• Archives of Plastic Surgery
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• 제36권5호
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• pp.670-673
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• 2009

Purpose: Epidural abscesses and subdural empyemas after craniotomy are uncommon, potentially lethal, complications of neurosurgery. Patients with these complications may be difficult to manage and dural reconstruction in these patients are challenging. Methods: A 28 - year - old female patient showed recurrent intracranial infection after craniotomy for evacuation of a arachnoid cyst and subdural hematoma. Despite prolonged systemic antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated WBC count, CSF leakage, low CSF glucose level, and purulent wound discharge. The authors removed the previously applied lyophilized dura and transferred free omental flap to reconstruct the dura, obliterate the cyst and cover the cerebral hemisphere in the craniotomy defect. Microvascular anastomosis was between gastroepiploic and superficial temporal vessels. Results: The postoperative course was uneventful and flap survival was excellent. The infection - resistant omental tissue allowed sufficient blood circulation and dead space control. The patient was discharged 1 month after surgery and wound discharge or recurrence was absent during 13 months of follow up periods. Conclusion: The use of vascularized free omentum proved useful in cases of intractable cranial wound infection and cerebrospinal fluid leakages.

• 대한중풍순환신경학회지
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• 제13권1호
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• pp.95-101
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• 2012

The purpose of this report is to investigate the clinical application of Korean Traditional treatment to abdominal pain patient after subdural hemorrhage occurred. The main herb medicine used in this study is Ondam-tang (wenda-tang) which is frequently used in psychiatric disorders. Also, acupuncture, moxibustion and physical rehabilitation treatment were practiced. After taking an Ondam-tang (wendan-tang), the clinical symptoms of the patient were improved.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.717-722
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• 2017

Objective : To evaluate the effectiveness and efficacy of delayed burr hole surgery in relation to the reduction of postoperative subdural hematoma (SDH) volume in patients with acute SDH. Methods : We retrospectively analyzed patients with acute SDH who received delayed burr hole surgery at our institute. Age, sex, Glasgow coma scale, maximal SDH thickness, volume of SDH, midline shifts, hounsfield unit (HU), and medical history of anticoagulant agent usage were recorded. Outcome measures were delayed operation day, reduction of SDH volume after operation, and the Glasgow outcome scale (GOS) score at discharge. The patients were divided two groups according to the postoperative reduction of volume of SDH (${\geq}50%$, group A; <50%, group B). We also analyzed variables and differences between two groups. Results : Eighteen patients were available for this analysis. The mean delayed of surgery was $13.9{\pm}7.5$ days. Maximal thickness of SDH was changed from $10.0{\pm}3.5mm$ to $12.2{\pm}3.7mm$. Volume of SDH was changed from $38.7{\pm}28.0mL$ to $42.6{\pm}29.6mL$. Midline shifts were changed from $5.8{\pm}3.3mm$ to $6.6{\pm}3.3mm$. HU were changed from $66.4{\pm}11.2$ to $53.2{\pm}20.6$. Post-operative reduction of SDH volume was $52.1{\pm}21.1%$. Eleven patients (61%) had a discharge GOS score of 1 (good recovery). Ten patients (56%) were enrolled in group A. Midline shifting was greater in group A than in group B ($7.4{\pm}3.3$ vs. $3.0{\pm}2.4mm$; p<0.02). The delay of surgery was shorter for group A than group B ($9.2{\pm}2.3$ vs. $19.8{\pm}7.7$ days; p<0.0008). Conclusion : Among well selected patients, delayed burr hole surgery in patients with acute SDH may be effective for reduction of SDH volume. Further studies will be necessary to establish the effectiveness and safety of delayed burr hole surgery in patients with acute SDH.

• Journal of Korean Neurosurgical Society
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• 제66권6호
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• pp.726-734
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• 2023

Objective : Chronic subdural hematoma (CSDH) patients using antithrombotic agents (AT) at high risk for cardiovascular disease are increasing. The authors aimed to analyze the factors influencing outcome by targeting patients using AT and to establish a desirable treatment strategy. Methods : A retrospective analysis was performed on data from 462 patients who underwent burr hole trephination (BHT) surgery for CSDH at five hospitals from March 2010 to June 2021. Outcomes included incidence of postoperative acute bleeding, recurrence rate, and morbidity or mortality rate. Patients were divided into the following four groups based on their history of AT use : no AT. Only antiplatelet agents (AP), only anticoagulants (AC), both of AP and AC. In addition, a concurrent literature review was conducted alongside our cohort study. Results : Of 462 patients, 119 (119/462, 25.76%) were using AT. AP prescription did not significantly delay surgery (p=0.318), but AC prescription led to a significant increase in the time interval from admission to operation (p=0.048). After BHT, AP or AC intake significantly increased the period required for an in-dwelling drain (p=0.026 and p=0.037). The use of AC was significantly related to acute bleeding (p=0.044), while the use of AP was not (p=0.808). Use of AP or AC had no significant effect on CSDH recurrence (p=0.517 and p=1.000) or reoperation (p=0.924 and p=1.000). Morbidity was not statistically correlated with use of either AP or AC (p=0.795 and p=0.557, respectively), and there was no significant correlation with mortality for use of these medications (p=0.470 and p=1.000). Conclusion : Elderly CSDH patients may benefit from maintenance of AT therapy during BHT due to reduced thromboembolic risk. However, the use of AC necessitates individualized due to potential postoperative bleeding. Careful post-operative monitoring could mitigate prognosis and recurrence impacts.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.348-352
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• 2014

Objective : Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia. Methods : In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated. Results : The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived. Conclusion : Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.142-150
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• 2010

Purpose: In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH). Methods: Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion. Results: Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57). Conclusion: For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.

• Tuberculosis and Respiratory Diseases
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• 제51권5호
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• pp.462-465
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• 2001

상기도 감염으로 인한 발작성 기침 후 복벽 혈종을 보인 1예를 보고하였다. 복벽 혈종은 수술을 요하는 급성 복증과 감별하여야하는 질환으로, 심한 기침 후 복동이 발생한 경우 반드시 복벽 혈종을 고려하여야하며, 필요한 경우 초음파 검사나 전산화단층촬영을 시행하여 불필요한 수술을 피해야한다.

• 한국방사선학회논문지
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• 제18권3호
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• pp.231-237
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• 2024

뇌손상에서 생존자의 경우 지속적인 장애를 유발하고 뇌출혈에 따른 경막외 혈종(EDH) 및 경막하 혈종(SDH)은 주요 임상 질환 중 하나라고 볼 수 있다. 본 연구에서는 컴퓨터단층검사(CT; Computed Tomography) 영상을 기반으로 뇌출혈에 따른 혈종을 자동 분할하고 3차원으로 모델링하고자 하였다. 혈종의 자동 분할을 위해서 개선된 GVF(gradient vector flow) 알고리즘을 구현하였다. 영상으로부터 경사 벡터를 계산과 반복계산을 거친 후 자동 분할을 하고 분할 좌표를 이용해서 3차원 모델을 생성하였다. 실험결과, 혈종의 경계에 대해서 정확하게 분할 성공하였다. 경계 부분과 얇은 혈종부분에서도 결과가 좋은 것으로 나타났고, 3차원 모델을 통해서 여러 방향에서 혈종의 강도, 확산 방향, 면적 등을 알 수 있었다. 본 연구에서 개발 한 뇌출혈 부위의 평면정보와 3차원 모델은 의료진에게 보조적인 진단자료로서 활용 될 수 있을 것으로 판단한다.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.183-186
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• 2017

A 7-year-old boy, diagnosed with an arachnoid cyst and subdural effusion on initial MRI, was admitted with left limb weakness and no history of head trauma. A subsequent follow-up MRI showed different stages of hematoma within multilayered enhancing membranes and in the arachnoid cyst, which was separated by the cerebrospinal fluid cleft. Craniotomy and fenestration of the cyst wall and hematoma removal were performed. The patient was diagnosed as a having a hemorrhagic rupture of an arachnoid cyst into the intradural space, probably via some one-way valve-like defect, based on the MRI and surgical findings. The MRI features and possible mechanism of this rare disease are discussed within the literature review.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.51-53
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• 2008

The syndrome of the sinking skin flap was introduced to explain the phenomenon of neurological deterioration after decompressive craniectomy. A 37-year-old man was admitted with acute subdural hematoma and traumatic intraparenchymal hematoma. After decompressive craniectomy, the patient suffered from hydrocephalus for which a ventriculoperitoneal (V-P) shunt was inserted. Following this procedure, the depression of the skin flap became remarkable and his mentation was deteriorated. The patient recovered uneventfully after temporary elevating of valve pressure and cranioplasty. We present a patient who was successfully managed with elevation of valve pressure and cranioplasty for the syndrome of the sinking scalp flap with review of a pertinent literature.