Nam Kyu You

Objective : The indications for repeated brain computed tomography (CT) for delayed intracranial hemorrhage (DICH) remain inconclusive. This study aimed to identify the risk factors for DICH in patients with severe trauma.Methods : Patients with blunt trauma, admitted to a level I trauma center between January 2018 and June 2020, were retrospectively reviewed. Patients who underwent repeat brain CT but had a normal initial brain CT were included. The patients were divided into the DICH and normal groups, and their general characteristics and outcomes were compared. Multi-logistic regression analysis was performed to identify the risk factors. Patients with DICH were also interviewed.Results : Of 784 patients, 37 (4.7%) were included in the DICH group. The DICH group presented with more severe injury. In multi-logistic regression, age over 65 years (odds ratio [OR], 2.681; 95% confidence interval [CI], 1.250–5.753; p=0.011), lowest systolic blood pressure under 90 mmHg during resuscitation (OR, 2.678; 95% CI, 1.247–5.750; p=0.012), severe abdominal injury (OR, 2.667; 95% CI, 1.213–5.864; p=0.015) and cervical spine fracture (OR, 2.408; 95% CI, 1.084–5.351; p=0.031) were associated with DICH. Among the 37 patients with DICH, one patient underwent an invasive procedure, and no mortality was reported.Conclusion : The incidence of DICH may be higher in patients with severe trauma and repeat brain CT could be considered in selected high-risk cases, even when the initial scan is normal.

Objective : High-ratio plasma transfusion is proposed as a strategy for treating polytrauma with severe traumatic brain injury (TBI). This study analyzed outcomes based on the ratio and timing of plasma transfusion.Methods : The clinical characteristics and results were collected from March 2016 to December 2022. Subjects included patients with severe TBI and polytrauma who underwent massive transfusion (MT). Severe TBI was defined as head abbreviated injury score (AIS) ≥3, and MT was defined as packed red blood cells (pRBCs) ≥4 units in the first 4 hours and ≥10 units in the first 24 hours. The 4-hour ratios were assigned to the “early group,” and the 24-hour ratios to the “catch-up group.” Next, the ratio of each group was divided into “≥1 : 1 (plasma ≥ pRBC)” and “<1 : 1 (plasma < pRBC)” groups, respectively.Results : In this study, 532 patients participated. Mortality rates between the 1 : 2 and 1 : 1.5 ratios did not differ statistically; however, a significant difference was noted only at the 1 : 1 ratio (p=0.006). In the early group, outcomes did not significantly differ. The logistic regression for 30-day mortality identified independent risk factors, including advanced age, low Glasgow coma scale (GOS) scores, high AIS head scores, and a ratio <1 : 1. For the catch-up group, the odds ratio for a favorable GOS at ≥1 : 1 was 1.61, with a 30-day mortality rate of 0.60 when comparing ≥1 : 1 to <1 : 1 ratios.Conclusion : This study showed that maintaining a ≥1 : 1 plasma ratio for 24 hours improved functional outcomes and survival, without increased morbidity. Therefore, high-ratio plasma transfusion may be effective in the treatment of patients with polytrauma and severe TBI.

Objective: Video recording is essential to training and education in the medical field. The recorded videos are used to education. There is less chance of experience in emergent or urgent traumatic brain injury (TBI) surgeries for residents. We used wearable action camcorders for surgical image recording in TBI, then evaluated its safety and feasibility for education. Methods: A wearable action camera was used to record surgical procedures. High-definition (1920×1080 p resolution, 60 frames per sec) quality was set and the camera was attached to the surgeon's head and recorded the view of the surgical field as seen by the surgeon. Burr hole trephination, craniotomy for hematoma removal, and decompressive craniectomy surgeries were recorded. The recorded video clips were stored securely and reviewed. To evaluate the usefulness of the images, we conducted reviews and surveys of the residents. Results: From January 2015 to December 2016, 81 cases of TBI surgery were recorded. Most video clips had a favorable view and image quality. Image distortion by overexposure occurred in 5 cases. Shut down due to misuse of device occurred in 2 cases and the recordings were out of focus in 5 cases. Results of the survey showed that TBI surgical video clips were helpful for understanding the sequence of surgery and sharing the field of view of the main operator. Conclusion: Wearable action camera can be used to record surgical video clips, including TBI surgery, and its videos may be helpful for the training and education of neurosurgery residents.

A 32-year-old woman presented to our hospital with occipital headache for >1 week following head trauma. She showed no other neurologic symptoms. Pain was aggravated by cervical flexion. Magnetic resonance imaging (MRI) findings showed a spinal epidural hematoma (SEH) at the C1 to C3 level. The C2 roots were encircled and compressed by the hematoma. Medication was prescribed and a neck collar was applied for symptom control. After three weeks, her occipital neuralgia disappeared and cervical flexion did not provoke pain. Followup MRI findings showed total resolution of the SEH. The findings of this case illustrate that occipital neuralgia, especially if characterized by rapid onset, can be caused by SEH after trauma.

We investigated the outcomes of gamma knife radiosurgery (GKRS) for elderly patients (≥ 65 years) with brain metastases, and identified survival-associated factors. We retrospectively analyzed data from 115 patients treated with GKRS for 1–15 brain metastases. The median patient age was 72 years; most primary tumors were pulmonary (n = 83). The mean lesion volume was 2.1 ± 4.8 mL. A mean dose of 19.3 Gy was delivered to the mean 63.9% isodose line. The median overall survival (OS) was 5.3 months (95% confidence interval [CI] 3.5–7.1). During follow-up (median, 5.1 months), 91 patients died of primary cancer progression while 1 died of unknown causes. The 6- and 12-month local control rates were 94.9 and 88.1%, respectively. On multivariate analysis, female sex (p = 0.005, hazard ratio [HR] 0.533, 95% CI 0.343–0.827) and a controlled primary tumor (p < 0.001, HR 0.328, 95% CI 0.180–0.596) were significantly favorable prognostic factors. Of non-small cell lung cancer patients with EGFR mutations, 76.5% were women (p = 0.005). The median OS of EGFR-mutant and EGFR-wildtype patients were 19.1 and 4.7 months, respectively (p = 0.080). Brain metastases < 3 mL showed better local control rates after GKRS (p = 0.005). GKRS produces favorable outcomes in women with brain metastases who are ≥ 65 years and have controlled primary tumors. Such patients are therefore suitable candidates for GKRS.

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Park JH, et al. Korean J Neurotrauma. 2014 Oct;10(2):112-118. http://dx.doi.org/10.13004/kjnt.2014.10.2.112

Park J, et al. Korean J Spine. 2014 Sep;11(3):209-211. http://dx.doi.org/10.14245/kjs.2014.11.3.209