Surgical Outcome of Spontaneous Intracerebral Hemorrhage in Less than Stuporous Mental Status

OBJECTIVE: Spontaneous supratentorial intracerebral hemorrhage can be considered as one of the most common forms of cerebravascular disease. Effective reduction of intracranial volume buffering capacity in elevated intracranial pressure is most important factor related to a poor prognosis in cases with huge hematoma and compromised mental status. The role of surgery in the management of such cases are still controversial. METHODS: Thirty patients with altered mental status less than stuporous and spontaneous supratentorial hematoma were underwent craniotomy or decompressive craniectomy and duroplasty. The hematoma volume were ranging from 31 to 120ml. In 14 patients, in whom a progression in secondary brain swelling was expected to occur after hematoma evacuation, a decompressive craniectomy with dural enlargement was performed. The overall clinical result was expressed as 30 day mortality, Glasgow outcome scale(GOS) and modified Rankin scale 1 year after surgery. The favorable outcome(GOS> or =4) were analyzed with variables [age, initial Glasgow coma scale(GCS), hematoma volume, location of hematoma, extent of midline shift, intraventricular hemorrhage, and time interval from ictus to surgery]. RESULTS: The overall clinical results showed 10% of 0-day mortality, 56.6% of favorable outcome and 53.3% of independency(< or =2 of modified Rankin scale). A significant statistical correlation was found between outcome and initial GCS and location of hematoma(p<0.05). The decompressive craniectomy and duroplasty proved some useful in increasing postoperative GCS of compromised patients. CONCLUSION: Surgical treatment of patients with spontaneous supratentorial intracerebral hemorrhage with altered mentality less than stuporous can have a positive role, in selected cases.

Two Cases of Surgical and Medical Treatment of Infectious Intracranial Aneurysms: Case Report

OBJECT: To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. METHOD: Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. RESULT: Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. CONCLUSION: Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.

Neurenteric Cyst in Upper Thoracic Spinal Canal: Case Report

No abstract available.

The Role of Radiologic Study in Diagnostic Work-up of Headache Patients

No abstract available.

Giant Fusiform Aneurysm by Circumferential Wrapping with Sutures-Reinforcement

Adirect intracranial operative approach with clipping the neck of the aneurysm is generally considered to be the ideal treatment for the intracranial arterial aneurysms. Several strategies exist for treating unclippable aneurysms. Intravascular techniques, proximal occlusion of the parent artery or trapping of the aneurysm, microsurgical bypass of the involved arterial segment, and reinforcement or wrapping of the aneurysmal wall are frequently used. The authors report a case with long term(6 years) follow-up results of the circumferential wrapping with sutures-reinforcement for giant fusiform aneurysm of the internal carotid artery. The giant fusiform aneurysm and ideal wrapping materials were discussed with review of literature.

Morphometric Study of the Pedicles of Lumbar Vertebrae in Koreans

OBJECTIVE: This study was undertaken to study pedicle morphology in Koreans to provide a reference guide in transpedicular screw fixation. METHODS: Pedicle measurements were obtained from 35 dried human lumbar columns(175 lumbar vertebrae). Anatomic evaluation was focused on pedicle transverse diameter, pedicle axis length and the distance from the pedicle axis point to the midline of the transverse process. Pedicle angle and vertebral body length also were measured. RESULT: In the transverse plan, pedicle diameter increased from L1(7.8mm) to L5(15.5mm). But in 20.0% of L1 and L2, its diameters was under 6.0mm. In the sagittal plan, it was not as constant and had similar diameter from L1 to L5. In the transverse plan, the pedicle angle increased from L1 to L5. But in the sagittal plan it decreased from L1 to L5. Also, the pedicle axis length did not show concordant change, but rather had similar length in lumbar vertebrae. In 15%, its length was under 45mm. CONCLUSION: These results suggest that using above 6mm diameter and 45mm length of screw for L1 and L2 can violate the pedicle and vertebrae. Above L4, the pedicle axis point was superior to the midline of the transverse process, below L4, it was inferior to the midline of the transverse process. This information may prove to be helpful when contemplating the placement of screws to the lumbar pedicles.

Clinical Analysis of Surgically Managed Cervical Spondylosis by Anterior Approach

Microsurgical anterior foraminodiscectomy was developed to improve the surgical result of cervical radiculopathy. We reviewed 40 patients with cervical spondylosis after anterior foraminodiscectomy with or without bony fusion over 5 years. The tunnel of anterior foraminodiscectomy was made at lateral one-third of the disc trajectory to intersect the uncinate process at the level of neuroforamen. The compressed nerve root and spinal cord were decompressed by removing the spondylotic spur and disc. The most common presenting symtom was radiating pain to upper extremity. The most frequent site of involvement was the C5-6. Operation of one level was performed in 57% of cases, 2 levels in 40% of cases and three levels in 3%. Of the 40 cases, interbody fusion was performed in 45% of cases. In 92.5% of the patient, the outcome was excellent or good based on Odom's criteria. Postoperative complications were encountered in 7.5%. The correlation between the clinical factors and postoperative results was assessed. As to age, duration of symtoms, herniation of soft and hard disc, number of the operative levels and with and without bony fusion, the clinical results were not stastistically significant.

The Effects of Arthroscopic Lavage Combined with Percutaneous multiple Drilling in Patients with Degenerative arthritis of knee

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.