Factors influencing the Effectiveness of Hemodilution Therapy for Patients with Ruptured Cerebral Aneurysm

We operated on 621 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm from 1979 to 1987. All the patients were operated on within 72 hours after the rupture of aneurysm. From 1979 to 1983, 312 patients with ruptured intracranial aneurysm were treated without postoperative hemodilution therapy (No-Hemodilution). From 1984 to 1987, 309 patients were treated with hemodilution therapy (Hemodilution). We have performed the hemodilution therapy for the prevention of cerebral ischemia due to vasospasm following SAH since January, 1984. Indication for the hemodilution therapy was the hematocrit value of above 30.0-33.0 % at Day 7 after onset. In the No-Hemodilution period (1979-1983), the mean value of hematocrit of 253 patients was 36.7 % and in the Hemodilution period (1984-1987) , the value of 150 patients was 31.9 %. The difference in these values is statistically significant. From the viewpoint of over-all outcome, the rate of Good Recovery was higher and that of Death was lower in the Hemodilution period (p < 0.001). 1. The correlation of the age and outcome: The mortality was higher with increasing age especially in patients over 60 years (p < 0.001). This result seemed to be due to the vulnerability of the brain by cerebral ischemia in the old age. 2. The correlation of the sites of ruptured aneurysm and outcome: In the ruptured aneurysm of the anterior cerebral artery, the mortality was higher than that of other sites (p < 0.001). Generally, the symptoms of ischemia in the anterior cerebral artery terri tory are more severe than those of other sites. By the hemodilution therapy the symptoms of ische mia in the anterior cerbral artery territory seemed to be prevented. 3. The correlation of the preoperative grade and outcome: The mortality and morbidity were higher especially in the preoperative grade (p < 0.001). In the preoperative grade Id the outcome has a tendency to be determined by the severity of cerebral vasospasm. By the hemodilution therapy the occurrence of ischemia is decreased. We conclude that the hemodilution therapy is effective for the prevention and treatment of cerebral ischemia due to vasognasm

The early effect of Gamma knife surgery for brain metastases

One hundred and sixty lesions in 68 patients with brain metastases were treated with gamma knife. Thirty four patients had multiple metastases. The mean follow-up was 8.3 months ( 1 to 25 months). More than 50 % reduction rate of tumors were observed 88% of all lesions in one month, 90% in final follow-up. Mean Karnofsky performance status score raised in values from 75% to 89% in one month after gamma knife surgery. Progressive neurological symptoms improved in 89 % of patients with symptoms within one week. Recurrences occurred in 4 %, and transient neurological deteriorations were observed in 7 % of all patients. No permanent deficits was recognized. The median survival was 10 months of all patients ,while 9 months in single lesion and 13 months in multiple lesions respectively. There was no significant difference between these two groups (p=0.96). These data may indicate that gamma knife surgery has rapid effect for brain metastases and is effective for even multiple brain metastases

The early effect of Gamma knife surgery for brain metastases

One hundred and sixty lesions in 68 patients with brain metastases were treated with gamma knife. Thirty four patients had multiple metastases. The mean follow-up was 8.3 months ( 1 to 25 months). More than 50 % reduction rate of tumors were observed 88% of all lesions in one month, 90% in final follow-up. Mean Karnofsky performance status score raised in values from 75% to 89% in one month after gamma knife surgery. Progressive neurological symptoms improved in 89 % of patients with symptoms within one week. Recurrences occurred in 4 %, and transient neurological deteriorations were observed in 7 % of all patients. No permanent deficits was recognized. The median survival was 10 months of all patients ,while 9 months in single lesion and 13 months in multiple lesions respectively. There was no significant difference between these two groups (p=0.96). These data may indicate that gamma knife surgery has rapid effect for brain metastases and is effective for even multiple brain metastases

Factors influencing the Effectiveness of Hemodilution Therapy for Patients with Ruptured Cerebral Aneurysm

We operated on 621 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm from 1979 to 1987. All the patients were operated on within 72 hours after the rupture of aneurysm. From 1979 to 1983, 312 patients with ruptured intracranial aneurysm were treated without postoperative hemodilution therapy (No-Hemodilution). From 1984 to 1987, 309 patients were treated with hemodilution therapy (Hemodilution). We have performed the hemodilution therapy for the prevention of cerebral ischemia due to vasospasm following SAH since January, 1984. Indication for the hemodilution therapy was the hematocrit value of above 30.0-33.0 % at Day 7 after onset. In the No-Hemodilution period (1979-1983), the mean value of hematocrit of 253 patients was 36.7 % and in the Hemodilution period (1984-1987) , the value of 150 patients was 31.9 %. The difference in these values is statistically significant. From the viewpoint of over-all outcome, the rate of Good Recovery was higher and that of Death was lower in the Hemodilution period (p < 0.001). 1. The correlation of the age and outcome: The mortality was higher with increasing age especially in patients over 60 years (p < 0.001). This result seemed to be due to the vulnerability of the brain by cerebral ischemia in the old age. 2. The correlation of the sites of ruptured aneurysm and outcome: In the ruptured aneurysm of the anterior cerebral artery, the mortality was higher than that of other sites (p < 0.001). Generally, the symptoms of ischemia in the anterior cerebral artery terri tory are more severe than those of other sites. By the hemodilution therapy the symptoms of ische mia in the anterior cerbral artery territory seemed to be prevented. 3. The correlation of the preoperative grade and outcome: The mortality and morbidity were higher especially in the preoperative grade (p < 0.001). In the preoperative grade Id the outcome has a tendency to be determined by the severity of cerebral vasospasm. By the hemodilution therapy the occurrence of ischemia is decreased. We conclude that the hemodilution therapy is effective for the prevention and treatment of cerebral ischemia due to vasognasm

MRI studies in two cases of hypertensive encephalopathy

Magnetic resonance imaging (MRI) findings were analyzed in two patients with hypertensive encephalopathy. MRI demonstrated focal cortical and subcortical lesions of hyperintense T 2 signal and hypointense Tl signal lesions with diffuse brain swelling. Focal lesions were hardly explained by involvements of major arterial supplies. There were no neurological focal signs suggesting dysfunctions in the abnormal areas of MRI. These MRI studies further support the hypothesis that hypertensive encephalopathy is induced by vasogenic edema during breakthrough of cerebral autoregulation. Prompt diagnosis and reduction of blood pressure are key points for improving the clinical condition. MRI better defines the cerebral involvements in detail and would help proper diagnosis and therapeutic decision