Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Progression of Subdural Effusion after Surgical Treatment

뇌경막하수종의 수술적 치료에 따른 임상 경과

  • Kim, Jaehyeon (Department of Neurosurgery, Presbyterian Medical Center)
  • Received : 2013.01.31
  • Accepted : 2013.04.11
  • Published : 2013.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to contribute to the medical treatment of subdural effusion through clinical sequence analysis of patients who experienced improvement of subdural drainage and had a second operation for subdural drainage or subduroperitoneal shunt. Sixteen cases of the whole patients who have been underwent subdural effusion and subdural drainage were analyzed during the period from 2006 July to 2012 June. The study gave us a result that all of patients, who was taking aspirin, have been under the second operation(p<0.001) and these group have had a subduraoperitoneal shunt(p=0.014)). According to the comparative analysis for the patients group that divided into two; one had subduroperitoneal shunt and the other had no subduroperitoneal shunt, the outcomes of this study were shown as follows. First, their median line deviation was serious in their brain CT. In addition, their subdural effusion increased or did not change with a headache, vomiting, fever and dyspnea. As a result of those symptoms. subduraoperitoneal shunt was carried out(p=0.006). The surgical method for patients who were taken asprin must be cautiously selected and the prevention of sudden disappearance of cerebrospinal fluid and excessive change of intracranial pressure is very important in operation craniectomy.

본 연구에서는 단순천공배액술을 시행하고 호전된 환자들과 이차 수술로 단순천공배액술을 실시하거나 경막하복강단락술을 실시한 환자들의 임상적 경과 분석을 통해 뇌경막하수종 치료에 도움이 되고자 한다. 2006년 7월부터 2012년 6월까지 본원에서 뇌경막하수종으로 입원하여 단순천공배액술을 시행받은 16례 전체 환자를 대상으로 분석하였다. 연구결과 아스피린을 복용하고 있는 환자는 모두 이차 수술을 시행하였다(p<0.001). 경막하복강단락술을 시행한 환자 4명 중 2명이 아스피린을 복용하여 통계적으로 유의하였다(p=0.014). 경막하복강단락술을 시행한 그룹과 시행하지 않은 그룹 간의 비교 결과, 4명의 환자는 일차수술 후 GCS의 변화는 없었으나 추적 전산화단층촬영 상 정중선 편위가 심하였고 경막하수종은 증가하거나 변화가 없었으며 두통, 구토, 발열, 호흡곤란 등의 뇌압상승 증상을 보여 단락술을 결정하게 되었다(p=0.006). 아스피린을 복용했던 환자들의 수술적 치료는 주의를 요하며 개두술 과정에서 뇌척수액의 급격한 소실과 뇌압의 지나친 변화를 예방하는 것이 중요하다고 사료된다.

Keywords

References

  1. M. A. Zanini, L. A. Resende, A. T. Faleiros, R. C. Gabarra, "Traumatic Subdural Hygromas: Proposed Pathogenesis Based Classification", J. Trauma, 64, 3, 705-713, 2008. DOI: http://dx.doi.org/10.1097/TA.0b013e3180485cfc
  2. K. Imai, "Rapid Spontaneous Resolution of Signs of Intracranial Herniation due to Subdural Hematoma-Case Report", Neurologia Med. Chir., 43, 3, 125-129, 2003. DOI: http://dx.doi.org/10.2176/nmc.43.125
  3. Y. Hasegawa, T. Tanaka, N. Kato, S. Kaku, T. Arai, T. Abe, "Arachnoidplasty for Traumatic Subdural Hygroma Associated with Arachnoid Cyst in the Middle Fossa", Neurol. Med. Chir., 50, 8, 698-701, 2010. DOI: http://dx.doi.org/10.2176/nmc.50.698
  4. M. Escosa-Bage and R. C. Sola, "Physiolopathology of Adult Onset External Hydrocephalus", Revista de Neurologia, 35, 2, 141-144, 2002.
  5. C. Kilincer, O. Simsek, M. K. Hamamcioglu, T. HIcdonmez, S. Cobanoglu, "Contralateral Subdural Effusion After Aneurysm Surgery and Decompressive Craniectomy: Case Report and Review of the Literature", Clinical Neurology and Neurosurgery, 107, 5, 412-416, 2005. DOI: http://dx.doi.org/10.1016/j.clineuro.2004.09.018
  6. S. W. Jeon, J. H. Choi, T. W. Jang, S. M. Moon, H.S. Hwang, J. H. Jeong, "Risk Factors Associated with Subdural Hygroma After Decompressive Craniectomy in Patients with Traumatic Brain Injury: a Comparative Study", J. Korean Neurosurg. Soc., 49, 355-358, 2011. DOI: http://dx.doi.org/10.3340/jkns.2011.49.6.355
  7. M. Caldarelli, C. Di Rocco, R. Romani, "Surgical Treatment of Chronic Subdural Hygromas in Infants and Children", Acta. Neurochir., 144, 581-588, 2002. DOI: http://dx.doi.org/10.1007/s00701-002-0947-0
  8. C. I. Ju, S. W. Kim, S. M. Lee, at al., "The Surgical Results of Trumatic Subdural Hygroma Treated with Subduroperitoneal Shunt", J. Korean Neurosurg. Soc, 37, 136-142, 2005.
  9. K. S. Lee, W. K. Bae, H. G. Bae, I. G. Yun, "The Fate of Traumatic Subdural Hygroma in Serial Computed Tomographic Scans", J. Korean Med. Sci., 15, 5, 560-568, 2000. https://doi.org/10.3346/jkms.2000.15.5.560
  10. H. Openshaw, J. A. Ressler, D.S. Snyder, "Lumbar Puncture and Subdural Hygroma and Hematomas in Hematopoietic Cell Transplant Patients", Bone Marrow Transplant, 41, 9, 791-795, 2008. DOI: http://dx.doi.org/10.1038/sj.bmt.1705971
  11. W. I. Schievink, M. M. Maya, B. K. Pikul, C. Louy, "Spontaneous Spinal Cerebrospinal Fluid Leaks as The Cause of Subdural Hematomas in Elderly Patients on Anticoagulation", J. Neurosurg, 112, 2, 295-299, 2010. DOI: http://dx.doi.org/10.3171/2008.10.JNS08428
  12. K. S. Lee, "The Pathogenesis and Clinical Significance of Traumatic Subdural Hygroma", Brain Inj, 12, 7, 595-603, 1998. DOI: http://dx.doi.org/10.1080/026990598122359
  13. W. W. Choi, K. H. Kim, "Prognostic Factors of Chronic Subdural Hamatoma", J. Korean Neuro. Soc., 32, 18-22, 2002.
  14. B. Aarabi, D. C. Hesdorffier, E. S. Ahn, C. Aresco, T. M. Scalea, H. M. Eisenbeg, "Outcome Following Decompressive Carniectomy for malignant swelling dueto Severe Head Injury", J. Neurosurg. 104, 4, 469-479. 2006. DOI: http://dx.doi.org/10.3171/jns.2006.104.4.469
  15. S. Q. Yu, J.S. Wang, ,N. Ji, "Compressive Brainstem Deformation Resulting from Subdural Hygroma After Neurosurgery: a Case Report", Chinese Medical Journal, 121, 11, 1055-1056, 2008.
  16. N. Yilmaz, N. Kiymaz, C. Yilmaz, A. Bay, "Surgical Treatment Outcomes in Subdural Effusion: a Clinical Study", Pediatr. Nerurosurg., 42, 1, 1-3, 2006. DOI: http://dx.doi.org/10.1159/000089502
  17. B. J. Connolly, L. A. Pearce, T. Kurth, C. S. Kase, R. G. Hart, "Aspirin Therapy and Risk of Subdural Hematoma: Meta-analysis of Randomized Clinical Trials", J. Stroke Cerebrovasc. Dis., 13, 1052-1057, 2013. DOI: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.01.007
  18. D. F. O'Brien, S. Basu, J. R. O'Donnell, G. A. Roberts, J. Phillips,. "Impact of Aspirin Therapy and Anticoagulation on The Prevalence of Spontaneous Subdural Hematoma", Ir. Med. J. 93, 8, 244-246, 2000.
  19. Z. S. Zhanaĭdarov, A. V. Klimash , R. N. Berdiev, V R. K. asumov, E.V. Zavgorodniaia, "Clinico-Neurological Features, Diagnostics and Surgical Treatment of Posttraumatic Chronic Subdural Hematomas", Vestn Khir Im I I Grek, 164, 6, 152-157, 2005.
  20. J. B. Cho, "Surgical Treatment of Subdural Hygromas in Infants and Children", J. Korean Neurosurg. Soc., 38, 273-280, 2005.
  21. B. Mokri, "Headache Caused by Decreased Intracranial Pressure: Diagnosis and Management", Curr. Opin. Neurol., 16, 3, 319-326, 2003. DOI: http://dx.doi.org/10.1097/00019052-200306000-00011
  22. O. A. Sveinsson, H. Asgeirsson, I. H. Olafsson, "Brain Abscess-overvies", Laeknabladid, 99, 1, 25-31, 2013.
  23. S. C. Lee, J. K. Kang, H. J. Jung, J. O. Dho, "Factors Affecting Brain Re-expansion after Simple Burr Hole Drainage in Chronic Subdural Hematoma", J. Korean Neurosurg. Soc., 27, 757-762, 1998.
  24. O. P. Gautschi, D. Cadosch, M. N. Stienen, , "Decompressive Craniectomy in Acu, L. A. Steiner, K. Schaller, "Decompressive Craniectomy in Acute Stroke-The Different Perspective", Anasthesiol Intensivmed Natfallmed Schmerzther, 47, 1, 8-13, 2012. DOI: http://dx.doi.org/10.1055/s-0032-1301374
  25. K. S. Yoon, S. R. Han, G. T. Yee, C. Y. Choi, M. J. Sohn, C. H. Lee, "Subduroperitoneal Shunt for Subdural Hygromas in Adults", J. Korean Neuro. Soc., 37, 436-442, 2005.