Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 191
Filtrar
1.
Artigo em Inglês | WPRIM | ID: wpr-195130

RESUMO

To better understand the anatomic location of scalp nerves involved in various neurosurgical procedures, including awake surgery and neuropathic pain control, a total of 30 anterolateral scalp cutaneous nerves were examined in Korean adult cadavers. The dissection was performed from the distal to the proximal aspects of the nerve. Considering the external bony landmarks, each reference point was defined for all measurements. The supraorbital nerve arose from the supraorbital notch or supraorbital foramen 29 mm lateral to the midline (range, 25-33 mm) and 5 mm below the supraorbital upper margin (range, 4-6 mm). The supratrochlear nerve exited from the orbital rim 16 mm lateral to the midline (range, 12-21 mm) and 7 mm below the supraorbital upper margin (range, 6-9 mm). The zygomaticotemporal nerve pierced the deep temporalis fascia 10 mm posterior to the frontozygomatic suture (range, 7-13 mm) and 22 mm above the upper margin of the zygomatic arch (range, 15-27 mm). In addition, three types of zygomaticotemporal nerve branches were found. Considering the superficial temporal artery, the auriculotemporal nerve was mostly located superficial or posterior to the artery (80%). There were no significant differences between the right and left sides or based on gender (P>0.05). These data can be applied to many neurosurgical diagnostic or therapeutic procedures related to anterolateral scalp cutaneous nerve.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cadáver , Osso Frontal/anatomia & histologia , Procedimentos Neurocirúrgicos , Órbita/anatomia & histologia , Nervos Periféricos/anatomia & histologia , Couro Cabeludo/inervação , Zigoma/anatomia & histologia
2.
Artigo em Inglês | WPRIM | ID: wpr-147503

RESUMO

OBJECTIVE: Most cases of spontaneous subarachnoid haemorrhage (SAH) are due to a ruptured cerebral aneurysm, yet sometimes the cause of bleeding can be obscure. We report here on the results of a retrospective single-center study to determine the role of the hemorrhage patterns for the patients with a negative angiogram on admission. METHODS : A total of 480 patients with spontaneous subarachnoid hemorrhage (SAH) were admitted from January 2004 to September 2008. Of these, 44 patients were included in this study because of their negative findings on their initial angiography. SAH was diagnosed by a computed tomographic scan or lumbar puncture. The clinical grade was assessed using the Hunt-Hess grading system, Fisher's grading system and the modified Rankin scale. RESULT : The overall incidence of an initially negative angiogram for patients with a spontaneous SAH was 10.2%. Based on the hemorrhage pattern on the admission CT, the most common pattern was the diffuse type (52.3%), followed by the perimesencephalic type (29.5%), the CT negative type (11.4%) and the localized non-perimesencephalic type (6.8%). The repeat angiogram revealed an aneurysm in 3 (7.7%) patients and exploration revealed a dissecting aneruysm of the vertebral artery in 1 patient. The patients with the diffuse type SAH significantly differed from the perimesencephalic group with regard to the Fisher grade (p = 0.002), the outcome at discharge (p = 0.004) and the need for EVD. CONCLUSION : Patients with SAH of an unknown cause, especially with perimesencephalic SAH, have an excellent prognosis and low mortality. We believe that digital subtraction angiogram is still the gold standard for making the diagnosis of aneurysm in patients with spontaneous SAH. A repeat angiogram is recommended for all the patients with initially angionegative SAH. For those patients with perimesencephalic SAH and a positive CSF study with a negative CT, we suggest to perform a CT angiogram as a less invasive follow-up study.


Assuntos
Humanos , Aneurisma , Angiografia , Seguimentos , Hemorragia , Incidência , Aneurisma Intracraniano , Prognóstico , Estudos Retrospectivos , Punção Espinal , Hemorragia Subaracnóidea , Artéria Vertebral
3.
Artigo em Inglês | WPRIM | ID: wpr-78441

RESUMO

Early delayed radiation effects are known to occur within several months after completing radiotherapy for brain tumors. We present marked changes of magnetic resonance imaging (MRI) scan that occurred one month after radiotherapy in a patient with a pleomorphic xanthoastrocytoma, which was eventually diagnosed as an early delayed radiation effect. Such an early development of dramatic MRI change has not been reported in patients treated with radiotherapy for pleomorphic xanthoastrocytomas.


Assuntos
Humanos , Barreira Hematoencefálica , Neoplasias Encefálicas , Imageamento por Ressonância Magnética
4.
Artigo em Inglês | WPRIM | ID: wpr-94525

RESUMO

OBJECTIVE: The aim of this study is to determine which patients with progressively deteriorating acute cerebellar infarction would benefit from surgical treatment and which surgical procedure would best benefit them. METHODS: Seventy six patients were treated at our hospital for cerebellar infarction over the past 3 years. Sixty nine patients received conservative management in the neurological department of our hospital. Among them, 7 patients (5 males and 2 females; average age, 49 yrs) were referred to neurosurgical department because of mental deterioration and underwent emergency surgery. Five patients underwent external ventricular drainage with suboccipital craniectomy and two patients underwent suboccipital craniectomy alone. RESULTS: Of the 7 surgically treated patients, 4 patients experienced good recovery and 2 patients experienced moderate disability (disabled but independent) and 1 patient experienced severe disability (conscious but disabled). There was no death. CONCLUSION: In patients conservatively treated for cerebellar infarction and showing mental deterioration and radiologically evident brainstem compression and ventricular enlargement, we strongly recommend suboccipital craniectomy (plus optional external ventricular drainage in case of showing hydrocephalus) as a first treatment option.


Assuntos
Feminino , Humanos , Masculino , Tronco Encefálico , Drenagem , Emergências , Infarto
5.
Artigo em Coreano | WPRIM | ID: wpr-32640

RESUMO

OBJECTIVE: We investigated the morphologic changes within 24 hours after a single gamma-irradiation in the rat brain. METHODS: Forty Sprague-Dawley rats were used. After a burr hole trephination on right parietal area, cerebral hemisphere was irradiated with 2Gy and 5Gy using iridium-192(192Ir), respectively. The effect was assessed at 4, 8, 12 and 24 hours after irradiation. The histological changes were scored following the detection of edema or disarray severity. TUNEL-positive cells exhibiting apoptotic morphology were counted in irradiated region. RESULTS: Cortical edema and disarray were initially showed at 4 or 8hour and almost all defined at 24hour after irradiation. And the injury was wedge shape. TUNEL-positive cells were minimal at 8hour after irradiation as the number of positive cells were 2.6+/-5.27(n=5) after 2Gy, and 0.8+/-0.84(n=5) after 5Gy. But, the number of apoptotic cells were increased markedly to 60+/-6.24 at 12hour after 2Gy and to 104+/-19.7 at 24hour after 5Gy. CONCLUSION: There were prominent morphologic changes immediately after gamma-irradiation. And, apoptosis was increased according to the time period. These findings implicate that brain irradiation induces rapid apoptotic change, which may play an important role in the pathogenesis of radiation-induced pathologic conditions.


Assuntos
Animais , Ratos , Apoptose , Encéfalo , Córtex Cerebral , Cérebro , Irradiação Craniana , Edema , Rabeprazol , Efeitos da Radiação , Lesões por Radiação , Ratos Sprague-Dawley , Trepanação
6.
Artigo em Inglês | WPRIM | ID: wpr-25004

RESUMO

OBJECTIVE: This paper describes our experience and implant technique for cranioplasty of a large cranial defects using a porous polyethylene implant(Medpor) and compares the results with polymethylmethacrylate(PMMA). METHODS: Sixteen cranioplasties were performed using Medpor(n=10) and PMMA(n=6) implants between June 2003 and January 2005. The criterion for patient enrollment was a defect larger than 10cm in diameter. This study compared the operation times and complications. RESULTS: The operation times ranged from 105 to 250minutes(Mean 180 degrees +/-44minutes) in Medpor and from 185 to 460minutes (mean 128minutes) in PMMA. The absolute operation times were shorter using the Medpor implant and the differences were statistically significant(P=0.030). Satisfactory cosmetic results were obtained in all cases using the Medpor implant and with no implant-related complications. Bone ingrowth to the medpor implant was presumed to be the result on an increase in Houndsfield units of the implant, particularly at the marginal areas in the serial follow-up brain computed tomography images. CONCLUSION: It is believed that the properties of a Medpor implant make this implant an good alternative to the existing methods of a cranial contour correction. However, a further follow-up study will be needed.


Assuntos
Humanos , Encéfalo , Seguimentos , Polietileno , Polimetil Metacrilato
7.
Artigo em Inglês | WPRIM | ID: wpr-175769

RESUMO

The expression of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF)2 in the irradiated brain was examined to test how a single high dose radiation, similar to that used for intraoperative radiation therapy given to the normal cerebrum, can affect the vascular endothelium. After a burr hole trephination in the rat skull, the cerebral hemisphere was exposed to a single 10 Gy dose of gamma rays, and the radiation effect was assessed at 1, 2, 4, 6, and 8 weeks after irradiation. His-tological changes, such as reactive gliosis, inflammation, vascular proliferation and necrosis, were correlated with the duration after irradiation. Significant VEGF and FGF2 expression in the 2- and 8-week were detected by enzyme-linked immunosorbent assay quantification in the radiation group. Immunohistochemical study for VEGF was done and the number of positive cells gradually increased over time, compared with the sham operation group. In conclusion, the radiation injuries consisted of radiation necrosis associated with the expression of VEGF and FGF2. These findings indicate that VEGF and FGF2 may play a role in the radiation injuries after intraoperative single high-dose irradiation.


Assuntos
Animais , Ratos , Encéfalo/metabolismo , Lesões Encefálicas/etiologia , Fator 2 de Crescimento de Fibroblastos/metabolismo , Necrose , Lesões por Radiação/patologia , Radiocirurgia/efeitos adversos , Ratos Sprague-Dawley , Regulação para Cima/efeitos da radiação , Fator A de Crescimento do Endotélio Vascular/metabolismo
8.
Artigo em Coreano | WPRIM | ID: wpr-87696

RESUMO

OBJECTIVE: The authors investigate the effectiveness and the demerits of the AMSLU(TM) cervical cage used in cervical spinal fusion for correction of cervical degenerative disc disease. METHODS: A total of 19 patients with cervical degenerative disc disease underwent anterior microdiscectomy and the AMSLU(TM) cage fusion. We made a retrospective comparative analysis between cases using the AMSLU(TM) cage and the classical autogenous iliac crest graft(AICG) with plate fixation about operative time, blood loss and hospital stay. The patient's neurological and functional outcomes were assessed on the basis of the modified Odom's criteria. RESULTS: The use of the AMSLU(TM) cage was found to save operative time(mean, 153+/-52min: P=0.004) and blood loss(mean, 236+/-171cc: P=0.032) as compared with the use of AICG. There was no donor-site complications and all patients were tolerable to ambulation at 1 day postoperatively. The patient's clinical success rate was 89% on discharge and 84% at 6 months postoperatively. CONCLUSION: The use of the AMSLU(TM) cage provides several advantages: no donor-site complications, brief instrument procedures, short operative time, small amount of blood loss and satisfactory clinical success rate. But it also has many limitations: short follow up period, kyphotic change and subsidence. Further investigations and clinical applications are necessary to use AMSLU(TM) cage in cases of spondylolisthesis and traumatic cervical disease.


Assuntos
Humanos , Seguimentos , Tempo de Internação , Duração da Cirurgia , Estudos Retrospectivos , Fusão Vertebral , Espondilolistese , Caminhada
9.
Artigo em Inglês | WPRIM | ID: wpr-16181

RESUMO

Posterior leukoencephalopathy syndrome(PLES) is a rare neurological complication which is associated with malignant hypertension, pre-eclampsia, and some drugs including immunosuppressive agents. A 9-year-old boy who had cerebellar medulloblastoma showed seizure on the seventeenth day after intravenous chemotherapy including ACNU and vincristine. Radiologic findings were consistent with those of PLES due to vasospasm. After hypertensive therapy, the symptoms were improved. We present a case of PLES with medulloblastoma which developed following chemotherapy with the regimen of medulloblastoma in a child.


Assuntos
Criança , Humanos , Masculino , Tratamento Farmacológico , Hipertensão Maligna , Imunossupressores , Leucoencefalopatias , Meduloblastoma , Nimustina , Síndrome da Leucoencefalopatia Posterior , Pré-Eclâmpsia , Convulsões , Vincristina
10.
Artigo em Inglês | WPRIM | ID: wpr-227604

RESUMO

Idiopathic granulomatous hypophysitis is a chronic inflammation of the pituitary gland. It has a rare occurrence and is diagnosed only on pathologic examination. We report a case of a 60-year-old patient presenting with headache, vomiting and isolated hyponatremia. MRI study showed a space occupying lesion of the pituitary gland with a marked enhancement after gadolinium injection. Pituitary biopsy was consistent with the diagnosis of idiopathic granulomatous hypophysitis. The aim of this case report is to discuss the variable clinical and radiological aspect of the disease.


Assuntos
Humanos , Pessoa de Meia-Idade , Biópsia , Diagnóstico , Gadolínio , Cefaleia , Hiponatremia , Inflamação , Imageamento por Ressonância Magnética , Hipófise , Vômito
11.
Artigo em Coreano | WPRIM | ID: wpr-207744

RESUMO

OBJECTIVE: Vascular endothelial growth factor(VEGF), which is also known as vascular permeability factor, induces angiogenesis and may play a key role in tumor-related neovascularization and peritumoral edema. There are many pathological conditions associated with VEGF expression, such as brain tumor, infection and trauma. Malignant brain tumor is characterized by its prominent neovascularization and severe peritumoral edema and it is known to express high VEGF activity. The aim of this study is to investigate any differences in cerebrospinal fluid(CSF) VEGF level among gliomas, and between tumors and non-tumorous conditions. METHODS: Cerebrospinal fluid samples were collected from 28 patients whose diagnosis had been surgically proven and they were centrifuged and stored at -73 degrees C. The concentration of VEGF was analyzed using commercially available ELISA kit. RESULTS: Glioblastoma patients showed much higher level of CSF VEGF than those of other gliomas and non-tumorous conditions. And higher CSF VEGF level was found in invasive pituitary adenoma, recurrent oligoden-droglioma, central neurocytoma and diffuse axonal injury. CONCLUSION: Absolute CSF VEGF level can be useful biological marker for primary malignant glioma, especially glioblastoma, and serial check-ups may contribute to early diagnosis of malignant transformation of low grade astrocytoma.


Assuntos
Humanos , Astrocitoma , Biomarcadores , Neoplasias Encefálicas , Encéfalo , Líquido Cefalorraquidiano , Diagnóstico , Lesão Axonal Difusa , Diagnóstico Precoce , Edema , Ensaio de Imunoadsorção Enzimática , Glioblastoma , Glioma , Neurocitoma , Neoplasias Hipofisárias , Fator A de Crescimento do Endotélio Vascular
12.
Artigo em Coreano | WPRIM | ID: wpr-9876

RESUMO

We report a case of multiple cerebral infarcts, which developed after intra-arterial(IA) carboplatin therapy in a patient with glioblastoma who had received surgery with conventional and intraoperative radiation therapy (IORT). A 31-year-old male patient presented with one-month history of worsening headaches and visual dimness. Seven years previously, he had been subjected to a subtotal resection of anaplastic astrocytoma in the right occipital lobe, followed by external radiation therapy with a total dose of 5580cGy. Carboplatin was given at an initial dose of 300mg/m2. Before and after the infusion of carboplatin, solumedrol(500mg/day) was given for seven days, with the dosage being gradually reduced over the next five days. In addition, 20% mannitol(100ml) was infused over a 15-minute period before chemotherapy, and the fluid volume of electrolyte was adjusted to maintain an optimal urine output. The patient underwent five cycles of IA carboplatin therapy. Careful attention should be given during IA carboplatin chemotherapy to patients who are also being treated with IORT.


Assuntos
Adulto , Humanos , Masculino , Astrocitoma , Carboplatina , Tratamento Farmacológico , Glioblastoma , Cefaleia , Lobo Occipital
13.
Artigo em Inglês | WPRIM | ID: wpr-194566

RESUMO

We report a case of de novo development of cavernous malformation after cranial irradiation. The patient was a 19-year-old male who had been operated on 10 years ago for cerebellar pilocytic astrocytoma. After subtotal tumor removal, he had received cranial irradiation for the residual tumor. He was readmitted for extraocular muscle palsy, dysarthria and facial weakness about 10 years after operation and irradiation. Magnetic resonance imaging of the brain showed an abnormal mixed signal lesion in the lower pons and pontomedullary junction. The patient underwent surgical removal of the hematoma in the pons and the cavernous malformation was identified.


Assuntos
Humanos , Masculino , Adulto Jovem , Astrocitoma , Encéfalo , Irradiação Craniana , Disartria , Hematoma , Imageamento por Ressonância Magnética , Neoplasia Residual , Paralisia , Ponte
14.
Artigo em Inglês | WPRIM | ID: wpr-197881

RESUMO

Total excision is a treatment of choice in preventing the relapse of craniopharyn-gioma, but for tumors involving an extensive area, it is often associated with an increased risk of complications. We have performed a partial or subtotal tumor removal followed by repeated injection of bleomycin into the remaining tumor through a subcutaneous reservoir as postoperative adjuvant therapy. A retro-spective review of clinical, radiological, and surgical data was performed for 10 patients (5 males and 5 females; age, 3-65 yr; follow-up duration, 12-79 months) with cystic craniopharyngiomas. The measurements of lactate dehydrogenase (LDH) level at each aspiration were performed. The shrinkage and/or stabiliza-tion of tumor was initially noted in all cases. The recurrence of tumor was seen in 4 cases (40%). The decreased or increased level of LDH was interpreted as tumor shrinkage or recurrence, respectively. The transient toxic reactions were observed in 3 patients (30%). Our study demonstrates that postoperative bleo-mycin injection for cystic craniopharyngioma, although does not appear to eradi-cate the tumor, decreases and stabilizes the tumor size, when used as an adju-vant therapy in young patients.


Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibióticos Antineoplásicos/administração & dosagem , Bleomicina/administração & dosagem , Encéfalo/efeitos da radiação , Craniofaringioma/tratamento farmacológico , Seguimentos , Injeções , L-Lactato Desidrogenase/metabolismo , Neoplasias Hipofisárias/tratamento farmacológico , Cuidados Pós-Operatórios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
15.
Artigo em Coreano | WPRIM | ID: wpr-93607

RESUMO

OBJECTIVE: The purpose of this study is to review retrospectively 28 patients with re-operation due to complications related to instrumentation from thoracic and lumbar spinal fusion surgery. METHODS: A total of 285 patients underwent spinal fusion surgery with instrumentation between 1996 and 2000. Of these, 11 men and 17 women(mean age 46 years, range 21 to 69 years) presented with complications related to instrumentation. Previous surgery was preformed for vertebral column instability secondary to fracture(4), spondylolisthesis(12), failed back surgery syndrome(7), osteomyelitis(1), herniated nuclus pulposus(4). All patients underwent repeated spinal surgery including removal of instrument, new instrument fixation, or I & D. The mean follow-up period after second operation was 19 months. RESULTS: The complications related instrumentation system include six interbody fusion system retropulsion, eight screw loosenings, five screw fractures, three screw malpositions, three osteomyelitis, and one donor site infection. After repeated surgery, eight became asymptomatic and did not require further treatment, but eleven showed persistent low back pain without neurological deficits and the remaining nine continued to have nerve root deficits. CONCLUSION: In conclusion, spinal fusion surgery with instrumentation offers an immediate postoperative stability of the thoracic and lumbar spine and enhances early fusion. However, it may be associated with few, but significant, complications which may permanantly. The proper selection of patients and meticulous surgical technique for surgery are probably the most important factors associated good outcomes and prevention of complications.


Assuntos
Humanos , Masculino , Seguimentos , Dor Lombar , Osteomielite , Estudos Retrospectivos , Fusão Vertebral , Coluna Vertebral , Espondilolistese , Doadores de Tecidos
16.
Artigo em Coreano | WPRIM | ID: wpr-104123

RESUMO

Cystic retrochiasmatic craniopharyngioma may reach enormous size by expanding into the posterior fossa along the retroclival area, which is very unusual finding. An 11-year-old girl presented with walking disturbance and irritability. On the neurological examination, she had positive Babinski sign, hyperactive deep tendon reflex, and left lateral gaze nystagmus. She also had right hearing disturbance. Initial magnetic resonance(MR) images revealed a huge, thin capsuled cystic mass which extended into the cerebellopontine angle down to the medulla oblongata. Secondary adjuvant chemotherapy, radiotherapy, and reoperation were necessary after first tumor removal by a suboccipital approach, due to the progression of disease. Finally, neurological condition was much improved without remnant tumor although some sequelae were remained. We report this interesting case because of its rarity, complex clinical presentation, and challenge in its management.


Assuntos
Criança , Feminino , Humanos , Ângulo Cerebelopontino , Quimioterapia Adjuvante , Craniofaringioma , Audição , Bulbo , Exame Neurológico , Radioterapia , Reflexo de Babinski , Reflexo de Estiramento , Reoperação , Caminhada
17.
Artigo em Coreano | WPRIM | ID: wpr-80449

RESUMO

We describe a case of primary malignant melanoma in the fourth ventricle treated with surgery and fractionated high dose radiotherapy. A 27-year-old man was referred to our institution due to drowsy mentality, dysconjugated gaze, and pupil dilatation following vertigo and posterior neck pain. Preoperative magnetic resonance images revealed a fourth ventricular tumor extending to C2 level. The mass was high-signal intensity on T1-weighted image, low- on T2-weighted and homogeneous strong enhancement. Extraneural focus of primary site was not found. After grossly total removal in two staged operations, fractionated high dose radiotherapy was given(6300 cGy, 180cGy X 35 fraction). No tumor recurrence was seen for 12 months after operation. Aggressive treatment involving operative total tumor removal and combined radiotherapy is considered to increase the life span of the patient even with this type of tumor.


Assuntos
Adulto , Humanos , Dilatação , Quarto Ventrículo , Melanoma , Cervicalgia , Pupila , Radioterapia , Recidiva , Vertigem
18.
Artigo em Coreano | WPRIM | ID: wpr-208544

RESUMO

OBJECTIVES: The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. MATERIALS AND METHODS: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M:F=8:8, mean age:43.7 years) and 7 children(M:F=5:2, mean age:10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. RESULTS: The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.


Assuntos
Adulto , Criança , Humanos , Craniofaringioma , Lobo Frontal , Hidrocefalia , Pressão Intracraniana , Estudos Retrospectivos , Tálamo
19.
Artigo em Coreano | WPRIM | ID: wpr-179364

RESUMO

Residual aneurysm is a challenging problem after clipping procedure for the aneurysms. The anthors describe one patient in whom endovascular treatment was sucessfully done to treat residual aneurysm after surgical clipping. We discussed the role of endovascular coil occlusion in case of incomplete surgical obliteration of aneurysms.


Assuntos
Humanos , Aneurisma , Aneurisma Intracraniano , Instrumentos Cirúrgicos
20.
Artigo em Coreano | WPRIM | ID: wpr-145251

RESUMO

OBJECTIVE: Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. METHOD: Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. RESULT: Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. CONCLUSION: It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.


Assuntos
Humanos , Aneurisma , Aneurisma Roto , Adesivo Tecidual de Fibrina , Seguimentos , Hemorragia , Aneurisma Intracraniano , Pescoço , Instrumentos Cirúrgicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA