Object. It remains unclear whether elderly patients with compressive cervical myelopathy can be expected to experience a promising surgery-related outcome after undergoing expansive laminoplasty. The purposes of this study were to evaluate the efficacy of expansive laminoplasty in elderly patients with cervical myelopathy due to multisegmental spondylotic canal stenosis and to analyze the effect of preoperative prognostic factors on outcome in elderly compared with younger patients. Methods. The authors reviewed the cases of 22 elderly (> 70 years of age) and 39 younger patients in whom expansive open-door laminoplasty was performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. The pre- and 12-month postoperative clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) disability scale. Factors affecting the clinical outcome were statistically analyzed by evaluating the recovery rate calculated from the JOA scale. There were no significant differences in the mean value of the preoperative factors, especially preoperative duration of symptoms and severity of preoperative disease, between the elderly and younger patient groups. In all patients, age at the time of the operation was shown to exert no significant influence on clinical outcome. The mean recovery rate was 58.8% in the elderly group and 61.8% in the younger group, and there was no significant intergroup difference. Improvement or attenuation in impaired upper- and lower-leg motor function was shown in all patients as was an absence in decline of sensory impairment of the extremities. In the elderly group, both the duration of symptoms and the severity of canal stenosis significantly (p < 0.05) affected the clinical outcome. In the younger group, the severity of preoperative symptoms had a significant (p < 0.05) influence on clinical outcome, whereas duration of the symptoms did not appreciably affect clinical improvement. Conclusions. Open-door expansive laminoplasty showed a promising effect on clinical outcome in elderly and younger patients with multisegmental cervical canal stenosis. Significant predictive factors for clinical outcome in the elderly patients were the duration of symptoms and the severity of stenosis, which may involve the static factor causing the cervical myelopathy. To improve the elderly patients' disability, surgery must be performed as early as possible before irreversible changes in the spinal cord develop.

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Background and Purpose: Delayed ischemic deficits contribute to the high morbidity and mortality rates associated with subarachnoid hemorrhage. We evaluated the potential usefulness of measuring coagulation and hemorheological variables and cardiolipin antibodies for prediction of delayed ischemic deficit after subarachnoid hemorrhage.Methods: Consecutive patients with subarachnoid hemorrhage were studied. Coagulation and hemorheological variables and cardiolipin antibodies were measured on admission, within 7 days of subarachnoid hemorrhage. A subset of patients was studied on admission and at two subsequent occasions.Results: Sixty-nine patients were studied. Sixty-one of these were without clinical manifestations of vasospasm at admission, and 16 developed delayed ischemic deficit during their hospitalization. None of the laboratory variables measured were significantly different between patients with or without later development of delayed ischemic deficit. Elevation of the fibrin fragment D-dimer was found in the group of eight patients admitted with ischemic symptoms and in 49% (34 of 69) of all patients, but this was not associated with delayed ischemic deficit. Sixteen patients were studied on three occasions; this group showed a significant decrease in hematocrit, an increased white blood cell count, and no change in fibrinogen concentration.

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Pre-radiosurgical embolization was carried out using cyanoacrylate in seven of 13 patients with cerebral arteriovenous malformations (AVMs) treated by stereotactic radiosurgery (SRS) with a linear accelerator (LINAC). The aim of embolization before SRS was the reduction of AVM volume and/or the elimination of vascular structures bearing an increased risk of haemorrhage. Staged-volume SRS was also performed in two patients because of residual irregular shaped nidus of AVMs even after the embolizations. Complete obliteration of the AVM nidus on angiogram was presented in five patients with embolizations (including one with staged-volume SRS) and in three of six patients with SRS alone, during follow-up periods after radiosurgery. No patients experienced haemorrhagic events after SRS. Although transient neurological symptoms were observed after embolizations in two patients, no permanent neurological deficits were presented in all patients with SRS. Pre-radiosurgical embolization may allow the effective influence on irradiation therapy in relatively large AVMs and promote more frequent obliteration in more small sized AVMs compared to those with SRS alone. However, further study must be needed to determine whether staged-volume SRS provides a high rate of AVM obliteration and its safeness.