• Journal of Korean Neurosurgical Society
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• 제53권6호
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• pp.380-382
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• 2013

We report a case of fatal duret hemorrhage (DH) in a patient with acute tentorial subdural hematoma and bilateral chronic subdural hematoma along the cerebral hemispheres. Preoperative CT angiography (CTA) revealed prominent parenchymal enhancement in the ventral pontomesencephalic area. After burr-hole drainage, a large hemorrhage developed in this area. The parenchymal enhancement in the CTA may reflect the pontomensencephalic perforating vessel injury, and may be a sign of impending DH of acute transtentorial downward herniation. Previous use of aspirin and warfarin might have potentiated the process of DH and increase the extent of the bleed.

• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.243-247
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• 2014

Objective : To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. Methods : We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. Results : Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. Conclusion : Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.

• 대한핵의학회지
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• 제2권1호
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• pp.59-66
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• 1968

Technetium 99m pertechnetate brain scanning were performed in 3 cases of head injury (2 chronic subdural hematomas and 1 acute epidural hematoma), 2 cases of brain abscess and I case of intracerebral hematoma associated with arteriovenous anomaly. In all the cases brain scintigrams showed "hot areas." Literatures on radioisotope scanning of intracranial lesions were briefly reviewed. With the improvement of radioisotope scanner and development of new radiopharmaceuticals brain scanning became a safe and useful screening test for diagnosis of intracranial lesions. Brain scanning can be easily performed even to a moribund patient without any discomfort and risk to the patient which are associated with cerebral angiography or pneumoencephalography. Brain scanning has been useful in diagnosis of brain tumor, brain abscess, subdural hematoma, and cerebral vascular diseases. In 80 to 90% of brain tumors positive scintigrams can be expected. Early studies were done with $^{203}Hg$-Neohydrin or $^{131}I$-serum albumin. With these agents, however, patients receive rather much radiation to the whole body and kidneys. In 1965 Harper introduced $^{99m}Tc$ to reduce radiation dose to the patient and improve statistical variation in isotope scanning.

• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.235-241
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• 2015

Objective : Magnetic resonance imaging (MRI) of chronic subdural hematoma (CSDH) detects various patterns, which can be attributed to many factors. The purpose of this study was to measure the level of interleukin-6 (IL-6), interleukin-8 (IL-8), and highly specific protein [beta-trace protein (${\beta}TP$)] for cerebrospinal fluid (CSF) in CSDHs, and correlate the levels of these markers with the MRI findings. Methods : Thirty one patients, treated surgically for CSDH, were divided on the basis of MRI findings into hyperintense and non-hyperintense groups. The concentrations of IL-6, IL-8, and ${\beta}TP$ in the subdural fluid and serum were measured. The ${\beta}TP$ was considered to indicate an admixture of CSF to the subdural fluid if ${\beta}TP$ in the subdural fluid $({\beta}TP_{SF})/{\beta}TP$ in the serum $({\beta}TP_{SER})>2$. Results : The mean concentrations of IL-6 and IL-8 of the hyperintense group (n=17) of T1-WI MRI were $3975.1{\pm}1040.8pg/mL$ and $6873.2{\pm}6365.4pg/mL$, whereas them of the non-hyperintense group (n=14) were $2173.5{\pm}1042.1pg/mL$ and $2851.2{\pm}6267.5pg/mL$ (p<0.001 and p=0.004). The mean concentrations of ${\beta}TP_{SF}$ and the ratio of ${\beta}TP_{SF}/{\beta}TP_{SER}$ of the hyperintense group (n=13) of T2-WI MRI were $7.3{\pm}2.9mg/L$ and $12.6{\pm}5.4$, whereas them of the non-hyperintense group (n=18) were $4.3{\pm}2.3mg/L$ and $7.5{\pm}3.9$ (p=0.011 and p=0.011). Conclusion : The hyperintense group on T1-WI MRI of CSDHs exhibited higher concentrations of IL-6 and IL-8 than non-hyperintense group. And, the hyperintese group on T2-WI MRI exhibited higher concentrations of ${\beta}TP_{SF}$ and the ratio of ${\beta}TP_{SF}/{\beta}TP_{SER}$ than non-hyperintense group. These findings appear to be associated with rebleeding and CSF admixture in the CSDHs.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.87-92
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• 2009

Objective: Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. Methods: From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge. Results: Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p> 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates. Conclusion: In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.

• Journal of Korean Neurosurgical Society
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• 제66권6호
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• pp.726-734
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• 2023

Objective : Chronic subdural hematoma (CSDH) patients using antithrombotic agents (AT) at high risk for cardiovascular disease are increasing. The authors aimed to analyze the factors influencing outcome by targeting patients using AT and to establish a desirable treatment strategy. Methods : A retrospective analysis was performed on data from 462 patients who underwent burr hole trephination (BHT) surgery for CSDH at five hospitals from March 2010 to June 2021. Outcomes included incidence of postoperative acute bleeding, recurrence rate, and morbidity or mortality rate. Patients were divided into the following four groups based on their history of AT use : no AT. Only antiplatelet agents (AP), only anticoagulants (AC), both of AP and AC. In addition, a concurrent literature review was conducted alongside our cohort study. Results : Of 462 patients, 119 (119/462, 25.76%) were using AT. AP prescription did not significantly delay surgery (p=0.318), but AC prescription led to a significant increase in the time interval from admission to operation (p=0.048). After BHT, AP or AC intake significantly increased the period required for an in-dwelling drain (p=0.026 and p=0.037). The use of AC was significantly related to acute bleeding (p=0.044), while the use of AP was not (p=0.808). Use of AP or AC had no significant effect on CSDH recurrence (p=0.517 and p=1.000) or reoperation (p=0.924 and p=1.000). Morbidity was not statistically correlated with use of either AP or AC (p=0.795 and p=0.557, respectively), and there was no significant correlation with mortality for use of these medications (p=0.470 and p=1.000). Conclusion : Elderly CSDH patients may benefit from maintenance of AT therapy during BHT due to reduced thromboembolic risk. However, the use of AC necessitates individualized due to potential postoperative bleeding. Careful post-operative monitoring could mitigate prognosis and recurrence impacts.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1997년도 추계 학술대회 연제집
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• pp.223-225
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• 1997

• Journal of Korean Neurosurgical Society
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• 제37권6호
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• pp.436-442
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• 2005

Objective: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. Methods: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. Results: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. Conclusion: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.

• 대한한의학방제학회지
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• 제26권4호
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• pp.341-362
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• 2018

Objective : This study's purpose was to review the clinical studies of Oryeong-San. Method : We searched papers about Oryeong-San using KISS, KTKP, PUBMED, Embase, Science Direct, and the key words "Goreisan", "Goreito", "Wu Ling San", "Oryeongsan", "Poria Five Powder" were used. Papers not matched with inclusion criteria were excluded. Results : Until today, there have been 133 studies on the effects of head diseases, urinary system diseases, edema, and other various effects of Oryeong-San. Of these, 23 studies were classified as clinical research papers. There were 8 cases of head diseases, 5 cases of urinary system diseases, 3 cases of edema, 2 cases of adjuvant, 1 case of Dysmenorrhea, 1 case of Primary Hypertension, 1 case of Primary Insomnia, 1 case of hydrocele, 1 case of side effects causing TINU syndrome. Conclusion : It can be seen that Oryeong-San has established the basis for application to the purpose of head disease(chronic subdural hematoma, hydrocephalus, hearing loss), urinary system disease(stone, urinary tract infection), edema, adjuvant, other hypertension and insomnia. On the other hand, considering one case that causes side effect of TINU syndrome, caution should be exercised when observing the progress of the patient taking the Oryeong-San.

• 대한중풍순환신경학회지
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• 제12권1호
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• pp.1-7
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• 2011

Objectives : The purpose is to discuss the clinical applications of Orungsan(Goreisan: 五苓散) as an alternative management for increased intracranial pressure in the field of neurosurgery in Japan. Methods and Results : Attention has focused on Kampo medicine(traditional Japanese medicine) for some cerebral disease including chronic subdural hematoma(CSDH) and cerebral infarction in Japan. Orungsan and one of its classes, Sirungtang(Saireto: 柴苓湯) are well known their effects on brain edema. After some studies of Orungsan has the anti-edemic effects by the inhibition of aquaporin, this herbal medicine has been used widely in the neurosurgery field in Japan. It is high time to think about where we are and we go ahead for the progress and the integration in medicine. We have reviewed the studies using Orungsan or Sirungtang, that was reported at the 20th annual meeting of 'the Japan society for Kampo medicine and neurological surgery' was held on November 5, 2011 in Tokyo. Fifteen studies related with Orungsan or Sirungtang were reported among all 32 studies at the meeting. Orungsan in ten, and Sirungtang in five among 14 studies contained specific clinical case. In the aspects of disease, thirteen papers were related with SDH, including CSDH(11), SSDH(1), aneurism clipping for SDH prevention(1), and one was acute cerebral infarction and one was multiple metastatic brain tumor. In the report style, case control study was 7(mostly retrospective), and the case report was 8. Conclusions : Orungsan may be plausible to be an alternative method to reduce brain edema after SDH and other brain injury in the field of neurosurgery.