Spontaneous Spinal Epidural Hematoma

The authors reviewed 16 cases of spontaneous spinal epidural hematoma(SSEH) described in the Journal of the Korean Neurosurgical Society and one case unpublished case of our own. Attention was focused on sex,age, medical history, position and vertebral level of the hematoma, preoperative neurological condition and operative result. This study comprised 17 patients, 14 males and 3 females, between five and 79 years old. All vertebral segments were affected, though the thoracic area predominated. In 13 patients, sensory and/or motor deficit was incomplete and in four, SSEH resulted in complete preoperative sensory and motor loss. In all patients, the hematomas were removed surgically through total laminectomy. In four, postoperative recovery was total, but in ten, was incomplete, and the neurological condition of three showed no improvement. We concluded that in cases of SSEH, this operation is the treatment of choice.

The Outcome of Surgical Management in Patients with Ruptured Anterior Communicating Artery Aneurysm

The purpose of this study was to assess the outcome of management in 123 patients who underwent surgery for a ruptured anterior communicating artery aneurysm, the period covered is August 1989 to January 1996. The outcome of surgical management was based on four primary factors : Clinical condition on admission(Hunt and Hess Grade) ; The distribution of hemorrhage, as seen on brain computerized tomography(Fisher Grade) ; The presence of delayed ischemic deficits ; And the time between aneurysmal rupture and surgery. Other conditions contributing to surgical outcome are reviewed. On the basis of the patients' status on discharge, the outcome was as follows : good, 92 patients(74.8%) ; fair, 11(8.9%) ; poor, 14(11.4%) ; and died, six(4.9%). The best results were for patients with grades I and II(H and H grade). Thirty-three of 40 who underwent early surgery(within 3 days) were rated as good, while 54 of 64 for whom surgery was delayed(after 7 days) showed a favorable result ; thus, outcome did not depend on whether treatment was early or delayed. The least favorable outcomes(poor or died) were attributed to massive hemorrhage, delayed ischemic deficits, infections(cerebritis and ventriculitis, for example) or rebleeding. Other pertinent factors influencing surgical outcome were the direction or shape of the aneurysm, multiplicity, perioperative premature rupture of aneurysms, and temporary clipping of proximal vessels. To improve management outcome, it is stressed that intensive care should be started as soon as an aneurysmal rupture is evident, and sterile manipulation should also be applied.

Multiple Cerebral Arteriovenous Malformation

Multiple cerebral arteriovenous malformations(AVMs) are thought to be rare lesions. The authors present a case of multiple AVMs in te left cerebral hemisphere. A 26-year-old male patient came to the hospital for evaluation of recurrent attacks of generalizd seizures. Cerebral angiography demonstrated two separated AVMs having different feeders and drain veins in the left cerebral hemisphere. Using staged operations we excised the lesions completely. The criteria and surgical tactics of multiple AVMs are discussed with a review of the literature.