• Journal of Korean Neurosurgical Society
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• 제38권4호
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• pp.281-286
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• 2005

Objective : The authors report our experience of urokinase thrombolysis in treating patients harboring nonaneurysmal spontanesous intraventricular hemorrhage[IVH] and evaluated complications, safety and feasibility of this procedure retrospectively. Methods : Fifty-three patients with nonaneurysmal IVH>15mL without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale[GCS]<5 were excluded. A catheter was directed into the IVH. Hematoma aspiration was followed by instillation of urokinase at the ear level of drainage bag under intracranial pressure monitoring system. This was repeated every 6hours until half of its initial volume. For analysis of prognostic factors, we classified the patients into two groups by Glasgow outcome scale[GOS]; good [$GOS\;{\ge}3$] and bad [GOS<3] prognosis group, and performed comparative analysis between two groups. Results : Mean age was 60.2years. The baseline hematoma size ranged 16 to 72mL. IVH volume reduction was done by an average of 74.2%. As complications, there were 3cases of rebleeding and 2cases of ventriculitis. No intracranial adverse effects were observed during thrombolytic theraphy. At 6months after the procedure, 29patients had achieved a good recovery, 15remained vegetative. 9patients died in hospital. The main good prognostic factors were young age, small IVH volume, and high GCS. Conclusion : The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.197-203
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• 2015

Objective : The potassium disturbance associated with thiopental continuous infusion in neurosurgical patients is well known. However, the effect of propofol continuous infusion on serum potassium levels has not been investigated extensively. Methods : We reviewed the medical records of 60 consecutive patients who received coma therapy or deep sedation for intracranial pressure control using either thiopental or propofol between January 2010 and January 2012. Results : The overall incidence of hypokalemia (K<3.5 mmol/L) was comparable between thiopental and propofol groups (89.2% vs. 82.6%). But, the incidence of moderate to severe hypokalemia (K<3.0 mmol/L) was significantly higher in thiopental group (51.4% vs. 13.0%, p=0.003). The lowest potassium level (2.9 mmol/L vs. 3.2 mmol/L, p=0.020) was lower in thiopental group. The patients in the thiopental group required greater potassium replacement than the propofol group patients (0.08 mmol/kg/h vs. 0.02 mmol/kg/h, p<0.001). On multivariate analysis, thiopental [odds ratio, 95% confidence interval, 7.31 (1.78-27.81); p=0.005] was associated with moderate to severe hypokalemia during continuous infusion. The incidence of rebound hyperkalemia (K>5.0 mmol/L, 32.4% vs. 4.3%, p=0.010) and the peak potassium concentration (4.8 mmol/L vs. 4.2 mmol/L, p=0.037) after the cessation of therapy were higher in thiopental group. On multivariate analysis, thiopental [8.82 (1.00-77.81); p=0.049] and duration of continuous infusion [1.02 (1.00-1.04); p=0.016] were associated with rebound hyperkalemia once therapy was discontinued. Conclusion : Propofol was less frequently associated with moderate to severe hypokalemia after induction and rebound hyperkalemia following the cessation of continuous infusion than thiopental.

• 한국임상수의학회지
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• 제27권4호
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• pp.450-452
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• 2010

4년령의 수컷 요크셔테리어가 두부의 둔상에 의한 구토와 무의식을 주증으로 내원하였다. 육안검사에서 안면 부종, 피하 출혈, 과유연을 확인하였다. 방사선 검사에서 후두골편이 뒤쪽으로 변위되어 있음이 확인되었다. 3차원으로 재구성한 컴퓨터단층촬영 영상에서 골편의 배쪽 부분이 불완전하게 부착되어 있음을 보여주었고, 골편의 불안정성 때문에 골편적출술을 실시하기로 결정하였다. 골편의 제거 후, 결손부는 널판근을 이용한 근육판으로 보강하였다. 환자 상태는 약간의 실조성 보행을 제외하고, 점차 개선되었다. 술 후 20개월째 추적조사에서 운동실조는 더 이상 관찰되지 않았다. 심한 두 개 내 출혈과 두개골 골절에도 불구하고, 수술적인 중재를 시작하기까지 환자의 신경학적인 상태는 심하게 악화되지는 않았다. 이는 바깥쪽으로 변위된 골편이 신경학적 악화를 야기할 수 있는 두개내압의 증가를 방지하는데 주요한 역할을 했기 때문이라고 사료된다.

• Journal of Veterinary Science
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• 제21권1호
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• pp.8.1-8.11
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• 2020

This study reports the clinical use of two sevoflurane-based anesthetic techniques in dogs undergoing craniectomy. Twenty-one animals undergoing elective rostrotentorial or transfrontal craniectomy for brain tumor excision, anesthetized with sevoflurane, were enrolled in this retrospective, observational study. Anesthetic records were allocated to two groups: Sevo-Op (sevoflurane and short acting opioid infusion): 8 dogs and Sevo-Dex (sevoflurane and dexmedetomidine infusion): 13 dogs. Average mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10-70) vs. 19.63 (10-25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.192-194
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• 2017

Giant arachnoid granulations have been reported to be associated with headaches, which can be acute or chronic in presentation. In some cases, idiopathic intracranial hypertension, previously called pseudotumor cerebri, may occur. The pathophysiology of these enlarged structures seen as filling defects on imaging is not clearly defined, although they are presumed to cause symptoms such as headache via pressure resulting from secondary venous sinus obstruction. We present a unique presentation of secondary headache in a 39-year-old man with no prior history of headaches found to have giant arachnoid granulations, presenting as migraine with aura.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.252-254
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• 2007

Ependymal cysts are neuroepithelial cysts, typically found in the central white matter of the temporoparietal and frontal lobes. Clinical symptoms usually result from neurological deficits referable to these regions, from seizures, and chronic headaches associated with increased intracranial pressure. We describe here a case of ependymal cyst on the right fronto-parietal lobe, presenting with tremor and weakness. The cyst was resected surgically and presurgical neurological abnormalities were improved. An exploratory surgery with establishment of an adequate route of drainage and histological examination of the cyst wall are mandatory in the management of patients with a progressive and symptomatic intraparenchymal cyst.

• Journal of Korean Neurosurgical Society
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• 제51권2호
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• pp.102-104
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• 2012

Although decompressive craniectomy is an effective treatment for various situations of increased intracranial pressure, it may be accompanied by several complications. Paradoxical herniation is known as a rare complication of lumbar puncture in patients with decompressive craniectomy. A 38-year-old man underwent decompressive craniectomy for severe brain swelling. He remained neurologically stable for five weeks, but then showed mental deterioration right after a lumbar puncture which was performed to rule out meningitis. A brain computed tomographic scan revealed a marked midline shift. The patient responded to the Trendelenburg position and intravenous fluids, and he achieved full neurologic recovery after successive cranioplasty. The authors discuss the possible mechanism of this rare case with a review of the literature.

• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.124-127
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• 2011

A 43-year-old male presenting with headache and dizziness underwent craniotomy and gross total resection of an extraaxial tumor was achieved via left occipital interhemispheric approach. The tumor was diagnosed as papillary meningioma arising from the left falcotentorium with such pathologic characteristics of bronchoalveolar adenocarcinoma. At postoperative day 40, he developed generalized tonic clonic seizure and then progressed to a status epilepticus pattern. Brain magnetic resonance imaging showed irregular leptomeningeal enhancement with a significant peritumoral area. Through a cerebrospinal fluid (CSF) study, we identified the meningioma cells of the papillary type from the CSF. At the postoperative day 60, he fell into semicomatose state, and the computed tomography imaging showed low density on both cerebral hemispheres, except the basal ganglia and cerebellum, with overall brain swelling and an increased intracranial pressure. He died on the following day. We experienced a rare case of a papillary meningioma with leptomeningeal seeding.

• 한국건강관리협회지
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• 제1권1호
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• pp.21-25
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• 2003

Vomiting in pediatric patient is frequently encountered problem in emergency room or outpatient clinic. In differential diagnosis, age of the patient or accompanying symptoms should be considered in the differential diagnosis. Accurate diagnosis is very important because surgical treatment is necessary in some of the conditions. Imaging diagnosis of conservative modality such as upper gastrointestinal series or colon study is still important radiological examination in the initial differential diagnosis, but recently ultrasonography offers accurate diagnosis in many situations. The cause of vomiting in pediatric are diverse according to the age group :neonatal sepsis, necrotizing enterocolitis, or hypertrophic pyloric stenosis in neonates : gastroesophageal reflux, viral enteritis, or intussusception in infant: midgut volvulus, appendicitis, metabolic disorders, or increased intracranial pressure also an be the cause. knowledge of radiological findings of normal gastrointestinal tract is important to recognize abnormalities. A discussion of radiological findings in variable surgical conditions to present as vomiting in pediatric patients is offered.

• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1140-1143
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• 2001

The mortality of patients with brain abscess has decreased significaltly. This has been attributed to improved diagnostic imaging, the evolution of neurosurgical techniques and understanding of intracranial pressure pathophysiology, greater critical care understanding, and newer antibiotics. However, the mortality associated with intraventricular rupture of brain abscess remained consistently high at or above 80% once identified. A case of intraventicular rupture of thalamic abscess with good quality of survival is presented based on aggressive 4-component therapeutic plan used. The four components are 1) extraventricular drainage for 6 weeks, 2) lavage of the ventricular system using closed irrigation system, 3) intravenous antibiotics, 4) intraventricular gentamicin and vancomycin, twice and once daily, respectively.