Shuzoh Misumi

Spontaneous resolution of chronic subdural hematomas.

Four patients with chronic subdural hematomas, all of which resolved spontaneously, were followed from the time of injury to resolution of the chronic subdural hematoma. Periodic computed tomographic (CT) scans showed spontaneous resolution 78, 174, 231, and 326 days after the development of the chronic subdural hematoma, respectively. Features of the CT scans and a possible mechanism of spontaneous resolution are discussed.

The Incidence of Delayed Traumatic Intracerebral Hematoma with Extradural Hemorrhages

After introduction of computerized tomography (CT), we experienced 22 patients with traumatic extradural and intracerebral combined hematomas, of whom 15 underwent sequential CT scans. In 14 of the 22 patients or 13 of the 15 patients whose initial CT scans were performed early, within 6 hours after injury, intracerebral hematomas developed more slowly than extradural hematomas. In ten of the 13 patients, development of intracerebral hematomas was demonstrated only after removal of extradural hematomas, and in four patients acute brain swelling was observed during surgery. Therefore it is emphasized that the incidence of post-surgical intracerebral hematoma with extradural hemorrhages is high and that acute brain swelling during surgery for extradural hematomas is largely caused by the delayed intracerebral hematomas.

Simple management of cerebrospinal fluid rhinorrhea after pituitary surgery

A simple procedure for managing postoperative cerebrospinal fluid rhinorrhea after pituitary surgery is described. Under local anesthesia, a needle is introduced manually through a nostril toward the sella turcica and EDH adhesive or fibrin glue is injected into the sellar cavity or sphenoid sinus, or both. This procedure is simple and safe to perform, acceptable to the patient, and can be done in a short hospital stay.

Traumatic extradural hematomas with delayed development.

After introduction of computerized tomography (CT), we experienced 74 patients with 78 traumatic extradural hematomas. Among these, 16 hematomas were subjected to sequential CT examinations in the early stage after injury. Four hematomas of four patients became enlarged, and another five hematomas of four patients were delayed. Accordingly the delayed extradural hematomas are thought to be less uncommon than previously believed. Three patients with four delayed extradural hematomas of surgical significance are reported, and pathogenesis of the delayed extradural hematoma is discussed.

Management of polyuria subsequent to pituitary surgery based on the diurnal pattern of urinary excretion

Polyuria subsequent to pituitary surgery was studied in 64 cases. Most cases of postoperative polyuria were due to diabetes insipidus. These cases showed a triphasic pattern in daily urinary volume. Observation of hourly urinary volume in polyuria revealed four diurnal patterns of urinary excretion: rhythmic, continuous, transient, and unspecific. Clinical observation of diurnal patterns has an advantage, in terms of simplicity of procedure, in immediately determining the nature of the polyuria, prognosticating diabetes insipidus, and eliminating inappropriate procedures in treatment. Indomethacin suppository is considered to be a favorable agent in reducing polyuria without disturbing the diurnal pattern in diabetes insipidus.