Retrospective Analysis of Re-operated Patients after Chronic Subdural Hematoma Surgery

OBJECTIVE: The aim of this study is to analyze the clinical symptoms, radiological changes, interval from first operation to symptom recurrence and to propose the proper treatment method for re-operated patients following chronic subdural hematoma surgery. METHODS: Between January 1992 and April 2003, 18 of 138patients of chronic subdural hematoma repeatedly underwent surgical treatment. The symptoms, mental status by Bender grade, radiological hematoma size and midline shifting, interval from symptom onset to diagnosis, surgical method and prognosis by Glasgow outcome scale(GOS) between the first attack and the recurrence were compared. RESULTS: The symptoms at the time of recurrence were nearly the same as with the first attack, but two patients(2/18, 11.1%) showed a more declined mentality. In addition, the recurred hematoma sizes were the same or large than those previously found. Many patients were recurred within two weeks(13/18, 72.2%). Most patients were operated on using the previous burr hole, with the exception of one patient who recurred at a different site. All patients had a good prognosis more than GOS 4(GOS 4: 4 , GOS 5: 12), but two died due to extracranial complication and infection. CONCLUSION: These results suggest that the early diagnosis and treatment are important, mostly recurred same symptoms within two weeks. Re-operation using the previous burr hole site is a good method.

An Iliac Arteriovenous Fistula and Pseudoaneurysm after Lumbar Disc Surgery

Lumbar disc surgery is a common operation with rare vascular complications. The authors report a case of iliac arteriovenous(AV) fistula and pseudoaneurysm as a complication of lumbar disc surgery. A 52-year-old man underwent lumbar disc surgery 14 months prior to the admission. His chief complaints were progressive pain and swelling on the left lower limb. Contrast medium enhanced computed tomography(CT) scan showed dilatation in both iliac veins, right iliac AV fistula, and an pseudoaneurysm. Angiogram demonstrated a pseudoaneurysm originated from the right common iliac artery, associated left iliac vein compression, and dilatation in both iliac veins. The patient was treated with an endovascular stent placement. Angiogram obtained after stent grafting demonstrated elimination of the pseudoaneurysm, occlusion of the AV fistula, and right iliac artery patency. One month after the stent placement, his leg pain and swelling were improved markedly. A high suspicion based on clinical signs, CT scan, and angiography are important in the early detection of AV fistula. An endovascular stent placement is considered a promising treatment in select patients with iliac AV fistulae and pseudoaneurysms.