Analysis of Outcome in Relation to the Timing of Surgery in Aneurysmal Subarachnoid Hemorrhagic Patients

The purpose of this study was to investigate whether early surgery benefits in the treatment of the patients with ruptured aneurysm by comparing the outcome in relation to the timing of surgery. The autho rs analyzed 81 patients with ruptured aneurysm who underwent operation during one year from January 1996 through December 1996. Among these, sixty patients(74%) underwent operation within 72 hours after first bleeding, and 21 patients (26%) after 72 hours following first bleeding. Thirtysix patients(82%) recovered without se rious neurological deficits in 44 patients with initial Hunt and Hess g rade I to III who were operated upon in early period, and four out of 16 patients with initial Hunt and Hess grade IV to V. Sixteen patients (84%) recovered without serious neurological deficits in 19 patients with initial Hunt and Hess grade I to III who received late operation but none in 2 patients in Hunt and Hess grade IV to V. Seven out of 60 (12%) patients died after early operation, one of 21(5%) patient died after late operation. The causes of morbidity were vasospasm (19 cases), rebleeding (5 cases), hydrocephalus (1 case) in early operation and vasospasm (2 cases), hydrocephalus (1 case) in late operation. It is concluded that early operation is mandatory even in the patients with poor clinical status prior to surgery since early aneurysmal surgery can minimize the chance of rebleeding, permit more aggressive treatment against vaso-spasm and improve the clinical outcome.

Case of Tuberculosis of the Skull, Presenting as Osteolytic Lesion: Case Report

Tuberculosis of the skull bone tuberculosis is a very rare disease. We report a case occurring in a 52 year-old male was referred to us because of headache and painful swelling in the right frontal area. Plain chest x-ray revealed fibrous, streaky, nodular, patchy opacities in the LUL together with pleural effusion. Plain skull x-ray and CT scan demonstrated osteolytic lesion in the right frontal bone; scanning showed hot uptake by the right frontal area, and this corresponding to skll findings revealed by plain film. After frontal craniotomy the involved bone flap and epidural abscess were removed. Pafthologically, typical granulomatous inflammation was seens; this was composed of caseation necrosis, epithelioid cells and surrounding lymphocytes and plasma cells.