Clinical Study of Surgically Treated Cerebral Aneurysms

The author reviewed 294 cases of surgically treated cerebral aneurysms during the period from January, 1987 to December, 1992. The results were as follow: The sex ratio between male and female was 1:1.53 and the mean age was 51.3 years. 2) At admission, 220 patients were in relatively good neurologic condition and functional recovery was obtained in 229 patients(78%). 3) The most common site was anterior communicating artery and the number of posterior circulation aneurysms was 12(4%). 4) The incidence of multiple aneurysms was 4% and clinical vasospasm was observed in 19% of the patients. 5) Operative mortality was 8.8% and the prognostic factors were related with age, sex, history of hypertension, amount of SAH, size and site of aneurysm, preoperative neurologic state, clinical vasospasm, and timing of operation.

Expression of p53 Protein and PCNA in Brain Tumors

Formalin-fixed, paraffin-embedded samples of 32 brain tumors(8 meningiomas, 10 astrocytomas(low grade 5, anaplastic 5), 8 glioblastoma multiforme, 6 oligodendrogliomas(low grade 2, anaplastic 3) were investigated by immunocytochemistry with monoclonal antibodies against p53 protein and proliferating cell nuclear antigen(PCNA). Expression of p53 protein was detected in 1 of 5 cases(20%) of low grade astrocytomas, 2 of 5 cases(40%) of anaplastic astrocytoma, 4 of 8 cases(50%) of glioblastoma multiforme and 4 of 4 cases(100%) of malignant oligodendroglioma. All low grade oligodendrogliomas, meningiomas fail to express p53. Expression of PCNA was detected in 3 of 8 cases of meningioma with very low labeling index(0-0.3), 2 of 5 cases of low grade astrocytoma with low labeling index(0-11.3), 3 of 5 cases of anaplastic astrocytoma with middle labeling index(0-28.2), 6 of 8 cases of glioblastoma multiforme and 4 of 4 cases of malignant oligodendroglioma with high labelling index(0-92.3, 7.6-48.1). Expression of PCNA was not detected in low grade oligodendrogliomas. Tumor group with high expression of p53 protein showed increment of PCNA expression. A strong positive correlation between tumor grade and extent of p53 protein and PCNA expression was found(p<0.002) .

Clinical Study According to the Modality of Treatment of Cerebral Arteriovenous Malformations

A series of 44 patients with cerebral arteriovenous malformations(AVM's) treated by various modalities from January, 1987, to March, 1994, at Chung-Ang University Hospital were reviewed with emphasis on the outcome. Of these patients, 8 received conservative treatment, 16 only surgery, 4 combined embolization and surgery, and 16 embolization alone. The follow-up period ranged from 7 months to 54 months with a mean of 20.6 months. The efficacy of the combined treatment was evaluated by the complications and the clinical outcome. When compared with surgery alone, preoperative embolization facilitated surgery by reducing intraoperative bleeding and shortening the time of surgery. Clinical outcome was better after preoperative embolization, with no occurrence of major complications and mortality. Five AVM's were totally occluded by embolization alone, but of the 5 cases, 1 case was readmitted due to bleeding 2 years after the embolization. It is concluded that combined treatment with preoperative embolization and surgery was helpful in the management of large, high grade AVM's by reducing the complications associated with their surgical removal.

Hypertensive Putaminal Hemorrhage: Surgical Versus Conservative Treatment

151 patients, with hypertensive putaminal hemorrhage, which confirmed by brain CT, were analyzed on the basis of Glasgow coma scale and Glasgow outcome scale. The results of the treatment of hypertensive putaminal hemorrhage and the assessment of the prognostic factors were as follows ; 1) The sex ratio was similar and the incidence was highest in the 5th decade for female and the 6th decade for male ; 75 percents of all cases were in the 5th and 6th decades. 2) A history of hypertension was a poor prognostic factor but a history of cerebrovascular disease was not a specific factor affecting the prognosis. 3) In the patients with low blood pressure, high G.C.S, and small amount of hematoma, were better the prognosis than in the patients with high blood pressure, low G.C.S, and large amount of hematoma. The prognosis was poor in old aged and in the patients with signs of herniation. 4) In the patients with G.C.S between 7-9, cerebral herniation signs, and the amount of hematoma between 40-80cc, the prognosis was better in operative treatment than conservative treatment. 5) The surgical modalities were not related to the prognosis.

Subdural Tension Pneumocephalus Follwing Surgery

Two cases of tension pneumocephalus follwing surgery are reported. Tension pneumocephalus appears to be another potential complication of the operation and should be considered whenever a patient fail to recover as expected following surgery. Peaking of frontal lobe, mountain appearance of frontal lobe, and air densities at the cisterns are characteristic findings of tension pneumocephalus. Its diagnosis and treatment are easy and simple.

Clinical Analysis of 65 Operated Cases of Lumbar Spinal Stenosis

No abstract available.