Bilateral Spontaneous Resolution of Traumatic Epidural Hematoma: A Case Report and Literature Review.

Epidural hematomas (EDHs) are a neurosurgical emergency characterized by the accumulation of blood in the epidural space surrounding the dura mater. Spontaneous resolution of EDH is an exceptionally rare occurrence, with only 16 cases reported in the medical literature where resolution occurred within 24 hours of onset. In this case report, we present a unique instance of a chronic EDH that spontaneously resolved over a period of seven months. This case adds to the scientific literature by highlighting an extremely prolonged duration of spontaneous EDH resolution, which, to our knowledge, has not been previously documented. A 59-year-old male suffered a head injury following a fall. He presented with a progressively worsening headache and nausea, raising concerns for a potential EDH. A computed tomography (CT) scan confirmed the presence of a large right parietal EDH measuring 58 × 23 × â€‹â€‹â€‹â€‹â€‹â€‹â€‹17 mm and a large left frontoparietal EDH measuring 90 × 20 ×​​​​​​​ 12 mm. These findings were crucial in establishing the primary diagnosis and guiding subsequent interventions. Upon diagnosis of the EDHs, the patient received conservative treatment and was closely monitored. Over a period of seven months, follow-up imaging revealed complete resolution of both EDHs, with restoration of normal midline structures and ventricular sizes. Notably, this represents the longest duration of spontaneous EDH resolution reported in the literature. We attribute this uncommon outcome to the activation of endogenous fibrinolytic pathways, which are responsible for dissolving blood clots and hematomas. In addition, the formation of new collateral blood vessels around the hematoma may help facilitate its resolution. This case underscores the significance of early recognition and vigilant monitoring of EDH cases. While immediate surgical intervention remains essential in most instances, conservative management can be considered in select cases. Our report demonstrates the possibility of spontaneous resolution of EDHs over an extended period, emphasizing the importance of continued observation and appropriate management. By shedding light on this rare occurrence, this case report contributes to the limited existing literature on the topic, providing valuable insights and adding to our understanding of EDH management.

Persistence of communicating hydrocephalus post choroid plexus tumor resection: Case reports and review of literature.

BACKGROUND: Hydrocephalus is the most common presentation of choroid plexus tumors; it is thought to be caused either by mass effect obstructing the cerebrospinal fluid pathways or secretory properties of the tumor. In these case reports, we present two cases of choroid plexus tumors with persistence of communicating hydrocephalus postoperatively and review similar reports in the literature. CASE DESCRIPTION: Case 1: a 2-month-old baby girl presented with bulging fontanelle, sunsetting eyes. Magnetic resonance imaging (MRI) showed large third ventricle mass with communicating hydrocephalus. She underwent complete excision of tumor through transcortical approach with perioperative intraventricular hemorrhage. Hydrocephalus persisted postoperatively and the patient required permanent ventriculoperitoneal (VP) shunt. Case 2: a 16-year-old boy presented decreased visual acuity, papilledema, and morning headaches. MRI showed a tumor in the right ventricle and communicating hydrocephalus. He underwent transparietal resection of the tumor. In both cases, hydrocephalus persisted postoperatively and patients required permanent VP shunt. Review of similar cases showed the majority of cases required permanent shunting. CONCLUSION: Choroid plexus tumor patients can present with communicating hydrocephalus that may persist post tumor resection for different etiologies. Careful follow-up to determine the need for cerebrospinal fluid diversion through a permanent VP shunt is important.

The efficacy of wrapping the neurorrhaphy site utilizing dura substitute: A case series.

BACKGROUND: Different procedures have been developed to improve the surgical outcome of peripheral nerve injuries. The purpose of this study was to evaluate the efficacy of wrapping the neurorrhaphy site utilizing dura substitute graft as an alternative conduit in the management of peripheral nerve injury. METHODS: This retrospective clinical case series included 42 patients with a single peripheral nerve injury. The mean age was 26.8 ± 11 years, and the mean duration of symptoms was 3 ± 1.8 months. The visual analogue score (VAS) for pain and the Medical Research Council's (MRC) grading for motor power were used to evaluate the functional outcome among our patients. All patients were operated on for primary microscopic end-to-end repair, followed by wrapping the neurorrhaphy site with dura substitute graft as a conduit. Patients were followed in the outpatient clinic with regular visits for average of 6 months. RESULTS: Thirty-seven patients (83%), showed functional improvement in all aspects, the VAS for pain and the MRC for motor power, as well as the functional state. One patient (2.3%) developed a postoperative hematoma collection, which needed immediate evacuation. Superficial wound infection, reported in two patients (4.7%), was treated conservatively. No postoperative neuroma was observed among our patients during the follow-up period. CONCLUSION: Wrapping the neurorrhaphy site utilizing dura substitute as conduit appears to be safe and might prove effective in managing peripheral nerve injury.