose of this study was to review the clinical outcome and efficacy of surgical treatment using internal instrumentation, and compare neurological, radiological and functional outcomes between anterior and posterior approach groups. Of these, 42 patients were operated via on posterior approaches and the other 22 patients by anterior approaches. At final follow up evaluation with mean period of 14.5 months, 50 patients(78%) were walking and 47 patients(92%) except 4 patients(A-A, three and C-C one patient) had improved using Frankel's grade in patients with neurological deficits(51 patients). No patient deteriorated. Radiological and functional outcomes were satisfactory in the majority of patients. In a comparison of the clinical outcomes between anterior and posterior approaches, there was no statistically significant difference in neurological outcome(the mean value of up-grade: anterior 1.05+/-.7, posterior 0.95+/-.9, p=0.42), but in radiological outcomes, there were no significant differences between the two groups in amount of restoration of vertebral compression(mean recovery rate: anterior 61.5%, posterior 50.9%), kyphotic deformity(mean recovery rate: anterior 47.9%, posterior 70.0%)(p>0.05), but the only difference was in the restoration of canal narrowing, with the anterior group more improved(recovery rate: anterior 86.4%, posterior 74.3%) (p<0.05). In functional outcomes by Prolo's scale, the anterior group was better than the posterior group(mean economic and functional status: anterior E(4.4), F(4.3); posterior E(3.5),F(3.9)). We conclude that agressive decompression, instrumentation and bone fusion has shown better clinical outcomes of the unstable thoracolumbar injured patients and the choice of surgical approaches depends on the general condition, age, status of bone mineral density, specific injury mechanism, radiological findings, and grade of neural injury at the time of injury of these patients.

Overview of Seizure Occurrence in the Patients with Chronic Subdural Hematoma

Recent studies have implicated that seizure occurrence was infrequent in the patients with chronic subdural hematoma(CSDH): However, the exact incidence of seizure occurrence in the patients with CSDH is unclear and the efficacy of prophylactic treatment with anticonvulsants(AC) has not been fully determined. We have analyzed a series of 186 adult patients with CSDH who have been operated at our institute from January 1990 to December 1994 to eneasure the incidence of seizure occurrence and to assess the efficacy of prophylactic treatment with AC. The patients who had past history of seizure disorder or alcoholism were excluded in this study. The results were as follows: 1) Post-operative seizure occurred in only 6 patients(3.2%) and all of the presented seizures were generalized type. 2) Among six patients who presented post-operative seizure, two patients showed additional brain CT findings such as intracerebral hemorrhage or cerebral infarction other than chronic subdural hematoma. 3) Operative method did not show a significant influence on the incidence of seizure occurrence. 4) Prophylactic AC were used in 177 patients and the incidence of seizure occurrence in this group was 3.4% which showed no significant statistical difference with the incidence of seizure occurrence of 0% in 9 patients who were not treated with AC. Above results suggest that prophylactic treatment with AC in the patients with CSDH should be considered cautiously except for the patients with the additional brain parenchymal lesions or past history of seizure disorder.

Surgical Management of Unruptured Aneurysm

The surgical management of patients with unruptured intracranial aneurysm continues to be controversial. To provide current data about surgical outcome of patients with unruptured intracranial aneurysm, we retrospectively reviewed 494 consecutive intracranial aneurysm patients who underwent surgery between January 1990 and May 1995. Among these 494, 16 patients with unruptured aneurysms were evaluated; those with unruptured aneurysm associated with ruptured aneurysm or arteriovenous malformation were excluded. Mode of presentation, location and size of aneurysm, surgical method and complications, and surgical result were analyzed. Evaluation revealed four patients with asymptomatic and 12 with symptomatic unruptured aneurysm. Of these 12, seven presented with mass effect, four with headache, and one with cerebral infarction. The aneurysms were located in the internal carotid artery(n=8), the middle cerebral artery(n=3), the vertebral artery(n=3), the anterior communicating artery(n=2), and the basilar artery(n=2). They ranged in size from smaller than 10mm to larger than 25mm(25mm: 1 case). An excellent or good outcome was achieved in 12 patients, including four with asymptomatic intracranial aneurysm. In three patients there were complications or sequelae and one died due to premature rupture of the aneurysm. We concluded that in patients harboring an unruptured intracranial aneurysm, aggressive early detection and surgical treatment may improve the outcome by preventing the devastating effects of subarachnoid hemorrhage.

Traumatic Pseudoaneurysm of the Right Posterior Auricular Artery

This report describes a case of traumatic psuedoaneurysm of the right posterior auricular artery resulting from injury sustained during a fall. The literature describing these rare complications of the scalp injury is also reviewed, and the diagnosis and treatment of this rare case are discussed.