Prognostic Factors in Spontaneous Thalamic Hemorrhage

OBJECT: Object of this study is to study which factors affect the prognosis in spontaneous thalamic hemorrhage treated with conservative method, stereotactic surgery and extraventricular drainage. MATERIAL AND METHODS: We analyzed 127 patients with spontaneous thalamic hemorrhage for evaluating the factors affecting prognosis. Various factors such as age, sex, location of hematoma, Glasgow coma scale(GCS) on admission, intraventricular hemorrhage(IVH), ventricular dilatation, CT classification, hematoma diameter, 4th ventricle dilatation, and treatment modality. RESULTS: The results were as follows: 1) Of the 40 patients with GCS of 3 to 8, 15 patients(37.5%) died. Of the 34 patients with GCS of 13-15, 33 patients(97%) survived 2) The 99 patients had intraventricular hemorrhage and 25 patients(25.2%) died. The 28 patients had no intraventricular hemorrhage and they all survived. 3) Of the 24 patients in whom the cerebrocaudate index(CCI) was more than 0.25, 10 patients(41.6%) died and only 2 patients had good prognosis. The 35 patients had no ventricular dilatation and all 35 patients survived 4) Of the 23 patients extending to hypothalamus or midbrain with ventricular hemorrhage, 11 patients(47.8%) died and 12 patients(52.1%) survived. 5) Of the 10 patients in whom hematoma diameter was more than 45mm, 4 patients(40%) died and 6 patients(60%) had a poor prognosis. 6) The 31 patients had hemorrhagic dilatation of the fourth ventricle and 16 patients(51.6%) died. Of the 29 patients with ventricular hemorrhage and no dilatation, 6 patients(20.6%) died. CONCLUSION: Multiple logistic regression analysis showed prognostic factors: GCS score(p<1/20.0001), extending to hypotahalamus or midbrain with ventricular hemorrhage(p<1/20.0001), thalamic hematoma with IVH(p<1/20.0001), dilated 4th ventricle hemorrhage(p<1/20.0012), hematoma diameter(p<1/20.0001), CCI(p<1/20.0001).

Clinical Analysis of Axis Fracture

This retrospective analysis describes the clinical characteristics, treatment, and long-term outcome of 30 patients with axis fracture admitted to our institution between January 1991 and December 1995. The incidence of axis fracture was 27.2% in the 110 cervical spine fractures. Among these, odontoid process fracture was the most common type, 19 cases(63%) followed by 8 hangmans fractures(27%), 3 miscellaneous fractures(10%). Hangman's fractures, odontoid type III fractures and miscellaneous fractures were treated with external immobilization devices. Remaining 11 odontoid type II fractures, and six patients with dens dislocation of 6 mm or greater were initially treated by early surgical stabilization. Individuals with dens dislocated less than 6 mm were treated by external immobilization only. Among the nonoperative group of acute axis fractures, there was no fusion failure. In the early operated group, all patients were stable clinically or radiologically. But three patients with posterior wiring and bone graft complained of their neck motion limitation.

Clinical Analysis of Anterior Approach with the Several Types of Cervical Plate for the Lower Cervical Lesions

The surgical approach to the lower cervical lesions, especially in traumatic injuries, has been controversial. Some authors advocated posterior fusion for such lesions, while others disagreed and reported good operative results with anterior approach using several types of cervical plates. We analysed 28 patients with lower cervical spine traumatic as well as pathological lesions who underwent 32 anterior surgical interventions with cervical plates during the period of August, 1991 and December, 1993. A successful postoperative vertebral stability was obtained in 5 patients(89.3%) and in 19 patients(87.5%) who had predominent posterior ligamentous injuries. Serious complications such as esophageal perforation and postoperative angulation were seen in 5 patients(17.3%) that were related to the process of reduction. With our clinical experiences, we support anterior fusion with cervical plates particularly for lower cervical lesions even though posterior fusion has ben preferred for traumatic posterior ligamentous complex injuries.