Influence of Routine Intraoperative Ventricular Drainage on the Incidence of Aneurysmal Rebleeding

OBJECTIVE: Although there are several risk factors to which related intraoperative aneurymal bleeding, the relationship between ventricular drainage to aneurysmal rebleeding is still controversial. We investigate to define the relationship of an immediate ventricular drainage after craniotomies in predissection stage rerupture of aneurysms. METHODS: Randomized prospective and retrospective analyses were performed on 197 consecutive patients with confirmed aneurysmal subarachnoid hemorrhage(SAH) who underwent aneurysmal clipping in acute stage during 5 years. The aneurysmal SAH patients were divided into two groups according to the use of intraoperative ventricular cerebrospinal fluid(CSF) drainage. Various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, location of aneurysms, and the presence of a "daughter" aneurysm and hydrocephalus were analyzed. RESULTS: Regardless the drained CSF amount, the incidence of the intraoperative aneurysmal rerupture in predissection stage during aneurysmal clipping has not showed any difference in both groups. Depending on the presence of the acute hydrocephalus, the rerupture incidence in dissection stage during aneurysmal surgery was not statistically significant. However, the frequency of rebleeding in patients with ventriculostomy(66% of 24) was significantly higher than in hydrocephalic patients without ventriculostomy(25% of 27) and patients without acute hydrocephalus(22% of 110). CONCLUSION: Routine intraoperative ventricular drainage does not increase the incidence of aneurysmal rebleeding and the more extensive arachnoid dissection is not necessary even during an early surgery. Moreover, it obtains an adequate intraoperative brain relaxation, which resulted in the decrease of retraction injury.

Effect of Radiofrequency Dorsal Root Entry Zone Lesion for Neuropathic Intractable Pain

OBJECTIVE: The authors report a retrospective analysis of the clinical effect of dorsal root entry zone (DREZ) lesioning for neuropathic intractable pain. METHODS: Fourteen patients who underwent dorsal root entry zone lesioning for various types of pain between September 1995 and August 2001 were evaluated retrospectively. Eleven male and three female patients whose ages ranging from 35 to 70 were studied. According to causes of intractable pain, patients were divided into paraplegic pain(7 patients), peripheral nerve injury pain(3), cancer pain(3), phantom limb pain(1) and root avulsion pain(1). Other preoperative pain managements showed no benificial effects. The changes in painful symtoms were closely observed during follow up period. The mean follow period after operation was 32.4 months. RESULTS: Postoperatively, the decrease in level of pain was classified into four groups : excellent, good, fair, poor. Excellent represented no pain without medication : Good, pain tolerable with non-opiate medicine ; Fair, pain tolerable with opiate medicine ; Poor, pain sustained. After operation, three patients were in excellent group, eight in good, one in fair, and two in poor. Twelve patients were in medically tolerable pain group accounting for 85.7%. There were no serious operation releated side effects. CONCLUSION: DREZ lesioning, in our series, provided substantial pain relief and this may be considered an option in management of these types of intractable neuropathic pain.

Thrombosed Cerebral Arteriovenous Malformation (AVM): Operative Case Report / 대한뇌혈관학회지

Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.