• Journal of Korean Neurosurgical Society
• /
• v.30 no.6
• /
• pp.705-710
• /
• 2001

Objective : Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. Methods : Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. Results : In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p = 0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p <0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p <0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. Conclusion : Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.6
• /
• pp.441-444
• /
• 2006

Objective : The goal of this study is to evaluate the clinical results in six patients who underwent surgical decompression for the acute subdural hematomas[ASDH] of posterior cranial fossa. Methods : Six patients [five males and one female] who had undergone surgery for ASDH of posterior cranial fossa between 2000 and 2005, were evaluated retrospectively with regard to clinicoradiological findings and surgical outcomes. The mean age was 45.8 years [range $9{\sim}67\;years$]. Results : Preoperative computed tomography showed ASDH on cerebellar hemisphere in four patients and on midline in two. All patients had the associated lesions such as subarachnoid hemorrhage, epidural or subdural hematoma, intraventricular hemorrhage, contusion or pneumocephalus in supratentorial area. Fracture of occipital bone was noted in two patients. Of the four patients who had 13 to 15 of Glasgow coma scale score at the time of admission, three were deteriorated within 24 hours after trauma. Of these three patients, delayed subdural hematoma developed 1 hour after initial normal CT finding in one patient and increased in thickness in another one. Postoperative outcome showed good recovery in three patients and moderate disability in one. Two patients were expired. Conclusion : This study supports that early diagnosis based on strict observation and prompt surgery in the patients with ASDH in posterior fossa will lead to the best results.

• Journal of Korean Neurosurgical Society
• /
• v.37 no.3
• /
• pp.197-200
• /
• 2005

Objective: Ultrasound can be used in the treatment of large intracerebral hematoma. The authors present our experiences with Ultrasound-guided catheter placement for lysis and drainage of ganglionic hematoma, with emphasis on technical aspects. Methods: The authors applied real-time ultrasonography for the aspiration of intracerebral hematoma in 6cases. Ultrasound-guided aspiration via a burrhole was performed under local anesthesia. We selected a temporal entry point instead of the frequently used precoronal approach in ganglionic hematoma. A burrhole was made 4 to 6cm posterior from posterior border of frontal process of the zygomatic bone at the level of 4 to 5cm above the external auditory meatus. Results: In all patients, the catheter was placed accurately into the hematoma target. All patients were irrigated with urokinase once to three times a day. The catheter could be removed within two or three days. The mean hematoma volume was reduced from initially 32mL to 5mL in an average of two days. There were no intraoperative complications related to the use of real-time ultrasonography and no postoperative infections were noted. Conclusion: Ultrasound allows an easy and precise localization of the hematoma and the distance from the surface to the target can be calculated. Ultrasound-guided catheter placement for fibrinolysis and hematoma drainage is a simple and safe procedure.

• Korean Journal of Head & Neck Oncology
• /
• v.33 no.1
• /
• pp.53-56
• /
• 2017

Pharyngocutaneous fistula is one of the most common wound complications after total laryngectomy. The leakage of saliva may cause an erosion of greater vessels nearby and result in a life-threatening bleeding. 65-year-old male received laryngectomy and pharyngectomy followed by Latissimus dorsi flap reconstruction due to recurred laryngeal cancer with oropharyngeal extension after postoperative radiotherapy. Pharyngeal fistula was developed and an excessive fresh blood flowed through the oral and nasal cavity. The patient was transferred to the operating room immediately, and the causing artery was ligated. The rupture of the common carotid artery and its branches should be warned when the pharyngocutaneous fistula is developed. Prompt and proper therapy must be performed for the patients with impending or acute hemorrhage.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.1
• /
• pp.115-121
• /
• 2024

After treatment of unilateral vertebral artery dissecting aneurysm (VADA), de novo VADA rarely occurs on the contralateral side. In this article, we report a case of subarachnoid hemorrhage (SAH) due to de novo VADA in the contralateral vertebral artery (VA) 3 years after parent artery occlusion of unilateral VADA, with a review of the literature. A 47-year-old woman was admitted to our hospital complaining of headache and impaired consciousness. Head computed tomography showed SAH, and three-dimensional computed tomography angiography showed a fusiform aneurysm in the left VA. We performed an emergency parent artery occlusion. Three years and 3 months after the initial treatment, the patient presented to our hospital with complaints of headache and neck pain. Magnetic resonance imaging revealed SAH, and magnetic resonance angiography revealed de novo VADA in the right VA. We performed a stent-assisted coil embolization. The patient had a good postoperative course and was discharged with a modified Rankin scale score of 0. Long-term follow-up is necessary in patients with VADA because contralateral de novo VADA can develop even several years after the initial treatment.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.8
• /
• pp.1013-1018
• /
• 2001

Objective : About 40% of patients who admit to the hospital after subarachnoid hemorrhage are poor clinical grade(Hunt-Hess grade IV, V). The majority of these patients have been excluded from early, aggressive treatment. The current study was undertaken to evaluate the outcome of urgent surgery for Hunt-Hess grade IV aneurysmal subarachnoid hemorrhage. Materials and Methods : We reviewed hospital records and radiographic studies of 36 patients who were Hunt-Hess grade IV among 201 cases with ruptured intracranial aneurysm admitted between Sep. 1995 and Dec. 2000. Operated patients were treated with urgent angiography and surgery within 24 hours of presentation, except six patients, and medical records of these patients were reviewed for the clinical course and Glasgow outcome scale(GOS). Results : Overall management results of the 36 patients were good recovery in 13(36.1%), moderate disability in 12 (33.3%), severe disability in 1(2.8%), vegetative state in 1(2.8%) and 9(25.0%) of surgically treated patients had died. Conclusion : Although with limited number of patients, we conclude that urgent surgery for Hunt-Hess grade IV patients results in a better neurologic outcome and urgent surgery combined with aggressive postoperative management can minimize mortality.

• Journal of Preventive Medicine and Public Health
• /
• v.50 no.3
• /
• pp.165-176
• /
• 2017

Objectives: This study aimed to estimate the risk of bleeding following minor oral surgical procedures and uninterrupted aspirin therapy in high-risk patients or patients with existing chronic diseases compared to patients who did not use aspirin during minor oral surgery at a public hospital. Methods: This retrospective cohort study analyzed the data of 2912 patients, aged 20 years or older, who underwent 5251 minor oral surgical procedures at a district hospital in Thailand. The aspirin group was comprised of patients continuing aspirin therapy during oral surgery. The non-aspirin group (reference) included all those who did not use aspirin during surgery. Immediate and late-onset bleeding was evaluated in each procedure. The risk ratio of bleeding was estimated using a multilevel Poisson regression. Results: The overall cumulative incidence of immediate bleeding was 1.3% of total procedures. No late-onset bleeding was found. A significantly greater incidence of bleeding was found in the aspirin group (5.8% of procedures, p<0.001). After adjusting for covariates, a multilevel Poisson regression model estimated that the bleeding risk in the aspirin group was 4.5 times higher than that of the non-aspirin group (95% confidence interval, 2.0 to 10.0; p<0.001). However, all bleeding events were controlled by simple hemostatic measures. Conclusions: High-risk patients or patients with existing chronic diseases who continued aspirin therapy following minor oral surgery were at a higher risk of hemorrhage than general patients who had not used aspirin. Nonetheless, bleeding complications were not life-threatening and could be promptly managed by simple hemostatic measures. The procedures could therefore be provided with an awareness of increased bleeding risk, prepared hemostatic measures, and postoperative monitoring, without the need for discontinuing aspirin, which could lead to more serious complications.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.6
• /
• pp.450-455
• /
• 2005

Objective : Pituitary apoplexy is a rare clinical syndrome caused by pituitary hemorrhage, hemorrhagic infarction, or ischemic infarction within a pituitary tumor or surrounding structure. We analyzed surgical outcomes of pituitary apoplexy. Methods : From 1995 to 2004, we reviewed our experience of 29 cases with pituitary apoplexy. In all patients, pre- and postoperative clinical presentation were checked and endocrine study were performed. Results : The most frequent symptoms were visual disturbance [24 cases, 82.8%] and headache [22 cases, 75.9%]. After surgery, headache improved in 86.4%, 88.9% among 18cases who had preoperative reduction in visual acuity and 75.0% among 12 cases who had preoperative reduction in visual field improved. In endocrine study, long-term steroid and thyroid hormone replacement therapy was necessary in 42.9% of 14 cases presenting preoperative hypopituitarism. Postoperative transient hypopituitarism developed in 5 cases [33.3%] and they all recovered in follow up study. Postoperative endocrinological recovery were in 77.9% of 9 cases with preoperative prolactinoma, 1 case in 2 cases with acromegaly and one case with Cushing disease. Postoperative complications were diabetes inspidus[DI] in 1 case [3.4%]. cerebrospinal fluid[CSF] leakage in 2 cases [6.8%] and death in 1 case [3.4%] due to sepsis, Conclusion : We report good results through surgery of pituitary apoplexy in a clinical and endocrine outcomes. The surgery should be performed as soon as possible to be a suitable method for treating pituitary apoplexy.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.6
• /
• pp.717-723
• /
• 2001

Objective : Subarachnoid hemorrhage(SAH) is still one of the most serious disease with high morbidity and mortality in the neurosurgical field. Clipping of the aneurysmal neck is the gold standard of the surgical treatment of aneurysmal SAH. The purpose of this study was to investigate the role of the postoperative angiography and to assess the risk factors related to the incomplete clipping. Materials and Methods : From July 1995 to June 1998, the pre- and postoperative angiography were performed in 50 patients among total 81 patients who have underwent the aneurysmal surgery. We reviewed the various contributing factors including age, sex, Hunt-Hess grade, Fisher grade and the premature rupture of aneurysm during operation retrospectively. Careful evaluation of pre- and postoperative angiography focusing on the size, shape, and remnant neck of the aneurysms and vasospasm was performed. According to the angiographic findings, the patients were divided into two groups ; a complete clipping group and an incomplete clipping group. The data were analyzed by using unpaired independent sample t test after F-test to compare the significance between two groups. Results : Incomplete clipping of aneurysms was found in 6(12%) patients through the evaluation of postoperative angiography. Among them, three cases were located on the middle cerebral artery territory. Whereas the patient age, sex, Hunt-Hess grade, and Fisher grade were not significant(p>0.05), an intraoperative premature rupture had a statistical significance(p<0.05). A severe vasospasm occurred in 24(48%) cases and one patient with anterior communicating aneurysm was reoperated due to residual sac. Conclusion : According to our experience, the surgeons' judgement is the most reliable factor in deciding the postoperative angiography. During the aneurysmal surgery, the premature rupture always disturbs a complete clipping of aneurysms. Therefore, the temporary clipping of parent arteries is considered essential for a successful clipping. We believe that the postoperative angiography has a role in decreasing the re-bleeding risk due to clip migration and an inaccurate clipping only in the selected cases.

• Journal of Chest Surgery
• /
• v.23 no.6
• /
• pp.1180-1190
• /
• 1990

96 patients underwent cardiac valve replacement for valvular heart diseases consecutively between February 1986 to February 1990 in the Department of Thoracic and Cardiovascular Surgery of Yeungnam University Hospital. The follow up period was between 6 months and 4.5 years postoperatively[mean 23.4$\pm$13.1 months]. 75 cases got mitral valve replacement, 6 cases, aortic valve replacement, 15 cases, double valve replacement. 30[31.2%] patients were male and 66[68.8%] were female and the age ranged from 14 to 66 years old. Early hospital death within 30 days postoperation were 5 patients[5.2%], consisting of by low cardiac output in 2, infective endocarditis in 1, multiple organ failure with sepsis in 1 patient. There was no late postoperative death. Most common early postoperative complication was wound disruption [8.7%] and then low cardiac output, pneumothorax, pleural effusion in order. Most common late postoperative complications were minor bleeding episodes[8.7%] related to anticoagulant therapy which were consisted of frequent epistaxis in 3, gum bleeding in 2, hemorrhagic gastritis in 1, hypermenorrhea in 1, hematoma in right arm in 1 patient. Valve-related complications included valve thrombosis [1.6%/ patient-year], valve failure due to pannus formation[1.1% /patient-year], prosthetic valve endocarditis[1, 1%o/patient-year] and minor anticoagulant hemorrhage[4.4% /patient-year]. 5 cases of reoperations were performed in 4 patients due to valve failure and all of them were in the mitral positions[2.7% /patient-year]. Cardiothoracic ratios in the chest X-ray decreased at the 6th month and 1st year postoperation in all patients. But in New York Heart Association[NYHA] functional class IV, no change in cardiothoracic ratio was found between 6 months and 1 year postoperation. In the echocardiogram, the size of the cardiac chambers decreased, but ejection fraction increased postoperatively in each functional class. In the electrocardiogram, decreases were found in the incidence of atrial fibrillation, left atrial enlargement, left ventricular hypertrophy with right bundle branch block increasing postoperatively in each functional class. The actuarial survival rate was 98.4% for all patients, 98.7% for mitral valve replacement, 83.8% for aortic valve replacement, and 80% for double valve replacement at the end of a 4.5 year follow up period. Meanwhile the actuarial freedom rate was 91.5% for prosthetic valve endocarditis, 91.6% for thromboembolism, 89.0% for prosthetic valve failure and 83.7% for minor anticoagulant hemorrhage. Preoperative NYHA class III and IV were 75% of all patients, but 95% of all patients were up graded to NYHA class I and II postoperatively.