The Predictors of Survival and Functional Outcome in Patients with Pontine Hemorrhage

OBJECTIVE: Pontine hemorrhages usually result in a much higher morbidity and mortality than any other intracranial vascular lesion. The purpose of this study was to evaluate survival and the contributing factors for patients with pontine hemorrhage. METHODS: Of the 41 patients who were admitted to our hospital with their first acute pontine hemorrhage from 1997 to 2005, 35 patients were included in this study. Medical records were reviewed to confirm the accuracy of diagnosis and collect demographic, clinical and radiological data. The patients were divided into two groups, survivors and deceased patients; then the survivors were divided again into a group of patients with good results and those with poor results. The location of the hematoma, maximum anteroposterior (AP) diameter, maximum transverse diameter, hematoma volume, ventricular extension, extension into the midbrain, hydrocephalus and initial Glasgow coma scale (GCS) were evaluated. RESULTS: The two year survival rate was 58.5%. The survival of patients with pontine hemorrhage was affected by initial GCS score and transverse hematoma diameter. Functional outcome of patients who survived was affected by initial GCS, maximum transverse diameter, maximum AP diameter and hematoma volume. CONCLUSION: The rate of survival after pontine hemorrhage is associated with the transverse diameter of the hematoma and more importantly the initial GCS. Long-term outcome of survivors is influenced by the initial GCS, transverse diameter, AP diameter and volume. Through the multivariate analysis, initial GCS is the only significant factor on survival. Strictly speaking, initial GCS is not modifiable. However, surgical reduction may be considered to amend theses decisive factors. Additional study for indication, timing and method of surgical management is needed.

Early Aneurysm Surgery using Eyebrow Incision for Poor Grade Patients

OBJECTIVE: This study is aimed to assess the clinical outcome in early and minimally invasive surgery using an eyebrow incision for the patients with poor grade aneurysm. METHODS: The authors retrospectively reviewed all 46 poor grade patients of Hunt and Hess(H-H) grade IV and V who suffered aneurysmal subarachnoid hemorrhage(SAH) between 1999 and 2004. All 35 patients harboring 43 aneurysms who underwent early surgery within 72 hours were included in this study. Clinical outcome was assessed by Glasgow outcome scale(GOS) and compared with that of conventional pterional approach. RESULTS: Twenty four patients were operated with conventional pterional approach and 11 with eyebrow approach within 72 hours after SAH. Seven multiple aneurysm patients harbor 15 aneurysms. Forty one aneurysms were treated with clippings. All 11 patients of eyebrow surgery group(ESG) were in H-H grade IV, 3 in Fisher grade III and 8 in Fisher grade IV. Among 24 patients of pterional approach group(PAG), 20 were in H-H grade IV and 4 in H-H grade V, 3 were in Fisher grade III and 21 in Fisher grade IV. Overall favorable outcome was achieved in 41.7% and 54.5% in PAG and ESG, respectively. Favorable outcome of H-H grade IV in PAG showed 45.0%. Overall mortality rate was 14.3%. CONCLUSION: It is concluded that the clinical outcome of early and minimally invasive aneurysmal surgery using eyebrow incision in the selected poor grade aneurysm patients can be compatible with that of conventional pterional surgery.

Treatment of Meningitis Caused by Vancomycin-Resistant Enterococcus with Synercid

Vancomycin-resistant enterococci(VRE) are rare cause of meningitis, occurring in immunocompromised patients, severely ill, hospitalized patient, and patients who have undergone neurosurgical procedures. Resistance to vancomycin has increased in frequency during the past few years. Limited therapeutic options are available for VRE infections and the optimum therapy has not been established. We report a case of VRE meningitis that was successfully treated with administration of quinupristindalfopristin (Synercid) by both intravenous and intraventricular routes. A brief review of the literature is provided, which indicates that optimal management with Synercid should include daily intraventricular doses of at least 2 mg and intravenous 0.5 mg/kg every 8 hours. We also review the previously reported cases of VRE meningitis.

Tension Pneumocephalus Following Eyebrow Aneurysmal Surgery

We report a rare case of tension pneumocephalus after eyebrow surgery for the treatment of a saccular aneurysm at posterior communicating artery. The patient's consciousness was suddenly aggravated due to the tension pneumocephalus on fifth postoperative day, which was treated by repairing the frontal sinus. The patient was recovered completely and uneventfully after this revision surgery.

Primary Intracranial Teratoma

Two case of primary intracranial teratomas are presented. One case is right cerebellopontine angle malignant teratoma of 3years old female and the other case is left frontal benign teratoma of 40 years old male. We reviewed the literatures and discussed these cases in the point of the rare sites and pathological characteristic of teratoma.

Surgical Experiences of Three Cases of Giant Pituitary Adenoma

Three cases of giant pituitray adenoma are reported. Two cases were operated by transsphenoidal approach and a case by transcranial approach. Transsphenoidal approach showed satisfactory results despite of marked suprasellar extension of tumors. We report rare giant pituitary adenomas with review of relevant literatures.

An Analysis of Major Complications after Brain Tumor Surgery

The ocurrence of complications after brain tumor surgery often lead to death. To decrease the incidence of complications, it is desirable to identify patients at risk as early as possible prior to surgery. It can be achieved by determining preoperatively those factors known to be of prognostic relevance in the development of such postoperative complications. The prognostic factors may be differ considerably depending on the population studied but the homogeneous population studied in this analysis may help to contribute to the reference guide in identifying those factors. Authors have retrospectively analysed the major complications developed after performing on 150 brain tumor surgeries during last five years to identify the prognostic factors.

A Clinical Analysis of Metastatic Spine Tumors

The authors analyed 27 cases of metastatic spine tumor in regard to diagnostic procedures, effects of radiation and their average survival time. Technetium-99m radiolabeled polyphosphate bone scans were superior to any other diagnostic procedures as a screening test for the early detection of spine metastases. Spinal CT scans with myelogram were useful to define the anatomic extent of destruction and cord comprssion. To prevent myelopathy, early radiation therapy was certainly helpful. The decompressive laminectomy alone have contributed little to the patients in regard to the prolongation of life and the correction of neurological deteriorations. The authors concluded that the one-stage laminectomy and adequate posterior stabilization with the use of internal fixation devices were the choice of treatment for control of pain and prevention of the complications from spinal instability in the following patients: 1) with early progressive myelopathy: 2) who were unable to move due to the pain evoked by motion; and 3) who showed the evidence of spinal instability radiologically and/or clinically.

Suprasellar Mass Lesions Presenting with Central Diabets Insipidus

Central diabetes insipidus(CDI) may result from any abnormalities in the supraoptic-neuropituitary axis. Since 1984, we have studied 7 suprasellar mass lesions presenting with CDI. There were 3 suprasellar germinomas including 1 pituitary stalk(infundibular) microgerminoma, 1 suprasellar lymphoma, 1 craniopharyngioma, 2 suprasellar mass lesions whose pathologies were not confirmed. In two case of germinoma, one at infundibulum and another at suprasellar region, the diagnosis was made on the basis of radiological and endocrinological findings and rapid disappearance of the mass after irradiation. The symptoms of CDI had improved within 2 months after the irradiation in all 3 cases of germinoma. Another 4 cases had been on DDAVP during follow-up periods more than one year. Primary tumorous lesions presenting with CDI always demonstrate pituitary stalk enlargement, suprasellar mass, or both. Among parasellar lesions presenting with CDI, germinoma and lymphoma are very sensitive to radiotherapy and have no need of surgery which and result in pituitary stalk damage and permanent CDI. And lesions of infectious and systemic disease also have no need of surgery. To avoid unnecessary surgery or biopsy, preoperative differential diagnosis of these lesions by CT scan findings and other systemic evaluations is important. In addition, elevation of serum prolactin level appeared to be related to infundibular lesions as a few authors suggested previously but not to aid differential diagnosis.

A Retrospective Analysis of Treatment and Prognosis in Brain Metastases

A retrospective analysis of brain metastasis with respect to the pathology, hydrocephalus, cause of death, survival time and therapeutic modality was carried out in 47 cases. The duration of survival after CNS metastasis far less depends on the primary tumor than the latent interval between the onset of first symptom from primary tumor and CNS metastasis dose. And death was attributable to the CNS metastases in at least 5.3% of these cases. Surgery and radiotherapy but chemotherapy were included in this study. Radiotherapy had significant effects on prolongation of survival. The surgery plus postoperative whole brain radiotherapy had the longest survivals than the other treatment modalities. The authors recommend guidelines for surgical resection, usually followed by radiotherapy:in cases which have good general condition enough to tolerate general anesthesia without any acute general morbidness, (1) single surgically accessible brain metastasis, (2) an incapacitating or large metastasis even when the tumor is not solitary, (3) uncertain primary cancer, (4) posterior fossa, especially cerebellar hemispheric metastasis. It seems that the presence of metastasis else where in the body should not exclude the case as a surgical candidate.

A Retrospective Analysis of Treatment and Prognosis in Brain Metastases

A retrospective analysis of brain metastasis with respect to the pathology, hydrocephalus, cause of death, survival time and therapeutic modality was carried out in 47 cases. The duration of survival after CNS metastasis far less depends on the primary tumor than the latent interval between the onset of first symptom from primary tumor and CNS metastasis dose. And death was attributable to the CNS metastases in at least 5.3% of these cases. Surgery and radiotherapy but chemotherapy were included in this study. Radiotherapy had significant effects on prolongation of survival. The surgery plus postoperative whole brain radiotherapy had the longest survivals than the other treatment modalities. The authors recommend guidelines for surgical resection, usually followed by radiotherapy:in cases which have good general condition enough to tolerate general anesthesia without any acute general morbidness, (1) single surgically accessible brain metastasis, (2) an incapacitating or large metastasis even when the tumor is not solitary, (3) uncertain primary cancer, (4) posterior fossa, especially cerebellar hemispheric metastasis. It seems that the presence of metastasis else where in the body should not exclude the case as a surgical candidate.

Clinical Analysis of Brain Tumors in Children

No abstract available.

Posterior Fossa Dural Arteriovenous Malformation: Case Report

The authors report a case of posterior fossa dural arteriovenous malformation with increased intracranial pressure. It was fed left occipital artery, posterior auricular artery, posterior meningeal branch of vertebral artery, and meningohypophyseal artery of left internal carotid artery. Treatment has been tried with transcatheter embolization using gelfoam and ivalon, intracranial clipping of feeders, ligation of external carotid artery, and radiation therapy. The unusual clinical manifestations such as visual disturbance and hearing impairment are discussed.

Analysis of Chemical Components of Hypertensive Intracerebral Hematoma: Preliminary Report

The authors ahve analyzed various chemical components of intracerebral hematoma in 20 cerebrovascular accident patients who were operated at the Department of Neurosurgery, Kosin Medical Center, from October, 1984 to April, 1986. The results showed that there are no differences between the levels of sodium and chloride in serum and hematoma, while potassium and phosphorus significantly higher in hematoma, and calcium lower in hematoma. The changes of various chemical components seem not to be correlated with the timing of operation. We are going to discuss the possible explanations of the changes.