• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.262-266
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• 2006

Objective : Chronic subdural hematoma[CSDH] is usually treated by burr hole trephination and hematoma evacuation with closed drainage and the surgical result is relatively good in most reported series. But, some patients experience the recurrence of CSDH. We study the clinical factors related to the recurrence of CSDH. Methods : 213 consecutive patients with CSDH who were treated with burr hole trephination and hematoma evacuation with closed drainage. The medical records, radiologic findings were reviewed retrospectively and clinical factors associated with the recurrent CSDH were analysed statistically. Results : 8.4%[18 cases] of the 213 patients who were treated due to CSDH were recurred. The demographic variables such as age, sex, coexisting diseases were not related to the recurrence. The preoperative hematoma thickness and postoperative hematoma thickness were not associated with the recurrence. The only factor related to the recurrence is postoperative hematoma density in this study. Conclusion : This study shows that postoperative hematoma density was strongly related to the recurrence of CSDH. However, several factors associated with the recurrent CSDH were reported in the liletrature. Thus, further study will be needed to uncover the factors related to the recurrence of CSDH.

• Journal of Korean Neurosurgical Society
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• 제41권1호
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• pp.11-15
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• 2007

Objective : The authors attempted to confirm the risk factors for recurrent chronic subdural hematoma[CSDH] after simple burr-hole drainage. Methods : A total of 302 patients with CSDH who were treated at our hospital between January 1998 and May 2005 were studied. Various parameters considered for analysis of factors associated with CSDH recurrence; demographic and clinical findings [age, sex, history of seizures, diabetes, vascular diseases], initial and perioperative CT findings [hematoma density, location of catheter tip, post operative intracranial air, intracranial hematoma extension, hematoma width, hematoma site]. Results : Twenty-four patients [7.9%] experienced recurrence, whereas 278 patients [92.1%] did not. Five major risk factors should be considered : 1) layered type by hematoma density, 2) type I, II by location of catheter tip, 3) presence of postoperative intracranial air, 4) cranial base type of intracranial hematoma extension, 5) greater hematoma width. Conclusion : In this study, we report that the incidence of postoperative CSDH recurrence can be reduced by the examination of the hematoma characteristics on initial and perioperative CT findings and by preventing subdural air accumulation during operation. In addition, the location of the catheter tip can be used as a helpful factor in reducing the recurrence.

• Journal of Korean Neurosurgical Society
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• 제61권1호
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• pp.97-104
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• 2018

Objective : Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH. Methods : We studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density : 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect. Results : Analysis showed statistically significant differences in surgical (A to B : p<0.001, A to C : p<0.001, B to C : p=0.129) and functional (A to B : p=0.039, A to C : p<0.001, B to C : p=0.108) outcomes and treatment failure rates (A to B : p=0.037, A to C : p=0.03, B to C : p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A. Conclusion : CSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.282-286
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• 2005

Objective: Symptomatic chronic subdural hematoma(CSDH) is a well-known neurosurgical entity and most of the lesion is managed by surgical treatment. The authors analyze the surgical indication and the treatment results of twist drill craniostomy with closed-system drainage(TDD) for the symptomatic CSDH. Methods: From March 2001 through December 2003, 31 patients who were treated with TDD for the symptomatic CSDH and followed more than 6months were included. The radiologic criteria of TDD in this study were 1) homogeneous density of hematoma on computed tomography(CT), 2) no septation of hematoma on magnetic resonance imaging(MRI), and 3) thicker hematoma more than twice thickness of skull. Surgical procedures were performed on the maximum thickness of hematoma on CT/MRI. Short and long Steinman pins were used to penetrate the skull and hematoma membrane. As the 5L catheter was inserted through the drill hole, it was kept for 1 - 7days for the drainage of CSDH. The patients of CSDH were followed with clinical symptoms and CT studies. Results: Most of all the 31 patients were improved. However, one patient was suffered from postoperative epidural hematoma and the other patients have received the secondary operation because of the recurrence of CSDH on 3 months after initial surgery. Conclusion: TDD is safe procedure for the symptomatic CSDH if the patients are selected appropriately.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.384-388
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• 2001

A 51-year-old woman presented with sudden severe headache, vomiting, and right hemiparesis at first admission. Computed tomography(CT) scans revealed an hemorrhagic density at left basal ganglia. Preoperative cerebral angiography showed no vascular lesion. Under the diagnosis of hypertensive intracerebral hemorrhage(ICH), total extirpation of hematoma was done. The postoperative neurological condition improved gradually and discharged without any neurological sequelae. Two months later, she revisited with headache, vomiting and progressive right hemiparesis. CT scans at second admission showed an irregular rim enhanced mass with central low density with surrounding edema at the initial bleeding area. Repeated craniotomy was performed and the mass was partially removed. The histopathological diagnosis of the specimen was confirmed as glioblastoma. The authors report a glioblastoma, which occurred at initial ICH site and regarded as a brain abscess with literature review.