BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage* ; Emergencies ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms* ; Retrospective Studies ; Ventriculostomy

No abstract available.

For securing large, giant, and wide-neck aneurysms, conventional coil embolization has substantial limitations, such as incomplete occlusion, recanalization, and a high recurrence rate. To overcome these limitations, a novel paradigm was suggested and, as a result, flow-diverting device was developed. The flow-diverting device is an innovative and effective technique to allow securing of large, giant, and wide-neck aneurysms. In numerous studies, the flow-diverting device has shown better outcomes than coil embolization. However, the flow-diverting device has also some risks, including rupture of aneurysm, intracerebral hemorrhage, and ischemic stroke. In addition, with more experience, unexpected complications are also reported.5) 7) In the present case, we experienced a delayed ischemic stroke at 27 days after endovascular treatment. The patient had multiple aneurysms and, among them, we treated a large posterior communicating artery aneurysm using Pipeline™ Embolization Device. The patient was tolerable for 25 days, but then suddenly presented intermittent right hemiparesis. In the initial diffusion magnetic resonance imaging (MRI), there was no acute lesion; however, in the follow-up MRI, an acute ischemic stroke was found in the territory of anterior choroidal artery which was covered by Pipeline Embolization Device. We suspect that neo-intimal overgrowth or a tiny thrombus have led to this delayed complication. Through our case, we learned that the neurosurgeon should be aware of the possibility of delayed ischemic stroke after flow diversion, as well as, long-term close observation and follow-up angiography are necessary even in the event of no acute complications.
Aneurysm ; Angiography ; Arteries ; Cerebral Hemorrhage ; Choroid ; Diffusion Magnetic Resonance Imaging ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Paresis ; Recurrence ; Rupture ; Stroke* ; Thrombosis

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. METHODS: A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. RESULTS: Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. CONCLUSION: 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.
Aging ; Angiography ; Arteries ; Blood Glucose ; Brain Stem ; Carotid Arteries ; Cerebral Hemorrhage* ; Constriction, Pathologic* ; Ganglion Cysts ; Humans ; Hypertension ; Kidney ; Logistic Models ; Phenobarbital ; Prevalence ; Risk Factors ; Stroke

BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage ; Emergencies ; Female ; Humans ; Intensive Care Units ; Critical Care ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms ; Retrospective Studies ; Ventriculostomy

OBJECTIVE: High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low- and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. METHODS: Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecularweight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. RESULTS: A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. CONCLUSION: Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.
Blood Coagulation ; Fibrinogen ; Hemorrhage ; Humans ; Infusions, Intravenous ; Molecular Weight ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Retrospective Studies ; Starch* ; Subarachnoid Hemorrhage

Accurate determination of the true incidence of blunt carotid artery injury is difficult because the patient may be asymptomatic or the condition may be masked by concomitant injuries. We present a case of blunt injury to the right common carotid artery and dissection with acute infarction on right fronto-temporo-parietal area and treated with carotid stent. We review the blunt carotid artery injury rate of occurrence, mechanism, presentation, screening, radiologic diagnosis, management and outcome.
Carotid Artery Injuries ; Carotid Artery, Common* ; Cerebral Infarction* ; Diagnosis ; Humans ; Incidence ; Infarction ; Masks ; Mass Screening ; Stents* ; Wounds, Nonpenetrating

OBJECTIVE: During the last two decades, detection of unruptured intracranial aneurysms has increased because of the improving diagnostic methods, but the management of unruptured intracranial aneurysm is still controversial. We analyzed the angiographic characteristics to compare ruptured aneurysms with unruptured aneurysms. METHODS: The patients were retrospectively selected for this study based on the availability of angiograms and a clear diagnosis of an unruptured or ruptured aneurysm. One hundred sixty nine patients with 209 aneurysms were included in the study. Sixty-one patients harbored only unruptured lesions, 85 only ruptured lesions and 27 had both ruptured and unruptured lesions. RESULTS: The mean age of all the patients was 55.3 years, and it was 53.34 years for those with ruptured aneurysms. It was found that 42.0% of the ruptured aneurysms were on the anterior communicating artery, compared with 10.3% of the unruptured aneurysms. None of the ophthalmic artery aneurysms were ruptured. The mean dome size, depth and aspect ratio of the ruptured aneurysms, except for the neck size, were significantly larger than that of the unruptured aneurysms, but the mean neck size of the ruptured and unruptured aneurysms showed no significant difference. A daughter sac was present in 7.2% of the unruptured aneurysms and in 17.0% of the ruptured aneurysms. CONCLUSION: We suggest that the morphologic features and location of aneurysms should be considered when making decisions regarding whether to treat unruptured aneurysms.
Aneurysm* ; Aneurysm, Ruptured ; Arteries ; Diagnosis ; Humans ; Intracranial Aneurysm ; Neck ; Nuclear Family ; Ophthalmic Artery ; Retrospective Studies ; Rupture*

OBJECTIVE: Hydrocephalus and vasospasm are the common complications of aneurysmal subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus and vasospasm are the causes of the neurological deficit and poor prognosis. This study was designed to investigate whether the frequency of a shunt-dependent hydrocephalus in patient suffering from aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia can be related to the duration and amount of cerebrospinal fluid drainage and medical history. METHODS: Retrospective analysis of consecutive 96 patients with aneurysmal subarachnoid hemorrhage was made from January 2000 to December 2002. Eighty one of these patients underwent the procedure for CSF drainage and 15 patients did not. 81 patients with aneurysmal SAH were divided into two groups which underwent shunt procedure and did not. In these two groups, we investigated and compared the incidence of shunt-dependent hydrocephalus and ischemia according to age, sex, aneurysmal site, H-H grade, Fisher grade, medical history and the amout of CSF drainage. RESULTS: The incidence of hydrocephalus following SAH was 53.1% and shunt-dependent hydrocephalus was 16.7% in 96 patients. The duration, total volume, and daily volume of CSF drainage were 6.9+/-3.3 days, 1542.3+/-982.5 ml, and 211.5+/-49.2 ml, respectively. The relationship between the daily volume of CSF drainage and shunt-dependent hydrocephalus was determined to to be statistically significant (p<0.05). Cerebral infarction and shunt-dependent hydrocephalus were found to be statistically associated (p<0.05). CONCLUSION: The continous drainage of cerebrospinal fluid in patients of aneurysmal subarachnoid hemorrhage increase chance of delayed hydrocephalus and they have not shown decrease cerebral infarction as a result of vasospasm.
Aneurysm ; Brain Ischemia ; Cerebral Infarction ; Cerebrospinal Fluid ; Drainage* ; Humans ; Hydrocephalus ; Incidence ; Ischemia ; Prognosis ; Retrospective Studies* ; Subarachnoid Hemorrhage*

OBJECTIVE: Hydrocephalus and vasospasm are the common complications of aneurysmal subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus and vasospasm are the causes of the neurological deficit and poor prognosis. This study was designed to investigate whether the frequency of a shunt-dependent hydrocephalus in patient suffering from aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia can be related to the duration and amount of cerebrospinal fluid drainage and medical history. METHODS: Retrospective analysis of consecutive 96 patients with aneurysmal subarachnoid hemorrhage was made from January 2000 to December 2002. Eighty one of these patients underwent the procedure for CSF drainage and 15 patients did not. 81 patients with aneurysmal SAH were divided into two groups which underwent shunt procedure and did not. In these two groups, we investigated and compared the incidence of shunt-dependent hydrocephalus and ischemia according to age, sex, aneurysmal site, H-H grade, Fisher grade, medical history and the amout of CSF drainage. RESULTS: The incidence of hydrocephalus following SAH was 53.1% and shunt-dependent hydrocephalus was 16.7% in 96 patients. The duration, total volume, and daily volume of CSF drainage were 6.9+/-3.3 days, 1542.3+/-982.5 ml, and 211.5+/-49.2 ml, respectively. The relationship between the daily volume of CSF drainage and shunt-dependent hydrocephalus was determined to to be statistically significant (p<0.05). Cerebral infarction and shunt-dependent hydrocephalus were found to be statistically associated (p<0.05). CONCLUSION: The continous drainage of cerebrospinal fluid in patients of aneurysmal subarachnoid hemorrhage increase chance of delayed hydrocephalus and they have not shown decrease cerebral infarction as a result of vasospasm.
Aneurysm ; Brain Ischemia ; Cerebral Infarction ; Cerebrospinal Fluid ; Drainage* ; Humans ; Hydrocephalus ; Incidence ; Ischemia ; Prognosis ; Retrospective Studies* ; Subarachnoid Hemorrhage*