• Journal of Korean Neurosurgical Society
• /
• v.59 no.5
• /
• pp.498-504
• /
• 2016

Objective : Although subdural hematoma (SDH) is commonly treatable by burr hole surgery in the late subacute or chronic stage, there is no clear consensus regarding appropriate management and exact predictive factors for postoperative recurrence also remain unclear. The aim of this study was to evaluate risk factors associated with recurrence of SDH that requires burr hole surgery in the late subacute or chronic stage. We also identified the appropriate timing of surgery for reducing the recurrence. Methods : We retrospectively reviewed 274 patients with SDH in the late subacute or chronic stage treated with burr hole surgery in our hospital between January 2007 and December 2014. Excluding patients with acute intracranial complications or unknown time of trauma onset left 216 patients included in the study. Results : Of 216 patients with SDH in the late subacute or chronic stage, recurrence was observed in 36 patients (16.7%). The timing of the operation in patients with late subacute stage (15-28 days) resulted in a significant decrease in recurrence (RR, 0.33; 95% CI, 0.17-0.65; p=0.001) compared to chronic stage (>28 days). Otherwise, no significant risk factors were associated with recurrences including comorbidities and surgical details. Conclusion : The results indicated that time from trauma onset to burr hole surgery may be important for decreasing the risk of recurrence. Therefore, unless patients can be treated conservatively without surgery, prompt surgical management is recommended in patients diagnosed as having late subacute or chronic subdural hematoma treatable by burr hole surgery, even when neurological deficits are unclear.

• Journal of the Korea Convergence Society
• /
• v.12 no.4
• /
• pp.285-291
• /
• 2021

This study is a retrospective study attempted to determine the factors that influence the survival of patients with traumatic acute subdural hematoma. The study subjects were 207 patients with traumatic subdural hematoma who visited the emergency room from January 2017 to February 2019 at C University Hospital in G Metropolitan City. Data analysis was using the SPSS 23.0 program, and χ2-test, t-test, and logistic regression analysis. As a result of the study, the factors affecting the survival of the subjects were under disease, complications, and initial GCS. Therefore, it is necessary to establish a medical system to check the subject's history and to train medical staff to prevent complications. In addition, it is necessary to improve the transfer system so that the GCS of the subject can be measured from the stage before transfer to a medical institution and transferred to a hospital that can be treated quickly.

• The Journal of the Society of Stroke on Korean Medicine
• /
• v.19 no.1
• /
• pp.49-54
• /
• 2018

A case of a 73-year-old male patient who fell down, presented with unusual traumatic subdural hematoma localized on the lesion of tentorium cerebelli. He was treated with acupuncture, electroacupuncture and herbal medicine - 五苓散(Oreong-san). To evaluate the progress, we followed up computed tomography imaging and checked up changing of symptoms. After 17days of treatment, there were notable improvement in computed tomography imaging and symptoms. Oreong-san might be effective in treating tentorium cerebelli subdural hematoma.

• Journal of Korean Neurosurgical Society
• /
• v.57 no.4
• /
• pp.266-270
• /
• 2015

Objective : Chronic subdural hematoma (CSDH) is one of the most frequent problems encountered in neurosurgery. Although burr-hole trephination is widely performed to treat CSDH, the incidence rate of recurrent CSDH is still 2-37%. The goal of this study is to determine the risk factors that affect recurrent CSDH. Methods : A total of 182 patients were included in this study who underwent burr-hole trephination. The clinical factors and radiographic features between the recurrence and the no recurrence groups were analyzed to find the parameters related to the postoperative recurrence of CSDH. Results : For the recurrence of CSDH that occurred in 25 patients (13.7%), among various risk factors, pre and postoperative midline displacements, which are more than 10 mm (p=0.000), and preoperative hemiparesis (p=0.026) had contributed to recurrent CSDH with statistical significance by univariate analysis. Unilateral CSDH were more frequently related to recurrent CSDH (16.3%), although it was not a statistical significant result (p=0.052). Furthermore, preoperative midline displacement only had statistical meaning for the recurrence of CSDH by multivariate analysis. Conclusion : This study indicates that the midline displacement on the preoperative computed tomography scan is the only independent predictor for the recurrence of CSDH.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.4
• /
• pp.262-266
• /
• 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
• /
• v.51 no.2
• /
• pp.91-93
• /
• 2012

Acute spontaneous subdural hematoma (SDH) of arterial origin is very rare. We report a case of acute spontaneous SDH that showed contrast media extravasation from cortical artery on angiograms. A 58-year-old male patient developed sudden onset headache and right hemiparesis. Brain CT scan demonstrated acute SDH at left convexity. The patient was drowsy mentality on admission. He had no history of head trauma. Cerebral angiography was performed and revealed a localized extravasation of the contrast media from distal cortical MCA branch. After angiography, the patient deteriorated to comatose mentality. Decompressive craniectomy for removal of SDH was performed. We verified the arterial origin of the bleeding and coagulated the bleeding focus. The histological diagnosis was aneurysmal artery. He recovered after surgery with mild disability. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.3
• /
• pp.310-313
• /
• 2016

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M.tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.1
• /
• pp.69-74
• /
• 2016

Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause.

• Journal of Korean Neurosurgical Society
• /
• v.47 no.6
• /
• pp.424-427
• /
• 2010

Objective : Chronic subdural hematomas (CSDH) are more common on the left hemisphere than on the right. We verified this left predilection of CSDH and tried to explain the reason for this discrepancy. Methods : We investigated the laterality of CSDH in 182 patients who were treated from January 2005 to December 2009. We examined the symmetry of the cranium and the location of the lesion. Results : CSDH was more common on the left-side. The cranium was symmetric in 63 patients, asymmetric in 119 patients. The asymmetric crania were flat on the right-side in 77 patients, on the left-side in 42 patients. The density of the CSDHs was hypodense in 29 patients, isodense 132 patients, and the others in 21 patients. Bilateral hematomas were more common in the hypodense group. In the right flat crania, the hematoma was more commonly located on the opposite side of the flat side. While in the left flat crania, the hematoma was more common on the same side. Conclusion : CSDHs occurred more frequently on the left side. The anatomical asymmetry of the cranium influences the left predilection of CSDH.

• Journal of Trauma and Injury
• /
• v.26 no.3
• /
• pp.238-242
• /
• 2013

Idiopathic thrombocytopenic purpura (ITP) is the condition of having an abnormally low platelet count with an unknown cause. Acute subdural hematomas (ASDHs) usually develop in trauma patients and often involve a high bleeding tendency. However, ITP patients rarely have a large ASDH, and when a traditional decompressive craniectomy is performed on patients with coagulopathy, the mortality rate is higher because of the greater bleeding risk. We report the case of an ITP patient with a large ASDH who treated with a burr-hole trephination and irrigation and who was discharged without any neurological deficit.