Patient Selection for Early Surgery in Ruptured Intracranial Aneurysm : Based on 10-year Experience with 1026 Patients

The purpose of this study was to set the guidelines for selection of patients to do early surgery in ruptured intracranial aneurysm. We assessed 706 patients with single rupture and without large hematoma, who underwent aneurysm surgery from 1985 to 1995. The male and female ratio was 1:1.5. Among the 706 patients, early surgery was performed in 214 cases. The results of early surgery were good in 193 cases(90.2%), fair in 13 cases(6.0%), poor in 1 case(0.5%) and dead in 7 cases(3.3%). The rate of dead outcome in the early surgery group was higher compared to other timing groups. The Fisher group 1, 2 and 3 reveale good outcome in early surgery group;92.6%, 96.3%, 88.8% respectively. The incidence of delayed ischemic deficits(DID) of early surgery group was same as other groups. However, in Fisher group 3, the incidence of DID was significantly low, 32.5%, in early surgery group. It is suggested that the criteria of selection of early surgery in patients with ruptured intracranial aneurysm would include as follows:1) patients with good clinical grade, 2) poor grade patients with marked irritability, acute hydrocephalus, and poorly controlled hypertension, 3) none-complex aneurysm requiring less brain retraction, dissection and brief temporary clipping, 4) age under 60 or over 60 with good physical status, and 5) Fisher group 3 requiring cisternal larvage and anticipated triple-H therapy.

Pseudolymphoma of the Cavernous Sinus: Case Report

A Case of pseudolymphoma involving the cavernous sinus in a 38-year-old male patient is reported. The patient was admitted because of intermittent diplopia and left side facial sensory change. The tumor was well demarcated, homogeneously enhancing mass in the left side cavernous sinus on MRI. The histopathological findings showed diffuse and dense infiltration of lymphocytes in connective tissue stroma without forming lymphoid follicle or germinal center and the infiltrating lymphocytes were well differentiated and matured. We report a rare case of pseudolymphoma arising in the cavernous sinus, which revealed polyclonal differentiation of lymphocytes confirmed the diagnosis of pseudolymphoma.