Proper Indication of Decompressive Craniectomy for the Patients with Massive Brain Edema after Intra-arterial Thrombectomy.

Objective: Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction.

Association of Bypass Surgery and Mortality in Moyamoya Disease.

Background: Patients with moyamoya disease (MMD) have a high risk of stroke or death. We investigated whether extracranial to intracranial bypass surgery can reduce mortality by preventing strokes in patients with MMD.

Methods And Results: This nationwide retrospective cohort study encompassed patients with MMD registered under the Rare Intractable Diseases program via the Relieved Co-Payment Policy between 2006 and 2019, using the Korean National Health Insurance Service database.

Effects of an Infection Control Protocol for Coronavirus Disease in Emergency Mechanical Thrombectomy.

Objective: Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time.

Methods: The last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed.

Changes in Blood Pressure and Heart Rate during Decompressive Craniectomy.

Objective: Rapid increase in intracranial pressure (ICP) can result in hypertension, bradycardia and apnea, referred to as the Cushing phenomenon. During decompressive craniectomy (DC), rapid ICP decreases can cause changes in mean atrial blood pressure (mABP) and heart rate (HR), which may be an indicator of intact autoregulation and vasomotor reflex.

Methods: A total of 82 patients who underwent DC due to traumatic brain injury (42 cases), hypertensive intracerebral hematoma (19 cases), or major infarction (21 cases) were included in this prospective study.

Clinical Significance of Decompressive Craniectomy Surface Area and Side.

Objective: Decompressive craniectomy (DC) can partially remove the unyielding skull vault and make affordable space for the expansion of swelling brain contents. The objective of this study was to compare clinical outcome according to DC surface area (DC area) and side.

Methods: A total of 324 patients underwent different surgical methods (unilateral DC, 212 cases and bilateral DC, 112 cases) were included in this retrospective analysis.

Temperature Difference between Brain and Axilla according to Body Temperature in the Patient with Brain Injury.

Objective: Commonly, brain temperature is estimated from measurements of body temperature. However, temperature difference between brain and body is still controversy. The objective of this study is to know temperature gradient between the brain and axilla according to body temperature in the patient with brain injury.

Progressive postoperative slippage of titanium aneurysm clip confirmed by follow-up radiographic imaging studies and by reoperation: a case report.

We report a case of postoperative slippage of a titanium clip that was used for a small ruptured anterior communicating artery aneurysm. Clipping was successful with no remnant in the initial operation. Progressive slippage of the clip was observed in follow-up brain computed tomography angiography studies.

Microsurgical anatomy of the facial nerve.

The facial nerve connections and pathways from the cortex to the brainstem are intricate and complicated. The extra-axial part of the facial nerve leaves the lateral part of the pontomedullary sulcus and enters the temporal bone through the internal acoustic meatus. In the temporal bone, the facial nerve branches into fibers innervating the glands and tongue.

Current Status of Neurosurgical and Neurointensive Care Units in Korea : A Brief Report on Nationwide Survey Results.

Objective: The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010.

Method: This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010.

Clinical Results of the Intra-Arterial Thrombolysis with Stent Retriever Device Weather Perfusion Diffusion Mismatching and Intravenous Tissue Plasminogen Activator Administration.

Objective: Intraarterial thrombolysis (IA-Tx) with stent retriever is accepted as an additional treatment for selected patients and the clinical benefit is well reported. Each intravenous tissue plasminogen activator administration (IV-tPA) and perfusion diffusion mismatching (P/D-mismatching) is well known the beneficial effects for recanalization and clinical outcomes. In this report, authors analyzed the clinical outcomes of additional IA-Tx with retrieval stent device, according to the combined IV-tPA and P/D-mismatching or not.

Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients.

Objective: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients.

Determining the Lower Limit of Cerebral Perfusion Pressure in Patients Undergoing Decompressive Craniectomy Following Traumatic Brain Injury.

Background: In patients with severe traumatic brain injury (TBI), maintaining systolic blood pressure >90 mm Hg, intracranial pressure (ICP) <20 mm Hg and cerebral perfusion pressure (CPP) >60-70 mm Hg is recommended to improve clinical outcomes. A recommended CPP value for patients treated with decompressive craniectomy (DC) has not been clearly studied. We aimed to determine whether the targeted CPP can be lowered in patients treated with DC.

Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before.

Spontaneous spinal subdural hematoma concurrent with cranial subdural hematoma.

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache.

The clinical efficacy of repeat brain computed tomography in patients with traumatic intracranial haemorrhage within 24 hours after blunt head injury.

This study was performed to determine the usefulness of repeated brain computed tomography (CT) within 24 hours of blunt head trauma in patients with traumatic intracranial haemorrhages (ICH) and who were initially treated nonsurgically. Factors associated with the worsening of lesions on repeat CT were evaluated. Medical records of all blunt head trauma patients with traumatic ICH admitted to our hospital from January 2003 to December 2006 were retrospectively reviewed.

Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm.

Hemifacial spasm (HFS) has characteristic and specific electrophysiological features, primarily the lateral spread response (LSR). The aim of this study was to evaluate the correlation between changes in the lateral spread response during microvascular decompression (MVD) and the clinical outcome after MVD. Seventy-two patients with HFS who were treated with MVD were included in this study.

Delayed diagnosis, due to the associated radiological abnormalities, of spontaneous intracranial hypotension caused by cerebrospinal fluid leakage at C1-2.

Spontaneous intracranial hypotension (SIH) is an uncommon clinical entity that is often diagnosed after a delay, or it is misdiagnosed due to the variety of clinical presentations and the associated radiological findings. We present here a case of SIH associated with chronic subdural haematoma (SDH) and subarachnoid haemorrhage. Following the diagnosis of the SIH, the patient underwent injection of an epidural blood patch for the SIH and burr hole trephination was done for treating the chronic subdural haematoma.

Peritumoral brain edema in meningiomas: correlations between magnetic resonance imaging, angiography, and pathology.

Background: The purpose of this study was to evaluate the radiologic characteristics and pathology related to the formation of peritumoral edema in meningiomas.

Methods: Seventy-nine patients with meningioma were examined by MRI and cerebral angiography. The predictive factors possibly related to peritumoral edema, such as patient age, sex, tumor location, tumor size, peritumoral rim (CSF cleft), shape of tumor margin, signal intensity of tumor in T2WI, pial blood supply, and pathology, were evaluated.

Assessment of cerebrovascular reserve before and after STA-MCA bypass surgery by SPECT and SPM analysis.

Objective: The purpose of this study was to objectively assess the efficacy of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery using Technetium (Tc)-99m-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) in patients who underwent STA-MCA bypass surgery.

Materials And Methods: Brain perfusion SPECT images obtained at baseline and after the administration of acetazolamide were reconstructed using statistical parametric mapping in 23 patients, both before and after STA-MCA bypass surgery. The clinical outcomes of the surgery were also recorded and compared with the hemodynamic changes.

Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms.

Background And Purpose: Despite experience and technological improvements, endovascular treatment of intracranial aneurysms still has inherent risks. We evaluated cerebral complications associated with this treatment.

Methods: From October 1998 to October 2002, 180 consecutive patients underwent 131 procedures for 118 ruptured aneurysms and 79 procedures for 72 unruptured aneurysms.