ABSTRACT
OBJECTIVE: We report a suboccipital lateral approach in order to propose more suitable stereotactic aspiration technique for cerebellar hematoma. METHODS: Using the Leksell's CT-stereotactic system, the patient was kept on a supine position under local anesthesia turning the head 30 to 40 degrees contralateral to the side of the lesion and bending the neck forward, so that the approach was made laterally toward the ipsilateral suboccipital area. Eight patients with cerebellar hematoma underwent this stereotactic technique. Six patients complicated with intraventricular hemorrhage or obstructive hydrocephalus underwent simultaneously external ventricular drainage(EVD) via Kocher's point without position change. The mean amount of hematoma was 23.7ml (14~58ml). RESULTS: All showed initially a partial removal of the hematoma about 6.1ml in mean volume through stereotactically placed catheters and the residual hematoma was drained out by urokinase irrigation for mean of 3.3 days. The mean operation time took 2 hours in cases combined with EVD and one hour and half in cases not. CONCLUSION: This surgical technique for the cerebellar hematoma can be easily done in a supine position under local anesthesia and surgical invasion is minimal. It also has benefits that EVD can be done without any position change.
Subject(s)
Humans , Anesthesia, Local , Catheters , Head , Hematoma , Hemorrhage , Hydrocephalus , Neck , Stereotaxic Techniques , Supine Position , Urokinase-Type Plasminogen ActivatorABSTRACT
Postherpetic neuralgia(PHN) is a neuropathic pain syndrome that is often intractable. A 75-year-old man suffered intractable pain due to herpes zoster between T4 and T6 dermatome. Allodynia, the severe superficial pain that he could not wear his clothes, was improved by ablative surgery such as dorsal root entry zone lesions and dorsal root ganglionectomy. However, deep cramping pain was sustained. Because of this excruciating pain, spinal cord stimulation(SCS) was decided. After the operation, the pain has been improved to tolerable state. As with our case, a constant deep cramping pain associated with other refractory painful condition of PHN, SCS could be considered as a useful option.