Outcome of Aneurysmal Subarachnoid Hemorrhage Patients with Hunt-Hess Grade III / 대한뇌혈관외과학회지

OBJECT: We designed this study to bring the outcome and the outcome predictors of Hunt-Hess grade III patients to light, and to be aid in determining treatment protocol of such a intermediate group. METHODS: All patients with non-traumatic subarachnoid hemorrhage who visited our hospital between January 1998 and December 2004, were reviewed. We selected 72 Hunt-Hess grade III aneurysmal subarachnoid hemorrhage patients for detailed review. 54 operations and 10 endovacular procedures were performed. The outcome of the patients were evaluated with Glasgow Outcome Scale (GOS). Through univariate and multivariate analysis, several clinical and operative factors were evaluated to determine the significance for the outcome. RESULT: Overall 58 patients were in good outcome group (GOS 4 or 5). overall 6-month mortality was 5.6%. Age, presence of intracerabral hemorrhage(ICH) on the initial computed tomography (CT) scan, and vasospasm were independently important in determining outcome. CONCLUSION: In the Hunt-Hess grade III aneurysmal SAH patient, age, presence of ICH on intial CT scan vasospasm have independent statistical significance to the outcome. More aggressive treatment of vasospasm can improve the outcome.

A Comparative Analysis of C-arm Fluoroscopic Guided and Computed Tomography-guided Stereotactic Catheter Drainage of Hypertensive Intracerebral Hematoma

OBJECTIVE: For the treatment of the hypertensive intracerebral hemorrhage, stereotactic catheter drainage of hematoma has been widely used as a less invasive and effective therapeutic modality. However stereotactic catheter drainage method occasionally can not be available. Here, we introduce C-arm fluoroscopic guided catheter drainage of hematoma as an alternative method. The authors compared the two methods and report the result with review of the literatures. METHODS: A total of 62 patients with hypertensive intracerebral hemorrhage who underwent catheter drainage between February 1996 and December 1999 were reviewed. The patients were divided into two groups according to the method of catheter insertion. The two groups were compared with respect to pre- and post-operative changes of hematoma volume and neurological deficit, hematoma drainage rate, duration of catheter placement, complication, and short term prognosis. RESULTS: The pre-operative hematoma volume was slightly large in the C-arm fluoroscopic guided method group. But post-operative hematoma volume, pre- and post-operative neurological deficit, hematoma drainage rate, duration of catheter placement, post-operative complication and short term prognosis were not different statistically between the two groups. The preparation time for operation was short in C-arm fluoroscopic guided group. CONCLUSION: C-arm fluoroscopic guided catheter drainage of intracerebral hematoma can be an alternative to the stereotactic guided method in the urgent situation or when the stereotactic system is not available

Meningeal and Cerebral Involvement of a Plasmacytoma in an IgG Multiple Myeloma Patient: Case Report

We present a case of meningeal and brain metastasis of multiple myeloma. A 60-year-old woman who had been diagnosed as multiple myeloma two years ago, was referred to neurosurgery department because of headache and nausea. The magnetic resonance image of the brain showed a large epidural mass and the parenchymal enhancement. The patient received an operation of tumor removal and cranioplasty. A histological diagnosis of metastatic multiple myeloma was made.