Analysis of Management According to CT Findings in Chronic Subdural Hematoma

OBJECTIVE: The brain computed tomography(CT) is an important tool throughout the clinical course of chronic subdural hematoma(CSDH). In CT findings, the density of CSDH is different in each case. We analyze management options and results according to the density of CSDH. METHODS: Seventy one patients with CSDH, who had been managed in our institute from August 2001 to December 2003, were reviewed retrospectively. The authors divided the patients into six groups according to the density of hematoma; Group A-hypodense rather than the brain parenchyma, group B-isodense, group C-hyperdense, group D-mixed with hypodense and hyperdense, group E-mixed with isodense and hypodense and group F-mixed with isodense and hypersdense. In each group, the operation method, the duration of the indwelling catheter and prognosis were analyzed. RESULTS: The patients who showed mixed density were 39 and, those who showed single density were 32. All the patients underwent burr hole drainage for the primary choice. There was only two cases that needed additional craniotomy. The average duration of indwelling catheter was 5.40+/-1.91days. Statistically the duration was not different in each group(p-value<0.05, Chi-square test). Three cases recurred, one in group C, another in group D, and the last in group E. It had no statistical significance due to low incidence of recurrence. CONCLUSION: We conclude that burr hole drainage is an acceptable primary treatment option for CSDH even though the density of hematoma is different in every single case.

Huge Choroid Plexus Carcinoma in an Infant

Choroid plexus carcinoma is a rare malignant brain tumor that occurs predominantly in childhood. A 203-day-old infant was admitted to our hospital with macrocephaly and right hemiparesis. The skull protruded diffusely in the left parietal area. Brain magnetic resonance imaging) revealed a huge mass in the left ventricle. We performed an open biopsy and discovered a choroid plexus carcinoma. The tumor bled very easily and hemostasis was difficult. After three cycles of chemotherapy, we resected the entire mass in a staged operation. Chemotherapy enabled us to resect the entire tumor by reducing its size. We report this case to stress the benefits of preoperative chemo-therapy and review the relevant literature.