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1.
Medicine (Baltimore) ; 103(5): e33765, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38306569

RESUMO

RATIONALE: Retroperitoneal hematomas are relatively common in patients undergoing nephrectomy. Herein, we report an unusual case involving a giant retroperitoneal hematoma and subsequent duodenal ulcerative bleeding following a radical nephrectomy. PATIENT CONCERNS: A 77-year-old woman was admitted to our hospital for lower back pain, and she had severe right hydronephrosis and a urinary tract infection. DIAGNOSES: The patient was diagnosed and confirmed as high-grade urothelial carcinoma. INTERVENTIONS: After ineffective conservative treatments, a right radical nephrectomy and ureteral stump resection were performed. The patient received proton pump inhibitors to prevent stress ulcer formation and bleeding. On the first day post-surgery, she had normal gastrointestinal (GI) endoscopy findings. On the second day post-surgery, abdominal computed tomography revealed a retroperitoneal hematoma. Notably, 14 days post-surgery, massive GI bleeding occurred, and GI endoscopy identified an almost perforated ulcer in the bulbar and descending duodenum. OUTCOMES: The patient died on day 15 after surgery. LESSONS: Duodenal ulceration and bleeding might occur following a retroperitoneal hematoma in patients treated with nephrectomy. Timely intervention may prevent duodenal ulcers and complications, and thus could be a promising life-saving intercession.


Assuntos
Carcinoma de Células de Transição , Úlcera Duodenal , Doenças Peritoneais , Neoplasias da Bexiga Urinária , Feminino , Humanos , Idoso , Úlcera/cirurgia , Úlcera/complicações , Carcinoma de Células de Transição/patologia , Neoplasias da Bexiga Urinária/patologia , Duodeno/patologia , Hemorragia Gastrointestinal/cirurgia , Hemorragia Gastrointestinal/complicações , Hematoma/etiologia , Hematoma/cirurgia , Hematoma/diagnóstico , Úlcera Duodenal/complicações , Úlcera Duodenal/cirurgia , Nefrectomia/efeitos adversos , Doenças Peritoneais/cirurgia
2.
BMC Med ; 22(1): 62, 2024 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-38331793

RESUMO

BACKGROUND: The distal transradial access (dTRA) has become an attractive and alternative access to the conventional transradial access (TRA) for cardiovascular interventional diagnosis and/or treatment. There was a lack of randomized clinical trials to evaluate the effect of the dTRA on the long-term radial artery occlusion (RAO). METHODS: This was a prospective, randomized controlled study. The primary endpoint was the incidence of long-term RAO at 3 months after discharge. The secondary endpoints included the successful puncture rate, puncture time, and other access-related complications. RESULTS: The incidence of long-term RAO was 0.8% (3/361) for dTRA and 3.3% (12/365) for TRA (risk ratio = 0.25, 95% confidence interval = 0.07-0.88, P = 0.02). The incidence of RAO at 24 h was significantly lower in the dTRA group than in the TRA group (2.5% vs. 6.7%, P < 0.01). The puncture success rate (96.0% vs. 98.5%, P = 0.03) and single puncture attempt (70.9% vs. 83.9%, P < 0.01) were significantly lower in the dTRA group than in the TRA group. However, the number of puncture attempts and puncture time were higher in the dTRA group. The dTRA group had a lower incidence of bleeding than the TRA group (1.5% vs. 6.0%, P < 0.01). There was no difference in the success rate of the procedure, total fluoroscopy time, or incidence of other access-related complications between the two groups. In the per-protocol analysis, the incidence of mEASY type ≥ II haematoma was significantly lower in the dTRA group, which was consistent with that in the as-treated analysis. CONCLUSIONS: The dTRA significantly reduced the incidence of long-term RAO, bleeding or haematoma. TRIAL REGISTRATION: ClinicalTrials.gov identifer: NCT05253820.


Assuntos
Arteriopatias Oclusivas , Intervenção Coronária Percutânea , Humanos , Artéria Radial/cirurgia , Estudos Prospectivos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/epidemiologia , Hemorragia , Hematoma/etiologia , Hematoma/complicações , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 103(6): e37211, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38335374

RESUMO

We aimed to explore the therapeutic effects of endoscopically assisted surgical approaches for HICH. In this retrospective cohort study, we retrospectively analyzed the treatment status of 118 patients with HICH who underwent surgery for hematoma removal. Among them, 61 patients underwent endoscopically assisted hematoma removal surgery through the frontal lobe approach (frontal lobe group); 57 patients underwent endoscopic hematoma assisted via the temporal lobe approach (temporal lobe group). Treatment effects, cerebral hemodynamic status before and after treatment, postoperative prognosis at one month, and incidence of complications were compared between the 2 groups. We found that the total effective treatment rate in the frontal lobe group was higher than that in the temporal lobe group (P < .05). After surgery, the R during the contraction period of the common cerebral artery in both groups decreased compared to that before surgery, and the frontal lobe group was significantly lower than the temporal lobe group; the V and Q were higher than those before surgery, and the frontal lobe group was significantly higher than the temporal lobe group (P < .05). The prognosis of the frontal lobe group was better than that of the temporal lobe group (P < .05). Compared to the endoscopic-assisted temporal approach, the endoscopic-assisted frontal lobe approach for the treatment of HICH can improve cerebral hemodynamic status, enhance treatment efficacy, and improve prognosis.


Assuntos
Hemorragia Intracraniana Hipertensiva , Humanos , Estudos Retrospectivos , Hemorragia Intracraniana Hipertensiva/cirurgia , Endoscopia/efeitos adversos , Craniotomia , Resultado do Tratamento , Hematoma/etiologia
6.
BMC Pediatr ; 24(1): 126, 2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-38365603

RESUMO

BACKGROUND: Scurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described. CASE PRESENTATION: A 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma. CONCLUSION: DVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy.


Assuntos
Escorbuto , Trombose Venosa , Humanos , Criança , Masculino , Adolescente , Escorbuto/complicações , Escorbuto/diagnóstico , Hematoma/etiologia , Hematoma/complicações , Ácido Ascórbico/uso terapêutico , Vitaminas , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
8.
Saudi Med J ; 45(1): 10-26, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38220242

RESUMO

OBJECTIVES: To study the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes of traumatic retropharyngeal hematoma (RH). METHODS: We used the Preferred Reporting Items of Systematic Reviews guidelines to carry out a systematic literature review to identify all published cases of traumatic RH by searching the PubMed database. Articles published between 1988 and 2022 that reported traumatic RH were included. However, articles that reported non-traumatic RHs and non-English articles were excluded from this study. RESULTS: Of the 62 articles screened, 56 were included. Most patients (55%) were above the mean age of 61.7. The majority of patients were male (69.7%). The main symptom was dyspnea (66.6%) and symptoms usually presented within 24 hours. Among the patients, 90.9% did not take anticoagulants or have coagulation disorders, and the main injury mechanism was falling (54.5%). Most of the computed tomography findings reported retropharyngeal (38%) and prevertebral (15%) hematoma. Meanwhile, magnetic resonance imaging revealed 2 masses in the retropharyngeal space and 2 RHs. With several treatment modalities, more than 50% of the cases were only observed (44 cases), and endotracheal intubation was the most commonly used airway management method (n=35). CONCLUSION: Traumatic RH is often caused by falls, particularly in elderly patients. Dyspnea is the primary symptom, usually appearing within 24 hours. Cervical vertebral fractures are the leading cause, and observation is the most common treatment approach.PROSPERO Reg. No.: CRD42022349010.


Assuntos
Doenças Faríngeas , Fraturas da Coluna Vertebral , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/terapia , Revisões Sistemáticas como Assunto , Fraturas da Coluna Vertebral/complicações , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Dispneia/etiologia
9.
Eur J Cardiothorac Surg ; 65(1)2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38212990

RESUMO

OBJECTIVES: This study aimed to investigate changes in haematoma thickness during the early period and their association with disease progression in patients who received initial medical treatment for type A intramural haematoma (IMH). METHODS: Medical records and serial computed tomography angiography (CTA) images of patients who did not undergo emergency aortic repair for type A IMH upon presentation were retrospectively reviewed. The haematoma remodelling rate was determined using the following equation: thickness of the haematoma on the first CTA (mm) - thickness of the haematoma on the second CTA (mm)time between the first and second CTAs (h). RESULTS: Among the 40 patients included in this study, 38 were indicated for initial watch-and-wait strategy, whereas 2 were indicated for emergency aortic repair but declined it. During hospitalization, 10 patients developed disease progression, with 2 in-hospital mortality cases. Analysis of the haematoma remodelling rate in 39 patients revealed that such a rate was significantly associated with the reciprocal of the time from onset. Analysis of all 70 CTA examinations performed within 24 h after the onset of IMH showed that haematoma thickness was significantly associated with the logarithm of the time from onset. Initial regression of the haematoma was not necessarily associated with avoidance of disease progression. CONCLUSIONS: In type A IMH, the thickness of the haematoma in the ascending aorta tended to decrease in the very early period; however, prompt regression of the haematoma was not necessarily associated with avoidance of disease progression.


Assuntos
Doenças da Aorta , Humanos , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Estudos Retrospectivos , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Progressão da Doença , Tomografia Computadorizada por Raios X
10.
Clin Neurol Neurosurg ; 236: 108118, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38237209

RESUMO

OBJECTIVE: To study the phenomenon, incidence and management of pathological migrating intramural hematoma in stenting for carotid artery dissection. METHODS: We consecutively enrolled CAD patients with stenting treatment over 10-year period, and retrospectively analyzed the pathological migrating intramural hematoma (PMIH) incidence of these CAD patients. Besides, we also explored the related factors with PMIH and provided an appropriate management strategy. RESULTS: A total of 67 CAD underwent stenting. PMIH occurred in 7 cases (10.4%). The median time from onset of symptoms to stenting was 5 days (3 to 11 days). There were 4 cases of PMIH in the proximal segment of stent and 3 cases of PMIH in the distal segment of stent. All the patients presented with new stenosis and no patient presented with dissecting aneurysm. Through proper management, none of the patients had occurred clinical complications. CONCLUSION: Pathological migrating intramural hematoma phenomenon exists in the stenting for carotid artery dissection, rescue angioplasty or stenting is needed for early treatment of moderate and severe stenosis due to migrating intramural hematoma on preventing further ischemic events.


Assuntos
Dissecção Aórtica , Doenças das Artérias Carótidas , Estenose das Carótidas , Acidente Vascular Cerebral , Humanos , Estenose das Carótidas/patologia , Estudos de Coortes , Constrição Patológica/etiologia , Estudos Retrospectivos , Dissecção Aórtica/cirurgia , Artérias Carótidas , Stents/efeitos adversos , Hematoma/cirurgia , Hematoma/etiologia , Resultado do Tratamento , Acidente Vascular Cerebral/etiologia
11.
Reprod Biomed Online ; 48(3): 103644, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38215685

RESUMO

RESEARCH QUESTION: Is there an association between intrauterine haematoma (IUH) and pregnancy outcomes in patients who undergo fetal reduction after double embryo transfer (DET), and if so, what is the relationship between IUH-related characteristics and pregnancy outcomes? DESIGN: Clinical information and pregnancy outcomes of women who underwent fetal reduction after DET were analysed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was undertaken based on IUH-related characteristics. The main outcome was incidence of fetal demise (<24 weeks), with other adverse pregnancy outcomes considered as secondary outcomes. RESULTS: Thirty-four IUH patients and 136 non-IUH patients who underwent fetal reduction after DET were included based on a 1:4 match for age, cycle type and fertilization method. IUH patients had a higher incidence of early fetal demise (20.6% versus 7.4%, P = 0.048), threatened abortion (48.1% versus 10.3%, P<0.001) and postpartum haemorrhage (PPH; 14.8% versus 4.0%, P = 0.043) compared with non-IUH patients. IUH was an independent risk factor for early fetal demise [adjusted OR (aOR) 3.34, 95% CI 1.14-9.77] and threatened abortion (aOR 8.61, 95% CI 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing fetal reduction that resulted in miscarriage had larger IUH volumes and earlier diagnosis (both P < 0.03). However, IUH characteristics (i.e. volume, changing pattern, presence or absence of cardiac activity) were not associated with threatened abortion or PPH. CONCLUSIONS: Fetal reduction should be performed with caution in IUH pregnancies after DET as the risk of fetal demise is relatively high. Particular attention should be given to IUH patients with early signs of threatened abortion and inevitable fetal demise.


Assuntos
Aborto Espontâneo , Ameaça de Aborto , Gravidez , Humanos , Feminino , Resultado da Gravidez , Redução de Gravidez Multifetal , Gravidez de Gêmeos , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Natimorto , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Hematoma/epidemiologia , Hematoma/etiologia , Estudos Retrospectivos
15.
BMC Cardiovasc Disord ; 24(1): 34, 2024 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-38184530

RESUMO

Coronary heavy calcification (HC) poses a sturdy challenge to percutaneous coronary intervention (PCI). Scores considering calcification length, thickness, or circumferential extent, are widely accepted to dictate upfront calcium modification to improve PCI outcomes. Although often marginalized, calcification shape (morphology) may require consideration during procedure planning in selected cases. This case demonstrates how a focal but spur-shaped calcification led to a massive proximal left anterior descending (LAD) dissecting intramural hematoma.


Assuntos
Calcinose , Intervenção Coronária Percutânea , Humanos , Cálcio , Intervenção Coronária Percutânea/efeitos adversos , Túnica Íntima , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia
16.
BMC Neurol ; 24(1): 5, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38166773

RESUMO

BACKGROUND: Spinal subarachnoid hematoma (SSH) is a known but rare entity that can cause cauda equina compression. The occurrence of SSH associated with aneurysmal subarachnoid hemorrhage has rarely been described in the literature. CASE PRESENTATION: A 56-year-old woman presented with subarachnoid hemorrhage secondary to a ruptured middle cerebral artery aneurysm and was managed with coiling embolization without stent assistance. There was no history of either lumbar puncture or the use of anticoagulants. The patient developed severe lumbago radiating to bilateral legs nine days after the procedure. Subsequent magnetic resonance imaging demonstrated a SSH extending from L5 to S2 and wrapping around the cauda equina. The patient was treated with intravenous methylprednisolone (250 mg/day) for four consecutive days, followed by a taper of oral prednisolone (20 mg/day) until complete recovery. Magnetic resonance imaging at one month follow-up revealed complete resolution of the SSH. CONCLUSIONS: Here, we report a case of acute cauda equina syndrome caused by a SSH after aneurysmal subarachnoid hemorrhage, which will facilitate timely intervention of patients with this disorder.


Assuntos
Síndrome da Cauda Equina , Cauda Equina , Hemorragia Subaracnóidea , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Síndrome da Cauda Equina/complicações , Síndrome da Cauda Equina/diagnóstico por imagem , Hematoma/etiologia , Espaço Subaracnóideo , Imageamento por Ressonância Magnética
17.
J Plast Reconstr Aesthet Surg ; 89: 125-133, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38181633

RESUMO

BACKGROUND: The efficacy of tranexamic acid (TXA) has been reported in breast surgery; however, its application and duration have varied across studies. This study aimed to assess the early postoperative outcomes of rinsing the breast pocket with TXA during prepectoral prosthetic breast reconstruction using an acellular dermal matrix (ADM). METHODS: A retrospective chart review was conducted in consecutive patients who underwent immediate prosthetic prepectoral reconstruction between August 2021 and December 2022. For cases performed during the earlier part of the study period (up to April 2022), TXA was not administered (non-TXA group), whereas those performed after April 2022 received topical TXA application during surgery (TXA group). Postoperative outcomes including hematoma, seroma, drainage volume, and drain maintenance duration were compared between the two groups using propensity score matching (PSM). RESULTS: A total of 674 breasts were analyzed; 280 in the TXA group and 394 were in the non-TXA group. There were 251 breasts in each group after PSM, and their characteristics were similar. The incidence of hematoma in the first 24 hours and total drain output were significantly lower in the TXA group than the non-TXA group. In cases of direct-to-implant cases, the TXA group showed a significantly lower seroma rate. CONCLUSIONS: Rinsing the breast pocket with TXA can potentially reduce the occurrence of hematoma and decrease drain output in prepectoral ADM-assisted prosthetic breast reconstruction. Moreover, this approach may be beneficial in lowering the incidence of seroma in direct-to-implant reconstruction.


Assuntos
Derme Acelular , Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Ácido Tranexâmico , Humanos , Feminino , Ácido Tranexâmico/uso terapêutico , Estudos Retrospectivos , Implante Mamário/efeitos adversos , Seroma/etiologia , Seroma/prevenção & controle , Mamoplastia/efeitos adversos , Hematoma/etiologia , Hematoma/prevenção & controle , Neoplasias da Mama/cirurgia
18.
J Stroke Cerebrovasc Dis ; 33(2): 107521, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38134549

RESUMO

INTRODUCTION: Intracerebral hemorrhage (ICH) incidence follows both seasonal and diurnal patterns with greater severity reported in nighttime hemorrhages. These differences have been attributed to variations in the coagulation cascade, blood pressure, and sleep-wake cycle that all have their own rhythmicity. The purpose of this analysis was to validate these trends in a large nationwide database of automated ICH detection scans and evaluate for differences in hematoma volume by image acquisition time. METHODS: Serial non-contrast head CT (NCHCT) data, processed with an automated imaging software (iSchemaView), was acquired from U.S. hospitals between 1/1/2020 and 12/31/2021. Final exclusion criteria included: (1) patient age ≤ 25, (2) hematoma volume ≥ 100 ml, (3) hematoma volume ≤ 0.4 ml. Imaging time was subdivided into three epochs: (1) Night: 23:00h-06:59h, (2) Day: 07:00h-14:59h, and (3) Evening: 15:00h-22:59h. RESULTS: A total of 19,397 scans were included in the final analysis with a median ICH volume of 2.9 ml and mean volume of 13.23 mL; 15.6% of scans had volumes above 30 ml. Peak imaging occurred around noon. Hematoma volume was significantly different across timepoints (p = 0.003), with ICHs presenting at night (average volume 14.2 ml) larger than those presenting during the day (12.9 ml, p = 0.002) or evening (13.0 ml, p = 0.012). CONCLUSION: In this real world, multi-site data set, we show similar diurnal trends in ICH incidence as previously reported and detected subtle differences in volume based on time of imaging. Further research is required to elucidate the potential underlying mechanisms for these differences.


Assuntos
Hemorragia Cerebral , Tomografia Computadorizada por Raios X , Humanos , Incidência , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/complicações , Coagulação Sanguínea , Hematoma/diagnóstico por imagem , Hematoma/epidemiologia , Hematoma/etiologia
19.
Coron Artery Dis ; 35(1): 14-22, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38085858

RESUMO

OBJECTIVE: We investigated the relationship between using a rotary compression device (RCD) with or without sterile gauze and adverse events in transradial access (TRA) for coronary intervention. METHODS: In this study involving 933 patients at Yueyang Hospital, we recorded TRA-related adverse events, such as bleeding, forearm hematoma, swollen palms, radial artery occlusion (RAO) and others. Logistic regression was applied to assess the association. RESULTS: Of the 933 patients (66.7% males, average age 67.8 years), 511 used RCD with sterile gauze, whereas 422 used RCD without sterile gauze. The most common adverse events were radial artery hemorrhage (7.4%), hand swelling (4.8%) and RAO (4.6%). Logistic regression analysis revealed that the use of RCD with sterile gauze was associated with a higher prevalence of adverse events [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.22-2.49), even with the adjustment of potential confounders (OR, 1.71; 95% CI, 1.19-2.45). Moreover, patients who used RCD with sterile gauze exhibited an increased risk of radial artery hemorrhage (OR, 1.83; 95% CI, 1.07-3.12), swelling of the hand (OR, 1.96; 95% CI, 1.02-3.75) and RAO (OR, 3.17; 95% CI, 1.49-6.72). CONCLUSIONS: The use of RCD with sterile gauze in TRA is associated with a higher incidence of adverse events.


Assuntos
Arteriopatias Oclusivas , Intervenção Coronária Percutânea , Masculino , Humanos , Idoso , Feminino , Estudos Retrospectivos , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/prevenção & controle , Hemostasia , Hematoma/etiologia , Hematoma/complicações , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial , Arteriopatias Oclusivas/etiologia , Resultado do Tratamento , Angiografia Coronária/efeitos adversos
20.
World Neurosurg ; 182: e854-e865, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38104931

RESUMO

BACKGROUND: We reviewed the clinical course and histopathologic findings for cases involving the formation of expanding cysts and/or hematomas after gamma knife surgery (GKS) for arteriovenous malformations (AVMs). METHODS: We report a single-center retrospective review of 18 patients who presented with cyst and/or hematoma expansion after GKS for AVMs between 1993 and 2023. Expanding cysts and hematomas were defined as well-demarcated cavities filled with fluid or well-marginated heterogenous hematomas presenting with expansion proximal to or in the location of the original AVM, respectively. Patient demographics, AVM characteristics, history of interventions and surgeries, and imaging and histopathologic features of expanding cysts and hematomas were collected for analysis. RESULTS: Among 1072 AVM patients treated using GKS, 18 presented with expanding cysts or hematomas during a total follow-up period of 16,757 patient-years (0.11 case/100 persons/patient-year). The time to cyst or hematoma identification was 4-13 years after initial GKS, with a mean duration of 8.6 years. Among the patients examined, 7 (38.9%) presented mainly with hematoma, 10 (55.6%) presented mainly with cysts, and 1 presented with approximately equal components of both. Among the 18 patients, 13 (72.2%) underwent craniotomy to treat cyst or hematoma expansion. All the specimens had similar histopathologic characteristics, including organizing hematoma with fresh and old hemorrhage, fibrinoid necrosis of the vessels, gliosis of normal brain tissue, infiltration of hemosiderin-laden histiocytes, and extravascular protein leakage. CONCLUSIONS: Our findings suggest that the formation of these 2 complications can be attributed to a common mechanism involving radiation-induced vascular damage in brain tissue adjacent to the AVM and subsequent chronic inflammation and capillary dilatation.


Assuntos
Cistos , Malformações Arteriovenosas Intracranianas , Radiocirurgia , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/radioterapia , Malformações Arteriovenosas Intracranianas/cirurgia , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Cistos/diagnóstico por imagem , Cistos/etiologia , Cistos/patologia , Encéfalo/patologia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Seguimentos
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