Therapeutic efficacy of drilling drainage combined with intraoperative middle meningeal artery occlusion in the management of chronic subdural hematoma: a clinical study.

BACKGROUND: The bone holes in the skull during surgical drainage were accurately located at the site of the MMA. The MMA was severed, and the hematoma was removed intraoperatively; furthermore, surgical drainage removed the pathogenic factors of CSDH. This study aimed to describe and compare the results of the new treatment with those of traditional surgical drainage, and to investigate the relevance of this approach. METHODS: From December 2021 to June 2023, 72 patients were randomly assigned to the observation group and the control group. The control group was treated with traditional surgical drainage, while the observation group was treated with DSA imaging to accurately locate the bone holes drilled in the skull on the MMA trunk before traditional surgical drainage. The MMA trunk was severed during the surgical drainage of the hematoma. The recurrence rate, time of indwelling drainage tube, complications, mRS, and other indicators of the two groups were compared, and the changes of cytokine components and imaging characteristics of the patients were collected and analyzed. RESULTS: Overall, 27 patients with 29-side hematoma in the observation group and 45 patients with 48-side hematoma in the control group were included in the study. The recurrence rate was 0/29 in the observation group and 4/48 in the control group, indicating that the recurrence rate in the observation group was lower than in the control group (P = .048). The mean indwelling time of the drainage tube in the observation group was 2.04 ± 0.61 days, and that in the control group was 2.48 ± 0.61 days. The indwelling time of the drainage tube in the observation group was shorter than in the control group (P = .003). No surgical complications were observed in the observation group or the control group. The differences in mRS scores before and after operation between the observation group and the control group were statistically significant (P < .001). The concentrations of cytokine IL6/IL8/IL10/VEGF in the hematoma fluid of the observation and control groups were significantly higher than those in venous blood (P < .001). After intraoperative irrigation and drainage, the concentrations of cytokines (IL6/IL8/IL10/VEGF) in the subdural hematoma fluid were significantly lower than they were preoperatively. In the observation group, the number of MMA on the hematoma side (11/29) before STA development was higher than that on the non-hematoma side (1/25), and the difference was statistically significant (P = .003). CONCLUSION: In patients with CSDH, accurately locating the MMA during surgical trepanation and drainage, severing the MMA during drainage, and properly draining the hematoma, can reduce the recurrence rate and retention time of drainage tubes, thereby significantly improving the postoperative mRS Score without increasing surgical complications.

Endovascular intervention with a low-profile visualized intraluminal support stent for ruptured, very small, wide-necked, intracranial aneurysms.

OBJECTIVE: To evaluate patients treated for ruptured, very small, wide-necked aneurysms using low-profile visualised intraluminal support alone or with stent-assisted coiling. METHODS: The retrospective study was conducted at the Department of Neurosurgery，First Affiliated Hospital of Bengbu Medical College, China, and comprised data of patients who presented with ruptured, very small, intracranial aneurysms between March 2015 and May 2019 who were treated using low-profile visualised intraluminal support alone or with stent-assisted coiling. Outcomes from radiology and clinical assessments were obtained related to the time the patients were discharged and their subsequent mid-term examination. RESULTS: Of the 10 patients, 6(60%) were males and 4(40%) were females. The overall mean age was 47.70±10.22 years (range: 23-62 years). In the sample, 7(70%) patients experienced total occlusion and 3(30%) had nearly complete occlusion. All the 10(100%) patients had uneventful recoveries. Progressive thrombosis to complete occlusion occurred in 3(30%) aneurysms that had initially presented with Raymond grade II. There was no case of stenosis or occlusion. CONCLUSION: Treatment of ruptured, very small, wide-necked intracranial aneurysms with stent-assisted coiling and lowprofile visualised intraluminal support provided superior technical outcomes.

[Clinical efficacy of restrictive fluid management in patients with severe traumatic brain injury].

OBJECTIVE: To investigate the effects of restrictive fluid management in patients with severe traumatic brain injury (sTBI). METHODS: Between January, 2019 and June, 2020, we randomly assigned 51 postoperative patients (stay in the ICU of no less than 7 days) with sTBI into treatment group (n=25) with restrictive fluid management and the control group (n=26) with conventional fluid management. The data of optic nerve sheath diameter (ONSD), middle cerebral artery pulsatility index (MAC- PI), neuron-specific enolase (NSE) level, inferior vena cava (IVC) diameter, Glascow Coma Scale (GCS) score, mean arterial blood pressure, heart rate, and fluid balance of the patients were collected at ICU admission and at 1, 3 and 7 days after ICU admission, and the duration of mechanical ventilation, ICU stay, and 28-day mortality were recorded. RESULTS: The cumulative fluid balance of the two groups were positive on day 1 and negative on days 3 and 7 after ICU admission; at the same time points, the patients in the treatment group had significantly greater negative fluid balance than those in the control group (P < 0.05). In both of the groups, the ONSD and MCA-PI values were significantly higher on day 1 than the baseline (P < 0.05), reached the peak levels on day 3, and decreased on day 7; at the same time point, these values were significantly lower in the treatment group than in the control group (P < 0.05). No significant difference was found in NSE level on day 1 between the two groups (P>0.05); on day 3, NSE level reached the peak level and was significantly higher in the control group (P < 0.05); on day 7, NSE level was lowered the level of day 1 in the treatment group but remained higher than day 1 level in the control group. The 28-day mortality rate did not differ significantly between the two groups (16.00% vs 23.08%, P>0.05); the duration of mechanical ventilation, length of ICU stay, and the number of tracheotomy were all significantly shorter or lower in the treatment group than in the control group (P < 0.05). CONCLUSIONS: Restrictive fluid management can reduce cerebral edema and improve the prognosis but does not affect the 28-day mortality of patients with sTBI.