A Clinical Analysis and Assessment of Outcome by Glasgow Coma Scale in 1210 Adult Head Injury

1210 patients with adult head injury who were admitted to the Department of Neurosurgery, Kyung Hee University Hospital during the period of 5 years from January, 1980 were analyzed clinicostatistically. The results were as follows : 1) There were 842 male and 368 females with the ratio of 2.3 : 1. 2) Higher incidence was observed on May and September of the year, and between 6:00 P.M. and 8:00 P.M. of the day. 3) The most common cause of head injury was traffic accident(58.3% of the total cases), especially pedestrian accident and the next causes were fall-down and assaults. 4) Loss of consciousness was observed in 862 cases(71% of the total cases) and the duration of unconsciousness seemed to be related with severity of clinical course. 5) Lucid interval was observed in 21.4% of the cases of intracranial mass lesion and the highest manifestated lesion was epidural hematoma. There was vomiting in 31.2% of the total cases and early posttraumatic epilepsy in 2.1%. 6) Skull fractures were identified in 375 cases ; 273 cases of linear, 50 cases of depressed, 41 cases of basal and 11 cases of diastic fractures. The most common site of linear skull fracture was temporoparietal bone. 7) 79.8% of epidural hematomas were associated with skull fractures and the most common site of hematoma was temporal area. 8) Of all cases of subdural hematoma, acute type was prevalent(59.7%) and in main involved site was frontotemporoparietal area. 9) The frequent associated injuries were mandible fracture and other facial bone fracture, chest injury and lower extrimities fracture in order. 10) The minor head injury of Glasgow Coma scale score(GCS) of 13 to 15 was 864 cases(71.4%), the moderate head injury of 9 to 12, 139 cases(11.5%), and the severe head injury of 3 to 8, 207 cases(17.1%). 11) Of 270 cases of severe head injury, the mortality was 43% and 21% had good recovery. But outcome was different according not only to GCS but also to the type of lesion. 12) Acute subdural hematoma with GCS of 3 to 5 was uniformly the worst problem(88% mortality), whereas subacute and chronic subdural hematoma had good outcome. 13) The overall mortality was 8.0% and the operation mortality in 283 cases was 19.8%. Among the 1,210 cases of head injury in adults, 80.8% showed good recovery and 11.2% remained in disabled or vegetative state.

Aneurysms of Basilar Bifurcation: Report of Two Cases

The authors report two cases of aneurysms of basilar bifurcation approached by modified frontolateral transsylvian route: each aneurysm was clipped successfully through the space between internal carotid artery and posterior communicating artery in case 1 and the space between internal carotid artery, posterior communicating artery and oculomotor nerve in case 2. Historical background and surgical approaches are discussed.