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Scalia G, Umana GE, Crea A, Vats A, Chaurasia B, Graziano F, Marrone S, Furnari M, Ponzo G, Giuffrida M, Fricia M, Cicero S, Nicoletti GF. Chronic encapsulated intracerebral hematomas: a systematic review. Br J Neurosurg 2023; 37:1000-1005. [PMID: 35001775 DOI: 10.1080/02688697.2021.2024499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 12/27/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Chronic encapsulated intracerebral hematoma (CEICH) is a rare type of intracerebral hematoma (ICH) with peculiar radiological features and presenting as subtle slow-growing lesion exerting mass effect. We performed a systematic review of the literature focused on diagnosis and management of patients affected by CEICH. MATERIAL AND METHODS A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases and pertinent Mesh terms. All papers that reported intraventricular CEICH, or CEICH cases treated conservatively or by CT-guided needle aspiration were not included in this study. A total of 40 papers were included in this review, with 58 patients (38 males and 20 females) and a mean age of 41.44 ± 20.05 years (range 1-80). RESULTS Neurological symptoms of onset include those related to an increase in intracranial pressure (ICP) in 28/58 cases (48.2%), seizures in 17/58 cases (29.3%), motor deficits in 14/58 cases (24.1%). The most frequent localization is atypical in 45/58 cases (77.6%). Surgical approach is not specified in 21/58 cases (36.2%), craniotomy was performed in 31/58 cases (53.4%), craniectomy in 5/58 cases (8.6%) and only in one case (1.7%) an endoscopic approach was performed. CEICH are usually located in an atypical site. CONCLUSIONS There is not an association with anticoagulants and antiplatelets intake. Arteriovenous malformation is the most frequent cause. Surgery is suggested, and craniotomy is the most used approach even if further investigation should be directed to analyze the efficacy of endoscopic approach of these lesions, which may show favorable outcome.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Antonio Crea
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Atul Vats
- Neurosurgery Department, James Cook University Hospital, Middlesbrough, UK
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Francesca Graziano
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Salvatore Marrone
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Massimo Furnari
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Giancarlo Ponzo
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Massimiliano Giuffrida
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
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Finitsis S, Bernier V, Buccheit I, Klein O, Bracard S, Zhu F, Gauchotte G, Anxionnat R. Late complications of radiosurgery for cerebral arteriovenous malformations: report of 5 cases of chronic encapsulated intracerebral hematomas and review of the literature. Radiat Oncol 2020; 15:177. [PMID: 32698881 PMCID: PMC7374821 DOI: 10.1186/s13014-020-01616-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/13/2020] [Indexed: 01/04/2023] Open
Abstract
Background Chronic encapsulated intracerebral hematomas (CEIHs) are a rare, late complication of radiosurgery for intracranial AVM. We present 5 cases treated mostly by surgical excision and review the literature. Methods Patients (age 39, 42, 36, 31, 62) presented with headache, paresthesia, hemiparesis or were asymptomatic. CEIHs presented 10 to 13 years (median 12 years) post radiosurgery. Three patients had demonstrated early radiation induced changes post radiosurgery. Angiographic cure, assessed with DSA, was present in all cases except 1 case with a small nidus remnant. MRI demonstrated mixed lesions with a solid enhancing part, organized hematoma and extensive surrounding edema while three cases had also a cystic component. Results Excision of the CEIHs with complete or partial removal of the capsule was performed in 4 patients and resulted in marked clinical improvement. One patient was managed conservatively with administration of steroids as surgery was judged excessively hazardous with eventual stabilization of his symptoms. Conclusions CEIHs are rare, late complications of radiosurgery for cranial AVM. They may be asymptomatic or provoke symptoms and may be preceded by early radiation induced changes. Complete removal of CEIHS is an effective treatment. Because of the long latency period of CEIHs, patients who had radiosurgery for brain AVMs should be followed by MRI at least 10 years even after complete obliteration.
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Affiliation(s)
- Stephanos Finitsis
- Aristotle University of Thessaloniki, Ahepa Hospital, Kyriakidi 1, 54621, Thessaoniki, Greece.
| | - Valerie Bernier
- Centre Alexis Vautrin, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne CS 30519, 54519, Vandoeuvre-lès-Nancy Cedex, France
| | - Isabelle Buccheit
- Centre Alexis Vautrin, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne CS 30519, 54519, Vandoeuvre-lès-Nancy Cedex, France
| | - Olivier Klein
- Hôpital d'Enfants, CHU de Nancy - Hôpitaux de Brabois, Rue du Morvan, 54511, Vandoeuvre-lès-Nancy Cedex, France
| | - Serge Bracard
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Universitaire de Nancy, 29 avenue du maréchal de Lattre de Tassigny CO 60034, 54035, Nancy, France
| | - Francois Zhu
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Universitaire de Nancy, 29 avenue du maréchal de Lattre de Tassigny CO 60034, 54035, Nancy, France
| | - Guillaume Gauchotte
- Département de Biopathologie - Anatomie et Cytologie Pathologiques, CHRU de Nancy - CHRU/ICL - bâtiment BBB, Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France
| | - René Anxionnat
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Universitaire de Nancy, 29 avenue du maréchal de Lattre de Tassigny CO 60034, 54035, Nancy, France
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