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

• Journal of Korean Neurosurgical Society
• /
• v.66 no.5
• /
• pp.552-561
• /
• 2023

Objective : A chronic subdural hematoma (CSDH) is a collection of bloody fluid located in the subdural space and encapsulated by neo-membranes. An inner subdural hygroma (ISH) is observed between the inner membrane of a CSDH and the brain surface. We present six cases of CSDH combined with ISH treated via endoscopy. Methods : Between 2011 and 2022, among the 107 patients diagnosed with CSDH in our institute, six patients were identified as presenting with CSDH combined with ISH and were included in this study. Preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) were performed simultaneously, and endoscopic surgery for aspiration of the hematoma was performed in all cases of CSDH combined with ISH. Results : The mean age of patients was 71 years (range, 66 to 79). The patients were all male. In two cases, the ISH was not identified on CT, but was clearly seen on MRI in all patients. The inner membrane of the CSDH was tense and bulging after draining of the CSDH in endoscopic view due to the high pressure of the ISH. After fenestration of the inner membrane of the CSDH and aspiration of the ISH, the membrane was sunken down due to the decreasing pressure of the ISH. There was one recurrence in post-operative 2-month follow up. The symptoms improved in all patients after surgery, and there were no surgery-related complications. Conclusion : CSDH combined with ISH can be diagnosed on imaging, and endoscopic surgery facilitates safe and effective treatment.

• Journal of Korean Neurosurgical Society
• /
• v.66 no.5
• /
• pp.582-590
• /
• 2023

Objective : Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. Methods : We examined our institutional Trauma Registry over a 2 year period. Results : A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Conclusion : Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.