Timing of chronic subdural hematoma treatment affects middle meningeal artery embolization outcome.

Background: Chronic subdural hematoma (CSDH) is a condition that tends to recur frequently. Although middle meningeal artery embolization (MMAE) is an effective CSDH treatment, there is currently no consensus regarding the optimal timing for embolization. Methods: In this single-center and retrospective study, we reviewed 72 cases with 1st-time recurrent CSDH from January 2018 to July 2023 and identified those treated with MMAE to examine its effect and the impact of differences in the timing of treatment. Results: Of the 72 cases with CSDH recurrence for the 1st time (mean age: 80.4 ± 9.7 years; men: 62 [86.1%]; mean first recurrence interval: 33 ± 24 days), 27 (37.5%) experienced a second recurrence. The mean first recurrence interval was shorter in cases with a second recurrence compared to cured cases: 24.3 ± 18.6 versus 38.3 ± 25.6 days, respectively (P = 0.005). MMAE was performed in 17 (23.6%) cases (mean age: 82 ± 6.2 years; men: 14 [82.4%]). The mean time from initial surgical treatment to embolization was 52.4 ± 35.4 days, and the mean recurrence interval before MMAE was 24.9 ± 19.6 days. Six cases (35.3%) experienced post-embolization recurrence and required surgical treatment. The mean recurrence interval before MMAE was shorter in cases with recurrence after MMAE (15 ± 6.4 vs. 30 ± 22.1 days, P = 0.023). The time from initial surgical treatment to embolization was significantly shorter: 31.3 ± 12.8 versus 63.9 ± 38.9 days (P = 0.039). Conclusion: Cases with a short first recurrence interval were more likely to experience a second recurrence. Repeated recurrences within a short time increased the likelihood of post-embolization recurrence. MMAE performed early following the initial surgical treatment increased the recurrence risk.

A Sporadic Pediatric Case of Huge Intracranial Supratentorial Desmoid-type Fibromatosis.

Desmoid-type fibromatosis (DTF) is a rare locally aggressive soft tissue neoplasm without metastatic potential. Here, we report a very rare sporadic case of an intracranial supratentorial extradural DTF measuring 82 mm in a 1-year-old girl, that recurred twice following surgery over the course of 16 months, requiring two other surgeries. In three surgeries, we resected a huge tumor with the dura which was thought to be tumor origin and removed this tumor infiltrated the frontal skull base by drilling widely. Furthermore, we treated the tumor invading the bone flap using liquid nitrogen for 20 minutes, and subsequently used it to perform a cranioplasty. This tumor has not recurred for past 8 months. DTF invading the skull base is prone to recurrence, and liquid nitrogen treatment is considered to be effective in pediatric patients, who need cranioplasty with tumor-infiltrating autologous bone flaps.

The Diagnosis and Management of Acute Stroke with Emergent Large Vessel Occlusion Screen.

Objective: Endovascular therapy (EVT) is a well-documented treatment for acute occlusion of major cerebral arteries. We carried out in-hospital triage using the emergency large vessel occlusion (ELVO) screen, a pre-hospital scale for acute stroke, to diagnose EVT cases and considered its efficacy. Methods: We investigated stroke cases examined within 24 hours of onset in a 6-month period beginning on March 15, 2019. The results of ELVO screen were retrospectively considered with the presence of atrial fibrillation and treatment of EVT. Results: A total of 146 cases were included. Of the 65 positive ELVO screen cases, 33 (51%) had large vessel occlusion (LVO). Of the 81 negative ELVO screen cases, 11 (14%) had LVO (sensitivity, 75%; specificity, 69%; positive predictive value, 51%; negative predictive value, 86%; accuracy, 71%; P <0.001). Among LVO cases, 16 of the 33 (48%) positive ELVO screen cases and 2 of the 11 (18%) negative ELVO screen cases were treated by EVT. Complications of atrial fibrillation were significantly more common in positive ELVO screen cases (P = 0.001). EVT was carried out in nearly half of the positive ELVO screen cases of atrial fibrillation, being a significantly higher rate (10 of 24 cases, 42%; P = 0.02). Conclusion: The accuracy of EVT use increased in positive ELVO screen cases, particularly in those with atrial fibrillation. In-hospital triage using ELVO screen, a pre-hospital scale, significantly aided in selecting patients requiring EVT.