Female ; Humans ; Middle Aged ; Neuroma, Acoustic ; complications ; Subarachnoid Hemorrhage ; etiology

To determine the characteristics of elderly patients with aneurysm surgery, various clinical variables in 40 elderly cases aged over 60 years among a total of 88 patients with early operated aneurysms during past 2 years were compared with that in 48 younger cases aged under 60 years. Factors evaluated in this studies were aged, sex, location of aneurysm, size of aneurysm, hemorrhage type on brain CT, Fisher's subarachnoid hemorrhage, Hunt- Hess grade on admission, surgical outcome on discharge, incidence of vasospasm and general postoperative complication. 1) Almost one-half(40) of the 88 patients were aged 60 years or older(mean ; 57.7 years). 2) The male to female ratio was 1 : 1.84 but female was more predominant over the age og 60. 3) Location of aneurysm, size of aneurysm, mean blood pressure on admission, hemorrhage type on brain CT, Fisher's SAH grade and general postoperative complications were not related to age. 4) The proportion of elderly patients of Hunt-Hess grade 3-5 was significantly higher than that of younger patients(p<0.05). 5) The surgical outcome was significantly poorer in elderly group(p<0.05). 6) The incidence of symptomatic vasospasm was significantly higher in the elderly group(p<0.05). 7) The surgical outcome was no significantly differance of same Hunt-Hess grade between elderly group and younger group. These results suggest that the high incidence of older patients is more consistent with a degenerative etiology than a development defect and among elderly patients poor outcome following early surgery is attributable to high incidence of poor preoperative neurological status and vasospasm.
Aged* ; Aneurysm* ; Blood Pressure ; Brain ; Female ; Hemorrhage ; Humans ; Incidence ; Male ; Postoperative Complications ; Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) can be classified as traumatic SAH or spontaneous SAH based on etiology. The traumatic SAH is the common manifestation of head injury and difficult to make a diagnosis in forensic investigation. Based on practical experiences of forensic investigation and relevant references, the main points (SAH identification, examination, death mechanism) were summarized in this article. For the understanding, we try to classify the traumatic SAH into three subtypes: brain injury associated SAH, traumatic rupture of basal cerebral vessels SAH and traumatic focal SAH.
Aneurysm, Ruptured/complications* ; Cause of Death ; Craniocerebral Trauma/complications* ; Diagnosis, Differential ; Forensic Pathology ; Hematoma, Epidural, Cranial/complications* ; Humans ; Intracranial Aneurysm/complications* ; Intracranial Arteriovenous Malformations/complications* ; Rupture/complications* ; Subarachnoid Hemorrhage/pathology* ; Subarachnoid Hemorrhage, Traumatic/pathology*

We present a case of subarachnoid hemorrhage induced by chronic suppurative otitis media and discuss the possible mechanism here. Chronic suppurative otitis media is a common suppurative inflammation of middle ear, which can cause sorts of extracranial and intracranial complications in the situation of lower resistance or higher virulence. However, the condition of subarachnoid haemorrhage caused by chronic suppurative otitis media is quite rare. According to this case and previously published articles, we consider that meningitis may be the main reason of subarachnoid hemorrhage induced by chronic suppurative otitis media.
Chronic Disease ; Ear, Middle ; Female ; Humans ; Meningitis ; complications ; Middle Aged ; Otitis Media, Suppurative ; complications ; Subarachnoid Hemorrhage ; complications

In spite of technical advances in neuroradiology, neuroanesthesiology, and microneurosurgery, the treatment of giant aneurysms remains problematic. Between 1983 and 1995, the authors encountered 42 consecutive cases of giant aneurysms, and this study focuses on their clinical manifestations, management, and outcome. The patients' ages ranged from 5 to 73 years, with peak incidence in the sixth decade ; the male to female ratio was 12 : 30. The follow-up period was from 2 to 110(mean, 36) months. The most common presenting symptom was a mass effect found in 22 patients(52%), followed by subarachnoid hemorrhage in 16(38%). Thirty patients underwent a surgical or interventional radiological procedure, comprising direct neck clipping(n=13), proximal clipping(n=7), detachable balloon occlusion(n=4), wrapping(n=3), trapping(n=1), and partial clipping with thrombectomy(n=2). The mortality rate was 16.7% and the morbidity rate, 40% ; the most common postoperative complication was distal cerebral infarction. At the last follow-up, 22 patients(73%) were able to perform daily activities without assistance. In this clinical study, the authors reviewed general aspects of the treatment of giant aneurysms. In conclusion, treatment of giant aneurysms should-for best results-be tailored to patients' individual requirements, determined after thorough examination. Despite advanced neurosurgical techniques, morbidity and mortality rates remain high.
Aneurysm* ; Cerebral Infarction ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Neck ; Postoperative Complications ; Subarachnoid Hemorrhage

OBJECTIVE: Aneurysms are very rarely encountered in the distal posterior inferior cerebellar artery (PICA). The authors experienced 5 cases with a distal PICA aneurysm among 368 cases of intracranial aneurysms during the period from January 2003 to January 2008. Here, the authors describe their clinical and surgical experiences and include a review of the relevant literature. METHODS: Using radiologic findings and charts, we retrospectively reviewed the surgical results of 5 cases with a distal PICA aneurysm treated from January 2003 to January 2008. RESULTS: The current five cases were composed of four cases of 'Good' and one case of 'Fair'. No postoperative complications occurred other than a ventriculo-peritoneal shunt due to hydrocephalus in Case 2. In all five cases, treatment was successful without neurological deficit. CONCLUSION: Surgical outcome of PICA aneurysms have been reported to be excellent because the amount of intraparenchymal injury is limited. More clinical experience, microsurgical technique developments, and endovascular surgery advancements are certain to improve treatment outcomes.
Aneurysm ; Arteries ; Hydrocephalus ; Intracranial Aneurysm ; Pica ; Postoperative Complications ; Retrospective Studies ; Subarachnoid Hemorrhage ; Ventriculoperitoneal Shunt

It became possible for a beginner of aneurysm surgery to shorten the stabilization period of surgical technique recently with several advances in the management of subarachnoid hemorrhage, such as early surgery, aggressive critical care, anesthetic technique, calcium channel blockers, and hypervolemia. The present study was conducted to determine whether surgical outcome actually changed over the years and what factors contributed to these changes. 219 good grade(Hunt-Hess grade I to III) patients with ruptured intracranial aneurysms operated by the same operator within 3 days after the attack from 190 to 995 were selected to reduce selection bias. All possible clinical and radiological factors for surgical outcome were analyzed to find significant factors, and then distributions of each significant factors were examined between 2 treatment periods(1990 to 1993 vs 1994 to 1995). Surgical outcome began to improve significantly since 1994(1990-93 vs 1994-95, p<0.005):75.0%(12/16) in 1990, 80.8%(21/26) in 1991, 77.4%(24/31) in 1992, 78.4%(40/51) in 1993, 87.8%(36/41) in 1994, 96.3%(52/54) in 1995 experienced good outcome. The decrease of postoperative surgical complications was the only factor influencing an increase of good outcome between 2 treatment periods. The distribution and characteristics of other possible biological significant factors for outcome were not different statistically. Improvement of surgery outcome by a vascular neurosurgeon depends on the number of experienced cases, and case qualities such as distributions of aneurysm size, location, and clinical grade etc. These results suggest that surgical technique importantly affects the change of surgical outcome, and consequently, considering usual level of surgical technique, more careful approach with assistance of an experienced vascular neurosurgeon than surgery by oneself will be necessary for first 4 to 5 years of aneurysm surgery.
Aneurysm* ; Calcium Channel Blockers ; Critical Care ; Humans ; Intracranial Aneurysm ; Postoperative Complications ; Selection Bias ; Subarachnoid Hemorrhage

The first case of haemorrhagic meningitis due to Bacillus anthracis in the European part of Turkey is reported here. B. anthracis, sensitive to penicillin, was isolated from the cerebrospinal fluid and blood cultures. Although appropriate therapy was administered, the patient died two days after hospitalization.
Adult ; Anthrax/*complications ; *Bacillus anthracis ; Fatal Outcome ; Humans ; Male ; Meningitis, Bacterial/*microbiology ; Subarachnoid Hemorrhage/*microbiology

The authors have reviewed and analyzed 105 cases of unruptured cerebral aneurysms in 94 patients from the medical records of 407 patients who had aneurysm sugery consecutively since the advent of microsurgery at the Department of Neurosurgery of Yonsei University. This study was done to define the clinical characteristics of intact intracranial aneurysms and to determine the principles of their management. There was no surgical mortality among 75 cases of intact intracranial aneurysms in 68 patients. Two cases of morbidity were not directly related to the surgery of intact aneurysms. As a result of the analysis of the cases, it was concluded that all symptomatic aneurysms should be treated immediately after the diagnosis, because they tend to be large in size and prone to rupture. If asymptomatic multiple unruptured aneurysms are accessible during surgery for a ruptured aneurysm, they should be treated at the same time. The decision for the treatment of unruptured aneurysms located opposite to ruptured ones or detected incidentally, should be made at the surgeon's discretion. The authors' belief is that intact intracranial aneurysms should be corrected regardless of their size when detected in young patients, in hypertensive patients, in hypertensive patients, or in patients with such high flow lesions as arteriovenous malformation.
Adult ; Aged ; Female ; Human ; Intracranial Aneurysm/surgery* ; Male ; Middle Age ; Postoperative Complications/etiology ; Prognosis ; Subarachnoid Hemorrhage/surgery

OBJECTIVE: The incidence of aneurysmal subarachnoid hemorrhage has been increasing. At the same time, surgical results for elderly patients are unsatisfactory and no guidelines of treatment are available. We carried out a study comparing variable factors and surgical results between young and old age groups to find ways to improve prognosis. METHODS: A retrospective study was carried out on 754 patients who were operated on between 1990 and 2004 by the same surgeon in our hospital. The patients were divided into seven groups according to age: 93 patients below 40 years of age (Group I), 419 patients aged 40~59 (Group II), 115 patients aged 60~64 (Group III), 82 patients aged 65~69 (Group IV), 28 patients aged 70~74 (Group V), 12 patients aged 75~79 (Group VI) and 5 patients over the age of 80 (Group VII). We then checked their medical history, Fisher's grade, Hunt-Hess grade, postoperative complications, and Glasgow Outcome Scale. RESULTS: Age was not a statistically significant factor among patients below 70 years of age (P value> or =0.05). But for those aged 70 and older, the age factor had a statistical value (P value< or =0.001). In addition, there was a close correlation between Hunt-Hess grade IV and V patients, and those with vasospasm, and hydrocephalus after surgery, with poor prognosis in elderly patients as well as young patients (P value< or =0.001). CONCLUSION: Advanced age (under the age of 70) dose not precluded adequate surgical treatment in patient with AN SAH, and we should be also alert to preventable causes of delayed neurological deterioration for improving the outcome in all elderly groups.
Age Factors ; Aged* ; Aneurysm* ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Incidence ; Operative Time ; Postoperative Complications ; Prognosis* ; Retrospective Studies ; Subarachnoid Hemorrhage