Tsutomu Yonemitsu

Results of stereotactic aspiration in 175 cases of putaminal hemorrhage.

Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous intracerebral hemorrhage and liver dysfunction.

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated gamma-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage.

Acoustic neurinoma presenting as subarachnoid hemorrhage

A 49-year-old man who had been suffering from disturbance of hearing for 5 years suddenly developed severe headache, nausea, and vomiting. Computed tomography (CT) scans both with and without contrast medium enhancement, performed on the day of admission, showed a nearly round high-density area in the left cerebellopontine angle. A left transaxillary vertebral angiogram showed no aneurysm or arteriovenous malformation. Hemorrhage from a tumor in the left cerebellopontine angle was suspected. CT scan without contrast medium enhancement, performed on the 17th day after onset, showed only a small, ill-defined high-density area in the cerebellopontine angle. An operation was performed on the 20th day after onset. The tumor was totally extirpated together with a clot. Histologically the tumor was an acoustic neurinoma with hemorrhage and necrosis. The postoperative course was favorable. Massive hemorrhage from primary intracranial tumors, especially acoustic neurinomas, is discussed. Radical operation on the tumor should be performed as soon as possible.

Experiences with CT-guided Stereotaxic Biopsies in 121 Cases

Needle biopsy using a CT-guided stereotaxic technique was performed in 121 cases of suspected brain tumour. Using this technique, it is possible to perform biopsies safely and accurately on even small and deep-seated lesions with a minimum of surgical intervention. However, accurate diagnoses are sometimes not possible when only a small number of viable cells are obtained, such as in lesions containing old haematoma, cystic tumours, previously treated tumours or tumours which are either too hard or too soft. We were able to make accurate diagnoses in 98 of our 121 cases (81%). The accuracy of diagnosis is somewhat hampered by the small volume of sample material obtained using this biopsy technique, and this fact should be kept in mind when evaluating the histological material.

Stereotactic Aspiration of Thalamic

Among 145 cases of spontaneous thalamic hemorrhage, stereotactic aspiration of the hematoma was done in 75 cases in which the hematoma was greater than 6 ml and the limbs on the affected side could not be elevated. Thirty-one of 40 operated cases with a long axis greater than 3.3 cm were capable of returning to useful activity 6 months postoperatively (excellent to fair). The results 6 months from onset in the 145 cases were as follows: 43% excellent or good, 32% fair, 11% poor and 13% dead. These results appear to indicate that stereotactic aspiration can produce improvements in therapeutic results for cases of thalamic hemorrhage.

Intracerebral hemorrhage from a metastatic brain tumor. Importance of differential diagnosis preceding stereotaxic hematoma aspiration

Three cases of sudden intracerebral hemorrhage, which were diagnosed as hemorrhage from metastatic brain tumors following stereotaxic aspiration of a hematoma, are reported. Two cases had subcortical hemorrhage and one had cerebellar hemorrhage. Neither contrast-enhanced computed tomography scans nor angiograms revealed any findings other than those indicating the hematoma in all three cases. However, retrospective study of the anamnesis showed very mild symptoms due to metastasis to the brain or spinal cord in one case each. In cases of intracerebral hematoma located at atypical sites, extreme care is required for the differential diagnosis.

An analysis of the results of treatment for ruptured cerebral aneurysms in acute stage

当科にて過去約6年間に, 最終クモ膜下出血発作後48時間以内に収容した破裂脳動脈瘤患者414例を対象とし, 初回破裂群, 先行破裂後1ヵ月以内の再破裂群に分け比較検討し, 以下の結果を得た.1) 入院時のgrade (Hunt&Kosnik) は再破裂群でより重症例が統計的有意に多かった.2) 手術成績及びoverallの成績でも初回破裂群が有意に良好な結果であった.3) 入院時のgrade別の治療成績では両群に有意の差は認められなかった.4) 再破裂はその多く (71%) が発作第1日目に集中し, さらに発症6時間以内が多かった (55%).5) 今後, 破裂脳動脈瘤の急性期治療成績を向上させる為には初回破裂発作直後よりの血圧の厳重な管理及び直ちに根治手術に持ってゆける様な救急システムの確立等が必要と考えられた.