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Risk Factor Analysis for the Recurrence of Chronic Subdural Hematoma: A Review of 368 Consecutive Surgical Cases.

Junhak KIM ; Jongun MOON ; Tackeun KIM ; Seongyeol AHN ; Gyojun HWANG ; Jaeseung BANG ; O Ki KWON ; Chang Wan OH

Korean Journal of Neurotrauma.2015;11(2):63-69. doi:10.13004/kjnt.2015.11.2.63

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common form of extra axial hemorrhage in the elderly. A surgical procedures such as a burr hole trephination are used for the CSDH treatment. The recurrence rate of CSDH is reported to range from 2.3 to 33%. In the current study, we focused on the determination of risk factors associated with the recurrence of CSDH. METHODS: We retrospectively reviewed 368 consecutive patients with CSDH treated by burr hole trephination. Univariate and multivariate analysis were performed to describe the relationships between clinical and radiological factors as well as the recurrence of CSDH. RESULTS: Totally 31 (8.4%) patients experienced a recurrence of CSDH in our study. The male group (10.2%) had a higher recurrence rate than the female group (3.1%). Also patients with malignant neoplasm history showed a high recurrence rate (17.9%). The recurrence rate of single layer CSDH (13.1%) and isodensity CSDH (11.7%) was highly significant also. CONCLUSION: Sex, history of malignant neoplasm and the hematoma type on computed tomography were factors related with the recurrence of CSDH in our study. These findings may be supportive in the identification of patients at risk for a recurrence of CSDH.
Aged ; Female ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Male ; Multivariate Analysis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Trephining

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Clinical Analysis of Results of Shunt Operation for Hydrocephalus Following Traumatic Brain Injury.

Ho Soo KIM ; Sung Un LEE ; Jae Hun CHA ; Weon HEO ; Joon Suk SONG ; Sung Jin KIM

Korean Journal of Neurotrauma.2015;11(2):58-62. doi:10.13004/kjnt.2015.11.2.58

OBJECTIVE: Ventricular enlargement following head injury is a frequent finding but cases requiring shunt operation are rare. The incidence and developing factors of post-traumatic hydrocephalus (PTH) have been variously reported, but studies for factors influencing outcomes of shunt operation for PTH are rare. The incidence of PTH requiring shunt operation, causing injuries, and factors influencing outcome of shunt operation need to be identified. METHODS: In total, 1,142 patients suffering from traumatic brain injury (TBI) between January 2007 and December 2012 were admitted to our department. Of them, 23 patients underwent shunt operation for diagnosed PTH. In this clinical study, we reviewed retrospectively our TBI database and in the 23 patients, we evaluated outcomes with Glasgow Outcome Score just before the operation, at 14 days, 3 months, and 6 months according to initial Glasgow Coma Scale (GCS) score, interval time between shunt operation and trauma, and lumbar cerebrospinal fluid (CSF) pressure. RESULTS: The incidence of PTH treated with shunt operation was 2.01%. Subdural hematoma (SDH) was the most common preceding head injury. The outcomes of shunt operation were not related with lumbar CSF pressure or interval time from trauma, but initial GCS score correlated with the outcome. CONCLUSION: In present study, 2.01% of TBI patients underwent shunt operation. SDH was the most common preceding injury. Admission GCS score was related to the outcome of shunt operation. However, there were no correlation between the outcome of shunt operation and initial lumbar CSF pressure or interval time of shunt operation after the trauma.
Brain Injuries* ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Glasgow Coma Scale ; Hematoma, Subdural ; Humans ; Hydrocephalus* ; Incidence ; Retrospective Studies ; Treatment Outcome

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Risk Factors of Chronic Subdural Hematoma Progression after Conservative Management of Cases with Initially Acute Subdural Hematoma.

Jong Joo LEE ; Yusam WON ; Taeyoung YANG ; Sion KIM ; Chun Sik CHOI ; Jaeyoung YANG

Korean Journal of Neurotrauma.2015;11(2):52-57. doi:10.13004/kjnt.2015.11.2.52

OBJECTIVE: Acute subdural hematoma (ASDH) patients are treated conservatively or surgically according to the guidelines for surgical treatment. Many patients with thin ASDH and mild neurologic deficit are managed conservatively, but sometimes aggravation of thin ASDH to chronic subdural hematoma (CSDH) results in exacerbated clinical symtoms and consequently requires surgery. The aim of this study is to evaluate risk factors that indicate progression of initially non-operated ASDH to CSDH. METHODS: We divided 177 patients, presenting with ASDH (managed conservatively initially) between January 2008 to December 2013, into two groups; 'CSDH progression group' (n=16) and 'non-CSDH progression group' (n=161). Patient's data including age, sex, past medical history, medication were collected and brain computed tomography was used for radiologic analysis. RESULTS: Our data demonstrated that no significant intergroup difference with respect to age, sex ratio, co-morbid conditions, medication history, ischemic heart disease, liver disease and end-stage renal disease was found. However, Hounsfield unit (hematoma density) and mixed density was higher in the 'ASDH progression group' (67.50+/-7.63) than in the 'non-CSDH progression group' (61.53+/-10.69) (p=0.031). Midline shifting and hematoma depth in the 'CSDH progression group' were significantly greater than the 'non-CSDH progression group' (p=0.067, p=0.005). CONCLUSION: Based on the results of this study, the risk factors that are related to progression of initially non-operated ASDH to CSDH are higher Hounsfield unit and hematoma depth. Therefore, we suggest that ASDH patients, who have bigger hematoma depth and higher Hounsfield unit, should be monitored and managed carefully during the follow-up period.
Brain ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural, Acute* ; Hematoma, Subdural, Chronic* ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Myocardial Ischemia ; Neurologic Manifestations ; Risk Factors* ; Sex Ratio

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Time Course and Characteristics of Astrocyte Activation in the Rat Brain after Injury.

Hyun Ho LEE ; Sung Choon PARK ; Il Seung CHOE ; Young KIM ; Young Soo HA

Korean Journal of Neurotrauma.2015;11(2):44-51. doi:10.13004/kjnt.2015.11.2.44

OBJECTIVE: After injury to the central nervous system (CNS), glial scar tissue is formed in the process of wound healing. This can be is a clinical problem because it interferes with axonal regeneration and functional recovery. It is known that intracellular proteins, including the glial fibrillary acidic protein (GFAP), nestin, and vimentin increase in the astrocytes after an injury to the CNS. By studying the time course and co-expression pattern of these intracellular proteins, this study will attempt to prove that these proteins are involved in the processes of glial scar formation. METHODS: Twenty-five male Sprague-Dawley rats were used in this study. Bregma of the cerebral cortex, an area was incised with a sharp blade, and perfusion was performed. The expressions of the intracellular proteins were assayed, while the co-localization of the intermediate filament (GFAP, nestin, and vimentin) and A2B5 were examined. RESULTS: At 12 hours, the GFAP was expressed in the white matter underlying the lesion, and in the cerebral cortex. Nestin was expressed in the astrocytes in the perilesional area after 3 days, while A2B5 was observed in the edge of the wound at 12 hours post-injury, with its expression reaching a peak at 7 days. Vimentin was detected in the white matter at 12 hours, and in the cortex, reaching a peak at 7 days. CONCLUSION: In the processes of glial scar formation, nestin, vimentin, and A2B5 were revealed in the astrocytes, and these factors may be involved in the division, proliferation, and transportation of the astrocytes.
Animals ; Astrocytes* ; Axons ; Brain* ; Central Nervous System ; Cerebral Cortex ; Cicatrix ; Glial Fibrillary Acidic Protein ; Gliosis ; Humans ; Intermediate Filaments ; Male ; Nestin ; Perfusion ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Transportation ; Vimentin ; Wound Healing ; Wounds and Injuries

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Management of Craniocerebral Gunshot Injuries: A Review.

Hernando Raphael ALVIS-MIRANDA ; Roberto ADIE VILLAFANE ; Alejandro ROJAS ; Gabriel ALCALA-CERRA ; Luis Rafael MOSCOTE-SALAZAR

Korean Journal of Neurotrauma.2015;11(2):35-43. doi:10.13004/kjnt.2015.11.2.35

Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.
Arm ; Brain ; Brain Injuries ; Cicatrix ; Craniocerebral Trauma ; Debridement ; Decompression ; Developing Countries ; Foreign Bodies ; Hemorrhage ; Humans ; Incidence ; Military Personnel ; Neuroimaging ; Neurons ; Quality of Life ; Resuscitation ; Scalp ; Vital Signs ; Wounds and Injuries

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History of Chronic Subdural Hematoma.

Kyeong Seok LEE

Korean Journal of Neurotrauma.2015;11(2):27-34. doi:10.13004/kjnt.2015.11.2.27

Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion.
Aging ; Brain ; Craniocerebral Trauma ; Head ; Hematoma, Subdural, Chronic* ; Natural History ; Shoulder ; Stroke ; Subdural Space ; Trephining ; United Nations

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Spinal Extradural Arachnoid Cyst.

Joon Bum WOO ; Dong Wuk SON ; Kyung Taek KANG ; Jun Seok LEE ; Geun Seong SONG ; Soon Ki SUNG ; Sang Weon LEE

Korean Journal of Neurotrauma.2016;12(2):185-190. doi:10.13004/kjnt.2016.12.2.185

A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.
Adult ; Aged ; Arachnoid* ; Cerebrospinal Fluid ; Consensus ; Epidural Space ; Female ; Fenestration, Labyrinth ; Follow-Up Studies ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Recurrence ; Subarachnoid Space

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Retro-Odontoid Pseudotumor without Atlantoaxial Subluxation or Rheumatic Arthritis.

Seung Han YU ; Hyuk Jin CHOI ; Won Ho CHO ; Seung Heon CHA ; In Ho HAN

Korean Journal of Neurotrauma.2016;12(2):180-184. doi:10.13004/kjnt.2016.12.2.180

We present a case of retro-odontoid pseudotumor (ROP) without rheumatoid arthritis (RA) or atlantoaxial subluxation (AAS). A 76-year-old woman presented with paresthesia and weakness of both lower and upper extremities. She had no laboratory or physical findings of RA. Dynamic X-ray showed no AAS and magnetic resonance imaging (MRI) showed a retro-odontoid mass compressing the spinal cord. Transdural mass debulking and biopsy were performed via minimal left suboccipital craniectomy and C1 hemilaminectomy. Two months after surgery, her symptoms were aggravated. Follow-up MRI visualized mass re-growth and spinal cord compression due to the mass and AAS. Posterior C1-2 fixation was performed without further decompression. Twelve months after posterior fixation, no symptoms were apparent and follow-up MRI showed complete resolution of the ROP with C1-2 bony fusion. The ROP with C1-2 instability might be completely resolved only C1-2 fusion without decompression. Furthermore, we speculated that osteoarthritis of C1-2 itself causes a partial tear or degradation of the transverse ligament, that induced formation of ROP.
Aged ; Arthritis, Rheumatoid ; Atlanto-Axial Joint ; Biopsy ; Decompression ; Female ; Follow-Up Studies ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Odontoid Process ; Osteoarthritis ; Paresthesia ; Rheumatic Fever* ; Spinal Cord ; Spinal Cord Compression ; Tears ; Upper Extremity

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The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report.

Hyun Jin HAN ; Jun Ho JUNG ; Chang Ki HONG ; Yong Bae KIM

Korean Journal of Neurotrauma.2016;12(2):175-179. doi:10.13004/kjnt.2016.12.2.175

Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.
Angiography, Digital Subtraction ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Middle Aged ; Multidetector Computed Tomography ; Neck Injuries ; Neck* ; Neurologic Manifestations ; Operating Rooms ; Vascular System Injuries ; Vital Signs ; Wounds, Penetrating

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Iatrogenic Vascular Injury Occurring during Discectomy in a Spondylodiscitis Patient.

Do Hyun KIM ; Tae Wan KIM ; Min Ki KIM ; Kwan Ho PARK

Korean Journal of Neurotrauma.2016;12(2):171-174. doi:10.13004/kjnt.2016.12.2.171

All iatrogenic vascular injury occurring during discectomy is a rare complication, but fatal if not immediately diagnosed. When a vascular injury is highly suspected during discectomy, immediate vascular evaluation is needed even vital signs are stable during and immediately after the operation. We describe a case of iatrogenic abdominal aortic injury that occurred during discectomy in a spondylodiscitis patient, which was treated by endovascular repair.
Discitis* ; Diskectomy* ; Humans ; Vascular System Injuries* ; Vital Signs

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