The Clinical Significance of Brain Computed Tomography at Three Days after Cerebral Aneurysm Surgery

OBJECTIVE: Despite recent technical advances in neurological surgery and medical management, patients with aneurysmal subarachnoid hemorrhage(SAH) who underwent surgery have been still at high risk of morbidity and mortality. For early prediction of postoperative outcome and proper management, we analyzed brain computed tomography(CT) findings taken at three days after cerebral aneurysm surgery. METHODS: Focusing on the relationship between the surgical outcomes and postoperative brain CT findings, the authors studied 153 consecutive patients with aneurysmal subarachnoid hemorrhage who had been treated surgically between January 1993 and December 1996. RESULTS: Brain CT findings were classified into following categories; non-specific(49 cases, 32.0%), hematoma at operation site(14 cases, 9.2%), ventricular dilatation(10 cases, 6.5%), subdural hygroma(27 cases, 17.6%), low density (28 cases, 18.3%), hemorrhage at remote site(0 cases, 0%) and combined lesions(25 cases, 16.3%). The poor surgical outcomes were 6% in normal CT finding group and 36% in abnormal CT finding group(p=0. 00011, Chi-square test). CONCLUSION: These findings suggest that postoperative third day brain CT findings could be used for an early predictor of outcomes and proper active managements could improve the poor outcome.

A Clinical Analysis of CT-guided Stereotactic Biopsy for Intracranial Mass Lesions

Using computed tomographic scanners, stereotactic guided brain biopsy usually permits safe and accurate pathologic diagnosis. In our department between 1991 and 1995, 35 patients underwent CT guided stereotactic biopsy and/or craniotomy with CRW stereotactic frame, and following results were obtained. 1) All lesions were supratentorial. As surgical intervention for the diagnosis, biopsy was carried out in 25(71.4%), aspiration of cystic content was in 2(6%), and stereotactic guided craniotomy was in 8 cases(23%) respectively. 2) A positive diagnosis could be obtained in 34 cases(97.1%), and inconclusive diagnosis disclosed in only one case (2.9%). Positive diagnoses included: 10 cases of astrocytoma(28.6%), 4 cases of glioblastoma(11.4%), metastasis, germinoma, and meningioma in that order. 3) It seemed to be difficcult to ascertain a grade and to search for any presence of mixed area in glioma cases, because open craniotomy was not carried out in all cases. 4) The biosy specimens were generally obtained with cup forceps, however a spiral needle core device with outer probe was very useful for obtaining tissue of tumor for an unavailable case with cup forceps. 5) The immediate post-operative CT scan after 3-4 hours of procedure gave information for accurate site of target under location of air bubble, and any evidence of complication such as hemorrhage. This study provides evidence that CT-guided stereotactic biopsy is a reliable, simple, and safe method for obtaining histological diagnosis of intracranial mass lesions.