Urokinase Thrombolysis for Nonaneurysmal Spontaneous Intraventricular Hemorrhage

OBJECTIVE: The authors report our experience of urokinase thrombolysis in treating patients harboring nonaneurysmal spontanesous intraventricular hemorrhage(IVH) and evaluated complications, safety and feasibility of this procedure retrospectively. METHODS: Fifty-three patients with nonaneurysmal IVH>15mL without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale(GCS) or =3) and bad (GOS<3) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 60.2 years. The baseline hematoma size ranged 16 to 72mL. IVH volume reduction was done by an average of 74.2%. As complications, there were 3cases of rebleeding and 2cases of ventriculitis. No intracranial adverse effects were observed during thrombolytic theraphy. At 6months after the procedure, 29patients had achieved a good recovery, 15remained vegetative. 9patients died in hospital. The main good prognostic factors were young age, small IVH volume, and high GCS. CONCLUSION: The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

Feasibility, Safety and Prognostic Factors for Computed Tomography Guided Aspiration and Thrombolysis of Intracerebral Hematoma - Clinical Analysis - / 대한뇌혈관외과학회지

OBJECTIVE: The authors reviewed experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomography (CT) guided thrombolysis and aspiration and evaluated feasibility, safety and prognostic factors of this procedure. METHODS: One hundred and ten patients with supratentorial ICH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS) or =4) and bad (GOS<4) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 59.8 years. The baseline hematoma size ranged from 15 to 72 mL. ICH volume reduced by an average of 74.2%. At 6 months after the procedure, 56 patients had achieved a good recovery, 29 patients were dependent, and 10 remained vegetative. Fifteen patients died in hospital. The main good prognostic factors were young age, small ICH volume, high GCS, absence of rebleeding, underlying disease and complications. CONCLUSION: CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Patients of ICH presenting with bad prognostic factors should require frequent radiological investigation and more meticulous procedure. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, and disability outcome.

The Safety and Feasibility of Urokinase Thrombolysis for Nonaneurysmal Intraventricular Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVES: The authors report experience with patients harboring nonaneurysmal intraventricular hemorrhage treated urokinase thrombolysis and evaluated safety and feasibility of this procedure. METHODS: Fifty-three patients with nonaneurysmal IVH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS) or =3) and bad (GOS<3) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 60.2 years .The baseline hematoma size ranged 16 to 72 ML. IVH volume reduction was done by an average of 74.2%. At 6 months after the procedure, 29 patients had achieved a good recovery, 15 remained vegetative. 9 patients died in hospital. The main good prognostic factors were young age, small IVH volume, high GCS, underlying disease and associated complications. CONCLUSION: The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

The Outcome of Anterior Microforaminotomy for Single Level Cervical Radicular Disease

OBJECTIVE: Anterior cervical microforaminotomy has become one of surgical options to treat cervical rad iculopathy. The goal of this study is to evaluate the effectiveness of anterior cervical microforaminotomy for single-level cervical radicular disease. METHODS: We performed a prospective review of radiological data and clinical records only in patients whom the patients met the inclusion criteria for this study. Among 53 patients who underwent anterior cervical microforaminotomy between June 2000 and May 2002, 36 patients were evaluated in this study. RESULTS: Male to female rate was 2: 1 and mean age was 46.1(28-63) years. Compressive pathological lesions included disc herniation in 24 cases(66.7%), spondylosis 10 cases(27.8%), and a combined of the two in 2 cases(5.5%). Twenty eight patients(77.8%) experienced excellent results, six patients(16.7%) experienced good results, and two patients(5.5%) experienced fair results. No patient demonstrated a poor or unchanged outcome. All patients showed adequate decompression in their postoperative computed tomography or magnetic resonance images. There were no complications. Mean hospital stay was 3.9(3-12) days. CONCLUSION: Patients treated with the anterior cervical microforaminotomy procedure for single-level cervical radicular disease have good outcomes. It appears to be a good alternative procedure for cervical radicular disease. But this procedure have complications such as vertebral artery injury. And long term follow up should be analyzed for instability or recurrence of disc herniation.

Lipomyelomeningocele: Clinical analysis of 14 Cases

Lipomyelomeningocele is the most common malformation leading to spinal cord tethering. Nonetheless, these lesion continues to pose a challenge in patient management. The purpose of this study was to identify the clinical feature, candidate for surgical repair, and outcome of lipomyelomeningocele in young children and adults. We studied the magnetic resonance images and/or lumbar myelo-CT of lipomyelomeningocele performed between January 1987 and September 1995 at our institutions and reviewed the pertinent medical records and radiologic stuies to detemine clinical feature, surgical candidate, and outcomes of these patients. Of the 14 cases(11 female and 3 males) studied, the most common factor that caused these patients to seek help was the cosmetic effect of the mass on their back, followed by urinary incontinence, and weakness of lower extremities. The patients' age ranged from 2 months to 21 years(mean, 5.0 years). All the patients underwent immediate surgical management that consisted of removal of lipoma, untethering of the cord, and complete dural sac repair. Follow up for these patients ranged from 6 to 82 months(median, 54 mo). None of the patients that underwent surgical correction before the emergence of neurological deficit had ever developed neurological deficits or uninary incontinence at the time of surgery, improved significantly. In conclusion, early detection and prophylactic surgery is imperative to prevent permanent neurological deficits and urinary dysfunction.

Anterolateral and Posterior Interbody Fusions for Lumbar Instability

Interbody fusion was performed on eight cases of lumbar instability;five spondylolisthesis and three spondylolysis. Five cases were operated by anterolateral approach through the retroperitoneal space, and posterior approach on three cases after Cloward. Symptomatic improvement was obtained in almost all cases and complete fusion was observed on the roentgenogram three months later. Ambulation was possible from the immediate postoperative day without external support. While posterior approach has an advantage to observe the nerve root under direct vision, anterolateral approach has the following advantages;It is less destructive to the spinal structures, It can be performed without teasing the neural elements, anterior slipping of the vertebral body can be reduced easily, and its was applicable to the upper lumber level where neural elements qre compact. We believe interbody fusion has definite advantage to obtain strong weight bearing stability than fusion of any other parts of the spine because it has rapid recovery, low morbidity and high percentage of complete cure without disability.