• Title/Summary/Keyword: Burr-hole

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A Clinical Analysis of Chronic Subdural Hematoma according to Age Factor (연령에 따른 만성 뇌경막하 혈종의 임상적 분석)

  • Jeong, Jae Eun;Kim, Gook Ki;Park, Jong Tae;Lim, Young Jin;Kim, Tae Sung;Rhee, Bong Arm;Leem, Won
    • Journal of Korean Neurosurgical Society
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    • v.29 no.6
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    • pp.748-753
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    • 2000
  • Objectives : A 10-year retrospective clinical study was undertaken to determine the differences between two groups according to age at presentation(group A, under 50 ; B, over 50). Methods : We analyzed 468 cases with chronic subdural hematoma admitted to the department of neurosurgery in our hospital from January 1987 to December 1996. The patients were divided into two groups according to age at presentation(group A, under 50 ; B, over 50). Results : 1) The number of group A was 126 cases(26.9%) and that of group B was 342 cases(73.1%), respectively. Males were more frequently involved than females in each group. 2) There noted a history of head trauma in 88.9% of group A and 92.4% of group B. Forty-nine patients(38.9%) of group A and 103 cases(30.1%) of group B revealed a history of alcoholism. 3) Group A patients presented with symptoms of increased intracranial pressure such as headache(75.% ), nausea and vomiting(68.0%). However, Group B patients had more frequent mental changes(84.0%) and focal neurological deficits such as hemiparesis(76.5%). 4) Onset of symptom and its duration was shorter in group A than group B. 5) Six patients among 441 cases(1.4%) treated with burr hole drainage and two patients of 27 cases(5.4%) with craniotomy died, and all of these were group B patients. The two cases among six patients with burr hole drainage developed huge intracerebral hemorrhage and brain stem hemorrhage, respectively. Conclusion : In treating patients with chronic subdural hematoma, distinguishing between two age groups is quite helpful to determine treatment strategies.

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Guidelines for Free-Hand Aspiration(FHA) of Putaminal Hemorrhage (피각부 자발성 뇌내출혈의 혈종흡입술을 위한 지표)

  • Yim, Sin Gil;Oh, Min Suk;Lim, Jun Seob;Kang, Myung Gi;Kwak, Yeon Sang;Park, Seung Gyu;Song, Gyung Bae;Kim, Han Yung
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup2
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    • pp.294-299
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    • 2001
  • Objectives : CT-guided stereotactic evacuation for spontaneous intracerebral hemorrhage can minimize the brain damage and can be performed safely and simply under local anesthesia. But that procedure is time consuming and has a risk of rebleeding because of the stress during head pin fixation. So authors describe easy and precise guidelines for FHA of putaminal hemorrhage without stereotactic instrument. Methods and Materials : We analyzed the data of 298 patients who underwent CT-guided stereotactic aspiration of putaminal hematoma in our hospital between January 1990 and December 2000. We divided the patients into three groups according to the location of hematoma : anterior portion, middle portion and posterior portion of putamen. Total number of catheters inserted into the hematoma were 345 and there were with regard to the direction and depth of catheters. Results : Proposed guidelines of catheter insertion to putaminal hemorrhage in our institution. 1) hematoma at the anterior portion of putamen ; Direction of catheter was the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between external auditory meatus(EOM) and 1cm posterior to EOM. Depth of catheter was 6-6.5cm. 2) hematoma at the middle portion of putamen ; Direction of catheter was the midpupillary line of the the eye and the point intersecting a line drawn from the burr hole to a point between 1cm and 2cm posterior to EOM. Depth of catheter was 6.5-7cm. 3) hematoma at the posterior portion of putamen ; Direction of catheter was 15 degree laterally from the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between 2cm and 3cm posterior to EOM. Depth of catheter was 7-7.5cm. We have performed FHA of putaminal hemorrhage in 48 cases according to this guideline. All catheter were inserted exactly at the center of hematoma and average operation time was about 30 minutes. Conclusion : Our proposed guidelines for putaminal hemorrhage are considered to be safe and simple method with similar accuracy and rapid decompression compared with traditional stereotactic method. Main advantages of this technique were unnecessity of stereotactic frame application and less time requirement for hematoma removal.

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Evaluation of punching process variables influencing micro via-hole quality of LTCC green sheet (LTCC 기판의 미세 비아홀 펀칭 중 공정 변수의 영향 평가)

  • Baek S. W.;Rhim S. H.;Oh S. I.;Yoon S. M.;Lee S.;Kim S. S.
    • Proceedings of the Korean Society for Technology of Plasticity Conference
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    • 2004.11a
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    • pp.260-265
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    • 2004
  • LTCC(Low temperature co-fired ceramic) is being recognized as a significant packaging material of electrical devices for the advantages such as relatively low temperature being needed for process, low conductor resistance and high printing resolution. In the process of LTCC electrical devices, the punched via-hole quality is one of the most important factors on the performance of the device. However, its mechanism is very complicated and optimization of the process seems difficult. In this paper, to clarify the process, via-hole punching experiments were carried out and the punched holes were examined in terms of their burr formation. The effects of thickness of PET sheet and ceramic sheet and punch-to-die clearance on via-hole quality were also discussed. Optimum process conditions are proposed and a factor k is introduced to express effect of the process variables.

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A study of Pulse EMM for Invar alloy (펄스 전압을 이용한 인바 합금의 미세 전해가공)

  • 김원묵;백승엽;이은상;탁용석
    • Proceedings of the Korean Society of Precision Engineering Conference
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    • 2004.10a
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    • pp.560-563
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    • 2004
  • Invar is a compound metal of Fe-Ni system and contain 36% Ni. The most distinction characteristic of Invar is the coefficient of thermal expansion is 1.0 10$^{-6}$ /$^{\circ}C$. That is a tenth of general steel material. This low thermal expansion characteristic of Invar is applied to the missile, aircraft, monitor CRT and frontier display's shadow mask such as FED and OLED. The usage of the Invar shadow mask for display is increasing due to the requirement of larger size and flatness monitor. The Invar shadow mask is machined by two ways electro-forming and laser now. However the electro-forming takes a too long time and the laser machining is accompanied with Burr. In this study, PEMM(pulse electrochemical micro machining) is conducted to machine the micro hole to the Invar and 80${\mu}{\textrm}{m}$ hole was machined.

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Predictive Factors for Recurrence after Burr-Hole Craniostomy of Chronic Subdural Hematoma

  • Kim, Sang Uk;Lee, Dong Hoon;Kim, Young Il;Yang, Seung Ho;Sung, Jae Hoon;Cho, Chul Bum
    • Journal of Korean Neurosurgical Society
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    • v.60 no.6
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    • pp.701-709
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    • 2017
  • Objective : Chronic subdural hematoma is a common and relatively benign disease. However, recurrence is common after surgical treatment, and the recurrence rate varies from 5% to 33%. The aim of this study was to investigate the predictive factors for recurrence of chronic subdural hematoma. Methods : We analyzed data from 248 patients with chronic subdural hematoma who were treated by burr-hole craniostomy with a closed drainage system for hematoma evacuation in this five-year retrospective study. Results : Thirty-one (12.6%) patients underwent re-operation for recurrence of chronic subdural hematoma. Univariate analysis revealed that anticoagulation (p=0.0279), headache (p=0.0323), and preoperative midline shifting (p=0.0321) showed significant differences with respect to recurrent chronic subdural hematoma. We performed a multivariate logistic regression analysis and found that diabetes mellitus (odds ratio [OR], 2.618; 95% confidence interval [CI], 1.0899-6.2898; p=0.0314), anticoagulation (OR, 6.739; 95% CI, 1.1287-40.2369; p=0.0364), headache (OR, 2.951; 95% CI, 1.1464-7.5964; p=0.0249), and preoperative midline shifting (OR, 1.0838; 95% CI, 1.0040-1.1699; p=0.0391) were independent predictive factors for recurrence of chronic subdural hematoma. Conclusion : We showed that diabetes mellitus, anticoagulation, headache, and preoperative midline shifting were independent predictors of recurrence of chronic subdural hematoma.

Analysis of Management According to CT Findings in Chronic Subdural Hematoma

  • Kim, Hae-Yoo;Kwon, Soon-Chan;Kim, Tae-Hong;Shin, Hyung-Shik;Hwang, Yong-Soon;Park, Sang-Keun
    • Journal of Korean Neurosurgical Society
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    • v.37 no.2
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    • pp.96-100
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    • 2005
  • Objective: The brain computed tomography(CT) is an important tool throughout the clinical course of chronic subdural hematoma(CSDH). In CT findings, the density of CSDH is different in each case. We analyze management options and results according to the density of CSDH. Methods: Seventy one patients with CSDH, who had been managed in our institute from August 2001 to December 2003, were reviewed retrospectively. The authors divided the patients into six groups according to the density of hematoma; Group A-hypodense rather than the brain parenchyma, group B-isodense, group C-hyperdense, group D-mixed with hypodense and hyperdense, group E-mixed with isodense and hypodense and group F-mixed with isodense and hypersdense. In each group, the operation method, the duration of the indwelling catheter and prognosis were analyzed. Results: The patients who showed mixed density were 39 and, those who showed single density were 32. All the patients underwent burr hole drainage for the primary choice. There was only two cases that needed additional craniotomy. The average duration of indwelling catheter was $5.40{\pm}1.91$ days. Statistically the duration was not different in each group(p-value<0.05, $x^2$ test). Three cases recurred, one in group C, another in group D, and the last in group E. It had no statistical significance due to low incidence of recurrence. Conclusion: We conclude that burr hole drainage is an acceptable primary treatment option for CSDH even though the density of hematoma is different in every single case.

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

  • Oh, Hyuk-Jin;Seo, Youngbeom;Choo, Yoon-Hee;Kim, Young Il;Kim, Kyung Hwan;Kwon, Sae Min;Lee, Min Ho;Chong, Kyuha
    • Journal of Korean Neurosurgical Society
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    • v.65 no.2
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    • pp.255-268
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    • 2022
  • Objective : Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence. Methods : We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women. Results : The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017). Conclusion : This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.

Non-surgical Recovery of a Chronic Subdural Hemorrhage Patient via the Exclusive Administration of Oryeong-san: A Case Report (오령산 단독 투여에 의한 만성 경막하출혈 환자의 비수술적 회복)

  • Juhwan Song;Sangho Ji;Sunny Kang;Sangkwan Lee;Cheol-Hyun Kim
    • The Journal of Internal Korean Medicine
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    • v.44 no.5
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    • pp.867-874
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    • 2023
  • Introduction: Chronic subdural hemorrhage (CSDH) primarily affects the elderly, and its incidence is rising due to aging trends. Although burr-hole craniostomy is a common treatment for CSDH, it often has a high recurrence rate and can sometimes result in poor outcomes. Oryeong-san, a traditional Korean medicine, is emerging as a potential remedy, with documented cases in both Korea and Japan. Case Presentation: In March 2021, a patient was diagnosed with an intracerebral hemorrhage in the left basal ganglia. A subsequent brain computed tomography in June 2022 revealed CSDH. Given the potential need for surgery if no CSDH absorption occurred, the patient was treated with Oryeong-san. Later computed tomography scans indicated that surgery was no longer necessary. Conclusions: This study evaluated the efficacy of Oryeong-san in treating CSDH. The results demonstrated complete CSDH absorption with no observed side effects, highlighting Oryeong-san as a promising and safe therapeutic option.

A Study of Automobile Product Design using Hole Expansion Testing of High Strength Steels (고장력강의 구멍 확장 실험을 이용한 자동차부품 설계연구)

  • Park, B.C.;Bae, K.U.;Gu, S.M.;Jang, S.H.;Hong, S.H.;Kim, Y.S.
    • Transactions of Materials Processing
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    • v.19 no.6
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    • pp.337-343
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    • 2010
  • Current need of weight reduction in automotive part increases the application for high strength steel (HSS). The various types of high strength steels have been used to produce chassis part, control arms and trailing arms for weight reduction and increasing of fatigue durability such as dual phase steel (DP) and ferrite bainite steel (FB). But, DP and FB steels have proven to show inferiority in durability as well as press formability. Edge cracking occurred often in flange forming and hole expansion processes is the major failure encountered. This paper discussed the behavior of edge stretchability of high strength steel of DP and FB steels. Experimental works have been conducted to study the effect of punch clearance and burr direction on hole expansion ratio (HER). Also finite element simulation (FEM) has been preformed to clarify the mechanism of flange crack and support the experimental results on HER of DP and FB steels. It was simulated the whole process of blanking process following by hole expansion process and ductile fracture criterion named the modified Cockcroft-Latham model which was used to capture the fracture initiation. From the hole expansion tests and FEM simulation studies it was concluded that ferrite bainite steel showed better stretch-flangeability than dual phase steel. It was attributed to the lower work hardening rate of ferrite bainite steel than dual phase steel at the sheared edge.

The Femto Second Laser Induced Ablation on the Titanium Alloy for Various Beam Overlap Ratio (빔 중첩율에 따른 티타늄 합금의 펨토초 레이저 어블레이션)

  • Chung, Il-Young;Kang, Kyung-Ho;Kim, Jae-Do
    • Journal of the Korean Society for Precision Engineering
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    • v.27 no.11
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    • pp.17-23
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    • 2010
  • Titanium alloy is one of the hard processing materials made by the traditional manufacturing method because of the excellent mechanical strength. Ablation of titanium alloy is investigated by using a femtosecond laser which is a regenerative amplified Ti:sapphire laser with 1kHz repetition rate, 184fs pulse duration time and 785nm wavelength. Experiments are carried out under various ablation conditions with different pulse overlap ratios for the rectangular shape and micro hole. Test results show that the ablation characteristic according to pulse overlap ratio of titanium alloy seems to be as non-linear type at the different zone of energy fluence. The optimal condition of rectangular shape processing is obtained at the laser peak power 1.3mW, pulse overlap ratio of 90%, beam gap of $1\;{\mu}m$. The micro hole has a good quality from the pulse overlap ratio of 99% at the same laser peak power. With the optimal processing condition, the fine rectangular shape and micro hole without burr and thermal damage are achieved.