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Delayed Operation of Acute Subdural Hematoma in Subacute Stage by Trephine Drainage using Urokinase
강현구,조규용,이래섭,임준섭 대한신경손상학회 2019 Korean Journal of Neurotrauma Vol.15 No.2
Objective: The principle operation of acute subdural hematoma (ASDH) is a craniotomy withhematoma removal, but a trephination with hematoma evacuation may be another method inselected cases. Trephine drainage was performed for ASDH patients in subacute stage usingurokinase (UK) instillation, and its results were evaluated. Methods: Between January 2016 and December 2018, the trephine evacuation using UK wasperformed in 9 patients. The interval between injury and operation was from 1 to 2 weeks. We underwent a burr hole trephination with drainage initially, and waited until the flow ofliquefied hematoma stopped, then instilled UK for the purpose of clot liquefaction. Results: The mean age of patients was 71.6 years (range, 38–90 years). The cause of ASDHwas trauma in 8 cases, and supposed a complication of anticoagulant medication in 1case. Four out of 8 patients took antiplatelet medications and one of them was a chronicalcoholism. The range of the Glasgow Coma Scale score before surgery was from 13 to 15. Most of patients, main symptom was headache at admission. The Glasgow Outcome Scalescore was 5 in 8 cases and 3 in 1 case. Conclusion: It is thought to be a useful operation method in selected patients with ASDHthat the subdural drainage in subacute stage with UK instillation. This method might beanother useful option for the patients with good mental state regardless of age and thepatients with a risk of bleeding due to antithrombotic medications.
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추골-기저 동맥 폐색 환자의 응급 스텐트 삽입 - 증례 보고 -
임병찬,조규용,임준섭,이래섭,옥영철 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.4
Acute vertebrobasilar artery occlusion is a fatal event, even after intra-arterial thrombectomy and thrombolysis. We are reporting a case of acute vertebral artery (VA) occlusion. A 37-year-old man was admitted with mild dizziness, but cardiopulmonary arrest suddenly developed after eleven hours. We performed cardiopulmonary resuscitation immediately and his mental and vital state was recovered. Thus we performed intra-arterial thrombectomy, thrombolysis and balloon angioplasty for left vertebral artery occlusion. But pre-existing stenosis of VA was revealed during intervention so we inserted a stent to the stenotic area. Conclusively, we obtained the good angiographical and clinical outcomes.
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Multiple Intracranial High Density Foci after Brain Parenchymal Catheterization
최태민,조규용,임병찬,임준섭,이래섭 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2
Objective: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. Methods: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. Results: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. Conclusion: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.
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Factors Related to Catheter-Induced Hemorrhage after Brain Parenchymal Catheterization
문종현,조규용,임병찬,임준섭,이래섭 전남대학교 의과학연구소 2013 전남의대학술지 Vol.49 No.3
This article aimed to investigate the incidence rate and possible risk factors for catheter-induced hemorrhage (CIH) after brain parenchymal catheterization. Between January 2011 and March 2013, 381 patients (572 punctures) who underwent brain parenchymal catheterization were retrospectively evaluated. All patients were checked by computerized tomography scan for the detection of hemorrhage within 48 hours after catheter insertion. CIH was defined as any evidence of new hemorrhage on the post-procedural computerized tomography scan. The incidence rate and the possible risk factors were analyzed by surgeon (4 different surgeons performed the procedures), characteristics of the catheter device, and patient background. Of 381 patients, 572 punctures were performed and CIH developed in 122 puncture cases (122/572, 21.3%). The risk factors related to CIH were Glasgow Coma Scale (GCS) score ≤8 (p<0.01) and prothrombin time international normalized ratio (PT INR) ≥1.3 (p=0.038). The amount of hemorrhage was minimal without additional operations. A low GCS score and high PT INR are implicated as potential risk factors for CIH after brain parenchymal catheterization. Careful and delicate operative technique can help to reduce postoperative complications in these patients.
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