Frontal ventriculoperitoneal shunt: technical note.

Cerebrospinal fluid shunt placement is one of the most commonly performed procedures in neurological surgery. The author describes a technique to avoid an additional skin incision in the frontal ventriculoperitoneal shunt procedure without the purchase of new instruments or prolongation of surgical time.

Intraoperative intracranial aneurysm rupture.

119 patients with surgically treated intracranial aneurysm between December 18, 1984 and October 1997 were analyzed resulting in nine patients with intraoperative aneurysm rupture. These nine cases formed the basis of this study. The incidence of intraoperative aneurysm rupture was 7.6 per cent. The mortality was 33.3 per cent. In our institution, maneuvers used to control profuse hemorrhage include induced hypotension, suction dissection, and temporary clips at the parent vessels. Some controversies exist regarding the effect of timing of surgery on intraoperative aneurysm rupture and ischemic consequence from induced hypotension. The argument is whether early surgery, within 72 hours, increases the incidence of intraoperative aneurysm rupture.

Post-traumatic hydrocephalus: experience in 17 consecutive cases.

BACKGROUND: Ventriculomegaly after head injury is one of controversial debate. Currently there is no definite way to distinguish post-traumatic hydrocephalus (PTH) from cerebral atrophy. The favourable outcome is only from CSF shunting in patients with true post-traumatic hydrocephalus, not hydrocephalus exvacuo. METHOD: 17 patients with post-traumatic hydrocephalus were retrospectively reviewed from January 1993 to February 1996 to determine risk factors and guidelines for the management of this problem. RESULTS: These 17 patients represented 1.6 per cent of the 1080 head-injured patients seen at Songklanagarind Hospital during that period. 385 patients were classified as severe head injury in whom 7 were complicated with post-traumatic hydrocephalus. Our study found a high incidence of correlation between PTH and decompressive craniectomy. The late effect of decompressive craniectomy may cause CSF blockage around the convexities and hydrocephalus. The diagnoses were based on clinical manifestations and CT scan appearances. The outcome was related closely to the initial GCS score and the method used for diagnosis. CONCLUSION: Post-traumatic hydrocephalus was 1.8 per cent in patients with severe head injury. Late neurological deterioration confirmed by CT scan findings was more useful than CT scan findings alone. CSF shunting was effective in patients with ventriculomegaly who had clinical signs and symptoms of increased intracranial pressure from post-traumatic hydrocephalus.

Traumatic hematomas of the posterior cranial fossa.

The objective of this study was to find out the result of treatment and the factors which can predict the outcome of traumatic hematomas of the posterior cranial fossa. Twenty two patients with traumatic hematomas of the posterior cranial fossa from 1,500 patients with traumatic intracranial hematomas were analyzed. There were fourteen male and eight female patients. The most common etiology was a motor vehicle accident. About 90 per cent of the patients had a direct injury to the occipital region. Ninety per cent of the patients had an occipital skull fracture or diastatic fracture of the lambdoid suture. The overall mortality rate was about 38 per cent. Patients having pure epidural hematoma had zero mortality. By contrast, patients suffering epidural hematoma with associated intracranial hematoma had 20 per cent mortality. Intracerebellar hematoma led to 60 per cent mortality. Glasgow Coma Scale (GCS) before operation was used to predict the patients' outcome. Ninety per cent of the patients who had a GCS between 13 and 15 had a good recovery. By contrast, only 30 per cent of the patients who had a GCS below 9 had a good recovery. Statistical analysis showed that the GCS value of below 9 predicted the poor outcome for the patients.

The further surgical experiences in intracranial meningiomas at Songklanagarind Hospital.

Meningioma is a common benign intracranial tumor documented in many reports. We retrospectively reviewed 81 patients with a total of 84 meningiomas. There were 61 females and 20 males. Most patients were in the third to sixth decades of life. The most common presenting symptoms were headache and decreased visual acuity. Focal neurological deficits and signs of increased intracranial pressure were found in most patients. The three most common tumor locations were falx and parasagittal, sphenoid wing and convexity. Of the 84 meningiomas, 67 were completely resected and 17 were partially resected. Operative morbidities were accounted for by hemiparesis, cranial nerve palsy and infection. There was only one operative death in our series. 70 patients had normal and good results, 4 patients had severe disabilities and results were unknown in 6 patients. Recurrences were detected in 8 patients and 5 patients underwent surgery again with good results in 4 patients. Recurrences occurred in 3 patients with total and 5 patients with subtotal resections. The most significant factor for recurrence was the extent of tumor resection.

Multiple intracranial aneurysms in Songklanagarind Hospital.

We retrospectively reviewed the 107 patients on whom direct surgery was performed for intracranial aneurysms between December 18, 1984 and July 25, 1996. The incidence of multiple intracranial aneurysms in our hospital is 6.5 per cent (7/107 cases). There were 16 aneurysms in 7 cases with multiple aneurysms. There were 2 and 5 patients with 3 and 2 aneurysms respectively. The most common site was at the junction of posterior communicating artery (PCoA) and internal carotid artery (ICA). The preoperative conditions of the patients were closely related to the operative results. We performed direct surgery on bilateral aneurysms by bifrontal approaches. There was no mortality.

Direct approach to a traumatic intracavernous internal carotid artery aneurysm: a case report.

A traumatic intracavernous ICA aneurysm is a rare complication of head injury with skull base fracture. The hallmark of this condition is delayed, repeated, progressively worse and eventually fatal epistaxis. Inadequate treatment and delayed diagnosis are the major contributors to the high mortality. After epistaxis is controlled by anterior and posterior nasal packing, the patient should be investigated with carotid angiography and cross-flow study. In general, the acceptable procedure for this lesion is the trapping procedure by internal carotid artery ligation at the neck and clipping just proximal to the origin of the opthalmic artery, or by detachable balloon occlusion. However, Dolenc's technique of direct approach to cavernous sinus lesions makes it feasible to clip directly, as in this reported case.

Treatment of severely head injured patients with absence of basal cisterns on initial CT scans.

Sixty-four severely head injured patients with absence of basal cisterns on initial CT scan were studied from January 1986 to March 1989. None had good recovery at 6 months follow-up period. The result from logistic regression analysis pointed to the GCS at 24 hours following injury as an independent, significant outcome predictor. Conventional treatment is not suitable for these patients. Earlier and more aggressive therapy should improve their outcome.

Results of delayed operations for ruptured supratentorial aneurysms in 22 consecutive patients.

Twenty-two patients with surgically treated ruptured aneurysms were reviewed retrospectively regarding age, sex, aneurysm site distribution, clinical grading, rebleeding, timing of surgery and long term results. The most common aneurysm site was in the Anterior Communicating artery (44%). The mean time between aneurysmal subarachnoid hemorrhage and surgery was 20 days. There were 4 cases with intraoperative rupture. The outcome was favorable in 63.6 per cent after a mean follow-up of 21 months. The overall mortality rate was 22.7 per cent. The results may be improved by an early, well planned operation.

Liquid meal emptying in non-ulcer dyspepsia: a study in 22 Thai patients.

Twenty-four patients with non-ulcer dyspepsia (NUD) were recruited for gastric emptying study of liquid meal before and after 1 week's treatment with domperidone (80 mg in 19, 40 mg in 2, dropout 1 and excluded 2). Delayed gastric emptying was found in 8 of 22 (36.36%). Clinical improvement was found in 11 patients after treatment. Gastric emptying improvement was found in 3 patients (2 without clinical improvement). No correlation was found between the clinical and gastric emptying improvement. (Fisher exact test p greater than 0.25). Impaired liquid emptying is common in NUD and domperidone improved clinical symptoms in 50 per cent of NUD in this study.

Intramedullary spinal lipomas.

A rare case of intramedullary spinal lipoma in a 54-year-old female is reported. Pathogenesis and treatment are reviewed. Advance in surgical techniques and instruments may improve the operative procedure and result.