OBJECTIVE: The aim of this study is to describe the surgical outcome and determine prognostic factors of hypertensive putaminal hemorrhage in the elderly patients. METHODS: In a retrospective study, we analyzed the surgical outcome of 61 patients under 50 year-old (the younger group) and 57 patients over 70 year-old (the older group) with hypertensive putaminal hemorrhage treated from April 1998 to May 2002 in our institution. Neurological condition, brain computed tomography characteristics, and previous disease were analysed to select prognostic factors. The Glasgow Outcome Scale after six months was used for comparison of outcome. RESULTS: Of 16 patients with an initial GCS of 3-6, six of the younger group (86%) and nine of the older group (100%) had poor outcomes (p=0.062). Of 64 patients with an initial GCS of 7-11, 24 of the younger group (73%) and 23 of the older group (74%) had good outcomes. Of 38 patients with an initial GCS of 12-15, 20 of the younger group (95%) and 16 of the older group (94%) had good outcomes. Of 58 patients with moderate hematoma (30-50ml), 23 of the younger group (79%) and 22 of the older group (76%) had good outcomes. Of 30 patients with large hematoma (>50ml), 6 of the younger group (40%) and 5 of the older group (33%) had good outcomes (P=0.144). Of 21 patients with intraventricular hemorrhage, 6 of the younger group (60%) and 10 of the older group (91%) had poor outcomes (2.6 versus 1.8: p=0.016). Of 13 patients with hydrocephalus, 4 of the younger group (67%) and 7 of the older group (100%) had poor outcomes (2.5 versus 1.4: p=0.006). The surgical outcome of hypertensive putaminal hemorrhage showed no significant difference in the older group compared with the younger group. Outcome was worse in the older group with intraventricular hemorrhage or hydrocephalus. CONCLUSION: We conclude that surgical treatment for hypertensive putaminal hemorrhage in the elderly patients without intraventricular hemorrhage or hydrocephalus is needed. Poor prognosis in elderly patients is significantly associated with intraventricular hemorrhage and hydrocephalus.
Aged* ; Brain ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Middle Aged ; Prognosis ; Putaminal Hemorrhage* ; Retrospective Studies

OBJECTIVE: The purpose of the study was to evaluate the clinical and radiological results after discectomy and Lubboc bone graft in the surgical management of the cervical diseases with a new titanium interbody implant and integrated screw fixation(PCB) by anterior approach. METHODS: The authors retrospectively analyzed 28 cases of anterior cervical fusion with PCB system and Lubboc bone(xeno graft) from september 1998 to december 2000. Twenty-eight patients with cervical diseases underwent decompression cervical lesion and followed from 5 to 27 months with a mean follow-up of 14 months. There patients were evaluated with clinically and radiologically at immediate postoperative period and at 3, 6, 9, and 12 months. RESULT: The authors investigated the pre- and postoperative intervertebral disc space, clinical outcomes, radiography fusion rate, and Cobb angle in the fixed segments by anterior approach. The lordotic angles and height of disc space were increased after the operation. The clinical outcome of patients follow-up was good or excellent result based on Odom's criteria with improvement of clinical symptom in about 92.9% of the cervical diseases. Two patients showed loosening of the lower and upper cervical screw of PCB instruments, and two patients showed swallowing difficulty and wound infection. CONCLUSION: The PCB system is a new implant for anterior cervical interbody fusion in the degenerative cervical disease and disc herniations. It provides immediate stability and segment distraction. The results of this study indicate that the PCB system is safe, easy handling of hardware, less complications, high fusion rate, and has provide the keeping the intervertebral disc space height and lordotic angles.
Decompression ; Deglutition ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Postoperative Period ; Radiography ; Retrospective Studies ; Titanium ; Transplants ; Wound Infection

OBJECTIVES: The purpose of this study is to review our experience with spontaneous thalamic hemorrhage. Clinical outcome of patients was brought about by comparing stereotactic aspiration and conservative medical therapy. METHODS: The study consists of seventy-three cases with spontaneous thalamic hemorrhage which were treated from the period of Jan. 1993 to Dec. 1999. Thirty-eighty patients were treated with computed tomography (CT) guided stereotactic aspiration and thirty-five patients were treated conservatively. We compared the factors affecting treatment and the factors are as follows: age and sex, conscious level on admission, hematoma volume, hematoma sites, presence of ventricular penetration. RESULTS: The results in the thirty eight stereotactic aspirated cases for the 6 months from oneset are as follows: good recovery or moderate disability in 43%, severe disability in 32%, vegitative state in 11%, dead in 13% respectively. The clinical result was more favorable in stereotactic aspiration, with 11-30cc hematoma volume, extend to internal capsule of hematoma, poor conscious level on admission than conservative medical therapy. But age and sex, conscious level on admission, presence of ventricular penetration were not influential in the statistical outcome between stereotactic aspiration and conservative medical therapy. CONCLUSION: Treatment modality of spontaneous thalamic hemorrhage is still controversial. But stereotactic aspiration is more recommended for improvement therapeutic results than conservative treatment or open craniotomy in case of 11-30cc hematoma volume, extend to internal capsule of hematoma and poor conscious level on admission.
Craniotomy ; Hematoma* ; Hemorrhage ; Humans ; Internal Capsule

An en bloc bilateral osteotomy of the orbital roofs and frontal sinus for large or deeply situated anterior skull base tumors offers less brain retraction and a wide exposure. The authors describe en bloc bilateral osteotomy of the orbital roofs and frontal sinus, with skull base reconstruction using inner table of the patient's own frontal bone flap. The approach in this report offers the advantage of wide exposure, one-site operation and short operation time.
Brain ; Frontal Bone ; Frontal Sinus ; Orbit ; Osteotomy ; Skull Base* ; Skull*

Two cases of iatrogenically induced false aneurysm of the superficial temporal artery are presented. One patient showed partially filled aneurysmal sac, 1x1 cm sized, on the main trunk of left superficial temporal artery by external carotid artery angiography. Another patient showed aneurysmal dilatation, 3x2 cm sized, of the superficial temporal artery with direct injection of Urograffin into the pulsatile mass. Aneurysm excision is indicated to reduce the risk of hemorrhage from the subsequent head trauma, to relieve headache, and for any cosmetic defect. The authors have reviewed the literature and discussed the incidence, classification, pathogenesis, clinical and angiographic diagnosis, differential diagnosis, and treatment.
Aneurysm ; Aneurysm, False* ; Angiography ; Carotid Artery, External ; Classification ; Craniocerebral Trauma ; Diagnosis ; Diagnosis, Differential ; Dilatation ; Headache ; Hemorrhage ; Humans ; Incidence ; Temporal Arteries*

Two hundreds and four consecutive patients who sustained proven spontaneous subarachnoid hemorrhage with conservative treatment were studied retrospectively. The reasons for conservative treatment were poor condition for surgery, difficulties in surgery and operation refusal. Comparative study was done in proven 47 cases of aneurysmal SAH, 27 cases of SAH with negative angiography and 130 cases of SAH without angiography about age, aneurysm site & size, neurologic grade mortality & morbidity, etc. Death had occurred in 2 weeks after attack predominantly. Rebleeding was most common cause of mortality(64%, 68/107). Survivals had good quality of life(73%, 19/26).
Aneurysm ; Angiography ; Disulfiram ; Follow-Up Studies* ; Humans ; Mortality ; Retrospective Studies ; Subarachnoid Hemorrhage

The authors have experienced 62 cases of chronic subdural hematoma from Jan. 1987 to May 1992 at National Medical Center. In these cases, 58 cases of chronic subdural hematoma were treated with burr hole and closed draninage, 4 cases were managed with conservative management. Male was predominant to female with the ratio of 6:1 and common age was 50-60 years old. Most common causes was head injury and there was cases of chronic subdural hematoma developed after shunt operation. Common symptom was mental change and headache. Brain expansion was delayed in old age group(over 50 years old), Brain CT was available in diagnosis but brain MRI was useful in diagnosis of scantly chronic subdural hematoma. Surgical outcome was related to preoperative neurologic grade and time interval of diagnosis. In this study, clinical improvement rates was 88% in surgically treated cases.
Brain ; Craniocerebral Trauma ; Diagnosis ; Female ; Headache ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Male

Stroke in infant was relatively rare. But recently, development of diagnostic tools and infantile intensive care unit were introduced. So, early detection and follow up study were easily performed and the motality of infant stroke was improved. The pathophysiologic factor was multiple such as structural, development and physiological aspects of brain circulation and cardiorespiratory perinatal accidents, which are the cause of several neuropathology. So, preventable secondary factors such as perinatal asphyxia, respiratory manipulation during daily care should be removed thus, mortality and morbidity were decreased. Therefore, the anthors analysized 16 patient, with storke whom age were younger less than 1 year for searching of preventable secondary factors.
Asphyxia ; Brain ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn* ; Intensive Care Units ; Mortality ; Stroke

The simultaneous occurrence of one or more intracranial aneurysm and an intracranial arteriovenous malformation(AVM) in a patient is unusual. Four cases of intracranial aneurysm associated with cerebral arteriovenous malformation(AVM) were found in a total of 67 patients with cerebral malformation(AVM). The site of aneurysm was related anatomically to the arterial supplying arteriovenous malformation(AVM) in 3 cases and the bleeding source was aneurismal rupture in all four cases(100%). It is generally accepted that aneurysm is caused by hemodynamic stress result from the presence of an arteriovenous malformation(AVM). The management of the unusual problem is controversial which are surgical obliteration of both vascular lesion in one stage(2 cases) and surgical obliteration of both vascular lesion in two stages(1 case) were accomplinished with good surgical result.
Aneurysm ; Hemodynamics ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Intracranial Arteriovenous Malformations* ; Rupture

Rupture of an intracranial dissecting aneurysm is a rare but dangerous event and are difficult to diagnosis and manage, and carry a high morbidity and mortality. The angiographic features typically showed fusiform dilatation and proximal and/or distal dilatation of the affected artery. Depending of location of dissection, surgical options are;ligation, trapping, or reenforcement of exposed abnormal portion of vessels. The authors report a case of nontraumatic dissecting aneurysm, stroke with subarachnoid hemorrhage(SAH) and the proximal porton of origin of PICA was treated with dlipping of vertebral artery proximal to dissecting aneurysm.
Aneurysm, Dissecting* ; Arteries ; Diagnosis ; Dilatation ; Mortality ; Pica ; Rupture ; Stroke ; Subarachnoid Hemorrhage ; Vertebral Artery*