• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.263-273
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• 2023

While the survival rate of preterm infants has increased dramatically over the last few decades, intraventricular hemorrhage and subsequent hydrocephalus remain major unsolved problems in neonatal intensive care. Once intraventricular hemorrhage occurs, severe neurological sequelae are inevitable. Treatment of this complicated pathology and achievement of favorable neurofunctional outcomes in fragile infants are crucial challenges for pediatric neurosurgeons. Fibrinolytic therapy, which chemically dissolves hematoma, is a promising and useful treatment method. In this paper, the historical background of fibrinolytic therapy for post-intraventricular hemorrhagic hydrocephalus in preterm infants is reviewed and a recent method of fibrinolytic therapy using urokinase is introduced.

• Journal of Korean Neurosurgical Society
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• v.44 no.6
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• pp.405-408
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• 2008

GBM is the most common primary brain tumor, but intraventricular GBM is rare and only few cases have been reported in the literature. The authors report a case of 64-year-old man who had a remote history of previous periventricular intracerebral hemorrhage. Brain computed tomography (CT) and magnetic resonance (MR) imaging showed an intraventricular lesion with inhomogeneous enhancement, infiltrative borders and necrotic cyst, and obstructive hydrocephalus. The patient underwent surgical removal through transcortical route via the bottom of previous hemorrhage site and the final pathologic diagnosis was GBM. We present a rare case of an intraventricular GBM with detailed clinical course, radiological findings, and pathological findings, and the possible origin of this lesion is discussed.

• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.367-369
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• 2012

Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Terson syndrome can be caused by intracranial hemorrhage, subdural or epidural hematoma and severe brain injury but is extremely rare in intraventricular hemorrhage associated with moyamoya disease. A 41-year-old man presented with left visual disturbance. He had a history of intraventicular hemorrhage associated with moyamoya disease three months prior to admission. At that time he was in comatose mentality. Ophthalmologic examination at our hospital detected a vitreous hemorrhage in his left eye, with right eye remaining normal. Vitrectomy with epiretinal membrane removal was performed. After operation his left visual acuity was recovered. Careful ophthalmologic examination is mandatory in patients with hemorrhagic moyamoya disease.

• Journal of Korean Neurosurgical Society
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• v.46 no.3
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• pp.257-260
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• 2009

Intraventricular hemorrhage long after successful encephaloduroarterio synangiosis (EDAS) is very rare. The effect of revascularization surgery for preventing hemorrhagic event of moyamoya disease remains controversial. We report a 17-year-old female with intracerebral hemorrhage and intraventricular hemorrahge 10 years after successful EDAS. Even though cerebral vessels angiography showed good collateral circulations without specific weak points, a cerebral hemorrhage could occur in patient with ischemic type of moyamoya disease long after successful indirect bypass operations. Good collateralization of cerebral angiography or magnetic resonance perfusion image after indirect bypass surgery would ensure against ischemic symptoms, not a hemorrhage. And, thus a life-time follow-up strategy might be necessary even if a good collateral circulation has been established.

• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.239-246
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• 2023

Germinal matrix and intraventricular hemorrhage (GM-IVH) are the major causes of intracranial hemorrhage in premature infants. Cranial ultrasound (cUS) is the imaging modality of choice for diagnosing and classifying GM-IVH. Magnetic resonance imaging (MRI), usually performed at term-equivalent age, is more sensitive than cUS in identifying hemorrhage in the brain. Post-hemorrhagic ventricular dilatation is a significant complication of GM-IVH and correlates with adverse neurodevelopmental outcomes. In this review, we discuss the various imaging findings of GM-IVH in premature infants, focusing on the role of cUS and MRI.

• Journal of Korean Neurosurgical Society
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• v.65 no.2
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• pp.325-330
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• 2022

Various grading systems and surgical techniques have been developed for the treatment of intraventricular hemorrhage (IVH); however, little attention has been paid to the fourth ventricle hematoma. Nonetheless, hemorrhagic dilation of the fourth ventricle may lead to catastrophic consequences for patients with massive IVH. We present two cases of massive IVH accompanied by massive fourth ventricle hematoma which was successfully removed with combination of suboccipital craniotomy for fourth ventricle hematoma and intraventricular fibrinolysis for supratentorial hematoma.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.87-96
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• 2023

Objective: This study reports the effectiveness of the Korean medicine treatment of patients with intracerebral and intraventricular hemorrhages suffering unilateral neglect symptoms. Case presentation: The patient was treated using Korean medicine, including acupuncture, herbal medicine, moxibustion, and a limb activation exercise. We measured Unilateral Neglect Symptom progress with a numeric rating scale, Albert's test, Line bisection test, Clock drawing test, and Catherine Bergego Scale. After eight days of combined Korean medicine and rehabilitation exercise, the Unilateral Neglect Symptom intensity reduced from NRS 8 to 6. In addition, Albert's test score decreased from 2.5% to 0%. The Line bisection test score decreased from 19 mm to 12 mm, and the Clock drawing test score improved from 8 to 10. Last, the Catherine Bergego Scale decreased from 12 to 9. No adverse events were observed during treatment. Conclusion: This study suggested that a complex treatment including Jaeumkunbi-tang, acupuncture, moxibustion, and limb activation exercise can be effective for an intracerebral hemorrhage with intraventricular hemorrhage patient suffering from Unilateral Neglect Symptoms. Consequently, more research is needed in the future.

• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.258-262
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• 2023

Germinal matrix-intraventricular hemorrhage (GM-IVH) is among the devastating neurological complications with mortality and neurodevelopmental disability rates ranging from 14.7% to 44.7% in preterm infants. The medical techniques have improved throughout the years, as the morbidity-free survival rate of very-low-birth-weight infants has increased; however, the neonatal and long-term morbidity rates have not significantly improved. To this date, there is no strong evidence on pharmacological management on GM-IVH, due to the limitation of well-designed randomized controlled studies. However, recombinant human erythropoietin administration in preterm infants seems to be the only effective pharmacological management in limited situations. Hence, further high-quality collaborative research studies are warranted in the future to ensure better outcomes among preterm infants with GM-IVH.

• Neonatal Medicine
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• v.25 no.1
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• pp.1-6
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• 2018

Extremely low birth weight infants remain at increased risk of intraventricular hemorrhage from the fragile vascular bed of the germinal matrix; the roles of hypotension (ischemia) and reperfusion (hyperemia) in the development of intraventricular hemorrhage are still debated. Cerebrovascular pressure autoregulation protects the brain by maintaining constant cerebral blood flow despite changes in blood pressure. The ontogeny of cerebrovascular pressure autoregulation has not been well established and uncertainty remains about the optimal arterial blood pressure required to support brain perfusion. Another important aspect of premature cerebral hemodynamics is the critical closing pressure--the arterial blood pressure at which cerebral blood flow ceases. Interestingly, in premature infants, the critical closing pressure approximates the mean arterial blood pressure. Often in this unique population, cerebral blood flow occurs only during systole when the diastolic arterial blood pressure is equal to the critical closing pressure. Moreover, the diastolic closing margin, a metric of cerebral perfusion that normalizes diastolic arterial blood pressure to the critical closing pressure, may be a better measure than arterial blood pressure for defining cerebral perfusion in premature infants. Elevated diastolic closing margin has been associated with intraventricular hemorrhage. This review summarizes the current state of understanding of cerebral hemodynamics in premature infants.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.126-130
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• 2000

A 40-year-old female with hypertensive thalamic hemorrhage, secondary intraventricular hemorrhage, and hydrocephalus was treated with extraventricular drainage. She developed catheter-related ventriculitis caused by gram-negative rods, Enterobacter aerogenes. She was treated with systemic pefloxacine, ceftazidime, amikin and intraventricular vancomycin, gentamicin was unsuccessful. The ventriculitis was successfully controlled by intraventricular administration of the pefloxacine. Regarding their excellent activity against gram-negative rods, Enterobacter aerogenes, and probable safety when administered intraventricularly, administration of the pefloxacine, may be considered in the treatment of ventriculitis if the pathogen is resistant to other conventional antibiotics.