• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.282-286
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• 2005

Objective: Symptomatic chronic subdural hematoma(CSDH) is a well-known neurosurgical entity and most of the lesion is managed by surgical treatment. The authors analyze the surgical indication and the treatment results of twist drill craniostomy with closed-system drainage(TDD) for the symptomatic CSDH. Methods: From March 2001 through December 2003, 31 patients who were treated with TDD for the symptomatic CSDH and followed more than 6months were included. The radiologic criteria of TDD in this study were 1) homogeneous density of hematoma on computed tomography(CT), 2) no septation of hematoma on magnetic resonance imaging(MRI), and 3) thicker hematoma more than twice thickness of skull. Surgical procedures were performed on the maximum thickness of hematoma on CT/MRI. Short and long Steinman pins were used to penetrate the skull and hematoma membrane. As the 5L catheter was inserted through the drill hole, it was kept for 1 - 7days for the drainage of CSDH. The patients of CSDH were followed with clinical symptoms and CT studies. Results: Most of all the 31 patients were improved. However, one patient was suffered from postoperative epidural hematoma and the other patients have received the secondary operation because of the recurrence of CSDH on 3 months after initial surgery. Conclusion: TDD is safe procedure for the symptomatic CSDH if the patients are selected appropriately.

• 동의생리병리학회지
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• 제16권6호
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• pp.1302-1307
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• 2002

We experienced a case of patient of incomplete spinal cord injury following slipping off his clothes. He had complications : both leg paresisㆍboth arm weaknessㆍurine disturbanceㆍboth leg & arm sensory disorder . We could treat these complications with the methods of medical treatments ; acupunctureㆍmoxa therapyㆍherb-medicationㆍelectro-acupuncture & muscle exercises. We obtained results that motor grade and muscle atrophy were improved.

• Archives of Plastic Surgery
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• 제32권3호
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• pp.389-392
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• 2005

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had acute optic nerve injury associated with a fracture of the right zygomaticomaxillary and fronto-naso-ethmoido-orbital bone and epidural hematoma on the right temporal lobe of brain. Bony fragments compressing the optic nerve on lateral side was identified on computed tomography. Decompression of the optic nerve combined with evacuation of epidural hematoma has been performed via transfrontal craniotomy. The patient had complete recovery of visual acuity without any complications. The role of optic nerve decompression in the management of patients with traumatic optic neuropathy is discussed. Surgical indication is controversial and the procedure should be considered only within the context of the specific indication of the individual patient.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.441-444
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• 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
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• 제42권3호
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• pp.228-231
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• 2007

The intracranial hemorrhage in regions remote from the site of initial operations is unusual but may present as fatal surgical complication. We report a rare case of multiple, sequential, remote intracranial hematomas after cranioplasty in a patient who did not have any prior risk factors. A 51-years-old man was transferred to the hospital after a head trauma. The brain computed tomography (CT) revealed acute subdural hemorrhage on the right hemisphere with prominent midline shifting. After performing decompressive craniectomy and hematoma removal, the patient recovered without any complications. However, the patient showed neurological deterioration immediately after cranioplasty, which was done three months after the first surgery. There was extensive hemorrhage in the posterior fossa remote from the site of the initial operation site. The brain CT taken soon after removing this hematoma evacuation displayed large epidural hematoma on the left hemisphere. This case represents posterior fossa hemorrhage after supratentorial procedure and sequential delayed hematoma on the contralateral supratentorial region thus seems very rare surgical complications. Despite several possible pathogenetic mechanisms for such remote hematomas, there are usually no clear cut relationships with each case as in our patient. However, for the successful outcome, prompt evaluation and intensive management seem mandatory.

• 대한두개안면성형외과학회지
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• 제21권3호
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• pp.198-201
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• 2020

Primary lung cancer commonly metastasizes to the brain, bones, liver, and adrenal glands. In some cases, bone metastasis serves as the first presenting sign of lung cancer with bone pain and headache, but it is not common. The incidence of skull metastasis in lung squamous cell carcinoma (SCC) is low, and there have been only a few cases of skull metastases serving as the first sign of malignancy with skull mass and epidural bleeding; however, no similar cases have been reported regarding that of hematoma. We report a case of an 84-year-old man who first presented with a simple forehead hematoma and was eventually diagnosed with SCC of the lung.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.13-21
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• 2022

Objective : Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. Methods : All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, follow-up hematoma thickness, and follow-up mRS score. Results : Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. Conclusion : HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.

• Journal of Korean Neurosurgical Society
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• 제62권2호
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• pp.225-231
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• 2019

Objective : Epidural haematoma (EDH) most commonly occurs in the supratentorial area, particularly in the temporal region, of the brain. Posterior fossa epidural haematoma (PFEDH) is less frequently observed, accounting for only 1.2% to 12.9% of all EDH cases. Because of the non-specific symptoms and the potential for rapid and fatal deterioration in children, an early computed tomography (CT) scanning is necessary for all suspicious cases. The aim of the present study was to share the experience of 48 cases and review the literature concerning PFEDH. Methods : A retrospective analysis was conducted for 48 paediatric cases diagnosed with PFEDH and admitted to Yuying Children's Hospital of Wenzhou Medical University from January 2010 to August 2015. The clinical features and outcomes were analyzed and compared with previous literature. Results : Seventeen patients were surgically treated in this series and 31 patients received non-operative treatment. The outcomes were good in 46 patients, evaluated using the Glasgow outcome score (GOS), while mild disability was observed in one patient, and only one case showed severe disability. There were no cases of mortality in this series. Conclusion : Posterior fossa epidural haematoma is relatively rare compared with supratentorial epidural haematoma. Early and serial CT scans should be performed for all suspicious cases. The criteria for the surgical treatment of paediatric patients with PFEDH were concluded. The overall prognosis was excellent in paediatric patients.

• 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.

• 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.