• Journal of Trauma and Injury
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• v.30 no.3
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• pp.98-102
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• 2017

Vertex epidural hematoma (VEH) is an uncommon presentation of all epidural hematomas and presents with a wide range of symptom and signs. Diagnosis as well as treatment of VEH is also difficult because of its location adjacent to superior sagittal sinus (SSS). A 43-year-old male visited our hospital after fall down and was diagnosed with VEH. While evaluating its location and patency of SSS, he was deteriorated and urgently underwent evacuation of VEH. Bilateral craniotomies on each side, leaving a central bony island to avoid bleeding of midline structure and provide an anchor for dural tack-ups. After the operation, VEH was totally removed and the patient has restored.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.5
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• pp.488-491
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• 2005

A 3-year-old female, 5kg, Shih-tzu developed an acute onset of depression, disorientation, hypersalivation, nystagmus after falling down 2 meter height place. In plain skull radiography, there was fracture line in the frontal and parietal bones and next day magnetic resonance imaging examination was performed. Magnetic resonance imaging of the brain was performed with 3.0 Tesla unit. Under general anesthesia, the dog was placed in prone with its head positioned in a birdcage coil. Transverse, sagittal and coronal fast spin echo images of the brain were obtained with the following pulse sequences: T1 weighted images (TR = 560 ms and TE = 18.6 ms) and T2 weighted images (TR = 3500 ms and TE = 80 ms). Magnetic resonance imaging showed epidural hematoma in the left frontal area resulting in compression of the adjacent brain parenchyma. Left lateral ventricle was compressed secondarily and the longitudinal fissure shifted to the right, representing mass effect. The lesion was iso-to slightly hyperintense on T1 weighted image and iso-slightly hypointense signal on T2 weighted image. At necropsy, there was a skull fracture and epidural hematoma in the left frontal area. Magnetic resonance imaging of epidural hematoma is reviewed.

• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.541-543
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• 2010

The purpose of this case report is to describe a rare case of a cervicothoracic spinal epidural hematoma (SEH) after anterior cervical spine surgery. A 60-year-old man complained of severe neck and arm pain 4 hours after anterior cervical discectomy and fusion at the C5-6 level. Magnetic resonance imaging revealed a postoperative SEH extending from C1 to T4. Direct hemostasis and drainage of loculated hematoma at the C5-6 level completely improved the patient's condition. When a patient complains of severe neck and/or arm pain after anterior cervical spinal surgery, though rare, the possibility of a postoperative SEH extending to non-decompressed, adjacent levels should be considered as with our case.

• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.335-339
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• 2006

Objective : The authors present eight cases of immediate post-operative epidural hematomas[EDHs] adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. Methods : Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. Results : In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography[CT] scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. Conclusion : Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.36-53
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• 2024

As the number of spinal surgeries being performed expands, the number of medical imaging procedures such as radiography, CT, and MRI is also increasing, and the importance of their interpretation is becoming more significant. Herein, we present the radiological findings of a variety of complications that can occur after spinal surgery and discuss how effectively and accurately they can be diagnosed through imaging. In particular, this study details the characteristic imaging findings specific to the early and long-term postoperative periods. Early complications of spinal surgery include improper placement of surgical instruments (instrument malpositioning), seromas, hematomas, pseudomeningoceles, and infections in the region surrounding the surgical site. Conversely, long-term complications may include osteolysis around surgical instruments, failure of fusion, adjacent segment disease, and the formation of epidural fibrosis or scar tissue. A precise understanding of the imaging assessments related to complications arising after spinal surgery is crucial to ensure timely and accurate diagnosis, which is necessary to achieve effective treatment.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1055-1062
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• 2000

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.