• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.366-370
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• 2001

Objective : The authors present three cases of brain tumors in which epidural hematomas(EDHs) were developed postoperatively in the remote areas from craniotomy sites. The preventive tactics as well as possible mechanisms of development of remote EDH are discussed. Material and Methods : The magnetic resonance imagings of three patients revealed a left lateral ventricular mass located just aside of foramen Monro in a 27-year-old male, a large cystic mass in the temporal lobe in a 35-year-old male, and a partially calcified pineal mass in a 27-year-old male patient. The surgical removals of these tumors were performed without any noticeable events during surgery via left frontal transcortical transventricular approach for lateral ventricular tumor, left temporal craniotomy for cystic temporal tumor, and right occipital transtentorial approach for pineal tumor. Results : Postoperative EDHs remote from the sites of craniotomy were detected by the immediate postoperative computerized tomographic scans. We obtained good outcomes without any morbidity in all three patients with emergent evacuation of the hematoma. The pathologic diagnoses were lateral ventricular ependymoastrocytoma, temporal craniopharyngioma and mixed germinoma of the pineal region. Conclusion : It is postulated that a sudden reduction of intracranial pressure(ICP) at the time of tumor removal may strip the dura from the inner table of the skull to cause EDH from the remote site of craniotomy. Gradual reduction of ICP with slow drainage of cerebrospinal fluid before tumor removal as well as lowering the head position of patient during surgery might be helpful for preventing this unusual complication.

• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.273-280
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• 2005

Objective : There is no acceptable indication and treatment of choice for infantile and child subdural hygroma and there are only a few reports about that in Korea. So the authors studied the clinical findings of infantile and child patients with subdural hygroma to improve the understanding and to suggest a standard treatment method. Methods : The authors retrospectively evaluated the causes, preoperative symptoms, radiological thicknesses, and postoperative results of 25patients with subdural hygroma who received surgical therapy. Results : There were 16boys and 9girls whose median age was 6months[range $2{\sim}120months$]. The main clinical manifestations were seizures, increased intracranial pressure, macrocrania and alteration of consciousness. Radiological thicknesses of the subdural hygroma varied from 7mm to 42mm and postoperative changes of thickness[y] could be expressed with the factor of month[x]: $y\;=\;-1.32\;{\times}\;+11.8$ in subdural drainage, and $y\;=\;-1.52\;{\times}\;+14.9$ in subduroperitoneal shunts. Of the 25patients, 2 [50%] were successfully treated by aspiration, 13 [59%] by subdural drainage, and 9 [69%] by subduroperitoneal shunt. Conclusion : It is suggested that the diagnosis and treatment of subdural hygroma in infants and children should be carefully addressed because of its high prevalence in children, and especially in infants. It is also suggested that the subdural drainage could be primary initial treatment method because it is simpler than a shunt, and since our data show that there is no statistical difference in postoperative recovery duration between the two operative methods.

• The Journal of Korean Oriental Chronic Disease
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• v.10 no.1
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• pp.21-31
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• 2005

We have analyzed 247 patients who were admitted to the 3rd ICU for intensive care between January 2003 and December 2003 to investigate characteristics of ICU patients and obtain better guidance and management in the ICU. The results are as follows: 1) The total number of patients was 247. The proportion of males was 59.1 %, of females was 40.9%, and the ratio of male to female was about 1.45:1. 2) The most prevalent age group is those in their seventies, the proportion is 33.6%. 3) The total admission days was 3,438days, and mean patient stay being 13.9days. 4) The total number of expired patients was 26, the mortality rate was 10.5%. The mortality in distribution by disease was higest in Cerebral infarction, rate was 53.8%. the proportion of raised intracranial pressure was 42.3%, of hemorrhagic transformation was 11.5%. 5) In distribution by admission channel, Oriental hospital E.R. was 60.7%, Oriental hospital ward was 38.5%, and etc. was 0.8%. 6) The number of patients of Cerebral infarction was 146(59.1%), being the highest in distribution by chief disease and the proportion of MCA territory infarction is highest in the Cerebral infarction(61.6%). 7) In distribution by Oriental Medicine therapy, the proportion of Acupuncture treatment was 15.8%, of Acupuncture treatment combination Herb medication was 78.5%, and of Acupuncture, Herb medication plus subcutaneous Acupuncture treatment was 5.7%.

• Journal of Korean Neurosurgical Society
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• v.37 no.6
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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.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.244-250
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• 2010

Objective : Adequate management of increased intracranial pressure (ICP) is critical in patients with traumatic brain injury (TBI), and decompressive craniectomy is widely used to treat refractory increased ICP. The authors reviewed and analyzed complications following decompressive craniectomy for the management of TBI. Methods : A total of 89 consecutive patients who underwent decompressive craniectomy for TBI between February 2004 and February 2009 were reviewed retrospectively. Incidence rates of complications secondary to decompressive craniectomy were determined, and analyses were performed to identify clinical factors associated with the development of complications and the poor outcome. Results : Complications secondary to decompressive craniectomy occurred in 48 of the 89 (53.9%) patients. Furthermore, these complications occurred in a sequential fashion at specific times after surgical intervention; cerebral contusion expansion ($2.2{\pm}1.2$ days), newly appearing subdural or epidural hematoma contralateral to the craniectomy defect ($1.5{\pm}0.9$ days), epilepsy ($2.7{\pm}1.5$ days), cerebrospinal fluid leakage through the scalp incision ($7.0{\pm}4.2$ days), and external cerebral herniation ($5.5{\pm}3.3$ days). Subdural effusion ($10.8{\pm}5.2$ days) and postoperative infection ($9.8{\pm}3.1$ days) developed between one and four weeks postoperatively. Trephined and post-traumatic hydrocephalus syndromes developed after one month postoperatively (at $79.5{\pm}23.6$ and $49.2{\pm}14.1$ days, respectively). Conclusion : A poor GCS score ($\leq$ 8) and an age of $\geq$ 65 were found to be related to the occurrence of one of the above-mentioned complications. These results should help neurosurgeons anticipate these complications, to adopt management strategies that reduce the risks of complications, and to improve clinical outcomes.

• Journal of Korean Neurosurgical Society
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• v.61 no.5
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• pp.640-644
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• 2018

Objective : The purpose of this pilot study was to examine the safety and function of the newly developed cerebrospinal fluid (CSF) reservoir called the V-Port. Methods : The newly developed V-Port consists of a non-collapsible reservoir outlined with a titanium cage and a connector for the ventricular catheter to be assembled. It is designed to be better palpated and more durable to multiple punctures than the Ommaya reservoir. A total of nine patients diagnosed with leptomeningeal carcinomatosis were selected for V-Port insertion. Each patient was followed up for evaluation for a month after the operation. Results : The average operation time for V-Port insertion was 42 minutes and the average incision size was 6.6 cm. The surgical technique of V-Port insertion was found to be intuitive by all neurosurgeons who participated in the pilot study. There was no obstruction or leakage of the V-Port during intrathecal chemotherapy or CSF drainage. Also, there were no complications including post-operative intracerebral hemorrhage, infection and skin problems related to the V-Port. Conclusion : V-Port is a safe and an easy to use implantable CSF reservoir that addresses problems of other implantable CSF reservoirs. Further multicenter clinical trial is needed to prove the safety and the function of the V-Port.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.4
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• pp.1765-1773
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• 2013

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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.6
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• pp.539-547
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• 2020

Purpose: Pediatric acute liver failure (PALF) is a serious condition; however, data on PALF in developing countries are sparse, particularly concerning molecular diagnosis and liver transplantation (LT). This study aimed to determine the causes, outcomes, and prognostic factors of PALF. Methods: We retrospectively reviewed the medical records of children (age <15 years) with PALF diagnosed using the American Association for the Study of Liver Diseases criteria at our center from 2011 to 2016. The collected data included laboratory results, complications, outcomes, and potential factors associated with death and LT. Results: We included a total of 27 patients, with a median age of 2 years (interquartile range, 3 months to 4 years). Viral infection was the most common etiology (n=8, 30%), predominantly dengue infection (n=4). A total of 16 patients (59%) died and 11 patients survived (3 patients with LT). The prognostic factors associated with death or LT requirement were grade IV hepatic encephalopathy (p<0.01), hypotension (p=0.02), gastrointestinal bleeding (p=0.03), increased intracranial pressure (p=0.04), and higher peak serum lactate level (p=0.01). Peak serum lactate ≥6 mmoL/L had a sensitivity of 79% and a specificity of 88% for predicting mortality or the necessity of LT. Conclusion: Viral infection was the most common cause of PALF. The mortality rate remained high, and a considerable number of patients required LT. In addition to several clinical factors, peak serum lactate could be a potential marker for predicting poor outcomes in PALF.

• Journal of Home Health Care Nursing
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• v.21 no.2
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• pp.110-119
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• 2014

Purpose: The objectives of this study were to identify interventions and to analyze the characteristics of headaches among hospitalized patients with subarachnoid hemorrhage with moderate or severe headaches. Methods: A retrospective review of the electronic medical records of 210 patients who received treatment for subarachnoid hemorrhage was conducted. Data collection was done using a structured headache record sheet. Data analysis was carried out using the PASW 18.0 version program. Results: There were significant differences in number and duration of headaches of headaches according to the presence of vasospasm, increased intracranial pressure, extraventricular drainage, use of hypertonic solution, and hospitalization period (p<0.05). Patients with vasospasm and extraventricular drainage experienced the most severe headache for a duration of 3 to 7 days. Other patients experienced the most severe headache for around 1-2 days. Conclusion: Hospitalized patients with subarachnoid hemorrhage who had vasospasms experienced more headaches and the duration of these headaches were longer. In particular, the assessment and interventions for headaches should increase and be carried out actively during this time because the intensity of these headaches is severe and lasts for 3-7 days. Additionally, we emphasize the need for regular administration of analgesics in order to promote patients' well-being. On the basis of the results of this study,we suggest that evidence-based interventions for the care of headaches among hospitalized patients with subarachnoid hemorrhage should be developed.

• Child Health Nursing Research
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• v.5 no.2
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• pp.198-210
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• 1999

The goal of respiratory management in high risk infants is to maintain proper oxygenation by supporting respiration, therefore to minimize the secondary complications and to promote the maximum growth and development. While on artificial ventilator to achieve this goal, the infants require endotracheal suctioning(ETS) to remove lung secretions. However, the negative effects of ETS in neoates have been documented and include hypoxia, bradycardia, mucosal damage, increased intracranial pressure, and death result. The purpose of the study was to investigate how ETS is currently performed in NICU, which would be beneficial to develop the standardized ETS protocol and to apply it to these population. A national-wide survey on clinical protocol of ETS was performed to 149 neonatal nurses with the average of 3 years and 6 months experience in neonatal nursing, 34.2% of whom was bachelor in nursing. The results showed that about 89% of the nurses initiate En primarily based on the need of the subjects. The aseptic regulation on ETS was used in 83.9% of the subjects. There was no regulation on the length of catheter in 32.9% and on ID/OD ratio in 17.4%. Many nurses administered hyperoygenation/hyperinflation/hyperventilation based on personal knowhow, rather than scientific rationals (77.2%, 40.9%, 75.2%, retrospectively). About 41% of the nurse regulate subjectively the suction power, while 73.8% of them rotate the sub ject's head during suctioning and the half of the nurses was favorable in adapting the closed-suctioning protocol. With the findings of the study, the current clinical application of E% in neonates appears to be based on adult care practices, or personal preference, rather than scientific validation of the safety and effectiveness of the procedure. This study support the needs for developing and applying the standardized ETS protocolin conjunction with the consideration given to the physiologic characteristics of the neonates in respiratory distress.