• Journal of Korean Neurosurgical Society
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• v.51 no.2
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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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• v.40 no.1
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• pp.51-53
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• 2006

Decompressive craniectomy is usually performed to relieve raised intracranial pressure[ICP] caused by various intracranial lesions. A 67-year-old man presented with acute subdural hematoma and traumatic intracerebral hematoma. The patient underwent a decompressive craniectomy. Four weeks later, the patient presented with acute neurological deterioration. Brain computed tomographic[CT] scans revealed the marked concavity of the brain at the site of the craniectomy and associated with midline shift which was reversed by cranioplasty. We report an unusual case of cerebral herniation from intracranial hypotension after decompressive craniectomy for a traumatic subdural hematoma. The cranioplasty may be helpful to prevent paradoxial cerebral herniation.

• Journal of Chest Surgery
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• v.7 no.1
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• pp.61-66
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• 1974

Primary tumors of the chest wall are rare than those of other portions of the body. Soft tissue tumors of the chest wall, though these are benign or malignant, should not be paid special attentions about their management than other soft tissue tumors of the body. Thoracic skeletal tumors, however, have some problems in the treatment because of defect in chest wall leading to herniation of lung and paradoxical movement of thoracic cage. The authors experienced 10 case of primary chest wall tumors at the department of thoracic and cardiovascular surgery, the national medical center, during last 15 years. Five of 10 cases were soft tissue tumors, and they were 2 case of lipoma and each one case of myxosarcoma and leiomyosarcoma. Among 5 bone tumors there no cases of sternal tumor, and their histopathological diagnosis were each one of fibrous dysplasia, giant cell tumor, osteochondroma, Ewing`s sarcoma and osteogenic sarcoma. Wide excision, though it was palliative one in certain case, was performed in 9 cases and only diagnostic incisional biopsy in one case, There were no postoperative deaths during admission to the hospital and all cases were missed during short term follow up after discharge from the hospital.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.652-664
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• 2022

The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on "paradoxical" motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.