Korean Journal of Neurotrauma最新文献

This study presents a case of penetrating craniocerebral injury resulting from a nail gun accident, which is a rare etiology for penetrating brain injuries. Immediate surgical intervention is crucial to mitigate the risk of infection. The patient was a 28-year-old male who underwent craniotomy for foreign body extraction and debridement following presentation. Preoperative imaging aided in the precise localization of the injury, and guided the surgical approach. The surgical technique focused on minimizing brain tissue manipulation to prevent further damage. Postoperative care included prophylactic antibiotics and antiseizure medications. No neurological deficits or signs of infection were found on follow-up examination. Nail gun-related injuries are rare; in this case, prompt surgical intervention and meticulous postoperative care contributed to favorable outcomes, emphasizing the importance of timely management in such cases.

The treatment of hydrocephalus with a ventriculoperitoneal (VP) shunt can lead to complications such as shunt migration. A 67-year-old male, who had previously undergone VP shunt surgery for normal-pressure hydrocephalus, presented approximately five years later with symptoms of general weakness and abdominal pain. Imaging revealed shunt malpositioning, with the catheter passing through an abnormal route to the heart. The catheter was successfully removed under fluoroscopic guidance while monitoring patient's electrocardiogram to prevent potential secondary complications. Although rare, cardiac migration of VP shunts can lead to life-threatening secondary complications. Our case highlights the possibility of delayed upward migration of the shunt catheter in patients with VP shunts, emphasizing the need for various strategies to address and manage this issue.

Objective: Cranioplasty (CP) is used to repair cranial defects after decompressive craniectomy. During this procedure, the temporal muscle can contract or retract toward the base and adhere to the scalp flaps above and/or below the dura. Several complications including functional and cosmetic problems can occur following CP. This study presents the technical notes and outcomes of CP.

Methods: This retrospective observational study collect data of CP-procedures using unseparated muscle-dura technique performed at our hospital in 2019-2022. Technical note is presented regarding the lack of separation of the temporal muscles from the dura mater. A bone flap or titanium mesh was placed above the temporal muscle layer, which was still attached to the dura mater. Functional outcomes were evaluated using OHIP-14 Questionnaire to assess mastication quality.

Results: Twenty-three patients were included in this study. Initial surgeries were mostly caused by trauma (65.2%). Most patients underwent autologous bone flap CP (52.2%), during which the bone flap was stored in either the abdominal subcutaneous pocket or cryoprecipitated. Only one patient experienced mastication problems after CP (p<0.001). Temporal hollowing remained a problem in this technique. However, dissection of the temporalis muscle to reduce temporal hollowing can cause facial nerve injuries and masticatory problems. Due to the lack of temporal muscle manipulation, our patients had minimal mastication problems.

Conclusion: CP should be performed to improve functional and aesthetic outcomes. A CP technique with the temporal muscle unseparated from the dura mater can be selected to avoid damage to the muscle and mastication problems after surgery.

Objective: Chronic subdural hematoma (CSDH) is commonly encountered in neurosurgery, and often occurs in elderly patients following a head injury. Despite favorable postoperative prognosis, recurrence remains common. Herein, we retrospectively analyzed the clinical and radiological data of patients at our institute to identify the risk factors for CSDH recurrence.

Methods: We investigated 370 patients who underwent surgery for CSDH at our institute. The following data were analyzed: sex, age, antiplatelet/anticoagulant use, preexisting diseases, radiological parameters, and surgical techniques. A univariate analysis was subsequently performed to examine the association between these variables and CSDH recurrence. Variables with a p-value of <0.05 in univariate analysis were further subjected to a multivariate logistic regression model to identify independent risk factors of CSDH.

Results: Of the 370 patients, 345 (93.2%) had no recurrence and 25 (6.8%) had recurrence. Univariate and multivariate analyses revealed that male sex, advanced age, bilateral hematoma, moderate or severe brain atrophy, separation type, gradation type, and burr hole trephination were independent risk factors for CSDH recurrence.

Conclusion: Sex, age, bilateral hematoma, brain atrophy, hematoma density and architecture, and surgical techniques are all associated with CSDH recurrence.

Objective: This study investigated the application of a deep learning-based object detection model for accurate localization and orientation estimation of spinal fixation surgical instruments during surgery.

Methods: We employed the You Only Look Once (YOLO) object detection framework with oriented bounding boxes (OBBs) to address the challenge of non-axis-aligned instruments in surgical scenes. The initial dataset of 100 images was created using brochure and website images from 11 manufacturers of commercially available pedicle screws used in spinal fusion surgeries, and data augmentation was used to expand 300 images. The model was trained, validated, and tested using 70%, 20%, and 10% of the images of lumbar pedicle screws, with the training process running for 100 epochs.

Results: The model testing results showed that it could detect the locations of the pedicle screws in the surgical scene as well as their direction angles through the OBBs. The F1 score of the model was 0.86 (precision: 1.00, recall: 0.80) at each confidence level and mAP50. The high precision suggests that the model effectively identifies true positive instrument detections, although the recall indicates a slight limitation in capturing all instruments present. This approach offers advantages over traditional object detection in bounding boxes for tasks where object orientation is crucial, and our findings suggest the potential of YOLOv8 OBB models in real-world surgical applications such as instrument tracking and surgical navigation.

Conclusion: Future work will explore incorporating additional data and the potential of hyperparameter optimization to improve overall model performance.

The past decade has witnessed rapid advancements in various surgical techniques for the clivus and surrounding structures. However, effective treatment of this region still poses significant challenges for neurosurgeons. The advent of endoscopic surgical procedure has reshaped skull base surgery in recent years. We present the rare case of a 67-year-old male gunshot victim who underwent endoscopic endonasal removal of a bullet lodged in the anterior lower clivus. The patient did not receive prophylactic antibiotic therapy. Based on this case, we propose that the endonasal endoscopic approach is highly advantageous for removing foreign bodies from the clivus. Furthermore, intraoperative navigation facilitates rapid lesion identification and reduces the surgical duration.

The first objective of this case series was to describe the case of a patient with severe symptomatic left internal carotid artery stenosis after a recent stroke. Several days after stent placement by transcarotid artery revascularization, the patient developed a left-sided subdural hematoma. The patient then underwent embolization of the left middle meningeal artery (MMA) despite blocked access to the left MMA because of an internal carotid stent. The external carotid artery was accessed by passing a guiding catheter through the stent wall. We describe this method as "intrawall access." This allowed a coaxial system to deliver polyvinyl alcohol particles to the MMA for embolization. Embolization was successfully performed, with the stent integrity and blood flow through it remaining uncompromised. Overall, we demonstrated a new method of access through a previously placed internal carotid stent to gain neurointerventional access to the external carotid artery, which was jailed by a stent, for treating an acute subdural hematoma via MMA embolization. The second objective of this case series was to demonstrate the first MMA embolization in literature carried out in the acute or acute-on-subacute setting, in this case, and in four others.