The Clipping on Supraclinoid Internal Carotid Artery Aneurysms

OBJECTIVE: We present a clinical analysis to envision the difficulties in supraclinoid internal carotid artery(ICA) aneurysmal neck clippings to improve the postoperative outcome. METHODS: Two hundred and fifty aneurysm surgeries were undertaken at our hospital from 1997 to 1998. There were 52 patients(20.4% of the total) of supraclinoid ICA saccular aneurysmal patients. Eighteen cases(34.6%) were found with diverse difficulties in direct neck clippings. The authors analyzed the causes of surgical difficulties in the clipping on supraclinoid ICA aneurysms, in a clinical perspective. RESULTS: Perfect aneurysmal clippings were performed in 45 patients(86.5%) of the total 52 cases of supraclinoid ICA aneurysms. The clipping and wrapping were needed in five cases(9.6%), trapping in one(1.9%) with one case(1.9%) needed only for wrapping. The causes of difficulties in direct neck clipings were : aneurysm sac involving perforator in six cases(11.5%), too short an ICA proximal to posterior communicating artery for temporary clipping in 5(9.6%), posterior communicating artery aneurysm directed to the ventral side in three(5.8%), dorsal wall aneurysm in one, severe atheromatous ICA in one, a larger sac than in angiographic finding with partial thrombosis in one, severe adhesion of aneurysm to 3rd cranial nerve in one patient. CONCLUSION: For supraclinoid ICA aneurysm surgery, sufficient preoperative plans and careful inspection including angiographic findings to foresee the various difficulties of neck clippings are needed.

Posttraumatic Seizures in Children: Risk Factors and Prophylactic Antiepileptic Drugs

OBJECTIVE: Identification of risk factors and prevention of the seizures are very important in the management of the pediatric traumatic brain injury(TBI). The authors conduct a study to find the risk factors of the pediatric posttraumatic seizures(PTS) and effectiveness of the prophylactic antiepileptic drugs(AED). METHODS: We respectively analyzed 82 pediatric patients below the age of 15 who visited our hospital with TBI from August 1995 to May 2001. Mean age at arrival was 6.1 years, ranging from 2 months to 15 years. Male to female ratio was 1.9 : 1. Mean follow-up period was 3.9 months ranging from 0.5 to 42 months. RESULTS: Among the 82 patients, 13(15.8%) experienced PTS. In eight of the 13 seizure patients, the seizures developed within 24 hours after trauma. Patients with Glascow coma scale score less than 8 had higher rate of seizure attack. Forty-seven patients(58%) used AED within 24 hours after trauma. Among them, two patients experienced seizure attacks. Among the other 35 patients who had not received prophylactic AED, 11 patients(31%) had seizures with significantly higher rate of PTS. CONCLUSION: PTS are common complication in pediatric TBI. Use of prophylactic AED in the early stage of TBI can reduce the development of early seizures.