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자발성 뇌실질내 혈종에 대한 Hematome과 Urokinase를 이용한 뇌정위적 혈종 흡인술에 대한 임상적 분석
노재섭,변진수,허철,홍순기,김헌주,한용표 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.4
We had tried to perform mechanical aspiration using Hematome and fibrinolytic drainage with Urokinase for treatment of spontaneous intracerebral hematoma(SICH) in 24 patients. Mean initial volume of SICH was 53.65 26.34㎖, mean evacuated amount of SICH after Hematome procedure was 46.25 23.64%, and mean evacuated amount of SICH after fibrinolytic drainage after Urokinase was 74.15 20.89%, compared with pre-operative status. We could aspirate more than 50% of hematoma if the Hematome procedure had been performed within 18 hours after ictus(p=0.0306). The rebleeding rate after Hematome procedure was 8.3%, and overall mortality rate was 12.5%. These results seem to indicate mechanical aspiration using Hematome and fibrinolytic drainage with Urokinase might be one of the useful method for treatment of SICH.
급성 뇌경막외 혈종의 비수술적 치료 결과 : Analysis of 43 Cases
김은영,정환영,김남규,김광명,오석전 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5
The authors present 43 cases of intracranial acute epidural hematomas(EDH's) managed by close observation. In each of 43 cases, the following criteria were met : 1) the patient was conscious soon after head injury ; 2) the volume of hematoma was under 30㎖(10㎖ in case of posterior fossa EDH's) ; 3) there was no severe effacement of basal cistern of 4th ventricle ; 4) there was no associated intradural lesion ; 5) the patient showed neither cerebral herniation nor cardiorespiratory abnormalies. Of the 43 patients, 31 (72%) showed no hematoma enlargement, and showed resolution of hematoma on computerized tomography(CT) scans over a period of 4 to 11 weeks. Repeat CT scans within 24 hours of initial CT revealed enlargment of EDH in 12 of 43 patients(28%), of these 12 EDH's, 5 were reabsorbed spontaneously from 6 to 10 weeks, and 7 were evacuated surgically. All patients recovered without morbidity except one who had craniotomy during observation. There was no specific location of EDH which was indicated or contraindicated for conservative treatment. Factors that influence outcome include the age of patient, initial CT finding, cerebrospinal fluid(CSF) leakage, the use of mannitol, and recovery from shock. Hematoma enlargement did not always accompany deterioration of consciousness, therefore repeat CT scans within 24 hours is strongly recommended.
Abusive Head Trauma in Infants and Children in Japan
Nonaka, Masahiro,Asai, Akio The Korean Neurosurgical Society 2022 Journal of Korean neurosurgical society Vol.65 No.3
Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.