Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 716
Filtrar
1.
Medicine (Baltimore) ; 99(21): e20291, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481310

RESUMO

Burr-hole craniostomy (BHC) is a widely accepted treatment for chronic subdural hematomas (CSDHs). This study adopted siphon irrigation to evacuate CSDHs and investigated its efficacy and safety as compared with the traditional irrigation used in BHC.A retrospective cohort study was conducted at a center between January 2017 and December 2018. The data of 171 patients who underwent burr-hole craniostomy for CSDH were collected and analyzed. A total of 68 patients underwent siphon irrigation (siphon group) and 103 patients were treated by a traditional method (control group). A follow-up was conducted 6 months after the surgery.No significant difference was observed in the baseline characteristics and preoperative computed tomography (CT) features of the 2 groups (P > .05). The postoperative CT features of the siphon group, which included the volume of hematoma evacuation (P = .034), hematoma evacuation rate (P < .001), recovery rate of the midline shift (P = .017), and occurrence of pneumocephalus (P = .037) were significantly different and better than those of the control group. The length of hospital stay after surgery of the siphon group was significantly shorter than that of the control group (P = .015). The Markwalder score of the siphon group was significantly superior to that of the control group on postoperative day 1 (P = .006). Although the recurrence rate in the siphon group (2/68, 2.5%) was lower than that in the control group (11/103, 8.9%), no statistically significant difference was observed between them (P = .069). Moreover, no significant differences were observed in terms of complications and mortality rate between the 2 groups.There was no significant difference in the recurrence rate between the groups that underwent siphon irrigation and traditional irrigation. However, in comparison, siphon irrigation can better improve postoperative CT features, promote early recovery of neurological dysfunction after surgery, and shorten the length of hospital stay. This indicates that siphon irrigation may be a better therapeutic option in BHC for CSDH.


Assuntos
Craniotomia/métodos , Hematoma Subdural Crônico/cirurgia , Trepanação/instrumentação , Idoso , Drenagem/métodos , Desenho de Equipamento , Feminino , Seguimentos , Hematoma Subdural Crônico/diagnóstico , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Irrigação Terapêutica/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Acta Neurochir (Wien) ; 162(8): 1795-1801, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32514620

RESUMO

BACKGROUND: To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic. METHODS: In this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms. RESULTS: During the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*p = 0.009). The total number of neuro-emergencies was significantly reduced (*p = 0.0007) across all types of disease, particularly in vascular (*p = 0.036) but also in spinal (*p = 0.007) and hydrocephalus (*p = 0.048) emergencies. Patients with spinal emergencies presented 48 h later (*p = 0.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*p = 0.046), and were less likely to reach favorable outcome (*p = 0.003) at discharge compared with previous years. CONCLUSIONS: Despite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.


Assuntos
Encefalopatias/cirurgia , Infecções por Coronavirus/epidemiologia , Emergências , Procedimentos Neurocirúrgicos , Pneumonia Viral/epidemiologia , Doenças da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Hemorragia Subaracnóidea/cirurgia , Adulto Jovem
3.
World Neurosurg ; 137: 350-356, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032785

RESUMO

BACKGROUND: Chronic subdural hematoma evacuation can be achieved in select patients through bedside placement of the Subdural Evacuation Port System (SEPS; Medtronic, Inc., Dublin, Ireland). This procedure involves drilling a burr hole at the thickest part of the hematoma. Identifying this location is often difficult, given the variable tilt of available imaging and distant anatomic landmarks. This paper evaluates the feasibility and accuracy of a bedside navigation system that relies on visible light-based 3-dimensional (3D) scanning and image registration to a pre-procedure computed tomography scan. The information provided by this system may increase accuracy of the burr hole location. METHODS: In Part 1, the accuracy of this system was evaluated using a rigid 3D printed phantom head with implanted fiducials. In Part 2, the navigation system was tested on 3 patients who underwent SEPS placement. RESULTS: The error in registration of this system was less than 2.5 mm when tested on a rigid 3D printed phantom head. Fiducials located in the posterior aspect of the head were difficult to reliably capture. For the 3 patients who underwent 5 SEPS placements, the distance between anticipated SEPS burr hole location based on registration and actual burr hole location was less than 1cm. CONCLUSIONS: A bedside cranial navigation system based on 3D scanning and image registration has been introduced. Such a system may increase the success rate of bedside procedures, such as SEPS placement. However, technical challenges such as the ability to scan hair and practical challenges such as minimization of patient movement during scans must be overcome.


Assuntos
Craniotomia/métodos , Hematoma Subdural Crônico/cirurgia , Imageamento Tridimensional , Neuronavegação , Humanos , Modelos Anatômicos , Procedimentos Neurocirúrgicos/métodos , Impressão Tridimensional , Tomografia Computadorizada por Raios X
4.
World Neurosurg ; 135: e723-e730, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899385

RESUMO

OBJECTIVE: The aim of the present study was to compare the outcomes of patients with chronic subdural hematoma after undergoing burr hole craniotomy with subperiosteal or subgaleal drainage (SPGD) with those of patients who have undergone burr hole craniotomy with subdural drainage. METHODS: We searched 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) for relevant reports from January 1995 to September 2019. Two reviewers recorded the major outcomes data as follows: recurrence, mortality, postoperative seizures, postoperative bleeding events, surgical infection, pneumocephalus, modified Rankin scale scores, and Glasgow outcome scale scores. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 3149 patients from 10 studies were included in our analysis. Compared with the SSD group, the SPGD group had a lower recurrence rate (OR, 0.72; 95% CI, 0.57-0.91) and a smaller risk of postoperative bleeding (OR, 0.41; 95% CI, 0.22-0.78). Also, no significant differences were found in the incidence of mortality (OR, 0.79; 95% CI, 0.54-1.18), postoperative seizures (OR, 0.74; 95% CI, 0.39-1.40), surgical infection (OR, 0.98; 95% CI, 0.55-1.76), pneumocephalus (OR, 0.58; 95% CI, 0.28-1.20), modified Rankin scale score 0-3 (OR, 1.04 at discharge; OR, 1.33 at 6 months), and Glasgow outcome scale score 4-5 (OR, 1.48; 95% CI, 0.82-2.67). CONCLUSIONS: Burr hole craniotomy with SPGD can be recommended as an effective and safe surgical therapy for patients with chronic subdural hematoma owing to its lower recurrence rate and reduced incidence of postoperative brain injuries, in addition to no increase in the rate of some postoperative complications. However, more studies are necessary for further confirmation.


Assuntos
Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Craniotomia/efeitos adversos , Craniotomia/métodos , Craniotomia/mortalidade , Drenagem/efeitos adversos , Drenagem/mortalidade , Métodos Epidemiológicos , Hematoma Subdural Crônico/mortalidade , Humanos , Recidiva , Resultado do Tratamento
5.
World Neurosurg ; 136: 90-100, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927124

RESUMO

BACKGROUND: The use of drains has been considered to be superior to no drains after burr hole drainage of chronic subdural hematomas (CSDHs). Therefore, routine placement of a subdural drain (SDD) is supported by most neurosurgeons. However, whether the drain location after CSDH burr hole evacuation influences patient outcomes is unclear. Therefore, we compared the efficacy and safety of subperiosteal drains (SPDs) with those of SDDs for patients with CSDHs. METHODS: Using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, eligible studies reported up to September 2019 were identified through a search of MEDLINE, EMBASE, and Cochrane Central. Pooled estimates, confidence intervals (CIs), and odds ratios (ORs) were calculated for all outcomes. RESULTS: Ten studies with 3169 patients were included. The use of a SPD after CSDH burr hole drainage resulted in a significant decrease in recurrences compared with the use of a SDD (OR, 0.73; 95% CI, 0.58-0.92; I2, 14%; P = 0.007). No significant differences were identified between the SPD and SDD groups in the favorable outcomes (OR, 1.29; 95% CI, 1-1.68; I2, 0%; P = 0.05). Adverse event rates, including mortality, seizures, and surgical infection, were not significantly different between the 2 groups. However, the use of SPDs was associated with a lower risk of parenchymal injuries compared with SDDs (OR, 0.29; 95% CI, 0.11-0.76; I2, 0%; P = 0.01). CONCLUSIONS: The results from the present meta-analysis suggest that the use of an SPD is safer and might be more effective than an SDD in the treatment of CSDH. However, more large randomized controlled trials are needed to investigate the use of SPDs in the management of CSDH.


Assuntos
Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Periósteo , Espaço Subdural , Humanos , Complicações Pós-Operatórias/epidemiologia , Recidiva , Reoperação/estatística & dados numéricos , Convulsões/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
6.
J Craniofac Surg ; 31(2): e171-e173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895851

RESUMO

The main treatment for chronic subdural hematoma (CSDH) is surgical drilling and drainage. Meanwhile, the most accepted treatment strategy for bilateral CSDHs (bCSDHs) is unilateral evacuation only on the larger or symptomatic side because the contralateral hematoma is generally either small or asymptomatic. However, the probability of recurrence is high. To effectively reduce this recurrence rate, embolization has been proposed. Because middle meningeal artery embolization may effectively block the blood supply of the CSDH, its combination with drilling and drainage could be an effective treatment strategy for addressing unilateral CSDH (uCSDH). In addition, the recurrence mechanism of bCSDH may be not completely same as that of the uCSDH. Hence, the authors need find a more effective treatment for it.


Assuntos
Drenagem/efeitos adversos , Embolização Terapêutica/efeitos adversos , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Crônico/etiologia , Humanos , Masculino , Artérias Meníngeas/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Recidiva , Resultado do Tratamento
7.
World Neurosurg ; 134: 240-263, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31682989

RESUMO

OBJECTIVE: Calcified or ossified chronic subdural hematoma (CSDH), characterized by slowly progressing neurologic symptoms, is a rarely seen entity that may remain asymptomatic for many years. Management of CSDH has improved dramatically in recent years as a result of advances in diagnostic tools, but there is still some controversy regarding the optimal treatment strategy. METHODS: In this systematic review, PRISMA guidelines were followed to query existing online databases between January 1930 and December 2018. We found a total of 88 articles containing 114 cases of calcified or ossified CSDH, comprising 83 patients operated on and 31 not operated on. RESULTS: In this study, there were 78 males and 29 females (7 with unreported gender) from 25 countries, ages ranging from 4 months to 86 years (mean, 33.7 years), with CSDH caused by head trauma in 33.3%, shunting for hydrocephalus in 27.2%, or after cranial surgery in 4.4%. The duration of symptoms ranged from acute onset to 20 years, with a mean of 24.1 months. Imaging techniques such as radiography, computed tomography, and magnetic resonance imaging were used, with pathologic confirmation of CSDH and complete recovery in 56.4% of patients. CONCLUSIONS: Incidence of calcified or ossified CSDH is high in certain countries, including the United States, Japan, and Turkey, with a steady increase in recent years. The therapy of choice is surgery in these patients and it should be considered in the differential diagnosis at presentation because of its infrequency and variable clinical manifestation, after shunting in children or head trauma in adults.


Assuntos
Calcinose/epidemiologia , Hematoma Subdural Crônico/epidemiologia , Ossificação Heterotópica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Derivações do Líquido Cefalorraquidiano , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Craniotomia , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Hidrocefalia/cirurgia , Incidência , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Radiografia , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
World Neurosurg ; 134: e549-e553, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678452

RESUMO

OBJECTIVE: This prospective study investigated whether tranexamic acid and Goreisan effectively prevent recurrence after burr hole surgery for chronic subdural hematoma. METHODS: A total of 297 patients with chronic subdural hematoma underwent initial burr hole surgery at our hospital from April 2014 to March 2018. Of these, 206 patients (250 hematomas) consented to participate in this study. Patients were randomly divided into the nonadministration, tranexamic acid, and Goreisan groups based on age. The oral administration intervention was implemented from the day after surgery, after which there was a 3-month follow-up. Recurrence rates were measured, and head computed tomography scan was used to measure the volume of residual hematoma 1 day, 1 week, and 1, 2, and 3 months after surgery. RESULTS: A total of 193 patients (232 hematomas) were followed-up for 3 months (82 hematomas in the nonadministration group, 72 hematomas in the tranexamic acid group, and 78 hematomas in the Goreisan group). There were no significant between-group differences in demographic characteristics, current drug treatment, comorbidities, hematoma, operation side (bilateral or unilateral), preoperative hematoma volume, and recurrence rates. At 1, 2, and 3 months, the residual hematoma volume was significantly smaller in the tranexamic acid group than in the other 2 groups. CONCLUSIONS: Oral administration of tranexamic acid or Goreisan does not minimize recurrence after chronic subdural hematoma burr hole surgery; however, tranexamic acid can reduce the hematoma volume.


Assuntos
Antifibrinolíticos/administração & dosagem , Hematoma Subdural Crônico/prevenção & controle , Hematoma Subdural Crônico/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Oral , Idoso , Feminino , Seguimentos , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico por imagem , Recidiva , Resultado do Tratamento
9.
World Neurosurg ; 134: e196-e203, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31605846

RESUMO

BACKGROUND: Chronic subdural hematomas (cSDHs) are common neurosurgical pathological entities and typically occur after trauma in elderly patients. The 2 most commonly used strategies for treatment have included burr hole drainage and craniotomy with decompression. However, the choice of these procedures has remained controversial and has been primarily determined by surgeon preference. We designed a matched-cohort analysis to compare these 2 procedures and identify the risk factors associated with the postoperative outcomes. Thus, we compared the rates of reoperation and mortality for patients who had undergone craniotomy versus burr hole evacuation for cSDH. METHODS: A retrospective review examining the data from 299 consecutive patients with cSHDs from 2002 to 2015 was performed. We compared the following endpoints between the 2 procedures: 30-day mortality, discharge to a skilled nursing facility, and the need for reoperation. We also compared the potential risk factors in the patients with different primary outcomes. RESULTS: Patients undergoing craniotomy had a decreased need for reoperation compared with patients treated with burr hole evacuation (7.5% vs. 15.7%; P = 0.044). Older age was associated with both increased disposition to a nursing facility and increased 30-day mortality in both groups. Increased 30-day mortality was associated with aspirin usage in patients who had undergone craniotomy and with warfarin (Coumadin) in patients who had undergone burr hole evacuation. CONCLUSIONS: Our study identified an increased need for reoperation for patients treated with burr hole evacuation compared with those undergoing craniotomy. Older age and low Glasgow coma scale scores were associated with worse outcomes in both groups. Certain methods of anticoagulation were also associated with worse outcomes, which varied between the 2 groups. We recommend that surgeons individualize the choice of procedure according to the specific patient characteristics with consideration of these findings.


Assuntos
Craniotomia/mortalidade , Craniotomia/tendências , Hematoma Subdural Crônico/mortalidade , Hematoma Subdural Crônico/cirurgia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Mortalidade/tendências , Complicações Pós-Operatórias/diagnóstico , Reoperação/tendências , Estudos Retrospectivos , Resultado do Tratamento
10.
World Neurosurg ; 134: e1037-e1046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759155

RESUMO

OBJECTIVE: The usefulness of endoscopic procedures for chronic subdural hematoma (CSDH) has been described, but the indications in patients of very advanced age have not been analyzed. The aim of this study was to evaluate the feasibility, safety, and usefulness of introduction of an endoscopic procedure for such patients. METHODS: We retrospectively analyzed the data of 540 CSDHs treated by burr-hole surgery with endoscopic examination. The safety of the endoscopic procedure was assessed according to postoperative complications, morbidity, and mortality. The outcome was evaluated by statistical comparison among 4 different age-groups, and the recurrence rate and risk factors for recurrence was investigated in patients of very advanced age. RESULTS: Postoperative complications occurred in 7 cases (1.5%). The 6-month morbidity and mortality were 13.5% and 4.5%. No complications, morbidity, or mortality associated with the additional endoscopic procedure occurred even in patients of very advanced age. The endoscopic features of trabecular structures and residual septa separating the cavity were also risk factors for recurrence in patients of very advanced age. Releasing of the septa showed the possibility of decreasing the risk of recurrence to 6.6% in patients aged ≥85 years as well as in younger patients. There were some inevitable problems such as prolongation of the surgical time and inadequate endoscopic surgical skill. CONCLUSIONS: An endoscopic procedure for CSDH can be safely indicated and useful even in patients aged ≥85 years. However, clinicians should carefully select the patients based on clinical information associated with risk factors for recurrence.


Assuntos
Hematoma Subdural Crônico/cirurgia , Neuroendoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso de 80 Anos ou mais , Craniotomia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Mortalidade , Recidiva , Estudos Retrospectivos
11.
World Neurosurg ; 134: 472-476, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31756510

RESUMO

BACKGROUND: Spinal subdural hematoma (SSDH), which can cause lower back pain, leg pain, and leg weakness, is rare and will usually be associated with a bleeding tendency, trauma, spinal vascular malformation, intraspinal tumor, or iatrogenic invasion. Only a few cases of SSDH after intracranial chronic subdural hematoma (CSDH) have been reported. We report a case of lumbar SSDH in the absence of predisposing factors after reoperation for recurrent intracranial CSDH, which improved with conservative treatment. CASE DESCRIPTION: Approximately 1 month after falling, a 63-year-old woman was experiencing left hemiparesis and impaired orientation that was diagnosed as right intracranial CSDH using computed tomography. Surgical treatment of the CSDH led to immediate improvement of her symptoms. On postoperative day 29, the right CSDH had recurred with left hemiparesis, and successful reoperation relieved the symptoms within a few hours postoperatively. However, 1 day after the second operation, very small acute subdural hematomas in regions along the left tentorium cerebelli and left falx cerebri were found on computed tomography. On day 31, she complained of sitting-induced bilateral radiating lower limb pain. Magnetic resonance imaging on day 34 showed an acute SSDH at the L4-L5 level and a sacral perineural cyst filled with hematoma, although her radiating pain was showing improvement. She was treated conservatively and was discharged without symptoms on day 44. CONCLUSIONS: Although SSDH is rare, it is important for neurosurgeons and physicians to consider the possibility of a SSDH when lower limb pain or paresis occurs after procedures that will result in rapid intracranial pressure alterations such as drainage of an intracranial CSDH.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Intracraniano/complicações , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/patologia , Feminino , Hematoma Subdural Crônico/patologia , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Intracraniano/patologia , Hematoma Subdural Intracraniano/cirurgia , Humanos , Região Lombossacral , Pessoa de Meia-Idade , Recidiva , Reoperação
12.
World Neurosurg ; 135: e616-e622, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31874290

RESUMO

BACKGROUND: Chronic subdural hematoma (cSDH) is an increasingly common condition due to the growing use of anticoagulation. Currently, there remains a lack of evidence to guide the optimal timing of anticoagulant reinitiation for stroke prevention in atrial fibrillation after cSDH evacuation. We aimed to better understand the perceived risks of hemorrhagic and embolic complications along with current practice patterns on restarting anticoagulation after surgical evacuation of cSDH. METHODS: We conducted a survey of Canadian neurosurgeons and stroke neurologists using a novel self-administered questionnaire using clinical cases that included questions on clinical experience, practice setting, practice patterns, and perceptions on stroke/bleeding risk with anticoagulation reinitiation after cSDH evacuation. The instrument was evaluated for clinical sensibility by 5 neurosurgeons, neurologists, and intensivists. RESULTS: The response rate after 4 mailings was 40% for neurosurgeons (55/136) and 21% for stroke neurologists (26/122). Almost all participants would restart anticoagulation for stroke prevention in atrial fibrillation after cSDH evacuation (91.8% in low-risk patients, 98.6% in high-risk patients). Time to reinitiation of anticoagulation varied considerably, particularly for high-risk patients where 36% of participants would restart anticoagulation within 1 week of surgery, 44% between 1 and 4 weeks after surgery, and 19% after 4 weeks postoperatively. The perceived risk of stroke and SDH reaccumulation varied considerably among participants and was dependent on timing of anticoagulation reinitiation. CONCLUSIONS: There is considerable variation in current practice patterns and perceived risks of embolic and hemorrhagic complications with anticoagulation reinitiation after cSDH evacuation. These results demonstrate clinical equipoise that warrant further targeted investigation in large-scale randomized controlled trials.


Assuntos
Anticoagulantes/administração & dosagem , Hematoma Subdural Crônico/cirurgia , Administração Oral , Adulto , Hemorragia/induzido quimicamente , Humanos , Cuidados Pós-Operatórios , Fatores de Risco , Acidente Vascular Cerebral/induzido quimicamente
13.
J Clin Neurosci ; 72: 270-276, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31866353

RESUMO

Chronic subdural hematoma (CSDH) is a common disease in older individuals with a substantial rate of recurrence. The mechanism of CSDH recurrence remains unclear. This study aimed to detect imaging parameters that could indicate the risk for CSDH recurrence by using quantitative volumetric analysis and computed tomography (CT) texture analysis (CTTA). Clinical and imaging parameters were retrospectively investigated in 147 newly diagnosed CSDH lesions in 114 patients surgically treated at the Keio University Hospital during a 6-year period. For CT images, quantitative volumetric and texture analyses were performed. Hematoma volume, postoperative air volume, hematoma density, and texture parameters including kurtosis, skewness, and entropy were evaluated and compared with CSDH recurrence rate. Data were statistically evaluated, and a difference of p < 0.05 was considered significant. Reoperation for CSDH recurrence was required in 27 sides (18.4%) of 26 patients. Multivariate analysis showed that postoperative hematoma volume and postoperative hematoma density were independent risk factors for symptomatic CSDH recurrence that required reoperation. Postoperative hematoma volume, postoperative significant residual air, and postoperative hematoma density were also identified as independent risk factors for potential CSDH recurrence. Preoperative hematoma entropy was prone to be associated with both symptomatic and potential CSDH recurrence in univariate analysis, but not in multivariate analysis because of confounding factors. Quantitative volumetric analysis and CTTA could aid in distinguishing individuals at risk for CSDH recurrence.


Assuntos
Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/estatística & dados numéricos , Tomografia Computadorizada por Raios X
14.
Medicine (Baltimore) ; 98(52): e18587, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876760

RESUMO

RATIONALE: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. However, complicated subdural empyema rarely occurs after trepanation and drainage of chronic subdural hematoma. PATIENT CONCERNS: A male patient (77 years old) was admitted to the hospital on the 2nd day of fever after an undergoing a "trepanation and drainage of chronic subdural hematoma" operation at a local hospital. After admission, the patient was treated with an emergency operation in which a subdural abscess was diagnosed and then administered antibiotics after the operation. DIAGNOSIS: According to the clinical manifestations, intraoperative findings of imaging examination and the results of pus culture, the diagnosis was subdural empyema. INTERVENTION: We surgically removed the subdural empyema. Postoperative antibiotics were administered according to the results of bacterial culture. OUTCOMES: At 3 months after the operation, the patient returned to the hospital for reexamination and was found to have achieved a good recovery and good self-care. LESSONS: Subdural empyema after trepanation and drainage of chronic subdural hematoma is a very rare and severe disease. Early diagnosis and operative intervention as well as the intravenous administration of antibiotics can improve the prognosis of patients and enhance their quality of life.


Assuntos
Empiema Subdural/etiologia , Hematoma Subdural Crônico/cirurgia , Trepanação , Idoso , Encéfalo/diagnóstico por imagem , Empiema Subdural/diagnóstico , Empiema Subdural/diagnóstico por imagem , Humanos , Masculino , Neuroimagem , Tomografia Computadorizada por Raios X , Trepanação/efeitos adversos , Trepanação/métodos
15.
World Neurosurg ; 132: e283-e289, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479790

RESUMO

OBJECTIVE: The randomized controlled Chronic Subdural Hematoma (cSDH)-Drain-Trial showed comparable recurrence rates after placing a subperiosteal drain (SPD) or a subdural drain (SDD) for surgically drained cSDH, although SDD was associated with higher rates of infection and iatrogenic brain injury. This subanalysis examines the time to recurrence and possible risk factors for recurrence after burr-hole drainage of cSDH and placement of a SPD compared with a SDD. METHODS: We included 220 patients from the preceding cSDH-Drain-Trial. Time to recurrence was compared within the 2 groups using a univariate Cox proportional hazards model. Apart from intraoperative brain expansion (iBE), defined by residual hematoma-cavity on computer tomography 24 hours after surgery, other possible pre-, intra- and postoperative risk factors for recurrence were assessed through univariate and multivariate analysis. RESULTS: Median time to recurrence was 22.5 days (interquartile range: 9.25-52 days, range: 0-81) showing no difference between the 2 groups. Less iBE (P = 0.019), lower Glasgow Outcome Scale score at discharge (P = 0.007), and lower Glasgow Coma Scale score at 24 hours (P = 0.037) were strongly associated with recurrence on univariate analysis. After multivariate logistic analysis, less iBE (odds ratio: 1.10, 95% CI: 1.01; 1.21; P = 0.03) remained the only significant risk factor associated with recurrence. When comparing the risk factors within the 2 groups, less iBE and lower Glasgow Outcome Scale score at release were associated with recurrence only in the SDD group. CONCLUSIONS: The inserted drain type after burr-hole drainage of cSDH does not seem to influence time to recurrence. SPD may be warranted in routine clinical practice, independent of individual patient, surgical, or hematoma characteristics.


Assuntos
Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Trepanação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periósteo/cirurgia , Recidiva , Fatores de Risco , Espaço Subdural/cirurgia , Fatores de Tempo
16.
World Neurosurg ; 132: e109-e115, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518737

RESUMO

OBJECTIVE: Computed tomography images of patients with chronic subdural hematoma (CSDH) sometimes show obliteration of the basal cistern with high density in an obliterated Sylvian cistern, termed pseudo-subarachnoid hemorrhage (SAH). The present study aimed to clarify the characteristics and outcomes of these conditions. METHODS: We retrospectively investigated 669 consecutive patients who were surgically treated for CSDH between January 2006 and May 2019. RESULTS: Basal cistern effacement and pseudo-SAH were found in 24 (3.6%) and 11 (1.6%) patients, respectively. Predictors of basal cistern effacement in patients with CSDH were younger age, cerebrospinal fluid leak, and bilateral CSDH (P < 0.05). In patients with basal and Sylvian cistern effacement, the significantly different main features to differentiate patients with and without pseudo-SAH were younger age, cerebrospinal fluid leak, and thick small hematomas on computed tomography slices of the Sylvian cistern (P < 0.05). Magnetic resonance imaging showed that high-density areas in the Sylvian cistern of pseudo-SAH on precontrast computed tomography images corresponded to the M1 segment of the middle cerebral artery. The outcomes of patients with basal cistern effacement and of patients with pseudo-SAH did not differ from other patients with CSDH, although rates of surgical complications were significantly higher among patients with basal cistern effacement. CONCLUSIONS: Although the outcomes of patients with basal cistern effacement and pseudo-SAH were similar to outcomes of other patients with CSDH, problematic postsurgical complications and cerebrospinal fluid leaks were more likely to arise in such patients.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Escala de Coma de Glasgow , Hematoma Subdural Crônico/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
World Neurosurg ; 132: e506-e513, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450003

RESUMO

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We aimed to investigate the predictive factors for the postsurgical recurrence of CSDH. METHODS: We retrospectively reviewed the medical records of patients with CSDH who underwent surgery in West China Hospital between January 2012 and June 2018. Univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, sex, history of injury, Markwalder grading, computed tomography findings, surgical methods, and outcomes. RESULTS: A total of 328 patients (281 men and 47 women) aged 22-93 years (mean age, 65.14 ± 13.76 years) were included. Computed tomography findings at admission showed mixed density hematoma in 136 patients, isodensity hematoma in 140, high-density hematoma in 34, and low-density hematoma in 18. The mortality and recurrence rate were 0.30% (1 of 328) and 2.44% (8 of 328), respectively. Six months postoperatively, 327 patients had Markwalder grade 0. Hematoma recurred in 8 patients of which 7 were mixed density hematoma and 1 was isodensity hematoma. Six patients who underwent craniotomy had thickened inner neomembrane that was resected. Univariate and multivariate analyses found mixed density hematoma to be an independent risk factor for the recurrence of CSDH. CONCLUSIONS: Burr hole craniostomy with irrigation and closed-system drainage is effective for the surgical treatment of CSDH. Mixed density hematoma is an independent predictor for the recurrence of CSDH. Presence of thick inner neomembrane might be the primary cause of CSDH recurrence.


Assuntos
Hematoma Subdural Crônico/patologia , Hematoma Subdural Crônico/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Trepanação/métodos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA