From March 1997 – September 2002, study on 31 patients intracerebral hemorrhage (28 male, 3 female) and 16 patients of control group (14 male, 2 female). The mortality of surgical treatment group was 32% and control group was 56%. Most of the benefit was in patients with lobar hemorrhage and following criteria: volume of hematoma  60cc, age  70, GCS  8. These is some suggestion that in the next future the treatment of intracerebral hemorrhage will involve non-invasive, stereotactic aspiration of hemorrhage through a single burr hole within hours
Intracranial Hemorrhage ; Hypertensive ; Surgery ; Cerebral Hemorrhage, Traumatic ; therapeutics ; surgery

To discover the effects of the time from injury to operative evacuation of the acute intracranial hematoma in the regard to improve outcome mortality, we reviewed the records 90 traumatic patients with acute intracrainal hematoma treated at our hospital between 1996 and 1997. The overall mortality late was 50%. The important prognostic variables included Glasgow coma scale(GCS), age, degree of midline shift in computerized tomography(CT), and lesional type of hematoma. Outcome was not significantly improved by rapid surgical decompression and no benefit revealed when surgery was performed within fast 4 hours. The mean interval from injury to surgery was 411 minutes for patient who died and 404 minutes for patients with functional recovery, but it was statistically insignificant. the mortality rate for those patients operated on within 4 hours of injury was 44% versus 52.3% for those operated on after 4 hours, and it was also statistically insignificant. In our opinion impart brain damage may be substantial and will affect recovery from intracranial hematoma and the operative timing-within the first 4 hours-may not be critical as has been commonly held.
Brain ; Coma ; Decompression, Surgical ; Hematoma ; Humans ; Intracranial Hemorrhage, Traumatic* ; Mortality*

The occurrence of delayed intracerebral hemorrhage is more frequent than previously reported and is associated with a poor outcome. Early detection and proper management is important in that aspect. The progression tends to be insidious. When the patient's consciousness gets worse or is not improving within resonable time, the second CT scan should be performed. In a retrospective study of 211 consecutive patients with traumatic intracranial hematomas, we identified 12 cases(5.6%) with delayed traumatic intracerebral hemorrhage(DTICH). Among these, five(41.6%) died of DTICH. Cerebral contusion on initial CT, acceleration-deceleration injury with rotational forces, surgical decompression would be important contributors in the development of DTICH.
Cerebral Hemorrhage ; Cerebral Hemorrhage, Traumatic* ; Consciousness ; Contusions ; Craniocerebral Trauma ; Decompression, Surgical ; Humans ; Intracranial Hemorrhage, Traumatic ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: The aim of this study is to determine the factors influencing the surgical outcome following craniotomy for head injury and to establish the criteria for surgical intervention in the age of 65 years or older. METHODS: We retrospectively investigated the mechanism of injury, types of computed tomography lesions, Glassgow coma scale(GCS) score at admission, pupillary reactivity, past medical history and surgical outcome following craniotomy in the elderly during 8 year period. RESULTS: There were 35 men and 21 women with a mean age of 70.7 years(range 65-87 years). The mortality rate at discharge was 58.9%. Good outcome was achieved only in 25 percent of the patients. The cause of injury did not affect on the surgical outcome. All of 19 patients with GCS of 5 or less at admission had poor outcome. Outcome was significantly worse in older patients(more than 75 years) compare to younger patients(less than 75 years). Ninety percent of the patients with pupillary abnormality had poor outcome, whereas 57.7 percent of the patients with bilateral reactive pupil had poor outcome. Past medical history did not affect on the surgical outcome following craniotomy. CONCLUSION: Surgical outcome is unexceptionally poor in the elderly head-injuried patients if the age is 75 years old or older, the GCS is 5 or less and the pupil is bilaterally dilated. Craniotomy under those circumstances is not desirable.
Aged* ; Coma ; Craniocerebral Trauma ; Craniotomy ; Female ; Humans ; Intracranial Hemorrhage, Traumatic* ; Male ; Mortality ; Pupil ; Retrospective Studies

It is not the best way to treat a hopeless patient with life-sustaining medical devices until the heart beats stop. Advanced medical technology may prolong the life for a significant period without recovery from the disease. However, it would give an unbearable economic burden to the family and the society. In 2006, we decided not to operate 9 patients with traumatic intracranial hematomas. We examined those patients with special references to possible legal and ethical problems. It is reasonable to withhold a treatment after documentation that the family never wants any life sustaining treatment when the treatment does not guarantee the meaningful life.
Craniocerebral Trauma* ; Decision Making ; Head* ; Heart ; Humans ; Intracranial Hemorrhage, Traumatic ; Medical Futility ; Resuscitation Orders ; Withholding Treatment

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH. METHODS: From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge. RESULTS: Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates. CONCLUSION: In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.
Catheters ; Drainage ; Head ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Hemorrhage, Traumatic ; Magnetic Resonance Imaging ; Prognosis ; Recurrence

Continuous venovenous hemodiafiltration (CVVHDF) was used to eliminate pentobarbital from the blood of a 30-year-old potentially brain dead male patient with traumatic intracranial hemorrhage after a motorcycle accident. The Acute Physiology and Chronic Health Evaluation (APACHE) II score of hospital day 1 was 24, but by day 8 it was 36, when the patient was considered to be brain dead. To control seizures and reduce intracranial pressure, pentobarbital had been administered in a continuous flow (2,880 mg/day for 5 days). Coma can be induced by pentobarbital at a serum level of 1~5 mg/dL. However, drug intoxication should be excluded from a brain death evaluation; therefore, the patient was not given any drug for approximately 88 hrs after ceasing pentobarbital in order for serum level to dip below 0.5 mg/dL (which is the hypnotic level). At 48 hours from CVVHDF, the pentobarbital level was close to the hypnotic level (0.1~0.5 mg/dL). Before stopping, the serum level of pentobarbital was 3.89 mg/dL and between 48 and 72 hours from CVVHDF, 4 cycles of pentobarbital half-life elimination (0.24 mg/dL) could be measured. Therefore, we suggest that in case of potential brain dead patients who have been administered pentobarbital, CVVHDF can enhance the elimination of pentobarbital from the circulatory system and shorten the waiting time for a brain death evaluation.
Adult ; APACHE ; Brain ; Brain Death ; Coma ; Half-Life ; Hemodiafiltration ; Humans ; Intracranial Hemorrhage, Traumatic ; Intracranial Pressure ; Male ; Motorcycles ; Pentobarbital ; Seizures

Twenty five consecutive patients requiring reoperation due to hemorrhage following surgery for intracranial hematoma removal were identified in a retrospective review of 211 cases of traumatic intracranial lesions treated at our hospital between January 1990 and December 1994. In cases involving head injury, reoperation is nowadays not uncommon. The incidence of cases requiring reoperation was 11.8%, while delayed or recurrent lesions were more common among older patients(mean age=44.39 years). Acute subdural hemorrhage was the most common initial lesion requiring reoperation: in intracerebral and acute subdural hemorrhage, the incidence of reoperation was relatively high(23.1% and 14.7%, respectively): acute epidural hemorrhage was next most common(8.8%). In 88.0% of cases, reoperation was performed within 24 hours. At the time of discharge, good recovery was reported in five cases(20.0%), moderate disability in ten(40.0%), severe disability in two(8.0%), vegetative state in two(8.0%) and death in six(24.0%). The outcome seems to be related to lesions requiring reoperation rather than initial lesions. Furthermore, closed observation and aggressive management can rapidly improve the outcome, even in patients requiring reoperation: it is, in addition, of the utmost importance that CT scans be used early and repeatedly, especially in patients who are at risk of delayed or recurrent lesions.
Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Traumatic* ; Intracranial Hemorrhages* ; Persistent Vegetative State ; Postoperative Hemorrhage ; Reoperation* ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI. METHODS: 36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation. RESULTS: Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation. CONCLUSION: Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy.
Brain Injuries ; Edema ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Intracranial Hemorrhage, Traumatic* ; Reoperation* ; Retrospective Studies ; Risk Factors*

We have analysed 111 cases of subdural hygroma that were development after various neurosurgical conditions including head injuries. The results were summarized as follows. 1) The peak incidence was the age of 50's and occured most frequently in male. 2) Causes were head injuries(91 cases), traumatic intracranial hematoma removal(10 cases), operation for intracranial aneurysms(4 cases), hypertensive intracerebral hemorrhage evacuation(2 cases), ventriculoperitoneal shunt(2 cases), brian tumor removal(1 cases), arachnoid cyst excision(1 cases), and cerebral infarction(1 cases). 3) Acute subdural hematoma was most often associated with complex subdural hygrom. 4) Clinical manifestations were headache, altered mental state, disorientation, nausea in order. 5) Operation were underwent in 27 cases and surgical complications were reaccumulation and pneumocephalus in order. 6) Mortality rate was 6.3%. 7) The prognois of the simple hygroma was very good, but the complex was not.
Arachnoid ; Craniocerebral Trauma ; Head ; Headache ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Intracranial Hemorrhage, Traumatic ; Lymphangioma, Cystic ; Male ; Mortality ; Nausea ; Pneumocephalus ; Subdural Effusion*