Recanalization Rate and its Associated Factors after Intravenous Tissue Plasminogen Activator Thrombolysis for Acute Major Cerebral Arterial Occlusion / 대한뇌혈관외과학회지

PURPOSE: To investigate the recanalization rate after intravenous administration of recombinant tissue plasminogen activator (IV-tPA) for acute major arterial occlusion of the anterior cerebral circulation and to investigate the relationship between atrial fibrillation and recanalization. METHODS: From April 2005 to April 2006, 16 patients with acute major arterial occlusion of the anterior cerebral circulation were treated with IV-tPA. Recanalization was classified as good (as compared with an unoccluded contralateral vessel; thrombolysis in myocardial infarction (TIMI) classification grade II and III) and poor (TIMI grade 0 and I). The clinical and radiological parameters associated with recanalization were analyzed. The clinical outcomes were evaluated by use of the National Institute of Health Stroke Scale (NIHSS) at 3 months after treatment. RESULTS: Of all of the 16 patients, 11 patients (68.8%) showed good recanalization. Among these 11 patients, nine patients survived (81.8%). However, only one patient survived (20%, p = 0.036) of the other five patients who showed poor recanalization. The pretreatment NIHSS score and atrial fibrillation were significantly correlated with the recanalization rate. Atrial fibrillation was found in 8 of 16 patients (50.0%) as the cause of the cerebral embolic infarction. Among the patients with atrial fibrillation only three patients showed good recanalization (37.5%); patients without atrial fibrillation showed good recanalization (100%, p = 0.026). CONCLUSIONS: I.-tPA appears to be effective and safe as a recanalization method for acute major cerebral arterial occlusion in patients that do not have atrial fibrillation. Good recanalization was associated with a good clinical result. Atrial fibrillation is a significant associated factor of poor recanalization and high mortality.

Acute Aneurysmal Subdural Hematoma: Clinical and Radiological Characteristics

OBJECTIVE: Acute spontaneous subdural hematoma(SDH) secondary to a ruptured intracranial aneurysm is a rare event. The authors present nine cases with aneurysmal SDH. METHODS: We analyzed nine cases of aneurysmal SDH from 337 patients who underwent treatment for a ruptured aneurysm between January 1998 and May 2004. Clinical and radiological characteristics and postoperative course were evaluated by reviewing medical records, surgical charts and intraoperative videos. RESULTS: The nine patients comprised four males and five females with a mean age of 53years (range 15-67years). The World Federation of Neurosurgical Societies grades on admission were I in one patient, II in two patients, III in five patients and V in one patient. With respect to location, there were four internal carotid-posterior communicating artery(ICA-Pcom) aneurysms, one distal anterior cerebral artery(DACA) aneurysm, one anterior communicating artery and three middle cerebral artery aneurysms. CT scans obtained from the four patients with ICA-Pcom aneurysms revealed SDH over the convexity and along the tentorium, and two of these patients presented with pure SDH without subarachnoid hemorrhage(SAH). In three patients with ICA-Pcom aneurysm, the ruptured aneurysm domes adhered to the petroclinoid fold. In the patient with the DACA aneurysm, the domes adhered tightiy to the pia mater and the falx. CONCLUSION: Ruptured intracranial aneurysm may cause SDH with or without SAH. In the absence of trauma, the possibility of aneurysmal SDH should be considered.

Post-Traumatic Syringomyelia Treated with Expansile Duraplasty and Syringosubarachnoid Shunt : Case Report

No abstract available.

Somatosensory Evoked Potentials Before and During Surgery in Patient with Cerebral Aneurysm

It has been known that the electrical activity of the brain is related to regional cerebral blood flow, and cerebral ischemia developed during the management of aneurysmal subarachnoid hemorrhage(SAH) is one of the major causes of morbidity and mortality. Somatosensory evoked potentials(SEPs) in response to median nerve stimulation at wrist have been recorded before and during surgery in 31 patients with aneurysmal SAH and 30 normal control subjects. The central conduction time(CCT), the time between the N4 peak recorded from the second cervical spine and the N20 peak recorded from the sensory cortex, were observed as an indicator of cortical activity. The results were as follows, 1) In patients with aneurysmal SAH, CCT recorded before surgery were not different from that of controls. 2) In patients with aneurysmal SAH, CCT recorded during surgery were found to be significantly increased by administration of anesthetics. 3) During surgery in aneurysmal SAH, CCT tended to be increased by brain retraction. 4) During surgery in aneurysmal SAH, CCT changes relative to the temporary occlusion of the parent artery were quite variable, ranging from rapid disappearance of N20 by only 2 minutes of temporary occlusion to no significant change after 20 minutes of occlusion. The rapid disappearance of N20 within 2 minutes after temporary occlusion was highly likely to be associated with appreciable neurologic deficit after surgery. These results suggest that somatosensory evoked potentials during the management of patients with aneurysmal SAH is considered to be a valuble indicator of cortical function, especially when temporary occlusion was performed to prevent premature rupture of cerebral aneurysm during surgery.