No abstract available.

No abstract available.
Abscess*

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.
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

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

The main pathophysiology of cerebral ischemia caused by occlusive cerebrovascular disease(CVD) are hemodynamic low perfusion and embolic mechanism. The main objects of surgical method for occlusive CVD are improvement of low perfusion and elimination of embolic source with surgical procedure. The causes of occlusive CVD can be devided as a atheromatous and non-atheromatous occlusion. The frequent sites of occlusion in atheromatous origin are carotid bifurcation, carotid siphon and middle cerebral artery(MCA), proximal subclavian and vertebral artery origin, vertebral artery proximal to origin of posterior inferior cerebellar artery(PICA), vertebral artery distal to origin of PICA and mid-basilar artery. The lesions of non-atheromatous occlusive disease are extracranial internal carotid artery(ICA) aneurysm, traumatic dissection with or without false aneurysm of ICA, loops and kinds of ICA, osteophytic or traumatic vertebral artery compression, traumatic dissection with or without false aneurysm of vertebral artery and Moya Moya disease. Depend on occlusion site and disease, the surgical procedures are different. The main surgical procedures for occlusive CVD are carotid endarterectomy, extracranial-intracranial(EC-IC) bypass surgery, vertebral artery endarterectomy, vertebral artery to common carotid artery transposition, resection and end-to-end or interposition vein graft of ICA, indirect revascularization for Moya Moya disease and unroof the transverse foramen of cervical vertebra. The author reviews the surgical indication and procedure of occlusive CVD briefly.
Aneurysm ; Aneurysm, False ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Endarterectomy ; Endarterectomy, Carotid ; Hemodynamics ; Moyamoya Disease ; Perfusion ; Pica ; Spine ; Transplants ; Veins ; Vertebral Artery

The main pathophysiology of cerebral ischemia caused by occlusive cerebrovascular disease(CVD) are hemodynamic low perfusion and embolic mechanism. The main objects of surgical method for occlusive CVD are improvement of low perfusion and elimination of embolic source with surgical procedure. The causes of occlusive CVD can be devided as a atheromatous and non-atheromatous occlusion. The frequent sites of occlusion in atheromatous origin are carotid bifurcation, carotid siphon and middle cerebral artery(MCA), proximal subclavian and vertebral artery origin, vertebral artery proximal to origin of posterior inferior cerebellar artery(PICA), vertebral artery distal to origin of PICA and mid-basilar artery. The lesions of non-atheromatous occlusive disease are extracranial internal carotid artery(ICA) aneurysm, traumatic dissection with or without false aneurysm of ICA, loops and kinds of ICA, osteophytic or traumatic vertebral artery compression, traumatic dissection with or without false aneurysm of vertebral artery and Moya Moya disease. Depend on occlusion site and disease, the surgical procedures are different. The main surgical procedures for occlusive CVD are carotid endarterectomy, extracranial-intracranial(EC-IC) bypass surgery, vertebral artery endarterectomy, vertebral artery to common carotid artery transposition, resection and end-to-end or interposition vein graft of ICA, indirect revascularization for Moya Moya disease and unroof the transverse foramen of cervical vertebra. The author reviews the surgical indication and procedure of occlusive CVD briefly.
Aneurysm ; Aneurysm, False ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Endarterectomy ; Endarterectomy, Carotid ; Hemodynamics ; Moyamoya Disease ; Perfusion ; Pica ; Spine ; Transplants ; Veins ; Vertebral Artery

Intracranial meningioma is one of the most easily detectable tumor in the preoperative period with the brain computerized tomographic(CT) scan. Although most of them are of benign nature, they present tendency to invade surrounding brain tissue and to recur in spite of complete surgical removal. Authors analysed the clinical features of 27 cases of histologically verified meningiomas and attempted to study the correlation between CT findings and histological types to predict their clinical invasiveness and aggressiveness. Female was predominated in occurance than male in the ratio of 17:10. Mean age of occurance was 40.5-year-old. The most frequent symptoms and signs were headache, papilledema and visual disturbance in order. The most frequent histological type was meningotheliomatous type(55.6%) which was followed by transitional(18.5%), fibroblastic(18.5%) and angioblastic(7.4%) types. In the finding of the brain CT scan, perifocal brain edema was noticed in nearly almost cases and high density of the tumor mass in the precontrast CT scan was predominated in transitional and fibroblastic types. But, marked perifocal brain edema, irregular tumor margin, loss of homogeneity of the tumor density and marked contrast enhancement, which were considered to be more aggressive and invasive findings, were predominated in the meningotheliomatous and angioblastic types. So, these types seemed to be more aggressive and invasive than other types. Large cystic meningiomas were 14.8% in author's cases.
Brain ; Brain Edema ; Female ; Fibroblasts ; Headache ; Humans ; Male ; Meningioma ; Papilledema ; Preoperative Period ; Tomography, X-Ray Computed