Comparative Clinical Analysis of Surgically Treated Spontaneous Intracranial Parenchymal Hematoma between with Stereotaxic Evacuation and Free-Hand Craniectomy

From Jun, 1983 to Sep, 1986, we operated 127 cases of spontaneous intracranical parenchymal hematoma. Among them, 88 cases were operated by stereotaxic evacuation of hematoma with computed B.R.W. system and 39 cases by free-hand craniectomy and leucotomy. We compared results of both methods. Results are as followings : 1) Nearly 90%(112 cases) were over 40 years old. 2) Prevalence of both sex were nearly same. 3) Hypertension cases on admission were 93 cases(73.2%). 4) Favorite anatomical locations were putamen(55 cases ; 43.3%), thalamus(32 cases ; 25.2%), subcortical(29 cases ; 22.8%), pontine, cerebellum in frequency. 5) Amount of removed hematoma were mostly 10-30ml and upper most case was 145ml. 6) Irrigation with urokinase were done in cases. 7) Surgical complication were 7 cases(5.5%) : 6 cases of reblecding : 1 case of ventriculitis. 8) Mortality of total cases were 26.0%(33 cases). 9) Comparative results between B.R.W. group and F.H.C. group were as followings ;(tab)B.R.W. group(tab)(tab)F.H.C. group(tab)(newline)Mortality(tab)13.60%(tab)(tab)28.20%(tab)(newline)(tab)AD(tab)DC(tab)AD(tab)DC(newline)Glasgow coma scale(tab)11.23+/-3.14(tab)12.72+/-3.87(tab)8.56+/-3.33(tab)10.97+/-4.93(newline)Motor power(tab)2.59+/-1.14(tab)3.44+/-1.27(tab)3.05+/-1.21(tab)3.32+/-1.53(newline)Motor of Putaminal Hx(tab)2.38+/-0.85(tab)3.13+/-1.00(tab)3.20+/-0.94(tab)3.00+/-1.41(newline)

A Study of Influencing Factors of Intracranial Pressure and Prognosis with Continuous Intracranial Pressure Monitoring in Severe Inreacranial Lesions

The cranium can be thought of a as shallow, rigid sphere of contrast volume. There are three main components within the intracranial space : brain, cerebrospinal fluid and blood. Intracranial volume and pressure are maintained constantly by Monroe-Kellie doctrine. Also intracranial pressure is influenced by a number of physiologic factors and it will be changed with intracranial lesion. Now we were look for the possible factors that influence the intracranial pressure with continuous intracranial pressure monitoring. At the same time we studied the possibility of the relationship between factors that influence ICP and ADL(Ability of Daily Life) in 43 severe brain lesions(33 cases ; intracerebral hematoma, 10 cases ; head injury). In cases of higher GCS, smaller hematoma, lower amplitude of ICP, lesser frequency of A-wave and lower elastance, the ICP were lowed. Ninety percent of cases that GCS is over 12 was belong to ADL I and II, but only nineteen percent of cases that GCS is under 7 was belong to ADL I and II. No case of internal capsule involved group was belong to ADL I but forty-eight percent of cases whose hematoma volume is under 10ml was belong to ADL I. Fifty percent of cases whose hematoma volume is under 10ml was belong to ADL I and no case that hematoma volume is over 20ml was belong to ADL I. Cases that PCO2 is in the range of 25mmHg-29mmHg were not belong to ADL I. In cases of higher amplitude of ICP, higher frequency of A-wave and higher elastance, the patient's ADL was grave. And in cases of ICP was progressively increased, the prognosis was also grave. Consequently we are able to guess that patient's prognosis will be influenced by initial GCS, internal capsule involvement, hematoma volume, PCO2, amplitude of ICP, frequency of A-Wave, brain elastance and curve of ICP.

Clinical Analysis of Chemonucleolysis for Treatment of Lumbar Disc Herniation / 영남의대학술지

During last 48 months, in our department 5 patients with single or multiple herniated lumbar discs have received chemonucleolysis. Forty-one of r51 cases have single level herniation and remaining cases have multiple level. Age distribution were from 19 to 59 years old. Over 4 months (longest case: 18 months) follow up revealed as follows: 40 cases (78%) revealed excellent results: 4 cases (7.8%) received discectomy 3-6 months after chemonucleolysis because of recurred symptoms: no anaphylaxis and no major complications were noted.

A BRW Stereotaxic Biopsy of Brain Stem Glioma / 영남의대학술지

Histopathological diagnosis of brain stem glioma should be performed for the purpose of the determination of its management and clinical course, but its surgical biopsy has been followed by high mortality and morbidity. We performed the tissue sampling for histological examination with BRW stereotaxic system under local anesthesia successfully.

The Application and Effect of the Brown-Roberts-Wells Stereotactic System in the Management of Intracranial Lesions / 영남의대학술지

In the past 10 years, modern technology has made deep seated obscure lesions visible. With development of computer technology and various stereotaxic techniques, many new procedures, refinement of old procedures, and development of new applications are possible. The authors are intended to provide a detailed description of our experience with the Brown-Roberts-Wells (BRW) stereotactic system in the evaluation and management of 90 patients with intracranial lesions, and to provide cases presentation of various inaccessible intracranial lesions.

Roles of BRW CT Stereotaxic in Less Accessible Brain Lesions

With improvement of computerized tomography(CT), stereotaxic surgery has been applied for neurosurgery ; aspiration of deep-seated brain lesions, radiotherapy using a small radiogenic sources, and evacuation of hematoma. And so, a prototype Brown-Roberts-Wells(BRW) CT stereotaxic system has been avaible to us. We report its utilization in evaluation and management of less accessible brain lesions. Surgical exploration was undertaken in 25 patients with various less accessible brain lesions using BRW system : 9 superficial lesions including the motor cortex and multiple lesions, 5 deep-seated lesions, 3 parasellar lesions, 8 brain stem lesions. Histologically, there are 5 gliomas, 4 metastatic cancers, 8 hematomas, 3 brain abscesses, 1 medulloblastoma, 1 malignant melanoma, 1 cryptic AVM, and 2 undiagnosed cases. There are two complications : 1 intratumoral bleeing, 1 rebleeding. The diagnostic rate is 92%. There is no mortality in this series. This BRW CT-guidance stereotaxic approach for less accessible lesions have following advantages ; 1) accurate, simple and safe ; 2) performed under local anesthesia ; 3) less traumatic and low cost ; 4) easily diagnosed ; 5) relatively no limitation in lesion sites.

Effects of Induction on Changes of Intracranial Pressure and Vital Signs during General Anesthesia / 대한마취과학회지

It is true that intracranial pressure(ICP) and mean arterial pressure(MAP) are increased by induction of conventional inhalation general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the ranges of ICP and MAP increase during induction of the general anesthesia with laryngoscopy and endotracheal intubation following thiopental sodium(4mg/kg) and succinyeholine chioride(1 mg/kg) injections in 16 neurosurgical patients with normal pulmonary and cardiac functions. All the patients were monitored ICP and intraarterial pressure preoperatively, and intracranial compliance, ICP, MAP and pulse rate were measured in all patients during induction of general anesthesia. The results were as follows: 1) Intracranial compliance; ICP during endotracheal intubation increased by 2 mmHg in those patients with pre-operatively normal range of compliance, but in those patients with compliance range of 2-3 ml/CmH2O, mean ICP increase was 5. 6+/-2. 45 mmHg, and in those patients with compliance range of 4-6 ml/CmH2O, it was 13. 010. 23 mmHg. 2) Mean ICP increased from 13.5+/-6.16 mmHg at pre-induction to-20.4+/-10.02 mmHg during endotracheal intubation, but it was not statistically significant(p>0.05) because the rate of ICP increase was not remarkable by endotracheal intubation in the patients without ICP increase in pre-induction. 3) Mean arterial pressure increased significantly from 116.71+/-6.65 mmHg at pre-induction to 160. 3+/-34. 24 mmHg during endotracheal intubation(P<0.05). 4) Pulsse rate increased significantly from 94.8+/-20.28 beat/min to 120.5+/-15.93 beat/min(p<0.001). 5) Cerebral perfusion pressure increased from 103.3+/-14.49mmHg 137.3+/- 35.91mmHg(p<0.025). It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patient with increased ICP.

Organized Expanding Spontaneous Intracerebral Hematoma / 영남의대학술지

The authors report a case of massive spontaneous intracerebral hematoma in a infant, caused by bleeding from cryptic vascular malformation associated with vitamin K dependant factor deficiency. The bleeding was initiated by vitamin K dependant factor deficiency, then 3 weeks later hematoma was expanded by rebleeding from malformed vessel after PT and PTT had been returned to normal values. The well circumscribed organized old hematoma with fresh expanded bleeding component within a huge rusty colored cystic fluid cavity was recognized in operative field and pathological ground.

Extraosseous Extradural Cervical Tuberculoma / 영남의대학술지

A 44-year-old female with cervical cord compression signs had myelographic and computerized tomographic evidence of extradural spinal cord compression without any tuberculous bony lesion or cold abscess. At surgery, cervical spinal cord was compressed by extraosseous extradural granulomatous tissue which was histologically proved a very rare localized extradural tuberculous granuloma.

Pineocytoma / 영남의대학술지

The management of pineal region tumor remains controversial. This paper reports a case of pineocytoma which was attempted to improve treatment planning by the use of clinical features, computerized tomography, and markers for germ-cell tumor. A presumptive diagnosis could be made and this tumor less likely to respond to radiotherapy was subjected to primary surgery.

Clinical Analysis of C.N.S. Cysticercosis / 영남의대학술지

During last 10 years we experienced 25 cases of C.N.S. cysticercosis. Now clinical analysis and evaluation of our cases were made and the results are followings; 1. Prevalence in man and women are nearly same and about 70% of cases are distributed between 20-50 years old. 2. According to Nieto's classification, mostly are ventricular (44%) and parenchymal type (36%). 3. Clinical manifestations were IICP (92%), focal neurological deficits (68%), seizure (48%), altered mental status (36%) and others listed on table 7. 4. In ventricular type, IICP and cerebellar dysfunction signs were predominated but seizure and focal neurological deficits were commonly seen in parenchymal type. 5. Subcutaneous cysticercus nodules were palpated in 32% of cases. 6. Positive stool ova was observed in 29% of cases. 7. Radiologic studies revealed as followings: 16% of cases showed abnormal findings on plain film, 84% on angiography, 94% on ventriculography and 100% on computed tomography and myelography. Computed tomography looks like most helpful diagnostic method for C.N.S. cysticercosis, they usually revealed lucent cystic lesion, hydrocephalic findings and contrast enhancement. 8. Suboccipital craniectomy, craniotomy with removal of parenchymal cyst or laminectomy were done according to location and types of lesion. 72% of operated cases revealed good results and mortality was 4% of cases.