No abstract available.

Computed tomography(CT) has enabled early recognition and treatment of focal injuries in patients with head trauma. However, CT has been less beneficial in identifying diffuse brain injury(DBI). The authors have analyzed retrospectively, a series of 132 patients with OBI observed for 2 years from Aug. 1986 to Jul. 1988 to evaluate the significance of the factors affecting outcome. Eighty-three patients were selected as being compatible with moderate and severe diffuse axonal injury(DAI) classified by Gennarelli, defined by coma without a CT lesion that is an obvious cause and coma greater than 24 hr with or without decerebration. The results are summarized as follows: 1) The 38(45.7%) out of 83 patients were found below age of 20, but there was no statistical significance between age distribution and outcome. 2) In case of initial Glasgow coma scale(GCS) of 7 or 8, 32(86.5%) out of 37 patients revealed good outcome, but 18(90%) of 20 patients with a score of 3 or 4 revealed poor outcome(p<0.01). 3) With regard to brain swelling in CT, there was significant statistical difference to outcome(p<0.05). 4) Small hemorrhages on corpus callosum, basal ganglia, basal cistern, peritentorial, lateral ventricle that is characteristic CT findings for DAI were showed 58(70%) out of all cases. It might be concluded that initial GCS, brain swelling and small hemorrhages in CT were significant factors affecting outcome in DAI.
Age Distribution ; Axons ; Basal Ganglia ; Brain ; Brain Edema ; Brain Injuries* ; Coma ; Corpus Callosum ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Hemorrhage ; Humans ; Lateral Ventricles ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Intracranial Aneurysm*

No abstract available.
Abscess*

No abstract available.
Hematoma*

Although the surgical technique of the management of an middle cerebral artery(MCA) aneurysm is not more difficult than that of an aneurysm in any other location, the surgical management outcome of this aneurysm is not better than that of other location aneurysms. This is probably due to occurrence of an intracerebral hemorrhage more frequently in an MCA aneurysm than other location aneurysms. This is required the proper surgical management of this aneurysm to be reviewed. The key points of surgery for MCA aneurysm can be summarized as follows: gently wide dissection and splitting of the sylvian fissure without injury of main sylvian veins; early adequate exposure of the M1 sites for temporary clips applications; avoid injuries of small branches of the MCA in sylvian fissure by using a low pressure suction during removing the intrasylvian hematoma; avoid injury of lenticulostriate arteries and narrowing of the parent arteries during clipping of aneurysms; and successful aneurysm obliteration with minimal brain retraction. Preoperative imagination of the configulation of aneurysm and the relationship between the aneurysm and surrounding vessels, such as M1, M2 and lenticulostriate arteries, from angiographic informations will decrease the incidence of premature aneurysmal ruptureduring surgery and improve the surgical management outcome of patients with MCA aneurysm. From September 1982 to December 1998, the authors has surgically treated 1025 patients of the cerebral aneurysms. Among these patients, 274 patients(26.7%) had the MCA anurysms. The surgical outcomes of these MCA aneurysm patients were good in 222 patients(81.0%) and death in 22 patients(8.0%). The authors discusses surgical anatomy and techniques for the management of MCA aneurysms on the basis of the author's experiences and a review of the literatures in order to improve the surgical management outcomes of patients with MCA aneurysm in the future.
Aneurysm ; Arteries ; Brain ; Cerebral Hemorrhage ; Cerebral Veins ; Hematoma ; Humans ; Imagination ; Incidence ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Parents ; Suction

The case of 17-year-old boy is presented, in whom back pain progressed to paraplegia. A spinal epidural hematoma was removed at surgery with complete recovery. No traumatic or febrile episode was obtainable. The importance of early diagnosis and early spinal decompression is stressed.
Adolescent ; Back Pain ; Decompression ; Early Diagnosis ; Hematoma, Epidural, Spinal* ; Humans ; Male ; Paraplegia

The spontaneous subdural hematoma due to dural metastasis is a rare events. It is suggested that disseminated intravascular coagulation(DIC) and vascular obstruction due to invasion of the dural vessel play the important factors in the formation of the subdural hematoma in cancer patient. The authors presented 5 cases with a review of the literature.
Disseminated Intravascular Coagulation* ; Hematoma, Subdural* ; Humans ; Neoplasm Metastasis

OBJECTS: The surgical management of large cerebral arteriovenous malformation(AVM) is still one of the most difficult fields in neurosurgery. To select the proper candiate for the surgery and improve the results of surgical management of large AVMs, the analysis of the author's cases and the review of the literstures are performed. METERIAL AND METHODS: During the past 17 years, 111 patients with cerebral AVMs were managed surgically. Among these cases, 23 patients had the large AVMs, more than 5 cm in the greatest diameter. The author analyzes these 23 cases clinically and discusses the natural history, surgical indication, surgical techniques, intraoperative and postoperative complications and their management on the basis of the author's experiences and a review of the literatures. RESULTS: Among 23 cases, 16 cases showed good outcome without any neurological morbidity. 6 cases showed mild neurological morbidity such as a memory disturbance, mild hemiparesis or unchanged patterns of seizure, and 1 case showed dense hemiplegia after surgery. There was no mortality. The surgical management of the large AVMs should be decided very carefully because their natural history is relatively benign. An early arterial phase of an angiogram is very useful in discriminating feeders from nidus. An intraoperative use of Doppler ultrasound miniature probe is useful for making a distinction between feeding arteries and drain veins. Wide opening of the fissures and sulci and follows the feeding arteries to the nidus, removing the nidus along the exact border to the brain, induced hypotension during operation and postoperative period with or without pentothal coma were the key points for the surgical management of large AVMs. CONCLUSION: The surgical management of large AVMs is so difficult that the candidates for surgery should be selected carefully bases on the characteristics of the AVMs and experiences of surgeons. However, with experience and meticulous attention, many of these lesions can be resected without development of any morbidity and mortality.
Arteries ; Arteriovenous Malformations ; Brain ; Coma ; Hemiplegia ; Humans ; Hypotension ; Intracranial Arteriovenous Malformations* ; Memory ; Mortality ; Natural History ; Neurosurgery ; Paresis ; Postoperative Care ; Postoperative Complications ; Postoperative Period ; Seizures ; Thiopental ; Ultrasonography ; Veins

OBJECTS: Although plenty of articles about microsurgical anatomy of the cerebral arteries exist in literatures, there is a few articles which studied the microsurgical anatomy of the cerebral venous system. To get the more accurate knowledge about microsurgical anatomy of the cerebral venous system related to the commonly used surgical approach route for cerebovascular lesions, this study is performed. MATERIAL AND METHODS: The author reviewed several articles which described about the anatomy of cerebral venous system, and selected some articles which studied the microsurgical anatomy of cerebral veins related to the area of the surgical approach routes for cerebrovascular lesions. General venous anatomy of lateral surface of cerebral hemisphere and the venous system related to the surgical approach route are described. RESULTS: The superficial cortical veins of lateral surface of cerebral hemisphere are divided into an ascending group, which drain into superior sagittal sinus, and a descending group, which drain into superficial sylvian veins or transverse sinus. Three anastomotic veins, such as the vein of Labbe, Trolard and the superficial sylvian veins, connect between superior sagittal sinus, veins along the sylvian fissure and transverse sinus. The anatomical knowledge of the sylvian and frontal basal veins, venous sinus around the superior sagittal sinus and medial frontal veins, and temporal basal veins are required in pterional, interhemispheric, and subtemporal approach respectively. CONCLUSION: The author concludes that the advancement of anatomical knowledge about cerebral venous system will contribute the improvement of outcome of surgically treated patients with cerebrovascular disease.
Cerebral Arteries ; Cerebral Veins ; Cerebrum ; Humans ; Superior Sagittal Sinus ; Veins