A Case of Traumatic Giant Aneurysm

The authors are reporting traumatic giant aneurysm arising from supraclinoid portion of internal carotid artery. The patients was a 22-years old man who had suffered a major head injury in a traffic accident. On admission he was comatous and there were multiple abrasion over the body and severe hemorrhage comming from the left ear with open fracture in left parietal. 4 weeks later, computed tomographic scan demonstrated large well enhanced mass in the suprasellar region. Carotid angiography showed giant aneurysm fed by supraclinoid portion of internal carotid artery. After frontotemporal craniectomy, direct approach was performed using surgical microscope.

The Use of Urokinase in Traumatic Intracerebral Hematoma Treatment

Urokinase use after stereotaxic evacuation of hematoma became a popular method in treatment of hypertensive intracerebral hematoma. We obtained excellent result in evacuaIon of the hematoma which was remained after stereotaxic evacuation or direct approach for 24 raumatic intracerebral hematoma cases. And we found several advantages in this method compared with standard treatment modalities. We think that this is a new, effective treatment method for traumatic intracerebral hematoma.

Surgical Experience on directly treated 18 Intracranial Aneurysm

Eighteen intracranial aneurysm were operated upon with direct approach under the surgical microscope. The aneurysms arising in the anterior communicating artery(8) were most common, followed by internal carotid artery(6), middle cerebral artery(2), posterior communicating artery(1), anterior cerebral artery(1) in order. We preferred pterional approach. And the timing of operation was scheduled as soon as possible if other conditions permitted. Mannitol administration, hypotensive anesthesia, Sugita clip, biobond or aneurysmostat were utilizes during the operation. The aneurysmal neck was clipped with Sugita clip mostly, but wrapping was also carried out in certain condition. The elasticity of the Sugita clip is seemed to be better than others. In even Sugita clip, however, overopening at the time of clipping made it weak and resulted in incomplete occlusion of the aneurysm neck. To obtain successful aneurysmal surgical result, following surgical care should be taken. 1) lesser brain retraction, 2) complete removal of subarachnoid clots, 3) Meticulous hemostasis of micro-oozing from bridging vein and internal dural surface. Uneventful two surgical cases were found to be fatal due to hidden post-operative oozing clots from the internal surface of the dura.