• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.271-275
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• 2015

Objective : Chronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery. The purpose of this study was to identify the incidence and risk factors of postoperative CSDH after surgical clipping for unruptured anterior circulation aneurysms. Methods : This retrospective study included 518 patients from a single tertiary institute from January 2008 to December 2013. CSDH was defined as subdural hemorrhage which needed surgical treatment. The degree of brain atrophy was estimated using the bicaudate ratio (BCR) index. We used uni- and multivariate analyses to identify risk factors correlated with CSDH. Results : Sixteen (3.1%) patients experienced postoperative CSDH that required burr hole drainage surgery. In univariate analyses, male gender (p<0.001), size of aneurysm (p=0.030), higher BCR index (p=0.004), and the use of antithrombotic medication (p=0.006) were associated with postoperative CSDH. In multivariate analyses using logistic regression test, male gender [odds ratio (OR) 4.037, range 1.287-12.688], high BCR index (OR 5.376, range 1.170-25.000), and the use of antithrombotic medication (OR 4.854, range 1.658-14.085) were associated with postoperative CSDH (p<0.05). Postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study. Conclusion : The incidence of CSDH was 3.1% in unruptured anterior circulation aneurysm surgery. This study shows that male gender, degree of brain atrophy, and the use of antithrombotic medication were associated with postoperative CSDH.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.748-753
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• 2000

Objectives : A 10-year retrospective clinical study was undertaken to determine the differences between two groups according to age at presentation(group A, under 50 ; B, over 50). Methods : We analyzed 468 cases with chronic subdural hematoma admitted to the department of neurosurgery in our hospital from January 1987 to December 1996. The patients were divided into two groups according to age at presentation(group A, under 50 ; B, over 50). Results : 1) The number of group A was 126 cases(26.9%) and that of group B was 342 cases(73.1%), respectively. Males were more frequently involved than females in each group. 2) There noted a history of head trauma in 88.9% of group A and 92.4% of group B. Forty-nine patients(38.9%) of group A and 103 cases(30.1%) of group B revealed a history of alcoholism. 3) Group A patients presented with symptoms of increased intracranial pressure such as headache(75.% ), nausea and vomiting(68.0%). However, Group B patients had more frequent mental changes(84.0%) and focal neurological deficits such as hemiparesis(76.5%). 4) Onset of symptom and its duration was shorter in group A than group B. 5) Six patients among 441 cases(1.4%) treated with burr hole drainage and two patients of 27 cases(5.4%) with craniotomy died, and all of these were group B patients. The two cases among six patients with burr hole drainage developed huge intracerebral hemorrhage and brain stem hemorrhage, respectively. Conclusion : In treating patients with chronic subdural hematoma, distinguishing between two age groups is quite helpful to determine treatment strategies.

• Investigative Magnetic Resonance Imaging
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• 제19권2호
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• pp.107-113
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• 2015

Purpose: Susceptibility weighted imaging (SWI) is a new magnetic resonance technique that can exploit the magnetic susceptibility differences of various tissues. Intracranial hemorrhage (ICH) looks a dark blooming on the magnitude images of SWI. However, the pattern of ICH on phase images is not well known. The purpose of this study is to characterize hemorrhagic lesions on the phase images of SWI. Materials and Methods: We retrospectively enrolled patients with ICH, who underwent both SWI and precontrast CT, between 2012 and 2013 (n = 95). An SWI was taken, using the 3-tesla system. A phase map was generated after postprocessing. Cases with an intracranial hemorrhage were reviewed by an experienced neuroradiologist and a trainee radiologist, with 10 years and 3 years of experience, respectively. The types and stages of the hemorrhages were determined in correlation with the precontrast CT, the T1- and T2-weighted images, and the FLAIR images. The size of the hemorrhage was measured by a one- directional axis on a magnitude image of SWI. The phase values of the ICH were qualitatively evaluated: hypo-, iso-, and hyper-intensity. We summarized the imaging features of the intracranial hemorrhage on the phase map of the SWI. Results: Four types of hemorrhage are observed: subdural and epidural; subarachnoid; parenchymal hemorrhage; and microbleed. The stages of the ICH were classified into 4 groups: acute (n = 34); early subacute (n = 11); late subacute (n = 15); chronic (n = 8); stage-unknown microbleeds (n = 27). The acute and early subacute hemorrhage showed heterogeneous mixed hyper-, iso-, and hypo-signal intensity; the late subacute hemorrhage showed homogeneous hyper-intensity, and the chronic hemorrhage showed a shrunken iso-signal intensity with the hyper-signal rim. All acute subarachnoid hemorrhages showed a homogeneous hyper-signal intensity. All parenchymal hemorrhages (> 3 mm) showed a dipole artifact on the phase images; however, microbleeds of less than 3 mm showed no dipole artifact. Larger hematomas showed a heterogeneous mixture of hyper-, iso-, and hypo-signal intensities. Conclusion: The pattern of the phase value of the SWI showed difference, according to the type, stage, and size.

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.211-219
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• 2013

Objective : The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. Methods : Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. Results : No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. Conclusion : A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging.

• Journal of Korean Neurosurgical Society
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• 제46권2호
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• pp.87-92
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• 2009

Objective: Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. Methods: From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge. Results: Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p> 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates. Conclusion: In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.

• 대한중풍순환신경학회지
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• 제14권1호
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• pp.107-114
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• 2013

■ Objectives The purpose is to review the application of the Kampo medicine(traditional Japanese medicine) in the neurosurgical field, through the analysis of the studies are presented at the Annual Meeting of Kampo Medicine Association of the Japan Neurosurgical Society. ■ Methods We have reviewed the studies that were reported at the 21th annual meeting of the Kampo medicine association of the Japan neurosurgical society was held on November 3 2012 in Tokyo, Japan. Seventeen included clinical reports were analyzed among all 25 studies at the meeting. Five studies were related with headache and eight were focused on the cerebrovascular disease including chronic subdural hemorrhage(CSDH) treated with Orungsan(Goreisan: 五苓散) or Siryungtang(Saireto: 柴苓湯), and other four were for pain managements. In the matters of headache, a unique feature was that Osuyutang(Gosyuyuto: 吳茱萸湯) or Oryungsan was considered as the first choice of the treatment for the headache, unlike Korea. It seems to consider to application the treatment of CSDH using Oryungsan in neurosurgery field of Korea. In addition, herbal prescription using Jackyakgamchotang(Syakuya kukanzoto: 芍藥甘草湯), Ukgansan(Yokkansan: 抑肝散), Chitabakilbang(Jidabokuippo: 治打撲一方) for acute/chronic pain is as well one of the peculiar points of Kampo medicine in Japan. ■ Conclusion It is expected that the recent studies performed in Japan neurosurgery fields to inspire domestic research and clinical applications, and needed to additional research and utilize in practice in Korea.

• 대한의용생체공학회:의공학회지
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• 제42권4호
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• pp.150-158
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• 2021

Intracranial hemorrhage (ICH) refers to acute bleeding inside the intracranial vault. Not only does this devastating disease record a very high mortality rate, but it can also cause serious chronic impairment of sensory, motor, and cognitive functions. Therefore, a prompt and professional diagnosis of the disease is highly critical. Noninvasive brain imaging data are essential for clinicians to efficiently diagnose the locus of brain lesion, volume of bleeding, and subsequent cortical damage, and to take clinical interventions. In particular, computed tomography (CT) images are used most often for the diagnosis of ICH. In order to diagnose ICH through CT images, not only medical specialists with a sufficient number of diagnosis experiences are required, but even when this condition is met, there are many cases where bleeding cannot be successfully detected due to factors such as low signal ratio and artifacts of the image itself. In addition, discrepancies between interpretations or even misinterpretations might exist causing critical clinical consequences. To resolve these clinical problems, we developed a diagnostic model predicting intracranial bleeding and its subtypes (intraparenchymal, intraventricular, subarachnoid, subdural, and epidural) by applying deep learning algorithms to CT images. We also constructed a visualization tool highlighting important regions in a CT image for predicting ICH. Specifically, 1) 27,758 CT brain images from RSNA were pre-processed to minimize the computational load. 2) Three different CNN-based models (ResNet, EfficientNet-B2, and EfficientNet-B7) were trained based on a training image data set. 3) Diagnosis performance of each of the three models was evaluated based on an independent test image data set: As a result of the model comparison, EfficientNet-B7's performance (classification accuracy = 91%) was a way greater than the other models. 4) Finally, based on the result of EfficientNet-B7, we visualized the lesions of internal bleeding using the Grad-CAM. Our research suggests that artificial intelligence-based diagnostic systems can help diagnose and treat brain diseases resolving various problems in clinical situations.