In treatment for intracranial aneurysms by coil embolization, recanalization remains the major limitation of coiling, particularly wide-necked or larger aneurysms. The aim of this study was to evaluate technical results and clinical outcome in a single center of consecutive patients with intracranial aneurysms treated with endovascular embolization using polyglycolic-lactic acid (PGLA) coated coils.

Between January 2005 and December 2010, 33 patients (male, 8 patients; female, 25 patients; mean age, 57 years) with saccular intracranial aneurysms were treated by means of an endovascular approach using PGLA coated coils. The endovascular procedures and technical outcomes were evaluated. The mean follow-up duration was 15.9 months (range, 6 to 72 months).

Successful embolizations with satisfactory results were achieved in 91%. The degree of occlusion of the treated aneurysm was complete in 23 (69.6%), small neck remnant in 7 (21.2%), and residual filling in 3 (9%). Thirty patients (90.9%) showed no interval change of the residual neck. Three patients (9.1%) demonstrated the recanalization, and 2 of them were successfully recoiled.

This preliminary study showed that PGLA coated coils may be safe option and preventable for recanalization in patients with intracranial aneurysms. Further study with more cases, longer follow-up data and well controlled design are required to confirm our results.

Of all the chronic pain syndromes postherpetic neuralgia ranks the most refractory to treatment. The eight postherpetic neuralgia patients have been treated with nerve blocks or neurolysis and obtained good result. We evaluate the therapeutic effect of nerve blocks for postherpetic neuralgia and reviewed the pathology, clinical consideration, treatments and prevention.

Eight patients with established postherpetic neuralgia enrolled in pain clinic of Mokdong Hospital of Ewha Womans University from March,2004 to December. Average age at 58 and about 63% of patients were over 68 years. Affected area of forehead was two patients. They have been treated with stellate ganglion block (SCB), two times supraorbital and supratrochlear nerves blocks and neurolysis with absolute alcohol. Face affected patient has was one and has been treated with 5 times SGB, 2 times supraorbital and supratrochlear nerves blocks, infraorbital and mental nerves blocks, and then 2times maxillary and mandibular nerves blocks. Chest affected two patients were treated with intercostal nerve blocks. Thoracic wall affected one patient received 2 times thoracic epidural blocks and thoracic nerve block. Scapalur and thoracic wall affected patient has been treated with SGB and 2 times thoracic epidural block. The chest and thoracic wall affected patient received 10 times intercostal blocks,2 times thoracic epidural blocks,3 times thoracic root block and neurolysis of intercostal nerves with absolute alcohol. The injected agents were 1% mepibacaine or 0.25% mercain heavy and methylprednisolone succinated, and at weekly intervals the agents were injected.

All patient having been treated with nerve blocks were free of pain at 3-9 months.

Although no controlled trial has been done of nerve blocks to treat postherpetic neuralgia, this technique is safe in experienced hands and, if effected, may be repeated. It suggested that local anesthetics and steroid are the effective components in nerve blocks. Data on the relief of acute pain with nerve blocks, however cannot be extrapolated to predict the prevention of postherpetic neuralgia. The best way to prevent herpes zoster becasuse of post herpetic neuralgia is so difficult to treat.

Lumbar disc herniations at the L1-L2, L2-L3, and L3-L4 level are rare. The purpose of this study is to observe the variable clinical finding of upper lumbar disc herniations and to provide proper treatment modality.

Between 1998 Jan. and 1999 Dec., seventeen patients with upper lumbar disc herniations who were undergone surgery in our institute were retrospectively evaluated. Patients were evaluated based on following factors : age, sex, aggravating factor, symptoms and signs type of disc herniation, type of surgery, and outcome of post-surgery.

The incidence of lumbar disc herniation at the level of L1-2, L2-3 and L3-4 is 6.1% with declining frequency as the level ascends. The peak age incidence is 6th decade in both sex. Preoperative symptomes and signs are variabe. In sixteen cases, posterior approach was done. In these cases, twelve cases were performed microscopic partial hemilaminectomy, and four cases with spinal stenosis were performed total laminectomy and posterior screw fixation with bone fusion. In one case, lateral extracavitary approach was done. In results of operation, fourteen cases showed more than good grade(82%).

The age incidence of lumbar disc herniations at the level of L1-2, L2-3 and L3-4 older than lumbar disc herniations at the lower level of L4-5 and L5-S1. The signs and symptoms are variable. In our cases, most of the patients were performed posterior approach with microscopic partial hemilaminectomy except the patients combined spinal stenosis. One case was performed a lateral extracavitary approach because the risk of the cord and cauda equina injuries. The prognosis of upper lumbar disc herniations after treatment with only microscopic partial hemilaminectomy and diskectomy is comparable with the prognosis of lumbar disc herniations at the lower level.

Despite of recent advances in pharmacological treatment and improvement surgical and anesthetic techniques, subarachnoid hemorrhage(SHA) from ruptured intracranial aneurysms with poor clinical grades still carries unacceptably high morbidity and mortality rates. Recently surgery for aneurysmal SAH with poor clinical grade has increased interest.

The authors experienced 57 patients with poor clinical grade (Hunt and Hess grade IV-V) after ancurysmal SAH. Among them 25 patients were treated with immediate CSF drainage via ventriculostomy, blood pressure control, early angiography(except 3 patients) and surgery within 12 hour of admission.

The outcomes of patients were categorized using a four-tiered scale :

1) independent and working

2) impaired but independent

3) severly impaired and dependent

4) dead

The average age was 48(13-75) and the male to female ratio was 7:18 in surgical group. The average time to admission and surgery was 12 hours or less among the 25 patients. Among them 9 cases were dead, 2 cases were severly impaired and dependent, 3 cases were impaired but dependent, and 11 cases were independent and working. In this patient all cases, exception one could be ligated with a clip.

The above results suggest that the acute aggressive surgery based on appropriate selection in poor aneurysmal SAH patients can reduce of the mortality.