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1.
Pan Afr Med J ; 38: 80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889246

RESUMO

Introduction: chronic subdural hematoma (cSDH) is not uncommon in sub-Saharan Africa and has a striking morbidity and mortality if not managed adequately. With the limited number of neurosurgeons in resource poor countries, general surgeons should be trained in the skills of craniotomy and burr-hole craniostomy. Methods: we conducted a retrospective review of all medical records of patients with cSDH, who underwent flap craniotomy at the Choithrams Memorial Hospital, Sierra Leone, between January 2016 and March 2018. The case notes, operative records and computerized axial tomography (CT) scans were reviewed and all pertinent data extracted. All patients were jointly managed post operatively by medical (neurological) and surgical teams in an intensive care unit. Results: a total of 23 patients had surgical drainage of the chronic subdural hematoma. The mean age of the patients was 65.8 years (ranging from 54-78) with a male: female ratio of 3: 2: 1. The main predisposing risk factors were head trauma (60.9%) and antiplatelet medications (21.7%). Hypertension was the most common comorbidity, followed by diabetes mellitus. Ten (62.5%) out of sixteen patients referred for Head CT-scan by the primary physicians, had an initial missed clinical diagnosis until computerized tomography (CT) scan confirmation report of chronic subdural hematoma (cSDH) was obtained. Flap craniotomy under general anesthesia with a subdural drainage left in situ (100%) was done for all patients. Mean duration of Intensive Care Unit (ICU) admission was 10.6 days (range 6-16 days). Twenty-one (91.3%) patients made a full recovery. There was no mortality. Conclusion: flap craniotomy for cSDH was safely performed by a traumatologist/general surgeon in a developing country where there is no neuro-surgical service. The outcome of the patients was favorable as there was co-management with the surgical and medical team.


Assuntos
Craniotomia/métodos , Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Retalhos Cirúrgicos , Idoso , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Serra Leoa , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
No Shinkei Geka ; 49(2): 238-243, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762443

RESUMO

Chronic subdural hematomas(SDHs)do not infrequently present isodensity on CT. They should not be overlooked, particularly if bilateral. Therefore, checking for an abnormal mass effect and visualizing the cortical sulci in higher slices should be routine. In suspected cases, MRI can be a reliable tool for establishing the diagnosis. SDHs or subdural hygromas are often found in patients with intracranial hypotension, along with other findings such as thickened dural enhancement, enlarged dural sinuses, an anterior shift of the brainstem, inferior shift of the cerebellar tonsils, and others. In such cases, some techniques are indicated for visualizing cerebrospinal fluid leakage from the dural sac. Conditions with similar imaging findings, such as chronic SDHs, include dural metastases, several kinds of granulomatous disease, and hypertrophic pachymeningitis. Additionally, it is essential to consider child abuse when SDH is found in children.


Assuntos
Maus-Tratos Infantis , Hematoma Subdural Crônico , Hipotensão Intracraniana , Vazamento de Líquido Cefalorraquidiano , Criança , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Imageamento por Ressonância Magnética
3.
J Clin Neurosci ; 86: 154-163, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775320

RESUMO

The subdural evacuating port system (SEPS) is a minimally invasive option for treating chronic subdural hematoma (cSDH). Individual case series have shown it to be safe and effective, but outcomes have not been systematically reviewed. We sought to review the literature in order to determine the safety and efficacy of SEPS as a first line treatment for cSDH. A comprehensive literature search for outcomes following SEPS placement as a primary treatment for cSDH was performed. The primary outcome was treatment success, which was defined as a composite of improvement in presenting symptoms and no need for further treatment in the operating room. Additional outcomes included discharge disposition, length of stay (LOS), hematoma recurrence, and complications. A total of 12 studies comprising 953 patients who underwent SEPS placement met the inclusion criteria. The pooled rate of a successful outcome was 0.79 (95% CI 0.75-0.83). Frequency of delayed hematoma recurrence was 0.15 (95% CI 0.10-0.21). The pooled inpatient mortality rate was 0.02 (95% CI 0.01-0.03). Complications rates included 0.02 (95% CI 0.00-0.03) for any acute hemorrhage, 0.01 (95% CI 0.00-0.01) for acute hemorrhage requiring surgery, and 0.02 (95% CI 0.01-0.03) for seizure. SEPS placement is associated with a success rate of 79% and very low rates of acute hemorrhage and seizure. This data supports its use as a first-line management strategy, although prospective randomized studies are needed.


Assuntos
Gerenciamento Clínico , Drenagem/mortalidade , Drenagem/métodos , Hematoma Subdural Crônico/mortalidade , Hematoma Subdural Crônico/cirurgia , Craniotomia/métodos , Craniotomia/mortalidade , Craniotomia/tendências , Drenagem/tendências , Feminino , Hematoma Subdural Crônico/diagnóstico , Humanos , Tempo de Internação/tendências , Masculino , Mortalidade/tendências , Salas Cirúrgicas/tendências , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Espaço Subdural/cirurgia , Resultado do Tratamento
4.
AJNR Am J Neuroradiol ; 42(3): 495-500, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33541902

RESUMO

BACKGROUND AND PURPOSE: Chronic subdural hematoma embolization, an apparently simple procedure, can prove to be challenging because of the advanced age of the target population. The aim of this study was to compare 2 arterial-access strategies, femoral versus patient-tailored CTA-based frontline access selection, in chronic subdural hematoma embolization procedures. MATERIALS AND METHODS: This was a monocentric retrospective study. From the March 15, 2018, to the February 14, 2019 (period 1), frontline femoral access was used. Between February 15, 2019, and March 30, 2020 (period 2), the choice of the frontline access, femoral or radial, was based on the CTA recommended as part of the preoperative work-up during both above-mentioned periods. The primary end point was the rate of catheterization failure. The secondary end points were the rate of access site conversion and fluoroscopy duration. RESULTS: During the study period, 124 patients (with 143 chronic subdural hematomas) underwent an embolization procedure (mean age, 74 [SD, 13] years). Forty-eight chronic subdural hematomas (43 patients) were included during period 1 and were compared with 95 chronic subdural hematomas (81 patients) during period 2. During the first period, 5/48 (10%) chronic subdural hematoma embolizations were aborted due to failed catheterization, significantly more than during period 2 (1/95, 1%; P = .009). The rates of femoral-to-radial (P = .55) and total conversion (P = .86) did not differ between the 2 periods. No significant difference was found regarding the duration of fluoroscopy (P = .62). CONCLUSIONS: A CTA-based patient-tailored choice of frontline arterial access reduces the rate of catheterization failure in chronic subdural hematoma embolization procedures.


Assuntos
Embolização Terapêutica/métodos , Artéria Femoral/cirurgia , Hematoma Subdural Crônico/cirurgia , Artéria Radial/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Cateterismo , Angiografia por Tomografia Computadorizada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento
5.
Acta Neurochir (Wien) ; 163(4): 1075-1081, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33555376

RESUMO

BACKGROUND: The primary aim of chronic subdural haematoma (CSDH) treatment is to relieve pressure to improve neurological symptoms. The secondary aim is to avoid recurrence. The blood supply from the middle meningeal artery (MMA) to the haematoma membranes has recently become a research target, to enhance our understanding of the processes leading to growth and re-growth of a CSDH. Several studies indicate that endovascular embolization of the MMA (eMMA) reduces recurrence rates, but this effect must be confirmed in a randomized controlled setting. Endovascular embolization is an advanced and costly procedure carrying a significant risk of embolism in the elderly. The aim of this study was to assess anatomical and technical aspects of surgical occlusion of the MMA (soMMA) via a single same-procedure burr hole, as an alternative to eMMA. METHOD: Technical aspects of soMMA were assessed using cadaver head dissection. MMA anatomy was examined by mapping the branching pattern and distribution of MMA in dry skulls, and CSDH position was investigated by analysis of computed tomography (CT) of CSDHs. Finally, we evaluated the possibility of CT-guided navigation to mark the branching point of the anterior MMA division on the skin. RESULTS: We established anatomical landmarks to locate the MMA and found that particularly the anterior MMA branch can be occluded through a single burr hole at the pterion during the same procedure as haematoma decompression. CT of 1454 CSDHs in 1162 patients showed that the CSDH was anteriorly located in 57.5% compared with posteriorly in only 3%. This correlated with the anterior branch of the MMA being dominant in 58% of dry skull samples examined. We further confirmed that the MMA can be localized by neuronavigation as an alternative to using anatomical landmarks and average measurements. CONCLUSION: A CSDH is mainly anteriorly located and supposedly primarily supplied by the anterior MMA branch. In a simulated setting, soMMA can be performed during the same procedure as haematoma decompression. A few reservations notwithstanding, we find that soMMA may be a viable alternative to eMMA in most CSDH cases and that soMMA should be further evaluated in a clinical setting.


Assuntos
Hematoma Subdural Crônico/cirurgia , Artérias Meníngeas/cirurgia , Trepanação/efeitos adversos , Idoso , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Hematoma Subdural Crônico/terapia , Humanos , Masculino , Artérias Meníngeas/anatomia & histologia , Pessoa de Meia-Idade , Trepanação/métodos
6.
Acta Neurochir (Wien) ; 163(4): 1069-1073, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33387043

RESUMO

Here is reported a case of dural arteriovenous fistula (DAVF) formation following middle meningeal artery (MMA) embolization. A 64-year-old male patient was operated for a bilateral CSDH by burr-hole craniostomy. Prophylactic post-operative MMA embolization was performed with 300-500-µm calibrated microparticles. The patient was admitted 3 months later for a left CSDH recurrence. Digital subtraction angiography demonstrated formation of a superior sagittal sinus DAVF fed by both superficial temporal arteries. This case highlights the possible role of local tissue hypoxia as a significant component of DAVF pathogenesis. Moreover, it has potential implications for MMA embolization as a management strategy for CSDH.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/etiologia , Embolização Terapêutica/efeitos adversos , Hematoma Subdural Crônico/cirurgia , Artérias Meníngeas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
7.
World Neurosurg ; 147: e272-e274, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33326859

RESUMO

OBJECTIVES: Craniotomies/craniostomies have been categorized as aerosol-generating procedures and are presumed to spread coronavirus disease 2019 (COVID-19). However, the presence of severe acute respiratory distress syndrome coronavirus 2 virus in the generated bone dust has never been proved. Our objective is to evaluate the presence of virus in the bone dust (aerosol) generated during emergency neurosurgical procedures performed on patients with active COVID-19. This would determine the true risk of disease transmission during the surgery. METHODS: Ten patients with active COVID-19 infection admitted to our institute in 1 month required emergency craniotomy/craniostomy. The bone dust and mucosal scrapings form paranasal sinuses (if opened) collected during these procedures were tested for the virus using reverse transcription polymerase chain reaction. The entire surgical team was observed for any symptoms related to COVID-19 for 14 days following surgery. RESULTS: Nine patients had moderate viral load in their nasopharyngeal cavity, as detected on reverse transcription polymerase chain reaction. None of the samples of bone dust from these 10 patients tested positive. Mucosal scrapping obtained in 1 patient in which mastoid air cells were inadvertently opened tested negative as well. No health workers from the operating room developed COVID-19-related symptoms. CONCLUSIONS: The bone dust generated during craniotomy/stomy of active patients does not contain the virus. The procedure on an active patient is unlikely to spread the disease. However, a study with larger cohort would be confirmatory.


Assuntos
Osso e Ossos/virologia , COVID-19/transmissão , Craniotomia , Poeira , Nasofaringe/virologia , Seios Paranasais/virologia , Mucosa Respiratória/virologia , SARS-CoV-2/genética , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Teste de Ácido Nucleico para COVID-19 , Criança , Pré-Escolar , Craniectomia Descompressiva , Feminino , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural Crônico/cirurgia , Humanos , Hidrocefalia/cirurgia , Transmissão de Doença Infecciosa do Paciente para o Profissional , Masculino , Processo Mastoide , Pessoa de Meia-Idade , Derivação Ventriculoperitoneal , Carga Viral , Adulto Jovem
8.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334750

RESUMO

A patient suffering from a cerebrovascular ischaemic stroke may present similar symptoms to a patient with a chronic subdural haematoma (CSDH). Head CT imaging of an old extensive hemispheric infarction may appear hypodense in a similar fashion as CSDH. We described a 46-year-old man with a 2-week history of mild headache and worsening right lower extremity hemiparesis. Eight years prior, he suffered a left middle cerebral artery territory infarct. The head CT scan showed a huge, slightly hypodense area on the left brain, causing a significant mass effect. A new stroke was of concern versus a chronic subdural haematoma inside the old encephalomalacia stroke cavity. Only three previously reported cases of CSDH occupying an encephalomalacic cavity had been reported. This rare presentation should be considered in the differential diagnosis in patients with a history of cerebrovascular stroke. MRI is useful in making a correct diagnosis.


Assuntos
Encefalomalacia/diagnóstico , Cefaleia/etiologia , Hematoma Subdural Crônico/diagnóstico , Infarto da Artéria Cerebral Média/complicações , Paresia/etiologia , Encéfalo/diagnóstico por imagem , Drenagem , Encefalomalacia/etiologia , Cefaleia/cirurgia , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
N Engl J Med ; 383(27): 2616-2627, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-33326713

RESUMO

BACKGROUND: Chronic subdural hematoma is a common neurologic disorder that is especially prevalent among older people. The effect of dexamethasone on outcomes in patients with chronic subdural hematoma has not been well studied. METHODS: We conducted a multicenter, randomized trial in the United Kingdom that enrolled adult patients with symptomatic chronic subdural hematoma. The patients were assigned in a 1:1 ratio to receive a 2-week tapering course of oral dexamethasone, starting at 8 mg twice daily, or placebo. The decision to surgically evacuate the hematoma was made by the treating clinician. The primary outcome was a score of 0 to 3, representing a favorable outcome, on the modified Rankin scale at 6 months after randomization; scores range from 0 (no symptoms) to 6 (death). RESULTS: From August 2015 through November 2019, a total of 748 patients were included in the trial after randomization - 375 were assigned to the dexamethasone group and 373 to the placebo group. The mean age of the patients was 74 years, and 94% underwent surgery to evacuate their hematomas during the index admission; 60% in both groups had a score of 1 to 3 on the modified Rankin scale at admission. In a modified intention-to-treat analysis that excluded the patients who withdrew consent for participation in the trial or who were lost to follow-up, leaving a total of 680 patients, a favorable outcome was reported in 286 of 341 patients (83.9%) in the dexamethasone group and in 306 of 339 patients (90.3%) in the placebo group (difference, -6.4 percentage points [95% confidence interval, -11.4 to -1.4] in favor of the placebo group; P = 0.01). Among the patients with available data, repeat surgery for recurrence of the hematoma was performed in 6 of 349 patients (1.7%) in the dexamethasone group and in 25 of 350 patients (7.1%) in the placebo group. More adverse events occurred in the dexamethasone group than in the placebo group. CONCLUSIONS: Among adults with symptomatic chronic subdural hematoma, most of whom had undergone surgery to remove their hematomas during the index admission, treatment with dexamethasone resulted in fewer favorable outcomes and more adverse events than placebo at 6 months, but fewer repeat operations were performed in the dexamethasone group. (Funded by the National Institute for Health Research Health Technology Assessment Programme; Dex-CSDH ISRCTN number, ISRCTN80782810.).


Assuntos
Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Hematoma Subdural Crônico/tratamento farmacológico , Administração Oral , Idoso , Terapia Combinada , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Pessoas com Deficiência , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/mortalidade , Hematoma Subdural Crônico/cirurgia , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento
10.
No Shinkei Geka ; 48(12): 1115-1120, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33353873

RESUMO

INTRODUCTION: Chronic subdural hematoma(CSDH)is a common condition encountered by neurosurgeons. Owing to increasing life expectancy and rapid population aging, the age at disease onset is delayed, which negatively affects hospital discharge arrangements. This retrospective study investigated patients aged ≥90 years who underwent surgery for CSDH. SUBJECTS AND METHOD: The study included 53 patients diagnosed with CSDH(63 sides)for the first time, who underwent surgery at our hospital between April 2018 and March 2019. The mean age was 78.7 years, and the study included 40 men. A subdural drain was placed after burr hole surgery performed for hematoma evacuation and lavage. The basic protocol included 8-day hospitalization comprising surgery on the day of admission, rehabilitation initiated the day after surgery, and suture removal 7 days after surgery, followed by hospital discharge. The 'elderly' group(Group E)included patients aged ≥90 years, and the 'others' group(Group O)included patients aged <90 years. This study focused on hospital discharge arrangements. RESULTS: The mean length of hospitalization was 7.6 days in 10 patients(19%)in Group E. The rate of intervention by a discharge support nurse or medical social worker(Medical Consultation Team)was 100% in Group E and 65% in Group O. All patients were discharged to planned living arrangements with the assistance of the Medical Consultation Team and rehabilitation intervention. CONCLUSION: Among elderly patients, difficulties with hospital discharge arrangements could be attributed to exacerbation of dementia symptoms after hospitalization and manifestations of disuse syndrome and complications. Surgical treatment can be offered to patients with CSDH regardless of age(even to those aged >90 years)and facilitates smooth discharge with multidisciplinary intervention.


Assuntos
Hematoma Subdural Crônico , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Drenagem , Hematoma Subdural Crônico/cirurgia , Hospitais , Humanos , Masculino , Estudos Retrospectivos , Trepanação
11.
J Clin Neurosci ; 82(Pt A): 147-154, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317724

RESUMO

Chronic subdural haemorrhage (CSDH) is a common neurosurgical entity with complex pathophysiological pathways. The generally favourable surgical outcome may be affected by its associated risks including recurrence rates. We performed a prospective randomized multi-center clinical trial comparing the addition of tranexamic acid (TXA) to standard neurosurgical procedures for patients with symptomatic CSDH. The primary endpoint was CSDH requiring repeat surgery within 6-month post-operatively. Secondary endpoints were comparison of post-operative volumes between the treatment arms and safety evaluation of the dosing regime. 90 patients were analyzed with 49 patients in the observation arm and 41 patients in the TXA arm. The observation arm had five (10.2%) recurrences compared to two (4.8%, p = 0.221) in the TXA arm. Patients in the TXA arm demonstrated a greater reduction of their CSDH volume at 6 weeks follow up (36.6%) compared to the observation arm (23.3%, p = 0.6648). There were no reportable serious adverse events recorded in the observation arm, compared to 4 (9.8%) patients in the TXA arm. The addition of TXA treatment to standard surgical drainage of CSH did not significantly reduce symptomatic post-operative recurrence. Patients in the TXA arm had a delay in the CSDH recurrence with a comparative reduction of residual hematoma volume at the 6-week follow up although the effect was unsustained. Larger randomized trials with dose adjustments should be considered to investigate subgroups of patients that may benefit from this medical adjunct.


Assuntos
Hematoma Subdural Crônico/tratamento farmacológico , Hematoma Subdural Crônico/cirurgia , Ácido Tranexâmico/uso terapêutico , Idoso , Antifibrinolíticos/administração & dosagem , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Ácido Tranexâmico/administração & dosagem , Resultado do Tratamento
14.
J Clin Neurosci ; 78: 79-85, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616352

RESUMO

Bilateral chronic subdural hematoma (bCSDH) is frequently drained unilaterally when the contralateral CSDH is small and asymptomatic. However, reoperation rates for contralateral CSDH growth can be high. We aimed to develop a prognostic scoring system to guide the selection of suitable patients for unilateral drainage of bCSDH. Data were collected retrospectively across three tertiary hospitals from 2010 to 2017 on all consecutive bCSDH patients aged 21 or above. Predictors of reoperation were identified using multivariable logistic regression. A prognostic score was developed and internally validated. 240 bCSDH patients were analyzed. 98 (40.8%) underwent unilateral and 142 (59.2%) underwent bilateral evacuation. Clinical outcomes were comparable between the unilateral and bilateral evacuation groups. Within the unilateral evacuation group, 4 (4.1%) had a reoperation for contralateral CSDH growth. Reoperation for contralateral CSDH was predicted by preoperative use of anticoagulants (OR = 15.0, 95% CI: 1.49-169.15, p = 0.017). Complete resolution of contralateral CSDH was predicted by its preoperative maximum width, with a cut-off of 9 mm producing the highest sensitivity and specificity (OR = 4.17 for ≤9 mm, 95% CI: 1.54-11.11, p = 0.004). Using our prognostic score, reoperation rate for contralateral CSDH was 1.6%, 3.6%, 16.7%, and 50.0% in low-risk, moderate-risk, high-risk and very high-risk patients, respectively. With each increase of 1 in the prognostic score, patients were 4 times as likely to undergo reoperation for contralateral CSDH (OR = 3.98, 95% CI: 1.36-13.53, p = 0.013). Our proposed risk score may be used as an adjunct in clinical decision making for bCSDH patients undergoing unilateral evacuation.


Assuntos
Hematoma Subdural Crônico/diagnóstico , Prognóstico , Reoperação/estatística & dados numéricos , Adulto , Idoso , Anticoagulantes , Tomada de Decisão Clínica , Drenagem , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária , Adulto Jovem
17.
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
18.
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
19.
World Neurosurg ; 140: 65-70, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32417224

RESUMO

BACKGROUND: Chronic subdural hematoma associated with dural calcifications in previously pediatric shunted patients is a rare condition. The inner dural membrane opening can lead to progressive brain herniation into the subdural space due to brain reexpansion. CASE DESCRIPTION: A 15-year-old boy, previously shunted at birth for congenital hydrocephalus, presented with a giant chronic right hemispheric subdural hematoma. After 2 surgical procedures in which the subdural calcified neomembrane was opened and a subdural shunt was implanted, he developed a cortical brain herniation into the subdural space, resulting in brain ischemia and upper limb weakness and vomiting. The final surgical treatment consisted of an extensive wide peeling of visceral calcified membrane mutually to programmable valve placement along the subduroperitoneal shunt, in order to create a positive gradient between the subdural space and the ventricles. The patient experienced a prompt clinical improvement. CONCLUSIONS: This case illustrates a rare complication of the treatment of a chronic subdural hematoma caused by insufficient opening of the calcified inner mambrane of the hematoma and encouraged by gradient pressure between the ventricular and subdural compartments. To avoid this complication, it is preferable to not open a thick, calcified, unelastic inner membrane. However, in case of lack of clinical and radiologic improvement, it may become necessary to open it: a wide opening should be attempted, in order to prevent brain strangulation.


Assuntos
Encefalocele/etiologia , Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adolescente , Calcinose/etiologia , Calcinose/cirurgia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hematoma Subdural Crônico/etiologia , Humanos , Doença Iatrogênica , Masculino , Procedimentos Neurocirúrgicos/métodos
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