Research of the safety of multi-slice computer tomography angiography as the evaluative criteria before aneurismal microsurgical clipping / 中华急诊医学杂志

Objective To evaluate if MS-CTA can be the primary and sole evaluative criteria for the treatment of intracranial aneurysms by microsurgery clipping. Methods Between January 2008 and October 2010, 105 patients with intracranial aneurysm underwent microsurgery clipping in our institution were respectively analyzed, out of which 39 patients with preoperative MS-CTA (64- or 320-slice CT scanner) examinations (MS-CTA group) , 21 with MS-CTA combined with DSA and 45 with DSA ( DSA group). The aneurismal size, neck, morphous and peripheral branches were compared between the CTA data and operative results, and the concordance between which were analyzed. The rate of operative complication and the GOS scale at discharge were also compared between MS-CTA group and DSA group. t test, Chi-Square test or Rank test were used for analysis of the patients' baseline data, Kappa test for the concordance between MS-CTA and operative results, Kruskal-Wallis test for operative complication and Mann-whitney test for the GOS at discharge between MS-CTA group and DSA group. Results Thirty-seven patients out of the MS -CTA group obtained successful microsurgery clipping, with 1 transferred to coil embolization because of the difficulty in exposing the aneurismal neck and 1 to decompressive craniectomy because of aneurismal rebleeding at removal cranium. There was a good concordance between MS-CTA and operative results on depicting aneurysmal size and neck ( κ =0.726 ,κ =0. 756) and a ordinary concordance on morphous and peripheral branches ( κ =0.524, κ =0.473). There was no significant difference on the rate of operative complication (P =0.509) and GOS scale (P =0.239) at discharge. Conclusions MS-CTA can reveal the important characteristics of intracranial aneurysms, and has a high safety as being the primary and sole criteria before microsurgery clipping.

Factors influencing the outcome of patients with acute extradural haematomas undergonig surgery.

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

The Clinical Analysis of Alcohol and Creatine Kinase-BB(CK-BB) in Acute Head Injury

Patients suffering a head-injury were often drinking alcohol shortly before the trauma, and it has been suggested that the degree of brain damage may be exacerbated due to high alcohol serum levels. To evaluate this, we assessed the level of consciousness, alcohol and creatinine kinase-bb(CK-BB) serum levels in 140 consecutive head-injured patients. Level of consciousness(GCS score) was strongly correlated to outcome(p<0.001) and serum CK-BB(P<0.05), but not to alcohol serum levels.

Clinical Analysis of Interhemispheric Subdural Hemorrhage and Tentorial Hemorrhage

A propecive analysis of 50 patients with acute interhemisphric subdural hemorrhage and tentorial hemorrhage, an unusual pattern of acute subdural hematoma, who were managed in a uniform way was analyzed to related outcome to hemorrhagic site, initial Glasgow Coma Scale(GCS) and combined injuries. The incidence of acute interhemisphric subdural hemorrhage(ISH) and tentoria hemorrhage(TH) after head trauma was 3.83%, 50 cases among 1303 head injured cases. And 80% of the above hemorrhage disapperaed within two weeks after trauma. There was no significant relationship between feature of hemorrhage and intial GCS(P>0.05), but there was highly significant relationship between initial GCS and Glasgow Outcome Scale(GOS) (p<0.001). There noted significant relationship between initial combined injury and GOS(p<0.01), and also brainstem injury and GOS(p<0.001).

Clinical Analysis of Traumatic Basal Ganglia Hematoma(TBGH)

Recently, the detection of traumatic intracerebral hematoma has been greatly expedited by the advent of computed tomography. However, Traumatic Basal Ganglia Hematoma(TBGH) has remained rare and its prognosis has been regarded as poor. The authors obtained following results from the analysis of clinical features and outcome on 50 cases of TBGH who has been treated at the department of neurosurgery, Wonju Christian Hospital from January, 1984 to June, 1988. 1) The incidence of TBGH was 2% of all head-injured patients. 2) The average age of patient was 26.6 years, and the most common cause was motorvehicular accident(80%). 3) The clinical features revealed mental deterioration on 44 cases, followed by motor weakness(23 cases), and decerebrate rigidity(16 cases). 4) The frequent location of hematoma was putamen(27 cases, >50%), internal capsule(9 cases, 14%). 5) The combined lesion showed mostly lower GCS(Glasgow Coma Scale) than solitary lesion(P<0.001). 6) The groups of both GCS above 8(P<0.001) and small hematoma volume below < 15ml(P<0.001) showed relatively good outcome.