Factors Associated With Subdural Hygroma Following Mild Traumatic Brain Injury / 대한신경손상학회지

Objective@#Subdural hygroma (SDG) is a complication of traumatic brain injury (TBI). In particular, the outcome and outpatient treatment period may vary depending on the occurrence of SDG. However, the pathogenesis of SDG has not been fully elucidated. Therefore, this study aimed to identify the risk factors associated with the occurrence of SDG after mild TBI. @*Methods@#We retrospectively analyzed 250 patients with mild TBI admitted to a single institution between January 2021 and December 2021. The SDG occurrence and control groups were analyzed according to the risk factors of SDG, such as age, history, initial computed tomography (CT) findings, and initial laboratory findings. @*Results@#The overall occurrence rate of SDG was 31.6% (n=79). A statistically significant association was found between preoperative diagnoses and the occurrence of SDG, such as subarachnoid hemorrhage (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.26–4.39) and basal skull fracture (OR, 0.32; 95% CI, 0.12–0.83). Additionally, age ≥70 years (OR, 3.20; 95% CI, 1.74–5.87) and the use of tranexamic acid (OR, 2.12; 95% CI, 1.05–4.54) were statistically significant factors. The prognostic evaluation of patients using the Glasgow Outcome Scale (GOS) did not show any statistical differences between patients with and without SDG. @*Conclusion@#SDG was not associated with the prognosis of patients assessed using the GOS. However, depending on the occurrence of SDG, differences in patient symptoms may occur after mild TBI. Therefore, the early evaluation of patients with mild TBI and determination of the probability of developing SDG are important.

Spinal Cord Infarction After Transarterial Chemoembolization for Hepatocellular Carcinoma / 대한신경손상학회지

Transarterial chemoembolization (TACE) is an effective treatment for unresectable hepatocellular carcinoma (HCC). It is considered relatively safe. However, fatal complications such as pulmonary edema and liver abscesses can occur. Spinal infarction due to local embolism of the central nervous system after TACE is a very rare, but fatal complication. Here, we report a case of spinal cord infarction after TACE for ruptured HCC. Paraplegia occurred at the T10 sensory level 6 hours after the procedure. The patient received steroid megadose therapy but died 5 days later due to exacerbation of metabolic acidosis and blood loss. This case demonstrates the need for a comprehensive and extensive study of arterial blood flow prior to angiography.

Modified Trajectory of C2 Laminar Screw - Double Bicortical Purchase of the Inferiorly Crossing Screw

The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.

Bilateral Vertebral Artery Dissecting Aneurysms: A Long Term Follow-up Results of Microsurgical Trapping and Proximal Occlusion

Regarding the bilateral vertebral artery (VA) dissecting aneurysms, treatment strategy remains controversial because there have not been enough cases to reach a conclusion on the best treatment. We present a patient underwent staged microsurgical trapping and endovascular coiling for each dissecting aneurysm of bilateral VA presenting subarachnoid hemorrhage (SAH). The ruptured side was managed by VA trapping procedure without any neurological deficit. Postoperative cerebral angiography revealed patent right PICA without filling of previous right dissecting aneurysm and spontaneous occlusion of the left dissecting aneurysm one month after trapping procedure. However, follow-up angiography revealed recanalization and growing of the left VA dissecting aneurysm one year after the operation. The patient underwent endovascular embolization using GDC for the proximal occlusion of the left VA and postoperative course was uneventful.

Lumbo-sacro-pelvic Fixation Using Iliac Screws for the Complex Lumbo-sacral Fractures

Fractures of lumbo-sacral junction involving bilateral sacral wings are rare. Posterior lumbo-sacral fixation does not always provide with sufficient stability in such cases. Various augmentation techniques including divergent sacral ala screws, S2 pedicle screws and Galveston rods have been reported to improve lumbo-sacral stabilization. Galveston technique using iliac bones would be the best surgical approach especially in patients with bilateral comminuted sacral fractures. However, original Galveston surgery is technically demanding and bending rods into the appropriate alignment is time consuming. We present a patient with unstable lumbo-sacral junction fractures and comminuted U-shaped sacral fractures treated by lumbo-sacro-pelvic fixation using iliac screws and discuss about the advantages of the iliac screws over the rod system of Galveston technique.

The Incidence of Aneurysmal Subarachnoid Hemorrhage in Youngdong District, Korea

OBJECTIVE: The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. METHODS: From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: 54.8+/-13.1 years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. RESULTS: In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: 54.9+/-13.2 years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was 7.8+/-1.7, 10.5+/-2.7, and 9.1+/-2.1 per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was 8.8+/-1.4, 11.2+/-1.3 and 10.0+/-1.0, respectively in the coastal regions of Youngdong district from 1999 to 2006. CONCLUSION: In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.

The Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery with Unusual Clinical Course

The dissecting aneurysms of the posterior cerebral circulation arise most commonly from the vertebral artery and occasionally extend to the posterior inferior cerebellar artery(PICA). The dissecting aneurysm localized in the PICA without involving the vertebral artery is rare. We present a PICA dissecting aneurysm that had kaleidoscopic clinical course of bleeding, occlusion, and recanalization before the surgery. The patient had serial follow-up angiograms based on significant changes of clinical status. The patient successfully underwent microsurgical trapping with clips for the dissecting aneurysm and showed neurological improvement.

A Case of Intracerebral Hemorrhage During Labor Without History of Preeclampsia / 대한산부인과학회잡지

Cerebrovascular disorders (infarction and intracranial hemorrhage), otherwise collectively referred to as stroke, are an uncommon and feared complication of pregnancy. Collectively, these disorders contribute up to 12% of all maternal deaths. Because of the common presentation with seizures, hypertension, proteinuria, and visual disturbance there has been diagnostic confusion with eclampsia, especially when cerebrovascular disorders occur antepartum or intrapartum. This case is intended to assist the clinician with clues for prompt diagnosis and therapy for this uncommon and unpreventable medical complication of pregnancy.

Ectopic Pituitary Adenoma within the Sphenoid Sinus

A 69-year-old woman presented with right abducent nerve paresis caused by an ectopic pituitary adenoma invading the posterior wall of the sphenoid sinus. The tumor was removed via transsphenoidal approach. The histological diagnosis was invasive pituitary adenoma with bony destruction. The symptom was improved without complication. The authors present a rare case of ectopic pituitary adenoma with a literature review.