The Clinical Analysis of Bleeding Pattern in Patients with Ruptured Middle Cerebral Artery Aneurysm

OBJECTIVES: The rupture of middle cerebral artery(MCA) aneurysm usually cause or is associated with higher incidence of intracerebral hemorrhages(ICH) than any other aneurysmal ruptures. Also, the outcome of patients who had ICH is known to be worse than patients who had subarachnoid hemorrhage(SAH) only. The authors report the bleeding pattern and outcome of ruptured MCA aneurysm patients. PATIENTS AND METHODS: A total 106 ruptured MCA aneurysm patients who were surgically treated were included and they were divided into 2 groups by the initial brain CT findings according to the presence or absence of ICH over 10cc in amount. The clinical data were analysed retrospectively. RESULTS: The overall mortality was 18.9%. Among 81 patients(76.4%) who had subarachnoid hemorrhage(SAH) only, 68 patients(84%) showed favorable outcome. Twenty five patients(23.6%) had ICH over 10cc in amount with or without SAH, and among them, 11 patients(44%) showed favorable outcome. The ICH was located in temporal lobe(15 patients, 60%), frontal lobe(3, 12%), sylvian fissure(6, 24%) and frontal-temporal lobe(1, 4%). Among 15 patients who had ICH in temporal lobe, only 4 patients(26.6%) showed favorable outcome and all 3 patients who had ICH in frontal lobe showed favorable outcome. CONCLUSION: ICH was presented in 23.6% of ruptured MCA aneurysm patients and the prognosis of patients with ICH was worse than patients with SAH only. The ICH was located mainly in the temporal lobe and sylvian fissure.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.