• Korean Journal of Adult Nursing
• /
• v.19 no.1
• /
• pp.45-54
• /
• 2007

Purpose: This study was to identify the significant acute physiological predictors of mortality and of functional and cognitive recovery in hemorrhagic stroke patients. Methods: The subjects were 108 hemorrhagic stroke patients admitted to Neurological Intensive Care Unit of a university hospital. Results: The significant physiological predictors of mortality and of functional and cognitive recovery were quite different upon admission Glasgow Coma Scale scores: respiratory rate, hematocrit, serum pH, osmolality, and $PaCO_2$ were the predictors in the subjects with a high Glasgow Coma Scale scores while blood pressure, $PaO_2$, respiratory rate, and hematocrit in the subjects with a low Glasgow coma scale scores. Conclusion: The physiological derangements induced by acute stroke are undoubtedly influence clinical outcome. More study is required to determine their diverse impacts on clinical outcomes.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.4
• /
• pp.500-506
• /
• 2000

Objective : To determine the role of preoperative embolization on postoperative neurological outcome in the treatment of cerebral AVMs, we retrospectively evaluated an effectiveness of combining preoperative embolization and microsurgery for arteriovenous malformations(AVM) of the brain. Method : Two groups(10 patients who underwent preoperative superselective embolization and surgery versus 27 patients who underwent surgery only) were compared and categorized by Spetzler-Martin grade, the size of AVM and postoperative clinical outcome using Glasgow Outcome Scale. The 37 patients included 23 males and 14 females, ranging in age from 11 to 74 years(mean 36 years). Results : The arteriovenous malformations in preoperative embolization and surgery group had a larger average greatest diameter(4.45cm versus 3.83cm) and were of higher Spetzler-Martin grade(80% versus 52% grade III through V). At 1 week after surgery, the preoperative embolization and surgery group represented a better outcome(60% versus 44% with Glasgow Outcome Scale score of 5). And over 6 months after surgery, the embolization and surgery group displayed more favorable clinical outcome(80% versus 63% with Glasgow Outcome Scale score of 5). Conclusion : Combined treatment with superselective preoperative embolization using N-butyl cyanoacrylate and direct surgery may help neurosurgeon treating the high grade AVMs thus improving the postsurgical outcome.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.3
• /
• pp.278-283
• /
• 2001

Objective : Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. Method : We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : All 15 patients(five men, ten women ; mean age, 52.3 years ; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale : GOS I, II), unfavorable in 6 cases(Glasgow outcome scale : GOS III, IV) and dead in 4 cases. Conclusion : Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.2
• /
• pp.232-242
• /
• 2019

Objective : To investigate the effects of trauma center establishment on the clinical characteristics and outcomes of trauma patients with traumatic brain injury (TBI). Methods : We enrolled 322 patients with severe trauma and TBI from January 2015 to December 2016. Clinical factors, indexes, and outcomes were compared before and after trauma center establishment (September 2015). The outcome was the Glasgow outcome scale classification at 3 months post-trauma. Results : Of the 322 patients, 120 (37.3%) and 202 (62.7%) were admitted before and after trauma center establishment, respectively. The two groups were significantly different in age (p=0.038), the trauma location within the city (p=0.010), the proportion of intensive care unit (ICU) admissions (p=0.001), and the emergency room stay time (p<0.001). Mortality occurred in 37 patients (11.5%). Although the preventable death rate decreased from before to after center establishment (23.1% vs. 12.5%), the difference was not significant. None of the clinical factors, indexes, or outcomes were different from before to after center establishment for patients with severe TBI (Glasgow coma scale score ${\leq}8$). However, the proportion of inter-hospital transfers increased and the time to emergency room arrival was longer in both the entire cohort and patients with severe TBI after versus before trauma center establishment. Conclusion : We confirmed that for patients with severe trauma and TBI, establishing a trauma center increased the proportion of ICU admissions and decreased the emergency room stay time and preventable death rate. However, management strategies for handling the high proportion of inter-hospital transfers and long times to emergency room arrival will be necessary.

• Journal of Korean Neurosurgical Society
• /
• v.42 no.4
• /
• pp.331-336
• /
• 2007

Objective : The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy. Methods : From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale. Results : All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases. Conclusion : We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.

• Journal of Korean Neurosurgical Society
• /
• v.44 no.3
• /
• pp.141-145
• /
• 2008

Objective : Barbiturate coma therapy (BCT) has been known to be an useful method to control increased intracranial pressure (IICP) refractory to medical and surgical treatments. We have used BCT for patients with severe IICP during the past 10 years, and analyzed our results with review of literatures. Methods : We analyzed 92 semicomatose or comatose patients with Glasgow coma scale (GCS) of 7 or less with severe IICP due to cerebral edema secondary to parenchymal damages irrespective of their causes. Forty patients who had received BCT with ICP monitoring from January 1997 to December 2006 were included in BCT group, and fifty-two patients who had been managed without BCT from January 1991 to December 1995 were divided into control group. We compared outcomes with Glasgow outcome scale (GOS) and survival rate between the two groups. Results : Good outcome (GOS=4 and 5) rates at 3-month after insult were 27.5% and 5.8% in BCT and control group, respectively (p<0.01). One-year survival rates were 35.9% and 12.5% in BCT and control group, respectively (p<0.01). In BCT group, the mean age of good outcome patients ($37.1{\pm}14.9$) was significantly lower than that of poor outcome patients ($48.1{\pm}13.5$) (p<0.05). Conclusion : With our 10-year experience, we suggest that BCT is an effective treatment method for severe IICP patients for better survival and GOS, especially for younger patients.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.1
• /
• pp.34-41
• /
• 2014

Objective : The purpose of this study was to describe the clinical characteristics, treatment outcomes, and prognostic factors in patients with brain abscesses treated in a single institute during a recent 10-year period. Methods : Fifty-one patients with brain abscesses who underwent navigation-assisted abscess aspiration with antibiotic treatment were included in this study. Variable parameters were collected from the patients' medical records and radiological data. A comparison was made between patients with favorable [Glasgow Outcome Scale (GOS) ${\geq}4$] and unfavorable (GOS <4) outcomes at discharge. Additionally, we investigated the factors influencing the duration of antibiotic administration. Results : The study included 41 male and 10 female patients with a mean age of 53 years. At admission, 42 patients (82%) showed either clear or mildly disturbed consciousness (GCS ${\geq}13$) and 24 patients (47%) had predisposing factors. The offending microorganisms were identified in 25 patients (49%), and Streptococcus species were the most commonly isolated bacteria (27%). The mean duration of antibiotic administration was 42 days. At discharge, 41 patients had a favorable outcome and 10 had an unfavorable outcome including 8 deaths. The decreased level of consciousness (GCS <13) on admission was likely associated with an unfavorable outcome (p=0.052), and initial hyperglycemia (${\geq}140mg/dL$) was an independent risk factor for prolonged antibiotic therapy (p=0.032). Conclusion : We found that the level of consciousness at admission was associated with treatment outcomes in patients with brain abscesses. Furthermore, initial hyperglycemia was closely related to the long-term use of antibiotic agents.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.4
• /
• pp.234-238
• /
• 2006

Objective : The operative indications on cerebellar hemorrhage have been controversial especially when the patient condition is grave. Therefore we investigated whether it can be justifiable if we perform the surgery in poor clinical grade. Methods : Clinical records and computerized tomography[CT] films of the 89 patients, who were undergone hospital treatment due to spontaneous cerebellar hemorrhage between May 1997 and May 2004, were retrospectively researched. Results : The study population consisted of 36 males and 53 female patients. The mean age was 65years [range $23{\sim}89$]. As a result of treatment, the patients, whose Glasgow coma scale[GCS] score were higher, showed better outcomes [p=0.001]. 13 patients [14.6%] were below 5 in GCS score and 10 patients of these were operated. Among 10 patients, 4 patients [40%] showed good outcome and 5 patients [50%] had been dead. 3 patients [60%] of these dead patients had the findings of intraventricular hemorrhage, fourth ventricular obliteration and hydrocephalus in CT scan. Conclusion : This study suggests that operation may be justifiable in clinically poor grade patient with spontaneous intra cerebellar hemorrhage.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.1
• /
• pp.108-112
• /
• 2000

Objective : Many authors suggest that patients with traumatic subarachnoid hemorrhage(tSAH) visible on first CT after heve injury had a significantly worse prognosis than patients who do not. The aim of this study is to identify patients with tSAH who present with a bad prognosis by reviewing their clinicoradiological features and plan appropriate treatments. Patients and Methods : We reviewed and analysed the factors that influenced discharge outcomes in 172 patients with tSAH for a 3-year period. The outcome was divided into good(good recovery and moderate disability of glasgow outcome scale) and good(severe disability, vegetative state and death). Results : A regression analysis of statistical significant factors(p<0.05) among the clinical and CT features ranked them by descending order of contribution to Glasgow Outcome Scale(GOS) scores at the time of discharge from acute hospitalization as follows 1) clinical : admission Glasgow Coma Scale(GCS), hypotension, CT grade, abnormal APTT, skull fracture, hyperglycemia(>160mg/dl), hypoxia, operation, 2) CT : basal cistern effacement(BCE), mass lesion, cortical sulcal effacement(CSE), midline shift. Conclusion : We have also experienced that the CT grading scale proposed by Green et al is a simple and useful prognostic factor. The authors believe that the patients with high CT grade need adjuvant therapies as of well surgery but it seems mandatory to consider early identification and correction of hypotension, hyperglycemia, and hypoxia in emergency setting.

• Journal of Korean Neurosurgical Society
• /
• v.66 no.1
• /
• pp.63-71
• /
• 2023

Objective : Traumatic brain injury (TBI) is one of the most common injuries in patients with multiple trauma, and it associates with high post-traumatic mortality and morbidity. A trauma center was established to provide optimal treatment for patients with severe trauma. This study aimed to compare the treatment outcomes of patients with severe TBI between non-trauma and trauma centers based on data from the Korean Neuro-Trauma Data Bank System (KNTDBS). Methods : From January 2018 to June 2021, 1122 patients were enrolled in the KNTDBS study. Among them, 253 patients from non-traumatic centers and 253 from trauma centers were matched using propensity score analysis. We evaluated baseline characteristics, the time required from injury to hospital arrival, surgery-related factors, neuromonitoring, and outcomes. Results : The time from injury to hospital arrival was shorter in the non-trauma centers (110.2 vs. 176.1 minutes, p=0.012). The operation time was shorter in the trauma centers (156.7 vs. 128.1 minutes, p=0.003). Neuromonitoring was performed in nine patients (3.6%) in the non-trauma centers and 67 patients (26.5%) in the trauma centers (p<0.001). Mortality rates were lower in trauma centers than in non-trauma centers (58.5% vs. 47.0%, p=0.014). The average Glasgow coma scale (GCS) at discharge was higher in the trauma centers (4.3 vs. 5.7, p=0.011). For the Glasgow outcome scale-extended (GOSE) at discharge, the favorable outcome (GOSE 5-8) was 17.4% in the non-trauma centers and 27.3% in the trauma centers (p=0.014). Conclusion : This study showed lower mortality rates, higher GCS scores at discharge, and higher rates of favorable outcomes in trauma centers than in non-trauma centers. The regional trauma medical system seems to have a positive impact in treating patients with severe TBI.