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1.
Rev. argent. neurocir ; 34(4): 262-279, dic. 2020. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1150434

ABSTRACT

Introducción: En las últimas décadas el uso de la posición sentada ha disminuido en frecuencia a causa de 2 complicaciones mayores: el embolismo aéreo venoso y la hipotensión intraoperatoria. Sin embargo es innegable que la posición sentada ofrece una serie de ventajas al neurocirujano, el anestesiólogo y al electrofisiólogo. Materiales y métodos: Estudio retrospectivo de pacientes operados en dos instituciones de Tucumán, entre enero de 2015 y diciembre de 2019. Resultados: Se operaron un total de 119 pacientes en posición sentada por vía posterior. Conclusión: Se presentó la técnica de posición semisentada paso a paso y consejos específicos. Se ilustró la utilidad de la misma mediante la presentación de casos representativos


Introduction: In the last decades, the use of the sitting position has been abandoned due to 2 major complications: venous air embolism and intraoperative hypotension. However, it is undeniable that the sitting position offers a series of advantages to the neurosurgeon, the anesthesiologist and the electrophysiologist. Materials and methods: Retrospective study of patients operated at two institutions in Tucumán, between January 2015 and December 2019. Results: A total of 119 patients were operated in a sitting position and posterior approach. Conclusion: The sitting position technique was presented step by step in detail, with the key steps and a series of tricks. The usefulness of the position was illustrated by presenting representative cases


Subject(s)
Embolism, Air , Patient Positioning , Neurosurgeons , Neurosurgery
2.
Rev. argent. neurocir ; 34(4): 337-341, dic. 2020. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1150486

ABSTRACT

La Federación Nacional de Neurocirugía (FNNC) fue fundada en la ciudad de Rosario el 23 de agosto de 2019, con el objetivo de crear una organización que nu-clee a todas las sociedades y asociaciones de neurociru-gía de nuestro país, con un perfil netamente gremial. La FNNC reconoce a la Asociación Argentina de Neuroci-rugía (AANC) como la organización que rige la activi-dad académica-profesional de la neurocirugía en todo el territorio de la República Argentina.Uno de los propósitos principales es lograr condiciones laborales dignas y correctamente remuneradas para to-dos los neurocirujanos que residan en suelo argentino. Pensamos que una de las herramientas necesarias para conseguir dicho propósito es lograr un equilibrio entre el número de neurocirujanos en actividad, el número de plazas de residentes, y el número de habitantes en Ar-gentina.Actualmente no existen datos concretos para realizar un diagnóstico de situación. Es por ello que la FNNC, apoyada y avalada por la AANC, tomó la iniciativa de realizar un análisis descriptivo de la situación actual y su proyección en los próximos años en relación con el nú-mero de neurocirujanos en Argentina.El objetivo del presente trabajo es presentar de forma sintética y clara los aspectos más relevantes de dicho es-tudio.


Subject(s)
Neurosurgery , Work , Statistical Analysis , Neurosurgeons
3.
Rev. argent. neurocir ; 34(4): 342-347, dic. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1150489

ABSTRACT

Uno de los objetivos de la Asociación Argentina de Neurocirugía (AANC) es la educación. La heterogeneidad en la formación teórica de los neurocirujanos argentinos originó la falta de un estándar en la adquisición, crecimiento y mantenimiento de las competencias. Para resolverlo se comenzó un proceso centrado en la educación de calidad que buscó establecer estándares teóricos. Fue esencial el uso del aprendizaje electrónico para poder llegar a todos los rincones del país y lograr una formación teórica homogénea. Al aprobar los contenidos de los cursos on-line, más la experiencia práctica obtenida durante la residencia, el postulante estaría en condiciones de rendir el examen final de certificación e ingresar como miembro titular a la AANC. Los resultados de esta estrategia mostraron que todos los postulantes para los exámenes de certificación tuvieron la misma formación teórica. También se produjo un gran aumento de los postulantes a la certificación. Los resultados demuestran que cuando se crean las condiciones adecuadas, los profesionales participan y se someten a las exigencias de un examen de certificación.


One of the objectives of the Asociación Argentina de Neurocirugía (AANC) is education. Heterogeneity in the theoretical training of Argentine neurosurgeons caused the lack of a standard in the acquisition, growth and maintenance of competencies. To resolve this, a process focused on quality education began, which sought to establish theoretical standards. The use of electronic learning was essential to be able to reach all corners of the country and achieve homogeneous theoretical training. By passing the contents of the online courses, plus the practical experience obtained during the residency, the applicant would be able to take the final certification exam and enter the ANA as a full member. The results of this strategy demonstrated that all applicants for the certification exam had the same theoretical training. Also, there was a large increase in applicants for certification and that when the right conditions are created, professionals participate and submit to the demands of a certification exam


Subject(s)
Neurosurgery , Certification , Education , Courses , Neurosurgeons , Learning
4.
Rev. argent. neurocir ; 34(3): 194-199, sept. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1120912

ABSTRACT

El manejo de pacientes debido a la aparición del nuevo coronavirus 2019 (COVID-19) representa un desafío para los equipos médicos y quirúrgicos, ya que modificó el funcionamiento de los sistemas de salud en casi todo el mundo. Para contribuir a la re organización del sistema de salud, el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires trabajó en adoptar distintas medidas en concordancia con las tomadas a nivel institucional y nacional; por lo que se analizó la bibliografia publicada, asi como las normas dictadas por el comité de crisis de nuestra institucion. A su vez realizamos una breve encuesta dirigida a neurocirujanos de america latina para conocer como se manejaban actualmente en relación a niveles de protección y realización de cirugias. La actual pandemia de COVID-19 es el mayor desafío que enfrentan los sistemas nacionales de salud en los últimos tiempos. Los neurocirujanos podemos contribuir a la reducción del riesgo de infección nosocomial de los trabajadores de la salud al adaptar distintos protocolos en pacientes con COVID-19.


Patient's management due to the appearance of new coronavirus 2019 (COVID-19) represents a challenge for medical and surgical departments, since it modified the running of health systems in almost all the world. In order to help in this new situation, the Neurosurgical Department of our institution has adopted different measures in accordance with those taken at institutional and national level. In order to do this, we made a literature review and we added to this, the norms dictated by the crisis committee of our hospital. We also carried out a brief survey among neurosurgeons from Latin America to find out how they managed protection levels in relation to surgery. COVID-19 pandemic is certainly one of the greatest challenge national health systems face in a century. Adapting different protocols in neurosurgical patients with COVID-19 can contribute in reducing the risk of nosocomial infection of health workers.


Subject(s)
Humans , Coronavirus Infections , Health Personnel , Coronavirus , Protocols , Pandemics , Neurosurgeons , Neurosurgery
5.
Rev. cuba. med. mil ; 49(2): e525, abr.-jun. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1139004

ABSTRACT

Experiencias y reflexiones del Dr. José Hernán Salas Rubio, presentadas en forma de conferencia, en el Congreso Internacional Neuro-Cuba 2017. Es profesor titular y consultante, uno de los más prominentes neurocirujanos cubanos. Ha trabajado como neurocirujano desde 1962 y contribuido a la formación de jóvenes neurocirujanos. Ha publicado cinco libros y más de cincuenta artículos científicos(AU)


Experiences and reflections of Dr. José Hernán Salas Rubio, presented as a lecture, at the Neuro-Cuba International Congress 2017. He is a full professor and consultant, one of the most prominent Cuban neurosurgeons. He has worked as a neurosurgeon since 1962 and contributed to the training of young neurosurgeons. He has published five books and more than fifty scientific articles(AU)


Subject(s)
Humans , Neurosurgeons/history , Mentors/history , Consultants
6.
Article in English | WPRIM | ID: wpr-811122

ABSTRACT

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.


Subject(s)
Chronic Pain , Diskectomy , Education , Emergency Medicine , Hospitals, Community , Humans , Internal Medicine , Minimally Invasive Surgical Procedures , Neurology , Neurosurgeons , Neurosurgery , Orthopedics , Pain Management , Pathology , Physicians, Primary Care , Radiculopathy , Referral and Consultation , Spine , Surgeons
7.
Rev. argent. neurocir ; 33(3): 147-150, sep. 2019. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1177355

ABSTRACT

Introducción: Debido a la naturaleza impredecible y demandante de la neurocirugía, es necesaria una comunicación segura y rápida entre colegas. WhatsApp se presenta, en este contexto, como una solución rentable, fácil, accesible y rápida. Por la característica fugaz de la tecnología los avances preceden a las normativas. Actualmente WhatsApp es una herramienta frecuente en los equipos neuroquirúrgicos y nos encontramos utilizando una herramienta de forma diaria e ignorando las consecuencias que puede traer el intercambio de información de pacientes en un medio que no se encuentra diseñado para tal fin. El presente trabajo pretende medir la adhesión de WhatsApp en neurocirugía y el nivel de conocimiento sobre sus ventajas y desventajas. Métodos: Se elaboró una encuesta sobre el uso del WhatsApp en Neurocirugía que se entregó impresa aleatoriamente a 150 neurocirujanos. Resultados: Se encuestaron 112 neurocirujanos con una edad promedio de 34 años. Un 98% usa Smartphone y la totalidad de estos usa WhatsApp. Un 96% utiliza WhatsApp para resolver cuestiones médicas fuera de su horario de trabajo. Ninguno de los entrevistados conoce el marco legal de WhatsApp. Conclusiones: Existe una fuerte adhesión al uso de WhatsApp en la práctica médica por parte de los neurocirujanos en Argentina. Esto se debe a su uso fácil, rápido, grupal y económico, que se adecua a la perfección con el ritmo y complejidad de nuestra profesión. Sin embargo, existe un total desconocimiento del marco legal de esta aplicación, del déficit de seguridad de los datos on-line; lo que se traduce en un potencial riesgo a la confidencialidad del acto médico.


Background: Due to the unpredictable and demanding nature of neurosurgery, safe and rapid communication between colleagues is necessary. WhatsApp is presented as a cost-effective, easy and accessible solution. Because of the rapid advanced of technology, it usually precedes regulations. Currently WhatsApp is a frequent tool in neurosurgical teams and we find ourselves using an instrument on a daily basis and ignoring the consequences that the exchange of patient information using this method can bring. The present work aims to measure the adherence of WhatsApp in neurosurgery and the level of knowledge about its advantages and disadvantages. Methods: A survey was developed on the use of WhatsApp in Neurosurgery that was delivered randomly to 150 neurosurgeons. Results: 112 neurosurgeons with an average age of 34 years were surveyed. 98% use Smartphone and all of them use WhatsApp. 96% use WhatsApp to resolve medical issues outside of their work hours. None of the interviewees knows the legal framework of WhatsApp. Conclusions: There is a strong adherence to the use of WhatsApp in medical practice by neurosurgeons in Argentina. This is due to its easy, fast, and economic use, which is perfectly adapted to the rhythm and complexity of our profession. However, there is a total ignorance of the legal framework of this application which translates into potential risks to patient's confidentiality.


Subject(s)
Neurosurgery , Technology , Communication , Information Dissemination , Ethics , Smartphone , Neurosurgeons
8.
Article in English | WPRIM | ID: wpr-765399

ABSTRACT

The Korean Women Neurosurgical Society (KWNS) was founded in 2008. To commemorate its 10th anniversary, herein we review its history and the status of Korean Neurosurgical Society (KNS)-certified women neurosurgeons. Based on the academic and social activity of the KWNS, we can expect to promote professional work as members of the KNS, facilitate interaction among neurosurgeons, and sustain professional careers.


Subject(s)
Anniversaries and Special Events , Female , Humans , Neurosurgeons , Neurosurgery
9.
Article in English | WPRIM | ID: wpr-765385

ABSTRACT

OBJECTIVE: Since less invasive endovascular treatment was introduced to South Korea in 1994, a considerable proportion of endovascular treatments have been performed by neuroradiology doctors, and endovascular treatments by vascular neurosurgeons have recently increased. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons. Thus, authors compared endovascular treatments collaboratively performed by vascular neurosurgeons with all cases throughout South Korea from 2013 to 2017 to elucidate the role of neurosurgeons in the field of endovascular treatment in South Korea. METHODS: The Society of Korean Endovascular Neurosurgeons (SKEN) has issued annual reports every year since 2014. These reports cover statistics on endovascular treatments collaboratively or individually performed by SKEN members from 2013 to 2017. The data was requested and collected from vascular neurosurgeons in various hospitals. The study involved 77 hospitals in its first year, and 100 in its last. National statistics on endovascular treatment from all over South Korea were obtained from the Healthcare Bigdata Hub website of the Health Insurance Review & Assessment Service based on the Electronic Data Interchange (EDI) codes (in the case of intra-arterial (IA) thrombolysis, however, statistics were based on a combination of the EDI and I63 codes, a cerebral infarction disease code) from 2013 to 2017. These two data sets were directly compared and the ratios were obtained. RESULTS: Regionally, during the entire study period, endovascular treatments by SKEN members were most common in Gyeonggi-do, followed by Seoul and Busan. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. The number of endovascular treatments performed by SKEN members increased every year. CONCLUSION: The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.


Subject(s)
Cerebral Angiography , Cerebral Infarction , Data Interpretation, Statistical , Dataset , Delivery of Health Care , Endovascular Procedures , Humans , Insurance, Health , Intracranial Aneurysm , Korea , Neurosurgeons , Neurosurgery , Seoul , Stroke , Vascular Malformations
10.
Article in English | WPRIM | ID: wpr-765350

ABSTRACT

Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).


Subject(s)
Canada , Child , Craniotomy , Epilepsy , Europe , Humans , Neurosurgeons , Pediatrics
11.
Article in English | WPRIM | ID: wpr-788825

ABSTRACT

The Korean Women Neurosurgical Society (KWNS) was founded in 2008. To commemorate its 10th anniversary, herein we review its history and the status of Korean Neurosurgical Society (KNS)-certified women neurosurgeons. Based on the academic and social activity of the KWNS, we can expect to promote professional work as members of the KNS, facilitate interaction among neurosurgeons, and sustain professional careers.


Subject(s)
Anniversaries and Special Events , Female , Humans , Neurosurgeons , Neurosurgery
12.
Article in English | WPRIM | ID: wpr-788812

ABSTRACT

OBJECTIVE: Since less invasive endovascular treatment was introduced to South Korea in 1994, a considerable proportion of endovascular treatments have been performed by neuroradiology doctors, and endovascular treatments by vascular neurosurgeons have recently increased. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons. Thus, authors compared endovascular treatments collaboratively performed by vascular neurosurgeons with all cases throughout South Korea from 2013 to 2017 to elucidate the role of neurosurgeons in the field of endovascular treatment in South Korea.METHODS: The Society of Korean Endovascular Neurosurgeons (SKEN) has issued annual reports every year since 2014. These reports cover statistics on endovascular treatments collaboratively or individually performed by SKEN members from 2013 to 2017. The data was requested and collected from vascular neurosurgeons in various hospitals. The study involved 77 hospitals in its first year, and 100 in its last. National statistics on endovascular treatment from all over South Korea were obtained from the Healthcare Bigdata Hub website of the Health Insurance Review & Assessment Service based on the Electronic Data Interchange (EDI) codes (in the case of intra-arterial (IA) thrombolysis, however, statistics were based on a combination of the EDI and I63 codes, a cerebral infarction disease code) from 2013 to 2017. These two data sets were directly compared and the ratios were obtained.RESULTS: Regionally, during the entire study period, endovascular treatments by SKEN members were most common in Gyeonggi-do, followed by Seoul and Busan. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. The number of endovascular treatments performed by SKEN members increased every year.CONCLUSION: The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.


Subject(s)
Cerebral Angiography , Cerebral Infarction , Data Interpretation, Statistical , Dataset , Delivery of Health Care , Endovascular Procedures , Humans , Insurance, Health , Intracranial Aneurysm , Korea , Neurosurgeons , Neurosurgery , Seoul , Stroke , Vascular Malformations
13.
Article in English | WPRIM | ID: wpr-788778

ABSTRACT

Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).


Subject(s)
Canada , Child , Craniotomy , Epilepsy , Europe , Humans , Neurosurgeons , Pediatrics
15.
Article in English | WPRIM | ID: wpr-785922

ABSTRACT

OBJECTIVE: Hypertensive intracerebral hemorrhage is a potentially life-threatening neurological deficit with the highest morbidity and mortality. In recent years, neuroendoscopy has been used to treat intracerebral hemorrhages (ICHs). However, the choice of neuroendoscopic surgery or craniotomy for patients with ICHs is controversial. The objective of this meta-analysis was to assess the efficacy of neuroendoscopic surgery compared to craniotomy in patients with supratentorial hypertensive ICH.MATERIALS AND METHODS: A systematic electronic search was performed using online electronic databases such as Pubmed, Embase, and Cochrane library updated on December 2017. The meta-analysis was performed by only including studies designed as randomized controlled trials.RESULTS: Three randomized controlled trials met our inclusion criteria. Pooled analysis of death showed that neuroendoscopic surgery decreased the rate of death compared to craniotomy (RR=0.58, 95% CI: 0.26–1.29; P=0.18). Pooled results of complications showed that neuroendoscopic surgery tended to have fewer complications than craniotomy had (RR=0.37, 95% CI: 0.28–0.49; P < 0.0001).CONCLUSION: Although the presenting analyses suggest that neuroendoscopic surgery should have fewer complications than craniotomy dose, it had no superior advantage in morbidity rate definitely. Therefore, it may be necessary for the neurosurgeons to select best optimal patients for individual treatment.


Subject(s)
Cerebral Hemorrhage , Craniotomy , Humans , Intracranial Hemorrhage, Hypertensive , Mortality , Neuroendoscopy , Neurosurgeons
16.
Article in English | WPRIM | ID: wpr-785327

ABSTRACT

BACKGROUND: It is not possible to measure how much activity is required to understand and code a medical data. We introduce an assessment method in clinical coding, and applied this method to neurosurgical terms.METHODS: Coding activity consists of two stages. At first, the coders need to understand a presented medical term (informational activity). The second coding stage is about a navigating terminology browser to find a code that matches the concept (code-matching activity). Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) was used for the coding system. A new computer application to record the trajectory of the computer mouse and record the usage time was programmed. Using this application, we measured the time that was spent. A senior neurosurgeon who has studied SNOMED CT has analyzed the accuracy of the input coding. This method was tested by five neurosurgical residents (NSRs) and five medical record administrators (MRAs), and 20 neurosurgical terms were used.RESULTS: The mean accuracy of the NSR group was 89.33%, and the mean accuracy of the MRA group was 80% (p=0.024). The mean duration for total coding of the NSR group was 158.47 seconds, and the mean duration for total coding of the MRA group was 271.75 seconds (p=0.003).CONCLUSION: We proposed a method to analyze the clinical coding process. Through this method, it was possible to accurately calculate the time required for the coding. In neurosurgical terms, NSRs had shorter time to complete the coding and higher accuracy than MRAs.


Subject(s)
Animals , Clinical Coding , Humans , Medical Informatics , Medical Record Administrators , Methods , Mice , Neurosurgeons , Systematized Nomenclature of Medicine
18.
Article in English | WPRIM | ID: wpr-759970

ABSTRACT

Patients with atlanto-occipital dislocation (AOD) are increasingly being transported to emergency rooms, alive, by the improved pre-hospital emergency rescue system. The author reports a fatal case of AOD with severe neurovascular injuries following a high-speed pedestrian collision. Therefore, nowadays, neurosurgeons can expect an increase in the occurrence of such cases; an early diagnosis and prompt occipitocervical fusion can save lives. This report reviews the current concepts of AOD in mild to fatal conditions.


Subject(s)
Atlanto-Occipital Joint , Joint Dislocations , Early Diagnosis , Emergencies , Emergency Service, Hospital , Humans , Neurosurgeons
19.
Article in English | WPRIM | ID: wpr-717712

ABSTRACT

We report the case of a patient with organized chronic subdural hematoma (OCSH) that was treated with craniotomy. A 72-year-old man was admitted with a complaint of a drowsy mental status after a generalized tonic-clonic seizure. A brain computed tomography scan acquired at a local hospital revealed a large chronic subdural hematoma (CSDH) in the left frontoparietal lobe. The patient had not experienced head trauma and had been taking clopidogrel due to angina. A neurosurgeon at the local hospital performed single burr hole trephination in the left frontal bone and drained some of the hematoma. Brain magnetic resonance imaging performed upon transfer to our hospital showed a large OCSH with a midline shift to the right side, revealing a low, heterogeneous signal on T2-weighted images (WI) and an isodense signal on T1-WI. We performed craniotomy and membranectomy to achieve adequate decompression and expansion of the brain. Following this, the patient recovered completely. Our findings support that neurosurgeons should consider the possibility of organization of a CSDH when selecting a diagnosis and treatment plan.


Subject(s)
Aged , Brain , Craniocerebral Trauma , Craniotomy , Decompression , Diagnosis , Frontal Bone , Hematoma , Hematoma, Subdural, Chronic , Humans , Magnetic Resonance Imaging , Neurosurgeons , Seizures , Trephining
20.
Article in English | WPRIM | ID: wpr-717479

ABSTRACT

Traumatic optic neuropathy (TON) is an important cause of severe visual loss after blunt or penetrating head and facial trauma. High-dose steroids and surgical interventions have been applied in the indirect TON. However, there is no convincing evidence that results of the treatment have any strong benefits in terms of improvement of visual acuity. Nevertheless, surgical decompression should be considered in the case of a direct bony compression to the optic nerve and a progressive visual loss in indirect TON. Neurosurgeon should be aware the surgical indication, optimal timing and relevant technique for the optic canal (OC) decompression. In this review article, we will focus on the surgical approaches to the OC and how to decompress it.


Subject(s)
Decompression , Decompression, Surgical , Head , Neurosurgeons , Optic Nerve , Optic Nerve Injuries , Steroids , Visual Acuity
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