The pathogenesis of delayed epidural hematoma after posterior fossa surgery

Acute cerebral venous outflow obstruction during convexity meningioma resection

BACKGROUND

Cerebral venous outflow obstruction involves idiopathic intracranial hypertension, and the most common related condition is dural venous sinus stenosis or, in other words, an obstruction of the dural venous sinuses. In these cases, the pathological process is often chronic, displays only mild symptoms, and rarely requires urgent surgical intervention. In this study, we present a unique case involving an acute cerebral venous outflow obstruction that occurred during meningioma resection that ultimately had catastrophic consequences.

MATERIALS AND METHODS

The patient's preoperative imaging only revealed an unremarkable frontal convexity meningioma with an average diameter exceeding 8 cm. She was admitted for a scheduled right frontoparietal craniotomy for lesion resection.

RESULTS

The patient's unique congenital dural venous sinus structure along with a non-surgical epidural hematoma both contributed to a catastrophic outcome, causing a progressive hemispheric encephalocele, significant blood loss, and wound closure difficulties.

CONCLUSION

Neurosurgeons should place an additional focus on cerebral venous outflow patency during tumor resection, even if the tumor does not involve the transverse or sigmoid sinuses. It is well known that the tacking sutures play an essential role in preventing an epidural hematoma, but the procedure to mitigate hematomas occurring outside the surgical field of view is not fully recognized by neurosurgeons. If dural tacking sutures are placed after complete tumor resection, the prophylactic effect for preventing EDH in the non-surgical areas may not be guaranteed. Therefore, we strongly advocate for the tacking sutures to be accurately placed before dural incisions are made.

Different Roles of Microvascular Decompression in Hemifacial Spasm and Trigeminal Neuralgia

Objectives  Microvascular decompression (MVD) involves the same procedure for both hemifacial spasm (HFS) and trigeminal neuralgia (TN), the resulting clinical courses are different. The aim of this study was to compare differences in MVD operations for HFS and TN and to determine the consequences of these differences on the clinical courses of the two diseases. Methods  The medical records of patients who underwent an MVD operation between January 1998 and March 2013 were reviewed. Results  A total of 2,263 patients were enrolled, 222 had TN and 2,040 had HFS. In the HFS group, the estimated cure rates at postoperative years 1, 2, and 3 were 92.0, 93.4, and 93.6%. In the TN group, the estimated cure rates at postoperative years 1, 2, and 3 were 88.4, 89.4, and 91.4%. Comparison of the initial treatment response between the HFS and TN groups did not reveal any statistically significant difference ( p  = 0.338). Among the 1,749 HFS patients initially cured by MVD, 57 were worsened. Among the 181 TN patients treated by MVD, 43 were worsened, with ≥ BNI III (Barrow Neurological Institute pain intensity score III) 12 worsened to a BNI score of IV. Comparing the recurrence rate between the HFS and TN groups, there was a statistically significant difference for cases with ≥ BNI III ( p  < 0.001), but not in cases with ≥ BNI IV ( p  = 0.498). Conclusion  MVD is a promising treatment for HFS. In contrast, MVD-treated TN had a risk of recurrence. The MVD operation should be carefully considered when applied as a treatment for TN patients.