We describe the case of a 57-year-old man who had traumatic subarachnoid hemorrhage (SAH) with a delayed growth of an ophthalmic artery aneurysm. Initially, computed tomography angiography did not show any evidence of aneurysmal dilatation, but digital subtraction angiography (DSA) after 3 days showed small aneurysmal dilatation or dissection of a presumed lesion. Early intervention or surgery was difficult because of the patient's unstable condition. The SAH was completely resolved within 7 days. Follow-up DSA was performed 2 weeks later and it revealed an increasing size and shape change. We treated the patient with coil embolization, partially filling the aneurysm to save the ophthalmic artery. DSA performed 6 months later indicated that the aneurysm was completely embolized, sparing the ophthalmic artery. In traumatic SAH, delayed growth of the aneurysm should always be considered, and follow-up imaging should be performed. Partial embolization to save the ophthalmic artery can be one of the treatment modalities for selected patients.

The author presents a 48-year-old man who showed an intracranial sewing needle incidentally detected on a skull radiograph. He had no history of cranial surgery or a penetrating head injury. On radiography, the sewing needle was found to be located close to the frontal bone in the midline, with a trajectory to the right anterior skull base. Computed tomography angiography revealed that the needle head was located at an approximately 3.57 mm depth from the inner table and attached to the cortical vein. The distal end of the needle was surrounded by the right distal pericallosal artery. No cortical injury or vascular injury was observed. The needle may have penetrated during the early period before the closure of the anterior fontanelle.

OBJECTIVE: Ruptured middle cerebral artery (MCA) aneurysm with intrasylvian hematoma usually accompanied by progressive cerebral swelling with poorer outcomes. The authors present characteristics and importance of intrasylvian hematoma removal in the aneurysm surgery. MATERIALS AND METHODS: From 2012 February to 2014 March, 24 aneurysm surgeries for ruptured MCA aneurysms with intrasylvian hematoma were performed in the authors' clinic. The patients were classified according to three groups. Group A included patients who underwent decompressive craniectomy within a few days after aneurysm surgery due to progressive cerebral swelling, group B included patients for whom decompression was not necessary, and group C included patients who showed severe cerebral swelling on admission and decompressive craniectomy and aneurysm surgery in one stage. RESULTS: The mean hematoma volume on admission was 28.56 mL, 24.96 mL, and 66.78 mL for groups A, B and C, respectively. Removal of a larger amount of hematoma was observed on postoperative computerized tomography scan in groups B and C (63.2% and 59.0%) compared with group A (33.4%). Although no statistical difference was found between group A and group B (p = 0.115), it tends to show the lesser amount of hematoma removed, the more likely cerebral swelling will progress. CONCLUSION: The lesser amount of hematoma in ruptured MCA aneurysm with intrasylvian hematoma tends to show benign clinical course than larger amounts. But, even if the hematoma is not easily removed in the operation, we suggest the other procedures such as continuous external catheter drainage of hematoma to avoid unnecessary coagulation or brain retraction.
Aneurysm ; Brain ; Catheters ; Decompression ; Decompressive Craniectomy ; Drainage ; Hematoma* ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery*

OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
Accidental Falls ; Accidents, Traffic ; Blood Pressure ; Body Temperature ; Carotid Artery, External* ; Endovascular Procedures ; Erythrocytes ; Facial Bones ; Follow-Up Studies ; Glasgow Coma Scale ; Groin ; Hemorrhage* ; Humans ; Maxillary Artery ; Maxillary Fractures ; Plasma ; Punctures

OBJECTIVE: The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. MATERIALS AND METHODS: A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. RESULTS: Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. CONCLUSION: It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
Accidental Falls ; Accidents, Traffic ; Blood Pressure ; Body Temperature ; Carotid Artery, External* ; Endovascular Procedures ; Erythrocytes ; Facial Bones ; Follow-Up Studies ; Glasgow Coma Scale ; Groin ; Hemorrhage* ; Humans ; Maxillary Artery ; Maxillary Fractures ; Plasma ; Punctures

Berardinelli lipodystrophy syndrome is a rare autosomal recessive disorder, characterized by loss of body fat, muscular hypertrophy, acanthosis nigricans, hepatomegaly, hyperlipidemia, insulin resistant diabetes, and elevated metabolic rate. The mechanism(s) responsible for these abnormalities is not known. We report a forteen-month old girl with Berardinelli Lipodystriphy Syndrome, who had signs above mentioned, with a brief review and its related literatures.
Acanthosis Nigricans ; Adipose Tissue ; Female ; Hepatomegaly ; Humans ; Hyperlipidemias ; Hypertrophy ; Insulin ; Lipodystrophy*

Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques.
Arteries* ; Decompression ; Facial Nerve* ; Hemifacial Spasm* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Polytetrafluoroethylene ; Postoperative Period ; Spasm ; Young Adult

OBJECTIVE: Computed tomography (CT), rather than conventional 2-dimensional radiography, was used to scan and measure pelvic parameters. The results were compared with measurements using X-ray. METHODS: Pelvic parameters were measured using both CT and X-ray in 254 patients who underwent both abdomino-pelvic CT and X-ray at the pelvic site. We assessed the similarity of the pelvic parameters between the 2 exams, as well as the correlations of pelvic parameters with sex and age. RESULTS: The mean values of the subjects’ pelvic parameters measured on X-ray were: sacral slope (SS), 31.6°; pelvic tilt (PT), 18.6°; and pelvic incidence (PI), 50.2°. The mean values measured on CT were: SS, 35.1°; PT, 11.9°; and PI, 47.0°. PT was found to be 4.07° higher on X-ray and 2.98° higher on CT in women, with these differences being statistically significant (p < 0.001, p < 0.001). PI was 4.10° higher on X-ray and 2.78° higher on CT in women, with these differences also being statistically significant (p < 0.001, p=0.009). We also observed a correlation between age and PI. For men, this correlation coefficient was 0.199 measured using X-ray and 0.184 measured using CT. For women, this correlation coefficient was 0.423 measured using X-ray and 0.372 measured using CT. CONCLUSION: When measured using CT compared to X-ray, SS increased by 3.5°, PT decreased by 6.7°, and PI decreased by 3.2°. There were also statistically significant differences in PT and PI between male and female subjects, while PI was found to increase with age.
Age Factors ; Female ; Humans ; Incidence* ; Male ; Posture* ; Radiography ; Sex Factors

PURPOSE: To test the hypothesis that chronic subdural hematoma (CSDH) enlarges by the causative factors, this study has performed. METERIALS AND METHODS: In 10 patients with CSDH, coagulation factors in venous blood taken at the time of surgery and hematomic contents aspirated from the CSDH were studied, using both laboratory assays and microscopy. RESULTS: When compared to the range of normal plasma, the hematoma fluids demonstrated a marked reduction in factor II, V, VII, VIII, and X, moderate reduction of factors IX and XI, and slight reduction of factor XII. Activated protein C and antithrombin III levels were decreased. The FDP (Fibrinogen Degradation Product) levels in chronic subdural hematoma were extremely high. The endothelial cells of the macrocapillaries (also called "sinusoid") showed numerous gap junctions between adjacent endothelial cells and a thinness or absence of the basement membrane, suggesting that the macrocapillaries are very fragile and susceptible to bleeding. CONCLUSION: Excessive coagulation in the hematoma, predominantly via the extrinsic clotting pathway, local hyperfibrinolysis, transmitted pulsations, and characteristics of the macrocapillaries play an important role in the leakage of blood and the enlargement of CSDH.

OBJECTIVE: This study was conducted to investigate survival related factors, as well as to evaluate the effects of early decompression on acute subdural hematoma (ASDH). METHODS: We retrospectively reviewed cases of decompressive craniectomy (DC) for decade. In total, 198 cases of DC involved ASDH were available for review, and 65 cases were excluded due to missing data on onset time and a delayed operation after closed observation with medical care. Finally, 133 cases of DC with ASDH were included in this study, and various factors including the time interval between trauma onset and operation were evaluated. RESULTS: In the present study, survival rate after DC in patients with ASDH was shown to be related to patient age (50 years old, p=0.012), brain compression ratio (p=0.042) and brain stem compression (p=0.020). Sex, preoperative mental status, and time interval between trauma onset and operation were not related with survival rate. Among those that survived (n=78), improvements in Glasgow Coma Scale (GCS) score of more than three points, compared to preoperative measurement, were more frequently observed among the early (less than 3 hours between trauma onset and operation) decompressed cases (p=0.013). However, improvements of more than 4 or 5 points on the GCS were not affected by early decompression. CONCLUSION: Early decompression of ASDH was not correlated with survival rate, but was related with neurological improvement (more than three points on the GCS). Accordingly, early decompression in ASDH, if indicated, may be of particular benefit.
Brain ; Brain Stem ; Decompression* ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hematoma, Subdural, Acute* ; Humans ; Retrospective Studies* ; Survival Rate