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The Clinical Analysis of Surgical Treatment in the Medically Intractable Seizure.

Dong Sup CHUNG ; Ki Won SUNG ; Jae Soo LEE ; Chang Rak CHOI ; Jin Un SONG

Journal of Korean Neurosurgical Society.1989;18(6):910-915.

We performed callosotomy and amygdalo-hippocampectomy in medically intractable seizure patients. Symptom duration of these patients was over 2 years and seizure was not controlled with anticonvulsants in spite of high level in drug monitoring according to their seizure type. 7 patients with generalized epilepsy were treated by anterior callosotomy and 8 patients with temporal lobe epilepsy were treated by amygdalo-hippocampectomy. Anyone of these patients were not dead and discovered permanent complications. And so these methods, anterior callostomy and amygdalo-hippocampectomy seems to be relatively safety and effective methods in treatment of medically intractable seizure.
Anticonvulsants ; Drug Monitoring ; Epilepsy, Generalized ; Epilepsy, Temporal Lobe ; Humans ; Seizures*

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Non-Operative Management of 20 Extradural Hematomas.

Soo II KIM ; Hun Joo KIM ; Yang Pya HAN ; Soon Ki HONG ; Chul HU

Journal of Korean Neurosurgical Society.1989;18(6):903-909.

The authors presented an analysis non-operative management on 20 epidural hematomas(EDH's) management who had been admitted from June, 1986. to May, 1988. The results were summarized as follows: 1) A number of EDH patients(17/20) with neurologically minor deficits could be successfully managed by conservative management, whereas we underwent surgical evacuation on 3 other cases with clot volume over 50cc. 2) Serial Brain CT scans on 20 patients revealed mostly two types of resolution pattern: One with an intervening expansile phase preceding net resorption(5 cases; 25%), and the other without this phase(15 cases; 75%). 3) All of patients presented mild symptoms and signs(Glasgow Coma Score>13). However, the common complaints were headache and vomiting. 4) The mean period from admission to discharge was 5.6 weeks, and the mean number of followup CT scan was 4.2 times.
Brain ; Coma ; Follow-Up Studies ; Headache ; Hematoma* ; Humans ; Tomography, X-Ray Computed ; Vomiting

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A Clinical Analysis of Cerebrovascular Disease in YUH.

Dong Ro HAN ; Eun Sig DOH ; Oh Lyong KIM ; Yong Chul CHI ; Byung Yearn CHOI ; Soo Ho CHO

Journal of Korean Neurosurgical Society.1989;18(6):893-902.

We have treated 634 cases of cerebrovascular disease who admitted to the Yeungnam University hospital form May 1983 to march 1988. The authors analysed the clinical aspects of cerebrovascular disease, and the results are as followings. 1) The hemorrhagic stroke was 4 times more than the ischemic stroke. 2) The hemorrhagic stroke occur most frequently in fifth decade and the ischemic stroke occur in sixth decade. 3) An infarction was most common in the ischemic stroke. 4) The most common cause of intracerebral hemorrhage was hypertension. S) The most common cause of subarachnoid hemorrhage was aneurysm. 6) The intracerebral hemorrhage occur most frequently in the putamen(35.1%) followed by the thalamus(29.2%), subcortical(24.8%), brain stem(5.9%) and cerebellum(5.0%). 7) The aneurysmal sac was located most frequently in the A-com(28.3%), followed by MCA(26.4%), and P-com(25.5%). The multiple aneurysm occurred in 13% of 92 cases.
Aneurysm ; Brain ; Cerebral Hemorrhage ; Hypertension ; Infarction ; Stroke ; Subarachnoid Hemorrhage

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A Clinical Analysis of Cerebral Infarction.

Sang Keyung LEE ; Byung Kook MIN ; Sung Nam HWANG ; Jong Sik SUK ; Duck Young CHOI

Journal of Korean Neurosurgical Society.1989;18(6):885-892.

The author analyzed 100 patients with cerebral infarction who had been admitted to Chung-Ang University Hospital during the recent two years. The results were obtained as follows; 1) The male to female ratio was 2.1: 1 and majority of patients were over fifth decades. 2) The most common neurological symptom was hemiparesis or hemiplegia(29.2%), and then followed by headache and vomiting(19.5%), & speech disturbance(19.5%). And 55% of the admitted patients were alert. 3) The commonly associated diseases were hypertension(60.9%) and diabetes mellitus(7.2%). The common E.K.G findings were sinus arrhythmia(20.7%), and L.V.H(18.0%). 4) Computerized tomographic findings were completely normal in 27 % of the patients on admission but those who showed abnormal CT findings, the most frequent finding was low density area in the middle cerebral artery territory including basal ganglia and internal capsule(35%). 5) Serum total cholesterol and triglyceride levels were significantly increased. 6) Cerebral infarction tends to attack more frequently during spring(38%), and winter(29%), & outcome was relatively good(66.0%).
Basal Ganglia ; Cerebral Infarction* ; Cholesterol ; Female ; Headache ; Humans ; Male ; Middle Cerebral Artery ; Paresis ; Triglycerides

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Clinical Experiences of Anterior Choroidal Artery Aneurysm.

Hean Hae CHOO ; Young Jin LIM ; Tae Sung KIM ; Gook Ki KIM ; Bong Arm RHEE ; Won LEEM

Journal of Korean Neurosurgical Society.1989;18(6):877-884.

The surgically treated 9 patients with anterior choroidal artery aneurysms were clinically analysed. The mean age of patients was fifty six and the size were between 3 mm and 12 mm. Anterior choroidal artery, although small, is important cerebral vessel because of its extensive strategic area of supply. We preserve anterior choroidal artery 8 out of 9 cases during clipping of aneurysm. Fortunately in the sacrificed case, no specific neurologic deficit was developed. So, we reviewed the anatomy & collateral circulation of this vessel.
Aneurysm* ; Arteries* ; Choroid* ; Collateral Circulation ; Humans ; Neurologic Manifestations

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Clinical Analysis of Giant Intracranial Aneurysm.

Yun Hee KIM ; Byung Ook CHOI ; Soo Chun KIM ; Jae Hong SIM

Journal of Korean Neurosurgical Society.1989;18(6):871-876.

The authors reported the cases of 23 patients with aneurysms measuring 2.5 cm or greater in diameter found during 7 years period in which we performed 596 operations for aneurysm of the 23 patients, 14 were treated by direct operation, 3 by internal carotid ligation with or without bypass surgery, 2 by trapping, 1 by wrapping and the other 3 by conservative therapy. The overall incidence of giant aneurysms was 3.9% but varied according to location; 9 cases were located on the internal carotid artery; 8 were on the anterior communicating artery; 5 were on the middle cerebral artery. 14 patients had hemorrhagic attacks, 7 had mass effects from the aneurysm, and 2 had ischemic events. Overall favorable outcome was 65% and the mortality was 13%. Based on the review of the literature, the appropriateness of surgery and surgical methods are discussed.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Intracranial Aneurysm* ; Ligation ; Middle Cerebral Artery ; Mortality

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Clinical Analysis and Surgical Results of Early, Intermediate, Delayed Operation in 100 Consecutive Aneurysmal Patients.

Chang Sik LEE ; Dong Youl RHEE

Journal of Korean Neurosurgical Society.1989;18(6):861-870.

We retrospectively reviewed 100 consecutive patients who were ruptured intracranial aneurysm and were operated on in the department of neurosurgery of Wallace Memorial Baptist Hospital from August 1984 to August 1988. The patients who were operated upon within the first 3 days of their most recent subarachnoid hemorrhage formed the early group, the patients operated upon with 4-7 days formed the intermediate group, after 8 days were considered as the delayed group. Early operation was performed in 30 patients, intermediate operation in 20 patients, and delayed operation in 50 patients. On the base of their clinical outcome, the patients were allocated to one of 4 outcome categories(good, fair, poor, death) at the time of their hospital discharge. The 80% favorable outcome estimated from early operation and 85% from intermediate operation and 90% from delayed operation. The mortality was estimated 13% from early operation and 0% from intermediate operation and 8% from the delayed operation. Each 4 cases of early, intermediate and delayed operation was needed shunt operation for hydrocephalus. In operative result, after 1987 was better than before 1987. In hypertensive patients, there was a tendency to observe poor prognosis than normotensive patients, especially with vasospasm.
Aneurysm* ; Humans ; Hydrocephalus ; Hypertension ; Intracranial Aneurysm ; Mortality ; Neurosurgery ; Prognosis ; Protestantism ; Retrospective Studies ; Subarachnoid Hemorrhage

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The Early to Emergency Surgery on the Deteriorating Aneurysms.

In Suk HAMM ; Yeun Mook PARK ; Seung Lae KIM

Journal of Korean Neurosurgical Society.1989;18(6):852-860.

The decision of proper time for operation on ruptured aneurysm is a very important tactic of treatment, because of the following major complications after subarachnoid hemorrhage. Recently it is widely accepted opinion that the ruptured aneurysm should receive an early operation for lower mortality and morbidity by preventing possible complications after subarachnoid hemorrhage such as rebleeding, symptomatic vasospasm and even hydrocephalus. Since 1985, we applied early to emergency surgery to the clinically deteriorating or non improving patients after aneurysm rupture and delayed surgery to the ameliorating patients who were placed under close observation. The early to emergency surgery on poor risk patient was performed within 48 hours after recent subarachnoid hemorrhage and delayed surgery was done after 2 weeks. Of the selective 95 poor-condition patients admitted to Kyungpook National University Hospital over the past 4 years from 1984, 60 got early surgeries and 35 delayed surgeries. Among the 60 patients in the early group, 22 patients with considerable intracranial hemorrhage were exempted from this comparative study. A few cases of vertebrobasilar aneurysms were not included in this paper for a little value in significance. In this prospective study, we evaluated the results of early and delayed surgeries of poor risk patients through clinical analyses and comparison, and we could gain better results from early surgeries.
Aneurysm* ; Aneurysm, Ruptured ; Emergencies* ; Gyeongsangbuk-do ; Humans ; Hydrocephalus ; Intracranial Hemorrhages ; Mortality ; Prospective Studies ; Rupture ; Subarachnoid Hemorrhage

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Clinical Analysis of Early Operation for Elderly Patients with Ruptured Aneurysm.

Jung Hoon LEE ; Byung Ook CHOI ; Soo Chun KIM ; Jae Hong SIM

Journal of Korean Neurosurgical Society.1989;18(6):846-851.

Direct operation for ruptured aneurysm should be the choice of treatment in elderly patients same as in younger cases. The early operation is an effective and reliable method to reduce the occurrence of rebleeding, vasospasm, ischemic complication, medical complication & to shorten lengths of hospitalization. To evaluate the risk of early operation of elderly patients with ruptured cerebral aneurysm. conducted a retrospective analysis 81 elderly patients with ruptured aneurysms who were over aged 60 years between Jan 1985 to June 1988. Of these, 47 case were performed early operation in which the direct intracranial operation was carried out within 3 days after last subarachnoid hemorrage. 77 % had favorable outcome and 13% died.
Aged* ; Aneurysm, Ruptured* ; Hospitalization ; Humans ; Intracranial Aneurysm ; Retrospective Studies

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Prognostic Factors in Intracranial Aneurysmal Surgery.

Byung Yearn CHOI ; Dong Ro HAN ; Oh Lyong KIM ; Yang Chul CHI ; Soo Ho CHO

Journal of Korean Neurosurgical Society.1989;18(6):836-845.

A prospective analysis of 80 consecutive operated cases of aneurysm were carried out to know the prognostic factors in intracranial aneurysmal surgery. Analysis of end-results with respect to aneurysmal locations and timing of operation showed that the internal carotid artery aneurysm did not make difference in outcome regardless of the timing of surgical intervention, but anterior cerebral artery, middle cerebral artery, and multiple aneurysm were more poor outcomes in the early surgical group(p<0.05). The more grave initial neurological state showed the worse surgical end-results. The poor results were shown in cases of above 3 mm in thickness of the basal cisternal hemorrhage and/or above 30 ml in volume of the intracerebral hematoma on the brain CT scan. During the operation, no sunkened brain, a spasm of offending artery, premature rupture of aneurysm, and post-operative residual intracerebral hematoma were also adverse effects to the post-operative outcomes.
Aneurysm ; Anterior Cerebral Artery ; Arteries ; Brain ; Carotid Artery, Internal ; Hematoma ; Hemorrhage ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prospective Studies ; Rupture ; Spasm ; Tomography, X-Ray Computed

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