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Vande Vyvere T, Pisică D, Wilms G, Claes L, Van Dyck P, Snoeckx A, van den Hauwe L, Pullens P, Verheyden J, Wintermark M, Dekeyzer S, Mac Donald CL, Maas AIR, Parizel PM. Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma 2024. [PMID: 38482818 DOI: 10.1089/neu.2023.0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.
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Affiliation(s)
- Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Dana Pisică
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Guido Wilms
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lene Claes
- icometrix, Research and Development, Leuven, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Molecular Imaging and Radiology (MIRA), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Luc van den Hauwe
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Pim Pullens
- Department of Imaging, University Hospital Ghent; IBITech/MEDISIP, Engineering and Architecture, Ghent University; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Belgium
| | - Jan Verheyden
- icometrix, Research and Development, Leuven, Belgium
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Center, Houston, Texas, USA
| | - Sven Dekeyzer
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Radiology, University Hospital Ghent, Belgium
| | - Christine L Mac Donald
- Department of Neurological Surgery, School of Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Paul M Parizel
- Department of Radiology, Royal Perth Hospital (RPH) and University of Western Australia (UWA), Perth, Australia; Western Australia National Imaging Facility (WA NIF) node, Australia
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Nouri A, Gondar R, Schaller K, Meling T. Chronic Subdural Hematoma (cSDH): A review of the current state of the art. BRAIN AND SPINE 2021; 1:100300. [PMID: 36247395 PMCID: PMC9560707 DOI: 10.1016/j.bas.2021.100300] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction Incidence of Chronic Subdural Hematoma (cSDH) is rising worldwide, partly due to an aging population, but also due to increased use of antithrombotic medication. Many recent studies have emerged to address current cSDH management strategies. Research question What is the state of the art of cSDH management. Material and methods Review. Results Head trauma, antithrombotic use and craniocerebral disproportion increase the risk of cSDH development. Most patients present with disorientation, GCS 13–15, and symptoms arising from cortical irritation and increased intracranial pressure. cSDH occurs bilaterally in 9–22%. CT allows assessment of cerebral compression (herniation, hematoma thickness, ventricle collapse, midline shift), hematoma age and presence of membranes, factors that ultimately determine treatment urgency and surgical approach. Recurrence remains the principle complication (9–33%), occurring more commonly with older age and bilateral cSDHs. Discussion and conclusion While incompletely understood, it is generally believed that injury in the dural cell layer results in bleeding from bridging veins, resulting in a hematoma formation, with or without a preceding hygroma, in a potential space approximating the junction between the dura and arachnoid. Neovascularization and leaking from the outer membrane are thought to propagate this process. Evidence that MMA embolization may reduce recurrence rates is a potentially exciting new treatment option, but also supports the theory that the MMA is implicated in the cSDH pathophysiology. The use of steroids remains a controversial topic without clear treatment guidelines. cSDH represents a common neurosurgical problem with burr-hole treatment remaining the gold standard, often in conjunction with subgaleal drains. MMA embolization to stop recurrence may represent an important evolution in understanding the pathophysiology of cSDH and improving treatment. Incidence of cSDH is rising, partly due to the aging population and increased antithrombotic use. cSDH occurs bilaterally in 9–22% of cases. Recurrence remains the principle complication and has been estimated at 9–33%. Risk factors for recurrence include old age and bilateral cSDHs. MMA embolization may reduce recurrence, but its efficacy and target population remain unclear.
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Duy L, Badeeb A, Duy W, Alqahtani E, Champion W, Kim DH, Martin D, Vartanians V, Coffin P, Small J. Heterogeneity of acute subdural collections: In search of a unifying feature. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620947624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction A variety of different acute subdural hematoma patterns of density have been reported in the literature and are commonly seen in clinical practice, including rare hypodense acute subdural hematomas. It is unclear if these acute hypodense collections are entirely hypodense or if on close inspection, they can reveal subtle, tiny hyperdense components. The purpose of this study was to determine if all acute subdural hemtomas contain a hyperdense component, including seemingly entirely hypodense subdural collections. Methods Non-contrast CT scans of 111 patients containing 320 hyperacute or acute subdural collections were analyzed for the presence of a hyperdense component. Hounsfield measurements were recorded. Results All hyperacute and acute subdural hematomas in our study had a hyperdense component. Hyperacute subdural hematomas have a hyperdense component >97.5% of the time (95% confidence), and acute subdural hematomas have a hyperdense component >99% of the time (95% confidence). Conclusion Lack of a hyperdense component in a subdural hematoma makes acute or hyperacute hematoma highly unlikely, and alternative diagnoses should be considered.
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Affiliation(s)
- Lindsay Duy
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Arwa Badeeb
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
- Radiology Department, King Abdulaziz University, Saudi Arabia
| | - Walter Duy
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Eman Alqahtani
- Diagnostic Radiology Department, UC San Diego Medical Center, USA
| | - Walter Champion
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Dae Hee Kim
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Dann Martin
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Vartan Vartanians
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Phillip Coffin
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
| | - Juan Small
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, USA
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Duy L, Badeeb A, Duy W, Alqahtani E, Champion W, Kim DH, Martin D, Vartanians V, Coffin P, Small JE. CT Attenuation of Acute Subdural Hematomas in Patients with Anemia. J Neuroimaging 2019; 29:536-539. [PMID: 30771278 DOI: 10.1111/jon.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Isodense and hypodense acute subdural hematomas have been reported in the literature in anemic patients. The purpose of this study is to see if there is a statistically significant difference between the Hounsfield unit measurements of acute subdural hematomas in anemic and nonanemic patients. METHODS A total of 109 patients were analyzed. We measured the most hyperdense component of the subdural hematoma and compared these measurements for both anemic and nonanemic patients. RESULTS All patients with anemia had a hyperdense component to their subdural hematomas during the acute period. No statistically significant difference was found in the density of the subdural hematomas between the two groups. More heterogeneous subdural hematomas were found in the anemic group than the nonanemic group, which suggests that anemia alone is not a sufficient explanation for acute homogenous isodense and hypodense subdural hematomas. CONCLUSION A hyperdense subdural component was present in all acute subdural hematomas in anemic patients. Therefore, anemia alone is not a sufficient explanation for a homogenous low-density acute subdural hematoma.
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Affiliation(s)
- Lindsay Duy
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Arwa Badeeb
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Walter Duy
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Eman Alqahtani
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Walter Champion
- Diagnostic Radiology Department, UC San Diego Medical Center, San Diego, CA
| | - Dae Hee Kim
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Dann Martin
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Vartan Vartanians
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Phillip Coffin
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
| | - Juan E Small
- Diagnostic Radiology Department, Lahey Hospital and Medical Center, Burlington, MA
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5
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Chew HS, Leyon JJ, Sawlani V, Senthil L. Role of neuroimaging in management of traumatic brain injury. TRAUMA-ENGLAND 2014. [DOI: 10.1177/1460408614532048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury is a significant cause of morbidity and mortality in the UK with substantial associated economic costs to the healthcare system. This article explores the role of neuroimaging in both acute and long-term management of traumatic brain injury patients. We discuss the indications for urgent cross-section imaging as well as radiological features of both primary insults and secondary injuries. The role of neuroimaging in guiding surgical therapy and monitoring post-operative traumatic brain injury patients has also been described. Following initial injury, traumatic brain injury patients can suffer from a wide variety of physical, social and psychological difficulties. New techniques such as diffusion tensor imaging in combination with conventional magnetic resonance imaging sequences may provide useful information in predicting long-term prognosis and guiding rehabilitation.
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Affiliation(s)
- Han Seng Chew
- Department of Neuroradiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Joe J Leyon
- Department of Neuroradiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Vijay Sawlani
- Department of Neuroradiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Latha Senthil
- Department of Neuroradiology, Queen Elizabeth Hospital, Birmingham, UK
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6
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Park HR, Lee KS, Shim JJ, Yoon SM, Bae HG, Doh JW. Multiple Densities of the Chronic Subdural Hematoma in CT Scans. J Korean Neurosurg Soc 2013; 54:38-41. [PMID: 24044079 PMCID: PMC3772285 DOI: 10.3340/jkns.2013.54.1.38] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/08/2013] [Accepted: 07/17/2013] [Indexed: 11/28/2022] Open
Abstract
Objective Density of the chronic subdural hematoma (cSDH) is variable. It often appears to be mixed density. Multiple densities of cSDH may result from multiple episodes of trauma. We investigated the frequency of mixed density and the causes of head injuries representing each density. Methods We could collect 242 cases of chronic SDH. The cSDHs were classified into four groups; hypodensity, homogeneous isodensity, layered type, and mixed type on the basis of CT scans. Results The density of cSDH was isodense in 115 patients, hypodense in 31 patients, mixed in 79 cases, and layered in 17 cases. The cSDH was on the left side in 115 patients, on the right side in 70 patients, and bilateral in 40 patients. The history of trauma was identifiable in 122 patients. The etiology could be identified in 67.7% of the hypodense hematomas, while it was obscure in 59.5% of the mixed hematomas. Conclusion Mixed density of cSDH results from multiple episodes of trauma, usually in the aged. It is hard to remember all the trivial traumas for the patients with the mixed density cSDHs. Although there were membranes within the mixed density hematomas, burr-holes were usually enough to drain the hematomas.
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Affiliation(s)
- Hye-Ran Park
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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7
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Lee KS, Shim JJ, Yoon SM, Doh JW, Yun IG, Bae HG. Acute-on-Chronic Subdural Hematoma: Not Uncommon Events. J Korean Neurosurg Soc 2011; 50:512-6. [PMID: 22323938 DOI: 10.3340/jkns.2011.50.6.512] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 09/27/2011] [Accepted: 12/19/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Patients with asymptomatic chronic subdural hematoma (SDH) are prone to fall or slip. Acute trauma on these patients may develop acute subdural bleeding over the chronic SDH. We recently experienced 9 patients with acute-on-chronic SDH. We report the clinical and radiological features of this lesion. METHODS We retrospectively examined the computed tomographic (CT) scans of 107 consecutive patients who diagnosed as chronic SDH from January 2008 to December 2010. All cases of CSDH were diagnosed on CT with or without MRI scan. RESULTS Acute-on-chronic SDH is not rare, being 8% of chronic SDH. The most common cause of trauma was a slip in drunken state. Alcoholism with multiple episodes of trauma was one of the prominent histories. Acute-on-chronic SDH appeared as a hyperdense layer of clot with irregular blurred margin or lumps in liquefied hematoma. Single or two burr holes was usually effective to remove the hematoma. CONCLUSION Repeated trauma may cause acute bleeding over the chronic SDH. It will be helpful to understand the role of repeated trauma as a mechanism of hematoma enlargement.
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Affiliation(s)
- Kyeong-Seok Lee
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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8
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The surgical management of chronic subdural hematoma. Neurosurg Rev 2011; 35:155-69; discussion 169. [PMID: 21909694 DOI: 10.1007/s10143-011-0349-y] [Citation(s) in RCA: 294] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/02/2011] [Accepted: 05/15/2011] [Indexed: 12/14/2022]
Abstract
Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.
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Abstract
Mild traumatic brain injury (mTBI) remains a challenge to accurately assess with conventional neuroimaging. Recent research holds out the promise that diffusion tensor imaging (DTI) can be used to predict recovery in mTBI patients. Unlike computed tomography or conventional magnetic resonance imaging, DTI is sensitive to microstructural axonal injury, the neuropathology that is thought to be most responsible for the persistent cognitive and behavioral impairments that often occur after mTBI. Through the use of newer DTI analysis techniques such as automated region of interest analysis, tract-based voxel-wise analysis, and quantitative tractography, researchers have shown that frontal and temporal association white matter pathways are most frequently damaged in mTBI and that the microstructural integrity of these tracts correlates with behavioral and cognitive measures. Future longitudinal DTI studies are needed to elucidate how symptoms and the microstructural pathology evolve over time. Moving forward, large-scale investigations will ascertain whether DTI can serve as a predictive imaging biomarker for long-term neurocognitive deficits after mTBI that would be of value for triaging patients to clinical trials of experimental cognitive enhancement therapies and rehabilitation methods, as well as for monitoring their response to these interventions.
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Rocchi G, Caroli E, Salvati M, Delfini R. Membranectomy in organized chronic subdural hematomas: indications and technical notes. ACTA ACUST UNITED AC 2007; 67:374-80; discussion 380. [PMID: 17350406 DOI: 10.1016/j.surneu.2006.08.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2006] [Accepted: 08/04/2006] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of the present study is to present our operative method of removing organized CSDHs and to structure the criteria for choosing this approach as first treatment. METHODS Between 1991 and 1999 at our Institution, 14 consecutive patients with organized CSDHs required 16 craniotomies with membranectomy. They represent 5.8% of all patients (243) treated for CSDHs in the same period. All the patients had preoperative contrast-enhanced CT, and 9 patients also had contrast MRI. RESULTS Initially, 9 patients underwent one burr hole or twist-drill hole. Of these 9 patients, 3 were treated at the same surgery with craniotomy and membranectomy as second treatment, 3 underwent a second burr hole and then membranectomy at the same surgery, and 3 patients underwent a second burr hole 3, 4, and 21 days after the first one and then membranectomy. Five patients underwent immediate craniotomy and membranectomy. There were no morbidity or mortality associated with this procedure. All patients had a full recovery without recurrence. CONCLUSIONS Contrast-enhanced MRI has greatly improved opportunities for discovering neomembrane before surgical intervention. We believe that MRI detection of thick and extensive membranes or solid clot with mass effect makes an immediate craniotomy to remove CSDH necessary.
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Affiliation(s)
- Giovanni Rocchi
- Department of Neurological Sciences, Neurosurgery, University of Rome La Sapienza, 00100 Rome, Italy
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12
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Iglesias A, Arias M, Meijide F, Brasa J. Quiste aracnoideo complicado con hemorragia intraquística y hematoma subdural espontáneo: hallazgos en resonancia magnética. RADIOLOGIA 2006; 48:245-8. [PMID: 17058653 DOI: 10.1016/s0033-8338(06)73162-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Arachnoid cysts are collections of cerebrospinal fluid within the arachnoid membrane. They are benign lesions and most are congenital. They are usually asymptomatic; however, they can bleed and become symptomatic. Although arachnoid cyst associated to intracystic hemorrhage and spontaneous subdural hematoma is an uncommon complication, it is a well-known indication for emergency neurosurgery. We present the findings in a ten-year-old boy diagnosed with arachnoid cyst complicated by intracystic hemorrhage and spontaneous subdural hematoma diagnosed by magnetic resonance.
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Affiliation(s)
- A Iglesias
- Unidad de Diagnóstico por Imagen (MEDTEC), Area de Servicio Compartido de Radiología, Complejo Hospitalario Universitario de Vigo, España.
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Abstract
Traumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging also can be important in the chronic therapy of TBI, identifying chronic sequelae, determining prognosis, and guiding rehabilitation.
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Affiliation(s)
- Bruce Lee
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvani 19104, USA
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14
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Lee B, Newberg A. Neuroimaging in traumatic brain imaging. Neurotherapeutics 2005. [DOI: 10.1007/bf03206678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Parizel PM, Van Goethem JW, Ozsarlak O, Maes M, Phillips CD. New developments in the neuroradiological diagnosis of craniocerebral trauma. Eur Radiol 2005; 15:569-81. [PMID: 15696294 DOI: 10.1007/s00330-004-2558-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 10/15/2004] [Indexed: 11/29/2022]
Abstract
Accurate radiographic diagnosis is a cornerstone of the clinical management and outcome prediction of the head-injured patient. New technological advances, such as multi-detector computed tomography (MDCT) scanning and diffusion-weighted magnetic resonance imaging (MRI) have influenced imaging strategy. In this article we review the impact of these developments on the neuroradiological diagnosis of acute head injury. In the acute phase, multi-detector CT has supplanted plain X-ray films of the skull as the initial imaging study of choice. MRI, including fluid-attenuated inversion recovery, gradient echo T2* and diffusion-weighted sequences, is useful in determining the severity of acute brain tissue injury and may help to predict outcome. The role of MRI in showing diffuse axonal injuries is emphasized. We review the different patterns of primary and secondary extra-axial and intra-axial traumatic brain lesions and integrate new insights. Assessment of intracranial hypertension and cerebral herniation are of major clinical importance in patient management. We discuss the issue of pediatric brain trauma and stress the importance of MRI in non-accidental injury. In summary, new developments in imaging technology have advanced our understanding of the pathophysiology of brain trauma and contribute to improving the survival of patients with craniocerebral injuries.
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Affiliation(s)
- P M Parizel
- Department of Radiology, University of Antwerp, Antwerp, Belgium.
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Holodny AI, Visvikis GA, Schlenk RP, Maniker AH. Bilateral subdural hematomas exactly isodense to the subjacent gray matter. J Emerg Med 2001; 20:413-4. [PMID: 11348826 DOI: 10.1016/s0736-4679(01)00292-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A I Holodny
- Department of Radiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103-2714, USA
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Spreer J, Ernestus RI, Lanfermann H, Lackner K. Connective tissue reactions in subdural haematomas: imaging with contrast-enhancement MRI. Acta Neurochir (Wien) 1997; 139:560-5. [PMID: 9248591 DOI: 10.1007/bf02751000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The sensitivity of contrast enhanced magnetic resonance imaging (MRI) in the detection of connective tissue reactions accompanying the maturation of subdural haematomas (SDH) was studied. An outer enhancing layer between the SDH and the tabula interna of the vault was shown in 16 out of 17 cases. In early SDH this outer enhancing layer presumably is due to vascular congestion and/or increased vascular permeability. A thickening of the outer enhancing layer and/or an inner enhancing layer between the haematoma and the subarachnoid space was visible in 9 patients and represented a haematoma capsule formed by proliferating granulation tissue. In 5 SDH septations were found, 3 SDH consisted almost completely of enhancing granulation tissue. Thus, contrast enhanced MRI delivers additional information about the structure of SDH, which are useful for determining the extent of surgical treatment especially in chronic SDH.
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Affiliation(s)
- J Spreer
- Department of Diagnostic Radiology, Albert-Ludwigs-Universität Freiburg/Brsg, Federal Republic of Germany
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Davenport RJ, Statham PF, Warlow CP. Detection of bilateral isodense subdural haematomas. BMJ (CLINICAL RESEARCH ED.) 1994; 309:792-4. [PMID: 7695701 PMCID: PMC2541035 DOI: 10.1136/bmj.309.6957.792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R J Davenport
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital
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