Korean Journal of Neurotrauma最新文献

Objective: Postoperative cerebrospinal fluid (CSF) accumulation is a common complication after cranioplasty, causing wound tension, delayed healing, and infection. We developed a grid-patterned polyetheretherketone (PEEK) cranioplasty flap to enhance tissue integration and reduce dead space. In this single-center, nonrandomized pilot study, we evaluated the feasibility and safety of this approach as a preventive strategy against postoperative CSF collection.

Methods: In this study, we prospectively included patients who underwent cranioplasty with patient-specific PEEK implants between March 2024 and October 2025. Patients who provided informed consent received a surface-modified PEEK flap with a grid-lattice pattern, whereas the others received a standard flap. We defined postoperative CSF collection as subgaleal fluid on examination or imaging evidence of a persistent space between the flap and scalp at 1 month and compared the outcomes and complications between the groups.

Results: We included 36 patients in this study, of whom 20 and 16 belonged to the control and surface-modified groups, respectively. Median ages were 56.5 and 60.5 years, and the interval from craniectomy to cranioplasty(63.0 days) was shorter in the surface-modified group(103.0 days). In the control, 2 patients developed hemorrhages and 2 cases of CSF accumulation (10% each), whereas no CSF accumulation or other complications occurred in the surface-modified group. The group differences were not statistically significant, reflecting the small sample size.

Conclusion: Grid-patterned surface modification of patient-specific PEEK flaps appeared feasible and safe, potentially helping prevent CSF collection after cranioplasty. These preliminary results are hypothesis-generating and warrant confirmation in larger controlled studies.

Objective: Elderly patients with traumatic brain injury (TBI) often exhibit atypical responses owing to age-related frailty and comorbidities. Although the Glasgow Coma Scale (GCS) is widely used for initial neurological assessment, it may be insufficient for accurate prognostication in geriatric populations. The elderly TBI (eTBI) score, which integrates clinical and laboratory markers, provides a broad evaluation framework and may enhance prognostic accuracy in conjunction with GCS. To evaluate the utility of combined GCS and eTBI scores in predicting 30-day functional outcomes in TBI patients aged 60 years or above.

Methods: A prospective observational study was conducted in 75 elderly patients with TBI admitted to the Sheri Kashmir Institute of Medical Sciences between April 2024 and March 2025. Clinical data were collected at admission and patients were stratified into risk categories using their eTBI scores. Functional outcomes were assessed after 30 days using the Glasgow Outcome Scale (GOS). Correlation analysis and ordinal logistic regression were employed to evaluate predictive accuracy.

Results: GCS showed a strong correlation with 30-day GOS (ρ=0.823, p<0.001), while eTBI exhibited a moderate to strong correlation (ρ=0.648, p<0.001). Both were independent predictors in logistic regression analysis: GCS score (odds ratio [OR], 1.85) and eTBI (OR, 1.32). The combined model (GCS + eTBI) improved predictive power (Nagelkerke R²=0.71) compared to GCS alone (R²=0.67, p=0.002). High-risk patients showed an 80% mortality rate, whereas low-risk patients achieved a 51.1% rate of good recovery.

Conclusion: Although GCS remains a strong standalone predictor, integrating eTBI enhances prognostic accuracy, especially in borderline cases. This combined approach enables better risk stratification and clinical decision making in geriatric patients with TBI.

Objective: This study aimed to translate the Moss Attention Rating Scale (MARS) into Korean and to validate the psychometric properties of the Korean version (K-MARS) in inpatients with moderate-to-severe traumatic brain injury (msTBI).

Methods: A prospective, single-center study was conducted, recruiting 51 patients with traumatic brain injury between 2023 and 2024. The K-MARS was translated using a standardized cross-cultural adaptation method. Internal consistency and test-retest reliability were also evaluated. Additional assessments of cognitive function, sleep quality, and mood were conducted to examine the convergent validity.

Results: The K-MARS demonstrated strong internal consistency, test-retest reliability, and convergent validity. Cronbach's alpha for the total score was 0.870, and intra-class correlation coefficients for test-retest reliability exceeded 0.90 for both the total score and all subscales. Significant correlations were observed between the K-MARS total score and overall cognitive performance, as well as with several attention-related measures, including the Trail Making Test and Digit Span Test.

Conclusion: The K-MARS is a psychometrically reliable and valid tool for assessing attention-related behaviors in Korean inpatients with msTBI. By capturing behaviorally observable attention deficits, the K-MARS helps identify individual attentional problems and guides the development of tailored cognitive rehabilitation plans.

The Korean Journal of Neurotrauma (KJNT) has been the official journal of the Korean Neurotraumatology Society for over 2 decades, and has evolved from a domestic publication to an internationally indexed journal. We aimed to comprehensively evaluate this journal's long-term development and academic trajectory using bibliometric analysis. A bibliometric analysis was conducted on all articles published in the KJNT between 2005 and 2025. Publication trends, article types, authorship, institutional participation, geographic distribution, research topics, and citation patterns were analyzed using descriptive statistics. Keyword trends were assessed using Medical Subject Headings-based standardization supplemented with title-based keyword extraction from earlier publications. Over a 20-year period, the KJNT has demonstrated a steady increase in publication volume, accompanied by notable structural changes in article composition. Traumatic brain injury remains the predominant research topic, with the number of studies on spinal cord injury and spinal trauma having increased over time. Review articles are the most highly cited publications, although one case report proposing an alternative treatment strategy has also achieved high citation impact. International submissions increased after the KJNT's transition to an English-language journal and major database indexation, currently representing approximately 30% of all publications, predominantly including case reports. Authorship analysis revealed broad institutional participation without concentration among specific individuals or centers. KJNT achieved stable growth through a strong clinical focus and collective academic engagement. To further enhance its global influence, continued efforts to promote high-quality original research and international collaborations are warranted.

Lumbar artery pseudoaneurysm is a rare vascular complication of vertebral compression fractures that can lead to life-threatening retroperitoneal hemorrhage. We report the case of an 84-year-old man with a history of cerebral infarction who was on clopidogrel and presented with acute back pain after a fall. Initial imaging revealed L1 and L2 compression fractures and left psoas hematoma without active bleeding. The patient was managed conservatively. However, follow-up computed tomography demonstrated the enlargement of the hematoma with the development of a pseudoaneurysm arising from the left third lumbar artery. Endovascular embolization was successfully performed using gel foam and coils. Post-procedure imaging confirmed the stabilization of the hematoma without recurrent bleeding, and the patient was discharged uneventfully. Lumbar artery pseudoaneurysms should be considered in older adult patients with persistent or progressive psoas hematomas following vertebral fractures, especially in those on antithrombotic therapy. Endovascular embolization is a safe and effective treatment modality.

Depressed skull fractures of the superior sagittal sinus (SSS) deserve special attention because they may lead to sinus obstruction or stenosis, resulting in venous hypertension. Here, we highlight an extremely unusual clinical presentation of a depressed skull fracture over the SSS obstructing the sinus, along with successful surgical management. A 35-year-old male patient presented with quadriplegia and intact sensations throughout the body following an alleged history of a rock falling on his head. On examination, computed tomography and magnetic resonance imaging of the brain revealed a depressed skull fracture over the SSS, with a filling defect in the SSS on magnetic resonance venography (MRV) underlying the fracture, along with venous hemorrhage and edema. The depressed fracture was elevated and managed postoperatively in the intensive care unit. At follow-up, the patient showed significant neurological improvement, and MRV demonstrated patent SSS. Radiological evidence of obstruction or thrombosis of the SSS, along with the corresponding neurological deficits in patients with midline depressed skull fractures, should be considered an indication for surgery.

Traumatic pseudoaneurysm of the middle meningeal artery (MMA) is a rare but potentially life-threatening condition, typically resulting from a laceration of the arterial wall due to adjacent skull fractures. We report an unusual case of a traumatic MMA pseudoaneurysm presenting with a large intracerebral hemorrhage (ICH) and significant subfalcine herniation that was successfully treated with preoperative glue embolization followed by decompressive craniectomy. This case emphasizes the importance of early vascular evaluation in traumatic ICH and highlights the value of endovascular embolization for achieving hemostatic control prior to surgery.

Objective: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. This study investigated the prognostic value of the initial blood glucose levels in surgically treated patients with TBI.

Methods: This prospective observational study included 90 patients with TBI who underwent surgery. Those with conditions affecting glucose metabolism, such as diabetes, were excluded. Blood glucose levels were measured on admission. Mortality and length of hospital stay were recorded, and correlations between glucose levels and outcomes were analyzed, including subgroup analyses according to TBI severity. Logistic regression was used to identify independent predictors and to control for confounding factors.

Results: Mean initial blood glucose was 149.89 mg/dL. Overall, higher blood glucose levels were significantly correlated with longer hospital stay (r=0.320, p=0.002) and increased mortality (r=0.524, p<0.001). This correlation with mortality was particularly strong in moderate TBI (r=0.478, p<0.001), with a threshold of 148.5 mg/dL predicting increased mortality (area under the curve 0.807, p=0.001; sensitivity, 92.3%; specificity, 51.5%). Elevated blood glucose levels were also correlated with longer hospital lengths of stay in patients with mild and moderate TBI. Blood glucose levels did not significantly predict mortality in patients with severe TBI.

Conclusion: Elevated initial blood glucose levels were associated with poorer outcomes in patients with TBI, especially in those with moderate TBI. Further research, including larger multicenter studies, is needed to validate our findings and explore optimal glucose management strategies.

Intraventricular hemorrhage (IVH) can occur because of different causes, one of which is a non-penetrating head injury. Traumatic IVH is rare and usually associated with a poor prognosis, mainly due to other related injuries. It can be the only computed tomography finding, but it is often associated with other intracranial bleeding events. Traumatic IVH is presumed to result from periventricular parenchymal bleeding or rupture of subependymal veins. Studies correlating thalamic edema with traumatic IVH are scarce. A 25-year-old male patient experienced loss of consciousness, subarachnoid hemorrhage, IVH involving the lateral and third ventricles, and left thalamic edema after a road traffic accident. The patient initially received conservative treatment in the intensive care unit, showed improvement, was transferred to the ward, and was discharged without complications. IVH takes a long time to resolve because of poor dissolution of blood clots and hemolysis in the cerebrospinal fluid. Expansile edema in the left thalamic region with progressive improvement suggests venous insufficiency, although venography does not confirm it. The relationship between thalamic edema and IVH remains unclear and requires further investigation. Conservative management and monitoring of complications are crucial.