Stereotactic Aspiration of HICH by CT-Guided U-Loop and Leksell System

We reviewed 178 patients with hypertensive intracerebral hematoma(HICH), which were treated with computed tomography(CT) guided stereotactic aspiration from Aug. 1986 to Dec. 1993(166 CT guided U-loop and 12 Leksell system). Our series consisted of 82 males and 96 females. The hemorrhages were located in putamen in 67.4%, thalamus in 20.2%, subcortex in 9% and cerebellum in 3.4%. Mean removal rate of hematoma was 55.3%. The results for the 178 cases who underwent stereotactic aspiration were good recovery in 45.5%, moderate disability in 28.0%, severe disability in 9.0% and vegetative state in 4.0%. The infection rate and rebleeding rate of all cases were 1.7% and 6.8% respectively. The mortality rate of all cases was 13.5%. We analysed the factors affecting the prognosis in 178 patients. Factors affecting good prognosis were high initial GCS, less amount of initial hematoma and no presence of intraventricular hemorrhage. Stereotactic aspiration by CT-guided U-loop and Leksell system is simple, safe and can minimize the brain damage. This method can e performed under local anesthesia.

Subdural Empyema Concomitant with Bilateral Subdural Effusion in Infant after Meningitis

Subdural empyema is a fulminating, purulent, bacterial infection located between the dura and arachnoidal membrane. Early diagnosis, adequate antibiotic therapy and surgical treatment played important roles in the successful management of subdural empyema. Subdural empyema can develop secondary to sinusitis, otitis media, meningitis, trauma or craniotomy. Subdural empyema in infants commonly develops secondary to infected subdural effusion associated with purulent meningitis. The incidence of this complication of meningitis in infants is approximately 2%. We report a case of subdural empyema concomitant with bilateral subdural effusion, which was successfully treated with surgical intervention and antibiotic therapy.