OBJECTIVE: Subdural effusion, also known as subdural hygroma (SDG), is a secondary complication that can occur after decompressive craniectomy (DC). However, the pathogenesis of SDG is not fully understood. It is unclear whether SDG occurrence is related to preoperative patient status or surgical technique. The purpose of this study is to identify risk factors for SDG after DC. METHODS: Fifty-nine patients who underwent DC from January 2016 to December 2016 at the same institution were analyzed. We retrospectively reviewed the clinical and radiological features of the patients. We divided the patients into two groups based on the occurrence of SDG after DC. The risk factors for SDG were analyzed. RESULTS: The overall SDG rate after DC was 39% (23 patients). A statistically significant association was observed between preoperative diagnosis, e.g., subdural hemorrhage (SDH; odds ratio [OR], 4.99; 95% confidence interval [CI], 1.36–18.34) or subarachnoid hemorrhage (SAH; OR, 4.18; 95% CI, 1.07–16.32), and the occurrence of SDG after DC. Traumatic brain injury (OR, 4.91; 95% CI, 1.35–17.91) and preoperative cortical opening (OR, 4.77; 95% CI, 1.39–16.32) were important risk factors for SDG. Several surgical techniques did not show a statistically significant association with SDG. The occurrence of SDG after DC was related to the length of hospital stay (p=0.012), but not to prognosis. CONCLUSION: After DC, SDG is not related to patients' prognosis but to the length of hospital stay. Therefore, it is necessary to study the occurrence of postoperative SDG by confirming the presence of preoperative SDH, SAH, and cortical opening.
Brain Injuries ; Decompressive Craniectomy* ; Diagnosis ; Hematoma, Subdural ; Humans ; Length of Stay ; Odds Ratio ; Prognosis ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage ; Subdural Effusion*

OBJECTIVE: After a rigorous management of increased intracranial pressure by decompressive craniectomy (DC), cranioplasty (CP) is usually carried out for functional and cosmetic purposes. However, the optimal timing of CP remains controversial. Our study aims to analyze the relationship between the optimal timing of CP and the post-operative complications. METHODS: From January 2013 to December 2015, ninety patients who underwent CP in a single institution were analyzed. We set the independent variables as follows: 1) patient characteristics; 2) the time interval between the DC and CP; 3) operation time; 4) anesthesia time; and 5) pre-operative computed tomography (CT) findings such as a degree of sunken brain by ratio of A (the median length from scalp to midline) to B (the length from midline to inner table of skull at this level). The dependent variables of this study are the event of post-operative complications. RESULTS: The overall complication rate was 33.3%. There was no statistical significance in the time interval between the DC and CP in the groups with and without complications of CP (p=0.632). However, there was a significant statistical difference in the degree of sunken brain by ratio (A/B) between the two groups (p<0.001). CONCLUSION: From this study, we conclude that it is better to determine the optimal timing of CP by the pre-operative CT finding than by the time interval between the DC and CP. Hereby, we suggest a potentially useful determinant of optimal timing of CP.
Anesthesia ; Brain* ; Decompressive Craniectomy ; Humans ; Intracranial Pressure ; Scalp ; Skull

Chronic subdural hematoma (CSDH) is a collection of old blood and its breakdown products between the surface of the brain parenchyma and the outermost layer called the dura. The most common treatment option for primary CSDH is burr-hole trephination; however, the treatment method for recurrent CSDH is still widely debated. An arachnoid cyst (AC) is a sac filled with cerebrospinal fluid located between the brain or spinal cord and the arachnoid membrane, which is one of the three meninges covering the brain or spinal cord. Although it is rare, the cyst is associated with CSDH in juveniles, and the recurrence rate of CSDH increases in such cases. Much of the literature has supported the preventive role of middle meningeal artery (MMA) embolization in recurrent CSDH. We report a 13-year-old male patient with recurrent CSDH and AC where the early intervention of MMA embolization was proven effective in preventing the further recurrence of CSDH.
Adolescent ; Arachnoid Cysts ; Arachnoid* ; Brain ; Cerebrospinal Fluid ; Early Intervention (Education) ; Embolization, Therapeutic ; Hematoma, Subdural, Chronic* ; Humans ; Male ; Membranes ; Meningeal Arteries* ; Meninges ; Recurrence ; Spinal Cord ; Trephining

No abstract available.
Ependymoma*

OBJECTIVE: The purpose of this study is to evaluate complications in 70 patients who had underwent endovascular treatment to occlude cerebral aneurysms. METHODS: From May 1999 to December 2002, we treated 70 patients by endovascular treatment or by combination of endovascular treatment and surgery. Complications have been developed in fifteen patients. Twelve patients had anterior circulation aneurysms: 4 posterior commmuncating artery ; 2 anterior communicating artery ; 2 paraclinoid artery ; 2 anterior choroidal artery ; 1 distal internal carotid artery ; 1 middle cerebral artery ; 1 pericallosal artery and three patients had posterior circulation aneurysms: 3 basilar artery tip. RESULTS: The complications related to the coil embolization were the thromboembolic event in 9 cases, rupture of the aneurysm in 3 cases, coil prolapse in 3 cases and coil migration in 1 case. CONCLUSION: The coil embolization can be a alternative good modality in the treatment of cerebral aneurysms. But careful attention should be required to reduce the various complications of procedures and to improve the prognosis of aneurysmal treatment. Effort to overcome the technical problem and to develop more comfortable device are needed for the better results of endovascular treatment.
Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Choroid ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prognosis ; Prolapse ; Rupture

Rosai-Dorfman disease (RDD) is an idiopathic histioproliferative disorder of the lymph nodes and extranodal sites. Central nervous system involvement is extremely rare. Intracranial RDD, especially the isolated form, resembles meninigioma both clinically and radiologically. Here, we report a case of isolated, intracranial, dura-based RDD. The patient presented with headache and dizziness with no evidence of lymphadenopathy. Histologically, the lesion consisted of large histiocytes with emperipolesis and lymphoplasma cell infiltrates with a fibrotic background. We discuss the differential diagnosis of this lesion. To our knowledge, this is the first reported Korean case of intracranial RDD.
Central Nervous System ; Diagnosis, Differential ; Dizziness ; Emperipolesis ; Headache ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Meninges

OBJECTIVE: The elderly population is rapidly growing, and the population over age 65 is expected to increase. To evaluate factors that determine recovery in this population, we report a clinical analysis of 77 elder patients of mild head trauma over 65 years of age. METHODS: The medical records were reviewed retrospectively for 77 head-injured patients aged 65 to 85 years who were admitted to our institution between March, 1995 and December, 1999. The outcome was compared with age, sex, Glasgow Coma Scale score, and radiologic characteristics. RESULTS: As in all age groups, males predominated and motor vehicle accidents accounted for a highest proportion(35%). Of the traffic accidents, pedestrian injuries were more common. The single most common lesion was subdural hematoma. The initial radiologic findings were not correlated with outcome. The GCS score was statistically correlated with prognosis. Sixty-one patients(79.2%) had favorable outcome. Ten of seventy-seven patients(13%) died whereas cerebral injury accounted for 5 deaths. Non-cerebral causes of death were composed of pneumonia, multi-organ failure and sepsis. The mean hospitalization was 52.3+/-12.6 days. CONCLUSION: The mortality rate after injury is higher in elderly patients. It is therefore the factors of intracranial and extracranial cause which influence survival and outcome be carefully treated. Neurologic deficits, even though mild, are the risk factor of poor prognosis in the elderly. Earlier identification of risk and aggressive support may be needed for decreasing the morbidity and the mortality in the elderly.
Accidents, Traffic ; Aged ; Cause of Death ; Craniocerebral Trauma* ; Glasgow Coma Scale ; Head* ; Hematoma, Subdural ; Hospitalization ; Humans ; Male ; Medical Records ; Mortality ; Motor Vehicles ; Neurologic Manifestations ; Pneumonia ; Prognosis* ; Retrospective Studies ; Risk Factors ; Sepsis

OBJECTIVE: The authors analyze the incidence, etiological and prognostic factors between contralateral and ipsilateral delayed epidural hematoma after evacuation of initial hematoma and to formulate recommendations for early detection of evolving hematoma and improvement of outcome. METHODS: Between July 1997 and December 1999, 417 patients underwent craniotomy at department of neurosurgery to evacuate an acute posttraumatic intracranial hematoma. Analysis of these clinical and neuroradiologic data showed that we underwent a second operation on 24 patient(5.8%) for removal of delayed epidural hematoma. In 10(2.4%) of these patients the second operation was undertaken to evacuate a new hematoma that had developed at a contralateral side from the initial hematoma. In 14 patients(3.4%), the second operation was to remove a epidural hematoma at the same site as the first craniotomy. RESULTS: 24 patients were divided into two groups. In Group A, 10 patients who developed contralateral delayed epidural hematoma were 31.5 years(11-61) of age and had skull fracture at the site of delayed epidual hematoma formation. Two of these patients revealed severe brain swelling during the evacuation of acute subdural hematoma. Eight of them were diagnosed within 24 hours after craniotomy through immediately postoperative computed tomography scan. In Group B, 14 patients who developed ipsilateral epidural hematoma were 56.1 years(27-75) of age. Six of them had hemorrhagic tendency related to past medical history. Eleven of these patients were associated with thrombocytopenia and consumptive coagulopathy when required second operation. Twelve patients were diagnosed within 48-72 hours after craniotomy due to clinical deterioration or failure to improve. There was no significant difference in outcome between two groups. CONCLUSION: The authors sought differential factors between contralateral and ipsilateral delayed epidural hematoma. Delayed epidural hematoma after craniotomy may need an urgent operation or lead to serious complication or disability. Postoperative computed tomography scan, intracranial pressure monitoring and repeat computed tomography scan within 72 hours of injury are strongly recommended in these cases, especially after decompression of cranial cavity.
Brain Edema ; Craniotomy ; Decompression ; Hematoma* ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Intracranial Pressure ; Neurosurgery ; Skull Fractures ; Thrombocytopenia

No abstract available.
Craniocerebral Trauma* ; Head* ; Hematoma*

No abstract available.
Frontal Bone* ; Humans