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ObjectiveCerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers.Materials and MethodsA retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed.ResultsMean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes.ConclusionMean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident.

ObjectiveTherapeutic hypothermia (TH) and decompressive craniectomy are neuroprotective interventions following severe brain swelling. The precise benefits, risks, and clinical outcomes in brain swelling after TH are still being investigated. We aimed to investigate the effects of TH in severe brain injury after decompressive craniectomy.MethodsWe reviewed the cases of 24 patients who underwent decompressive craniectomy with intracranial pressure (ICP) monitor insertion in one medical center between January 2012 and May 2016. All patients had an ICP greater than 15 mmHg and a Glasgow Coma Scale score of less than 7 at the time of intervention. TH was induced in half of the patients (n=12) directly after surgery; the remaining 12 patients remained normothermic. The ICP, vital signs, complications, and functional outcomes were reviewed and compared between the patient groups.ResultsThe mean ICP in the TH group was significantly lower than in the normothermia group. Complications during the 3 days after surgery were not different between the groups, with the exception of hypokalemia in the TH group. Mortality in the intensive care unit (ICU) was higher in the normothermia group, but the functional outcomes 3 months after surgery were not different between the TH and normothermia groups.ConclusionTH after decompressive craniectomy was effective for lowering ICP in patients with severe brain swelling. TH also reduced mortality in the ICU, but it had no benefit in functional outcomes.

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Introduction An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to its complex surrounding structures. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysm and its clinical outcomes.Methods Patients who underwent microsurgical clipping of unruptured anterior communicating aneurysm in our hospital were retrospectively analyzed between January 2008 and December 2020. Demographic data, anatomical features of anterior communicating artery complex and aneurysm, surgical technique, character of postoperative infarction, and its clinical course were evaluated.Results Notably, 66 of 848 patients (7.8%) had a radiologic infarction and 34 patients (4%) had symptomatic infarction. Univariable and multivariable logistic regression analysis showed that hypertension (OR 2.05; p<0.05), previous cerebrovascular accident (OR 2.79; p<0.05), posterior projection (OR 3.94; p<0.01), aneurysm size (OR 1.16; p<0.01), skull base to aneurysm distance (cut-off value 10 mm; OR 3.36, p<0.01) were associated with postoperative infarction. In the pterional approach, closed A2 was an additional risk factor (OR 1.98; p<0.05). The worst outcome was presented with the infarction of A2 cortical branches (mRS=2.00±1.63).ConclusionHypertension, old cerebrovascular accidents, posteriorly projecting aneurysm, size, and high positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of unruptured anterior communicating artery aneurysm. Additionally, closed A2 plane is an additional risk factor for postoperative infarction in pterional approach.