Intracranial Dural Arteriovenous Malfirmation: Report of Three Cases

Most of dural arteriovenous malformations(D-AVM's) are known to be an acquired lesion developed by a previously thrombosed dural sinus. They are usually no greater than 1 or 2 cm in size and most often present as spontaneous intracranial hematoma in fifth and sixth decades of life. We had surgical experiences of an unusual case of a 8 cm sized dural AVM in an infancy presented with a large scalp mass and two other cases presented with spontaneous intracerebral hemorrhage and subdural hematoma.

Clinical Analysis of Spontaneous Intracranial Hemorrhage Associated with Intraventricular Hemorrhage

The authors analyzed retrospectively 183 cases of spontaneous intractranial hemorrhages associated with intraventricular hemorrhage according to their etiology, location of involved intraventricular hemorrhage(IVH), initial Hunt and Hess Grade, activities of daily living(ADL) system, and degree of inital ventricular dilatation. The overall incidence of spontaneous intracranial hemorrhage associated with intraventricular hemorrhage was 55%, 183 cases among 333 spontaneous intracranial hemorrhages. The etiologies of intraventricular hemorrhage were hypertension, aneurysm, and arteriovenous malformation, in order of frequency, which constituted 85% of total cases. There noted significant relationship between initial Hunt and Hess Grade and final outcome on 6-month follow-up(P>0.0001). Although initial subarachnoid hemorrhage appeared to provoke the dilatation of ventricle more than without it, in cases of survival, subarachnoid hemorrhage did not appear to inhibit the absorption of intraventricular hemorrhage (P>0.05). The overall mortality rate on 6-month follow-up was 20.2%, but poor outcome was noted in 40.4%.

Correlation of changes of intracranial pressure and clinical manifestations in spontaneous intracerebral hemorrhage / 영남의대학술지

Recently, many authors have reported about the relationship of the volumes of hemorrhage in the brain parenchyma, hemorrhagic sites, optimal operation time, and the effects of mannitol and steroid on control of ICP to clinical manifestations. Many attempts to measure ICP in hydrocephalus, brain tumor, and head injury have been reported. But the measurements of intracranial pressure in spontaneous intracerebral hemorrhage are rare. Intracranial pressure was monitored prospectively in 30 patients who had stereotaxic surgery for spontaneous intracerebral hemorrhage. The results are as follows. 1. Intracranial pressure was increased in high PaCO₂. 2. There were no correlation in ICP, rebleeding and ADL ad discharge (P>0.05). 3. ICP was the most high level in 72 hours after operation. 4. There was 63.2% decrease in ICP after irrigation with 6000 IU urokinase in the site of hemorrhage. 5. There was no correlation between the numbers of natural drainage and ADL at discharge (P>0.05). 6. The higher the initial GCS, the higher the postoperative GCS.

Spontaneous Intracranial Hemorrhage Caused by Brain Tumor

919 consecutive brain tumor cases and 665 consecutive spontaneous intracranial hemorrhage cases were reviewed for the analysis of cases in which spontaneous intracranial hemorrhage caused by brain tumor was confirmed with gross operative findings. Authors analyzed their incidence, patients' demography, tumor histology, clinical symptoms and signs, predisposing factor, tumor vascularity, type of hemorrhage, relations between the clinical symptoms and signs and the type of hemorrhage, relations between the location of tumor and the type of hemorrhage and the outcome of treatment. The conclusions are as follow; 1) The proportion of the hemorrhage caused by brain tumor to the total spontaneous intracranial hemorrhage was 5.1%(34/665). 2) The proportion of the spontaneous intracranial hemorrhage caused by brain tumor to the total brain tumor was 3.7%(34/919) and the proportion of that excluding pituitary adenoma was 2.5%(18/729). 3) Compared with the other brain tumors, oligodendroglioma and pituitary adenoma had significant tendency of hemorrhage(p<0.05, p<0.01, respectively) and meningioma had a significantly low incidence of hemorrhage(p<0.05). 4) The hemorrhage brought about major symptoms in 13 cases(72%), minor symptoms in 2 cases(11%). These cases showed no symptoms related to the hemorrhage. 5) Among the 18 cases of spontaneous intracranial hemorrhage caused by brain tumor, one case with the major attack died of postoperative pneumonia. There were additional 2 motalities which were not related to the preoperative hemorrhage. And most of the symptoms associated with the preoperative hemorrhage stabilized or improved with operative treatment.