Stereotactic evacuation of hematoma is clearly of value in selected patients with spontaneous putuminal hemorrhage, whose eyes are closed but will open in response to strong stimuli (neurological Grade 3) on admission.

The present study analyzed the impact of case volume on outcome after cerebral aneurysm clipping at all 382 core neurosurgical training centers certified by the Japan Neurosurgical Society. A survey requested information on all clipping surgeries for cerebral aneurysms performed during 2003. Among these centers, 369 (96.6%) responded to our request and data satisfactory for analysis were obtained for 11,974 patients. Clinical condition was graded on admission according to the classification of the World Federation of Neurosurgical Societies. Outcomes were evaluated at discharge using the modified Rankin scale. Case volume at centers was divided into three groups based on the number of clippings (º30, 30-50, AE50) performed in 2003. Totals of 7,578 (63.3%) and 4,396 (36.7%) patients underwent clipping for ruptured and unruptured aneurysms, respectively. The mortality rate was 9.6% for patients with ruptured aneurysms, and 0.2% for patients with unruptured aneurysms. No significant correlation was detected between case volume and outcome for either ruptured (Spearman's correlation coefficient ＝ 0.034, p ＝ 0.483) or unruptured aneurysms (Spearman's correlation coefficient ＝ 0.029, p ＝ 0.562). Furthermore, no relationships between case volume and outcome were identified for ruptured aneurysms in each neurological grade or unruptured aneurysms (Kruskal-Wallis test).

Stroke leaves serious neurological sequelae, which require long-term medical and social care, imposing financial and mental burdens on the patients and their families, and causing enormous losses to society. It is currently required that medical resources be used efficiently and the cost-effectiveness of treatment be analyzed carefully. We conducted a follow-up survey of stroke patients admitted to the hospital attached to our university in order to build a picture of the current status of chronic-phase stroke medical treatment. In total, 330 patients were analyzed in this study. We evaluated utility and medical cost at one year after onset. To investigate the relationship between activities of daily living (ADL) classified according to the modified Rankin scale (mRS) and quality of life (QOL), utility was calculated for each ADL level. Utility at 1 year post-onset for each mRS level was: ADL0, 0.89; ADL1, 0.79; ADL2, 0.65; ADL3, 0.58; ADL4, 0.36; and ADL5, 0.09. A significant correlation was seen between utility and mRS. Direct monthly medical costs at 1 year post-onset were 61,536 yen in the ADL0 group and 383,444 yen in the ADL5 group, indicating that a worse ADL score required higher medical costs. Direct monthly costs were significantly different between ADL levels. This present study has clarified the QOL and medical costs of chronic-phase stroke patients, and many cost-utility analyses will be based on our data in the future in Japan.

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