A Comparative Study of Local versus General Anesthesia for Chronic Subdural Hematoma in Elderly Patients Over 60 Years / 대한신경손상학회지

OBJECTIVE: The purpose of this study is to compare the surgical and anesthetic complications of the local and general anesthesia in chronic subdural hematoma (CSDH) patients. METHODS: We retrospectively analyzed the medical record and brain CT of CSDH patients over 60-years-old, who were treated surgically in our institution between January 2005 and December 2012. RESULTS: One hundred six patients with CSDH were enrolled for this study and 61 patients had a burr hole craniostomy under the local anesthesia. In local anesthesia group, surgical complication was not increased than general anesthesia group. But in general anesthesia group, heart disease such as arrhythmia, acute myocardial infarction was relatively increased than local anesthesia group (p=0.04). And the hospitalization period of local anesthesia group was shorter than that of general anesthesia group (p=0.001). CONCLUSION: In this present study, there was no significant difference of surgical complications between the local and general anesthesia group. But the general anesthesia group had more cardiovascular complications and longer hospitalization periods. In conclusion, when we planned the burr hole craniostomy for the elderly patients with CSDH, local anesthesia should be considered more actively for postoperative prognosis.

Differentiation of Tuboovarian Abscess from Endometriosis: CT Indicators

PURPOSE: To assess and compare CT findings of surgically confirmed cases of tuboovarian abscesses (TOA) and endometriosis in order to identify indicators which may be helpful in making correct preoperative diagnoses. MATERIALS AND METHODS: Of the 35 consecutive patients with surgically confirmed TOA, CT images were available for 11 of those patients. As a comparative group, 36 patients with surgically confirmed endometriosis with CT images were selected. CT images of TOA were compared with those of endometriosis. A retrospective analysis of the CT images of both groups was performed without knowledge of the pathologic diagnosis. The analysis compared the thickness and enhancement pattern of the cyst wall, attenuation of the cyst content, size and shape of the cyst, and paraaortic lymphadenopathy. RESULTS: Mean thickness of the cyst wall was 6.2+/-2.0 mm in TOA and 4.5+/-2.4 mm in endometriosis. Multilayered appearance in both diseases was seen on enhanced CT in 91% (10/11) of TOA cases and in 25% (9/36) of endometriosis cases. Hounsefield units of the cyst contents were 20.0+/-5.5 HU and 24.7+/-10.0 HU for TOA and endometriosis, respectively. Mean diameter of the cysts was 7.5+/-1.7 cm in TOA and 7.9+/-3.1 in endometriosis. Shape of the cyst was multilocular in 82% (9/11) of TOA cases and in 75% (27/36) of endometriosis cases. Paraaortic lymphadenopathy was present in 73% (8/11) and 44% (16/36) for TOA and endometriosis, respectively. CONCLUSION: TOA should be suspected on CT when a multilocular cystic ovarian mass is observed, especially if the lesion has a thick wall and has a multilayered appearance, and is accompanied by paraaortic lymphadenopathy.