Remote Cerebellar Hemorrhage After Surgery for an Unruptured Aneurysm / 대한뇌혈관외과학회지

We report here on 2 cases of remote cerebellar hemorrhage (RCH) that developed after surgery for supratentorial unruptured aneurysm. In both cases, cerebral angiography was performed to diagnose the aneurysms and then screening was conducted for determining if there were any previous bleeding tendencies and comorbidities. After surgery, computed tomography (CT) was immediately performed to check for postoperative hemorrhage or infarction, and the images showed cerebellar hemorrhage that was relatively far away from the surgical site. We present the similarities of the 2 patients' preoperative angiography and CT and their perioperative blood pressure, and we discuss these findings to illuminate the pathophysiology of RCH.

Clinical Analysis of Distal Posterior Inferior Cerebellar Artery Aneurysm / 대한뇌혈관외과학회지

OBJECTIVE: This study was designed to determine the clinical characteristics of patients with aneurysms that are located at the distal posterior inferior cerebellar artery (dPICA). PATIENTS & METHODS: From September 1976 to June 2007, 54 consecutive patients with PICA aneurysms were treated at our institute. Among them, 19 patients had PICA aneurysms distal to the junction of the vertebral artery-PICA. We retrospectively reviewed the database and imaging studies as sources of information for analysis. RESULTS: Five patients were male and 14 patients were female. The mean age was 44.6 years old (range: 23-70). Sixteen patients had ruptured lesions: 1 patient was Hunt and Hess Grade I, 4 were Grade II, 5 were Grade III, 4 were Grade IV and 2 were Grade V. Intraventricular hemorrhage or intracerebral hemorrhage was identified in 5 patients on the initial computed tomography (CT). Three patients had unruptured lesions. The locations of aneurysm were the lateral medullary segment in 10 patients, the tonsillomedullary segment in 1 patient, the telovelotonsillar segment in 5 patients and the cortical segment in 3 patients. Most aneurysms (17) were the saccular shape. Seventeen aneurysms were small and 2 were large or giant. The mean diameter of aneurysm was 6.5 mm (range: 2.0-28.0) and the mean diameter of the ruptured aneurysm was 4.8 mm (range: 2.0-12.0). Two patients had mirror aneurysms. Post-hemorrhagic hydrocephalus was identified in 10 patients on the initial CT and shunt surgery was performed on 3 patients. The obliteration methods of the aneurysms were microsurgery in 15 patients (midline suboccipital approach: 9, lateral suboccipital approach: 6) and endovascular surgery in 4 patients (therapeutic distal PICA occlusion: 3, intra-aneurysmal coiling: 1). Early surgery was performed on 2 patients, intermediate surgery (days between rupture: 4-10) was performed on 4 patients and delayed surgery was performed on 10 patients. The mean post-treatment follow up period was 49.5 months (range: 7-156). The clinical outcome was assessed using the modified Glasgow Outcome Scale. All the patients showed favorable outcomes. Five patients suffered from treatmentrelated complications (a CSF collection requiring wound revision for dura repair: 2, shunt surgery: 1 and transient hemiparesis due to impairment of the blood flow distal to the aneurysm: 2). CONCLUSIONS: In our series, distal PICA aneurysms had the characteristics of a female predominance, they more often presented with intraventricular hemorrhage and the rupture was of a relatively small size. Both microsurgery and endovascular surgery can be troublesome due to the small size, wide neck and tortuosity of the proximal parent artery and the location of aneurysms at a branching site. The surgeons should be careful for preserving vessel patency and insuring watertight dura repair.

The Clinical Evaluation of Calcium Phosphate Cement Compared with Polymethylmethacrylate for Kyphoplasty

OBJECTIVE: We investigated the clinical outcome of kyphoplasty using calcium phosphate (CaP) for vertebral augmentation compared with polymethylmethacrylate (PMMA). We conducted a retrospective study to determine whether patients with osteoporotic vertebral fracture who underwent CaP kyphoplasty had improved outcome in the correction of vertebral body and relief of pain compared with those who underwent PMMA treatment. METHODS: From January 2005 to December 2006, 117 consecutive patients with osteoporotic compression fracture were treated at our institute. Among them, 23 patients have treated to kyphoplasty using PMMA or CaP. We reviewed the clinical data and imaging studies retrospectively as sources for analysis. RESULTS: The 23 patients included in the study. A mean ages of CaP and PMMA group were 70+/-9.5 and 67+/-9.5 years respectively. Preoperative compression ratios (CR) were 0.71+/-0.12 and 0.74+/-0.15 on both groups. Postoperative CR, however, showed the difference between two groups. The differences of preoperative and postoperative Cobb`s angle were 10.04 and 2.18 on CaP and PMMA group respectively and the mean injected volume of cement were 3.85+/-1.73 and 4.4+/-1.23 ml. CONCLUSION: The amount of injected volume of bone cement in kyphoplasty has no difference on both groups. But, follow-up compression ratio and Cobb`s angle are larger in CaP group than PMMA group. However, pain and functional recovery is not different on both group. As a result, CaP can not sufficiently support the strength of vertebral body, but be used to control the acute pain.