Characteristics of Blunt Cerebrovascular Injury in Khon Kaen Hospital: A Descriptive Study

2026-03-23T20:43:50+07:00

Background: Evidence on blunt cerebrovascular injury (BCVI) remains limited. This study aimed to describe the characteristics of BCVI in a tertiary care referral hospital and trauma center in northeastern Thailand. Methods: This retrospective descriptive study was conducted in the trauma ward and trauma intensive care unit (TICU) at Khon Kaen Hospital from 2020 to 2025. The eligible criteria were the patients sustained blunt trauma and were diagnosed BCVI by computed tomography of 4 vessels of the neck (CTA neck). Baseline data were recorded, including injury characteristics, clinical signs symptoms, and risk factors following standard screening criteria including Denver and Memphis group. Potential endpoints including mortality and in-hospital stroke were also collected. Results: A total of 14 patients were included in this study. Most were male 71.4%. The mean age was 47.9±17.5 years. The mean injury severity score (ISS) was 18.9±7.0. The potential parameters for BCVI were severe TBI with GCS < 6 (28.6%) and stroke as a primary presentation (28.6%). Relevant CT findings suggestive of BCVI were cervical spine fracture (42.9%) and complex skull fracture, respectively (28.6%). Most of the patients were presented with total occlusion (grade 4) BCVI with prevalence of 42.9%. The locations of BCVI were equal between common carotid and vertebral arteries. There were 3 (21.4%) patients with in-hospital stroke and 28.6% in-hospital mortality. Median hospital cost was 96,884.5 [45,090.5, 268,775.5] baht. Conclusion: BCVI was prevalent in tertiary care referral hospital and trauma center. Serious in-hospital complications especially stroke and death were not uncommon. The best way to prevent complications is early detection with high index of suspicious.

A Retrospective Review of the Clinical Outcomes of Stereotactic Radiation for Pituitary Adenoma In Ramathibodi Hospital

2026-03-28T19:20:18+07:00

Background: Stereotactic radiation, including conventional stereotactic radiotherapy (CSRT), hypofractionated stereotactic radiotherapy (HFSRT), and stereotactic radiosurgery (SRS), plays a crucial role in the management of nonfunctioning pituitary adenomas (NFPAs) and functioning. However, the optimal selection of treatment modality to maximize long-term control while minimizing late toxicities, particularly delayed hypopituitarism, remains a subject of ongoing clinical debate. Objective: To evaluate the long-term efficacy and safety of a tailored, risk-adapted stereotactic radiation strategy for the management of pituitary adenomas. Material and method: We retrospectively reviewed 127 patients with pituitary adenomas treated with conventional stereotactic radiotherapy (CSRT) (n=86), hypofractionated stereotactic radiotherapy (HFSRT) (n=29), or stereotactic radiosurgery (SRS) (n=12). The primary outcomes were radiographic tumor local control and biochemical control in functioning adenomas. Secondary outcomes included late toxicities and the evaluation of predictors for new-onset hypopituitarism, which was specifically analyzed using Cox proportional hazards regression in a subgroup of preoperatively hormonally intact patients (n=73). Results: The overall radiographic tumor control rate was 96.6%, with no significant difference in progression-free survival (PFS) across the three modalities (p = 0.823). Among functioning adenomas, the overall biochemical control rate was 87.9%, with 69.7% achieving remission off medication. Regarding secondary outcomes, the treatment demonstrated a highly favorable safety profile; zero instances of Grade 3-4 severe toxicities, radiation necrosis, or cerebrovascular events were observed. New-onset hypopituitarism occurred in 12.6% of the cohort (all Grade 1-2). In the preoperatively hormonally intact subgroup, multivariate analysis revealed that the specific radiation modality was not an independent predictor of new endocrine deficits. Conclusion: A tailored, risk-adapted stereotactic radiation strategy provides excellent and comparable long-term local control and biochemical control for pituitary adenomas. The choice of radiation modality does not independently predict delayed hypopituitarism. Instead, the risk of endocrine decline is likely multifactorial, emphasizing the importance of baseline tumor complexity and the preexisting functional reserve of the gland when counseling patients.

Thai Journal of Neurological Surgery

Characteristics of Blunt Cerebrovascular Injury in Khon Kaen Hospital: A Descriptive Study

A Retrospective Review of the Clinical Outcomes of Stereotactic Radiation for Pituitary Adenoma In Ramathibodi Hospital