A Comparative Analysis of Stereotactic Evacuation & Conservative Treatment in Hypertensive Putaminal Hemorrhage

We have analysed 144 patients with hypertensive putaminal hemorrhage, admitting from January 1992 to December 1993. Surgical treated group with Komai's stereotactic system was 71 patients and medical treated group was 73 patients. The results were as follows: 1) The patients with ventricular rupture were 36 cases(25%). According to the degree of ventricular rupture, the mortality was increased and the good outcome was decreased(P40ml), the outcome in both treated group was similar. 4) According to CT classification, in class II(extending to anterior limb of internal capsule), good outcome of surgical group was better than that of non-surgical group. In class V(extending th thalamus or subthalamus), the mortality in surgical group was lower than that of non-surgical group(P<0.05) .

Streotactic Evacuation and Urokinase Irrigation in the Management of Spontaneous Intracerebral Hemorrhage

The best treatment modality of spontaneous intracerebral hematoma is still controversial. But stereotactic surgery can minimize the brain damage and be performed under local anesthesia. Recently we experienced 46 cases of spontaneous intracerebral hematoma which were operated using ZD(Zamorano-Dujovny) stereotactic system and urokinase irrigation from November 1990 to April 1993. Before operation, computerized tomographic scanning was done to locate the hematoma, assess the amount, and to determine the stereotactic coordinates. The silastic tube was inserted after stereotactic evacuation of hematoma and urokinase irrigation was repeated every 6 to 8 hours until the hematoma was cleared up. The results were analysed and we concluded that we can substitute open craniectomy or conservative treatment for stereotactic evacuation of spontaneous intracerebral hematoma combined with urokinase irrigation in certain instances and can minimize the brain damage regardless the patient's general condition or past history.

Stereotactic Removal of the Third Ventricle Colloid Cyst

Colloid cyst of the third ventricle is rare intracranial lesion. It has been estimated that they comprise approximately 0.55% of all tumors of the brain. A new interest has been developed in this lesion, which is completely benign histologically but, because of its deep and strategic location, poses a difficult therapetic problem. The contrast between the histological benignancy and the risk of morbidity and mortality associated with often surgical exploration and removal has led to alternative procedures. We reported here a 33-year-old male patient with colloid cyst of the third ventricle presenting with headache and vomiting. Who was treated by stereotacic removal utilizing CRW stereotactic system and followed up post-operatively for more than 3 years.

Stereotactic Surgery Using Pelorus System

Thirty-four patients with various intracranial lesions underwent the stereotatic surgery using the Pelorus system, which consists of integrated skull set, phantom and Arc adaptor, between September, 1987 and October, 1988.10 of 12 biopsies(83%) were diagnosed as 4 metastatic tumors, 3 glioblastoma multiforme, 1 cerebral infarction and 1 calcification. Fifteen patients with the spontaneous intracerebral hematoma and 2 with the abscess were treated successfully. Two patients with the malignant tumors underwent the stereotatic isotope implantation with I125. Only one case of transient hemiparesis among 34 procedures developed. From the results, the use of a simple interlocking plate system, rather than a bulky frame produce benifits evident during application with capabilities and accuracy of most other stereotactic system. It has offered the advantages of stereotaxis to a currently possible wide range of patients, which it can be used to diagnose and treat.