Clinical Analysis of Prognostic Factors in Primary Intraventricular Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVE: This study was conducted to evaluate the prognostic factors of primary intraventricular hemorrhage. METHODS: We retrospectively reviewed 26 patients who suffered from primary intraventricular hemorrhage between 2003 and 2007. We analyzed the various factors that might influence the prognosis and these included the patient age, the disease etiology, the initial Glasgow Coma Scale(GCS) score, the pupil reflex, Evan's ratio, Graeb's score, the ventriculocranial ratio (VCR) and dilatation of the fourth ventricle. The clinical outcomes were evaluated for each patient by using the Glasgow Outcome Scale (GOS) three months after the hemorrhage. RESULTS: The overall mortality rate was 38.5%. The factors correlated with a poor clinical outcome are an initial GCS score below 12 (p0.05). Dilatation of the fourth ventricle showed a poor outcome in 10 patients (83.3%), but this was without clinical significance (p>0.05). CONCLUSION: A low initial GCS score, a high Graeb's score, the absence of a pupil reflex, a high VCR and the presence of obstructive hydrocephalus are associated with a poor outcome in patients with primary intraventricular hemorrhage.

Preliminary Radiological Outcomes of Cervical Arthroplasty with Bryan and Prestige LP Cervical Disc Prosthesis

OBJECTIVE: Postoperative motion preservation and prevention of adjacent segment degeneration is well recognized after placing artificial cervical disc prosthesis in patients with degenerative cervical disc disease. The authors investigated postoperative changes in motion dynamics in two different types of artificial cervical disc prosthesis, Bryan and Prestige LP cervical disc prosthesis, and compared them. METHODS: Twenty five patients underwent anterior cervical discectomy and implantation of artificial cervical disc prosthesis: 10 with Bryan and 15 with Prestige LP. Radiological assessments, including overall sagittal alignment angle, range of motion (ROM) of overall sagittal, functional spine unit (FSU) angle, segmental ROM of FSU and ROM of adjacent segment (Upper and Lower level) using static and dynamic lateral radiographs, were performed preoperatively and postoperatively. The mean postoperative follow up period was 18.6 months (range 10.4~28.5) in Bryan and 9.2 months (range 6.5~12.6) in Prestige LP. RESULTS: The overall sagittal alignment angle was decreased 2.9degrees in Bryan group (p=0.033) and increased 5.7degrees in Prestige LP group (p=0.017). The FSU angle at treated level was decreased 0.4degrees in Bryan group (p=0.929) and increased 2.9degrees in Prestige LP group (p=0.008). The ROM of overall sagittal was decreased in both groups (Bryan: 8.6degrees p=0.075, Prestige LP: 2.9degrees p=0.182). The segmental ROM of FSU was increased 1.0degrees in Prestige LP group (p=0.191) but, decreased 0.6degrees in Bryan group (p=0.929). The ROM of adjacent segment was decreased in both groups (Bryan: upper p=0.023 lower p=0.050, Prestige LP: upper p=0.570 lower p=0.132). The postoperative radiological results of comparison between two different artificial disc showed that overall sagittal alignment angle and FSU angle were more increased in Prestige LP (p=0.005, p=0.026, respectively). CONCLUSION: The segmental ROM of FSU was preserved and ROM of adjacent segment was decreased in both groups. This means that postoperative adjacent segment disease may be prevented regardless of types of implants. On comparison study, postoperative cervical curvature was more lordotic in Prestige LP. Therefore, Prestige LP is more suitable to maintain postoperative cervical lordosis. The limitation of our study is small number of case and short and unequal follow up period between two types of implants. Further long term study will be needed.

Prognostic factors influencing outcomes in elderly patients with aneurysmal subarachnoid hemorrhage / 대한뇌혈관외과학회지

OBJECTIVE: This study evaluated the prognostic factors that influence the surgical outcomes of elderly patients older than 65 years old with an aneurysmal subarachnoid hemorrhage. METHODS: Ninety-two patients older than 65 years old, who were operated in our hospital between 1998 and 2005, were reviewed retrospectively. The clinical outcomes were evaluated using the modified Rankin Scale three months after surgery. RESULTS: The preoperative neurological status, such as the Hunt-Hess grade (p<0.001), World Federation of Neurological Surgeons (WFNS) grade (p<0.001), and the Fisher grade (p=0.001), was significantly associated with the surgical outcomes in this series. The vasospasm (0.016) and ventriculostomy (0.039) are factors influencing the surgical outcomes. However, the other factors including hypertension (0.831), smoking (0.228), accompanying disorder (0.706), size of aneurysms (0.177), location of aneurysms (0.755), shunt operation (0.356), and timing of surgery (0.194) had no influence on the surgical outcome. CONCLUSION: In elderly patients with intracranial aneurysms, the preoperative neurological status, vasospasm, and ventriculostomy are the most significant prognostic factors.