A Clinical Analysis of Ruptured Intracranial Aneurysms: The Relationship Between Vasospasm on Angiogram and Surgical Prognosis

A clinical analysis of vasospasm as seen angiographically after the onset of subarachnoid hemorrhage was carried out in 22 out of 4 cases of ruptured intracranial aneurysms experienced in our department from January, 1978 to May, 1979. The following results were obtained. The incidence of vasospasm was 50%. 2) Angiographic filling abnormalities(vasospasm) were morphologically classified into 4 types:tapering, diffuse, segmental and nodular types. 3) No significant difference was found in the location of the arteries with vasospasm in relation to the site of the ruptured aneurysm. In this study, the most frequent occurance of spasm was noted in cases of internal carotid aneurysm(69.2%). 4) Discrepancy in the incidence of angiographic spasm between the group with only one subarachnoid hemorrhage(41.9% out of 31 cases) and the other group with more than one hemorrhage(50% out of 44 cases) was demonstrated. While vasospasm occurred frequently within 9 days after the last hemorrhage in cases with more than two hemorrhage, the appearance of vasospasm was frequently seen angiographically between 10 to 17 days after hemorrhage in cases with only one hemorrhage. 5) There was no relationship between the age and the incidence of spasm, and most cases with spasm showed bloody and xanthochromic C.S.F. 6) Neurological findings were as follows:mental disturbance 12 cases, cranial nerve palsy 3 cases, paresis 3 cases, seizure 2 cases and visual disturbance 2 cases. These neurologic deficits may not be related to the spasm. 7) Follow up carotid angiography was performed in 9 cases of those treated by direct approach. Among 5 cases with vasospasm in preoperative angiogram, the spasm persited in 2 cases and was not no longer visualized in 3 cases. On the other hand, in 2 cases without preoperative spasm, postoperative spasm was detected. 8) Of 23 cases of ruptured aneurysms treated surgically(including 3 cases of carotid ligation), 2 out of 15 cases with spasm expired and all 8 cases without spasm were cured. 9) The diffuse type(using above classification) had the worst postoperative prognosis:i.e., among 9 cases with that type of spasm, 2 cases expired and one case resulted in a mild neurologic deficit. Other types of spasm had no special relationship with the postoperative prognosis.

3 Cases of Neurofibromatosis Associated with Intracranial and Spinal Lesions

Variable manifestations of neurofibromatosis are properly defined as a hereditary, harmatomatous disorder, probably of neural crest origin, involving not only neuroectoderm and mesoderm but also endoderm, with the potential of appearing in any organ system of the body. Recently, we have experienced 3 cases of neurofibromatosis, one case associated with glioblastoma multiforme in left frontal lobe, another case associated with multiple neurofibromas in thoracic region and cauda equina, the third case associated with retroperitoneal neurofibroma and dural ectasia.

Suprasellar Cystic Meningioma Simulating Craniopharyngioma: A Case Report

An unusual case of meningioma with a large cyst on the sellar region which was misinterpreted to craniopharyngioma was reported. A 6-year-old boy was admitted to our hospital on May 8, 1980 because of headache, blurred vision and walking disturbance. On admission, neurological examination revealed marked diminished visual acuity associated with optic atrophy in both eyes, gait disturbances, incoordination and precocious puberty. Plain skull film showed marked digital markings and seperation of the coronal suture. Right carotid angiography in AP view revealed widening of the U-loop and space occupying lesion on the suprasellar region in lateral view. Neither detection of the tumor feeding artery nor tumor stain was seen. Conary ventriculography revealed marked dilation of the both lateral ventricles and blockage of the foramen of Monro. CT scan disclosed a well defined low density area and small multilobulated cysts in the suprasellar region. The margin of the tumor and low density area were markedly enhanced by contrast media. At operation, the tumor was found to consist of a yellowish brown nodule firmly adherent to the diaphragma sellae and a large cyst. The tumor was partially removed together with the whole cyst wall. The resected nodule was relatively hard and had multiple small cysts in it's cut surface. Postoperative course was uneventful. The neurological deficits except precocious puberty were much improved on discharge time. Reviewing the literature and the pathogenesis of cystic change in meningiomas were discussed.