Clinical Analysis of Chronic Subdural Hematoma after Burr-Hole Craniostomy and Closed-System Drainage

In a retrospective study between January 1984, and July 1985, 50 cases of chronic subdural hematoma were analysed. All hematomas were operated on by enlarged burr-hole craniostomy and closed-system drainage. The results of the analysis were summerized as follows: 1) Eighty percent of the patients were 40 years or older. The ratio of male versus female was 4.6:1. 2) History of trauma was present in 70%, Seven patients were known to be chronic alcoholics. 3) The major clinical symptoms and signs were headache(72%), alteration of consciousness(54%), motor weakness(48%), papilledema(34%). 4) Clinical findings at admission and outcome at discharge were graded according to the scale proposed by Markwalder et al. Majority of the patients belonged to group 1(52%), followed by . group 2(40%), 3(6%). 5) The hematoma densities in brain CT at admission were hypodense(46%), isodense(34%), hyperdense(16%), and mixed-dense(4%). The shapes were planoconvex(42%), crescentic(32%), biconvex(26%). Four patients(8%) had bilateral hematomas at admission. 6) The average numbers of burr-hole craniostomy were two (80%), and the average duration of drainage was three days(72%). Only four hematomas were without neomembranes. 7) Burr-hole craniostomy and catheter drainage resulted in an excellent outcome in 43 patients(86%) at the time of discharge. There was no death in this study group.

A Clinical Analysis of Ventriculoperitoneal Shunt

The author analyzed 73 patients with hydrocephalus, who were managed by ventriculoperitoneal shunt in recent 5 years at Chung-Ang University Hospital. The causes of hydrocephalus were brain tumor(23%), head trauma(21%), aqueductal stenosis(16%), myelomeningocele(4%), spontaneous subarachnoid hemorrhage (14%), meningitis(12%) and idiopathic normal pressure hydrocephalus(10%). Their symptoms and signs were gait disturbance(39 patients), mental change(31 patients), papilledema(30 patients) and urinary incontinence(20 patients). Gait disturbance of 39 patients was improved in 23 patients(59%), but visual acuity was improved in only 1 patient. The brain computed tomography showed "roundness" of frontal horns(100%), moderate ventricular dilatation(61%), obliteration of cerebral sulci(68%) and periventricular low densities(56% ). Accu-Flo distal slit valve system was applied in all cases and medium pressure valve(closing pressure: 5-9 cm H20) was selected in 65 patients. Twenty reoperations were done in 16 patients and their causes were shunt malfunction(13 cases) and infection(4 cases) . Ventricular puncture was done through the Keen's point in all cases and ventricular catheter tip was inserted into the contralateral frontal horn in 30 cases, but there was no shunt malfunction in those patients.

Paraplegia:An Initial Manifestation of a Ruptured ICA Bifurcation Aneurysm

A case of sudden paraplegia as the first symptom of a ruptured internal carotid artery bifurcation aneurysm is reported. Sudden appearance of paraparesis or paraplegia is an exceptional event in patients with intracranial aneurysms. The various pathogenic mechanisms are briefly discussed. Insufficient blood perfusion of both paracentral areas was the cause of paraplegia in this case.