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Pahwa B, Tayal A, Chandra A, Das JM. Subdural Hematoma due to Dural Metastasis: A Systematic Review on Frequency, Clinical Characteristics, and Neurosurgical Management. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38437862 DOI: 10.1055/s-0044-1782141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Subdural hematoma (SDH) occasionally accompanies dural metastasis and is associated with high recurrence rate, significantly impacting patient morbidity and mortality. This systematic review aims to evaluate the characteristics, management options, and outcomes of patients with SDH associated with dural metastasis. METHODS A comprehensive search of the PubMed and Cochrane databases was conducted for English-language studies published from inception to March 20, 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors reviewed cases of histopathologically confirmed SDH with non-central nervous system (non-CNS) tumor metastasis, focusing on therapeutic management of SDH. Statistical analysis was performed using SPSS software, with a significance level set at 0.05. RESULTS This review included 32 studies comprising 37 patients with 43 SDH cases associated with dural metastasis. Chronic SDH was the most frequently observed presentation (n = 28, 65.12%). The systemic malignancies most commonly associated with SDH due to dural metastasis were prostate carcinoma (n = 9, 24.32%) and gastric carcinoma (n = 5, 13.51%). A statistically significant association was found between metastatic melanoma and subacute SDH (p = 0.010). The majority of patients were treated with burr holes (n = 15, 40.54%) or craniotomies (n = 14, 37.84%), with no statistically significant difference in mortality rates between the two techniques (p = 0.390). Adjuvant therapy was administered to a limited number of patients (n = 5, 13.51%), including chemotherapy (n = 2, 5.41%), whole brain radiotherapy (n = 1, 2.70%), a combination of chemotherapy and whole brain radiotherapy (n = 1, 2.70%), and transcatheter arterial chemoembolization (n = 1, 2.70%). The overall recurrence rate was 45.95% (n = 17), with burr holes being the most common management approach (n = 4, 10.81%). Within a median of 8 days, 67.57% (n = 25) of patients succumbed, primarily due to rebleeding (n = 3, 8.11%), disseminated intravascular coagulation (n = 3, 8.11%), and pneumonia (n = 3, 8.11%). CONCLUSION This review highlights the need for improving existing neurosurgical options and exploring novel treatment methods. It also emphasizes the importance of dural biopsy in patients with suspected metastasis to rule out a neoplastic etiology.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Anish Tayal
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Atulya Chandra
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Joe M Das
- Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
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Kokot K, Dzierżanowski J, Krakowiak M, Fercho J, Yuser R, Kosel L, Nowiński E, Nacewicz J, Modliborska D, Szmuda T, Zieliński P. Dural metastasis of prostate carcinoma mimicking intracranial hematoma: a case report and literature review. J Surg Case Rep 2024; 2024:rjae014. [PMID: 38328455 PMCID: PMC10847406 DOI: 10.1093/jscr/rjae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Dural metastases of prostate adenocarcinoma are an extremely rare complication and may mimic intracranial hematoma. Preoperatively diagnosis may be difficult due to similarities in symptoms and radiological appearance. We present a 65-year-old man admitted to the ED with a history of headache, nausea, vomiting, vertigo, diplopia, as well as numbness of his left lower extremity. Past medical history confirmed metastatic prostate cancer disease. After computed tomography and contrast computed tomography, the consulting radiologist diagnosed a chronic subdural hematoma. After burr hole trephination and dural opening, tumorous mass was detected. Histopathologic samples were taken. Histopathological examination was consistent with metastatic adenocarcinoma of the prostate. Although rare, dural metastases need to be included in oncological patients presenting in the ED with symptoms and radiological imaging suggesting hematoma. Both neurooncological and neurosurgical consultations are essential in order to apply the best treatment strategy.
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Affiliation(s)
- Klaudia Kokot
- Students’ Scientific Circle of Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | | | - Michał Krakowiak
- Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | - Justyna Fercho
- Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
- Cardiac Surgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | - Rami Yuser
- Students’ Scientific Circle of Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | - Laura Kosel
- Students’ Scientific Circle of Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | - Eryk Nowiński
- Students’ Scientific Circle of Neurosurgery, Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | - Jacek Nacewicz
- Department of Neurosurgery, Provincial Specialist Hospital in Słupsk, Hubalczyków 1, Słupsk 76-200, Poland
| | - Dorota Modliborska
- Department of Neurosurgery, Provincial Specialist Hospital in Słupsk, Hubalczyków 1, Słupsk 76-200, Poland
| | - Tomasz Szmuda
- Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
| | - Piotr Zieliński
- Neurosurgery Department, Medical University of Gdansk, Gdansk 80-952, Poland
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Pangratz-Daller C, Grimm J, Pfaff JAR, Kraus TFJ, Sotlar K, Rahman Al-Schameri A, Kral M, Griessenauer CJ, Schwartz C. Meningeal Metastasis Causing Chronic Subdural Hematoma in a Cancer Patient with Bilateral Papilledema and Suspected Cerebral Venous Thrombosis: A Case Report. J Neurol Surg A Cent Eur Neurosurg 2024; 85:105-111. [PMID: 35453161 DOI: 10.1055/a-1832-3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Meningeal metastasis has been reported as a very rare cause of chronic subdural hematoma (CSH). Here, we report a female patient who had undergone initial burr hole drainage of a CSH at an outside hospital. Postoperatively, the patient additionally suffered from visual impairment due to bilateral papilledema and the patient was eventually transferred to our neurosurgical department for additional treatment. A craniotomy was performed and due to intraoperative suspicious findings, histopathologic samples were obtained that revealed a metastasis of thus far undiagnosed triple negative breast cancer. Furthermore, the patient was suspected to have a partial cerebral venous thrombosis (CVT). Our case report addresses this extremely rare clinical constellation. We provide a detailed overview on our patient's clinical and radiologic course, and discuss the potential association of CSH with meningeal metastasis and bilateral papilledema.
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Affiliation(s)
- Cornelia Pangratz-Daller
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jochen Grimm
- Department of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Johannes A R Pfaff
- Department of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Theo F J Kraus
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Abdul Rahman Al-Schameri
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Kral
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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Sukumaran M, Mao Q, Cantrell DR, Jahromi BS, Potts MB. Holohemispheric Prostate Carcinoma Dural Metastasis Mimicking Subdural Hematoma: Case Report and Review of the Literature. J Neurol Surg Rep 2022; 83:e23-e28. [PMID: 35273900 PMCID: PMC8904147 DOI: 10.1055/s-0042-1744127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/11/2020] [Indexed: 11/22/2022] Open
Abstract
Prostate carcinomas are the most common malignancy to metastasize to the dura. These metastases can commonly mimic subdural hematomas and may similarly present with brain compression. The optimal management and outcomes after surgical management are not well characterized. We present a case of prostate carcinoma metastatic to the dura that was initially thought to be a large isodense subdural hematoma and was treated with surgical decompression. We also review the literature regarding prostate dural metastases mimicking subdural hematomas and discuss the relevant imaging findings, treatments, and outcomes. Dural metastasis should be considered when a patient with known metastatic prostate cancer presents with imaging evidence of a subdural mass.
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Affiliation(s)
- Madhav Sukumaran
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Qinwen Mao
- Department of Pathology, Feinberg School of Medicine of Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Donald R Cantrell
- Department of Radiology, Feinberg School of Medicine of Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Babak S Jahromi
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Matthew B Potts
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, United States
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Aleksić V, Joković M, Ilić R, Bogosavljević V, Đurović B. Dural metastasis of prostate carcinoma misdiagnosed as a bilateral subdural hematoma: A case report. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30108-1. [PMID: 33036873 DOI: 10.1016/j.neucir.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/08/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
Dural metastases originating from prostate cancer are exceedingly uncommon and may clinically imitate a subdural hematoma. Additionally, head computed tomography scan findings can be mistaken for meningioma or subdural hematoma. We present a 75-year-old male patient with dural metastasis as a first presenting sign of prostate cancer, misdiagnosed as a bilateral subdural hematoma on initial non-contrast brain CT scan. Also, a review of literature is presented. We found 12 cases of dural metastasis of prostate cancer mimicking subdural hematoma described in the literature, and unlike in our case, prostate cancer was already diagnosed.
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Affiliation(s)
- Vuk Aleksić
- Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, Serbia.
| | - Miloš Joković
- Neurosurgery Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Rosanda Ilić
- Neurosurgery Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Branko Đurović
- Neurosurgery Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Ganau M, Gallinaro P, Cebula H, Scibilia A, Todeschi J, Gubian A, Nannavecchia B, Signorelli F, Pop R, Coca HA, Proust F, Chibbaro S. Intracranial Metastases from Prostate Carcinoma: Classification, Management, and Prognostication. World Neurosurg 2019; 134:e559-e565. [PMID: 31678450 DOI: 10.1016/j.wneu.2019.10.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prostate carcinomas rarely metastasize to the central nervous system but, when they do, dural localizations are as common as and far more aggressive than intraparenchymal ones. Those metastases can be further classified according to their extension toward the subdural or extradural space and can frequently simulate other pathologic conditions including chronic subdural hematomas, abscess, and primary bone tumors. Beside the challenges of the preoperative differential diagnostic and complexity of surgical planning and operative excision, subdural metastases seem to carry a much poorer prognosis. METHODS A series of consecutive patients admitted during a 12-year period through our oncall pathway for subdural/extradural collections or intraparenchymal lesions found, on histologic analysis, to represent intracranial prostate cancer metastases was retrospectively reviewed. RESULTS A total of 19 patients were included, but only 3 were diagnosed with small cell prostate carcinoma, while the majority had a primary prostate adenocarcinoma. Metastases could be classified as pure subdural space lesions, dural-based lesions, extradural/bony lesions, and pure intraparenchymal lesions. All patients with subdural metastases and 3 out of 5 patients with dural-based lesions required an emergency intervention due to rapidly deteriorating neurologic status. The mean follow-up in our series was 37 months; only subdural localizations had a remarkably unfavorable outcome. CONCLUSIONS Supported by our experience and the review of the literature, we suggest that a low threshold for contrast-enhanced computed tomography/magnetic resonance imaging is advisable in case of suspicious subdural collection, even in an emergency setting, for patients with previous medical history of prostate cancer.
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Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Paolo Gallinaro
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
| | - Helene Cebula
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Antonino Scibilia
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Arthur Gubian
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | | | | | - Raoul Pop
- Department of Neuroradiology, Hautepierre University Hospital, Strasbourg, France
| | - Hugo-Andres Coca
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Francois Proust
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
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7
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Tan LQ, Loh DDL, Qiu L, Ng YP, Hwang PYK. When hoofbeats mean zebras not horses: Tumour mimics of subdural haematoma - Case series and literature review. J Clin Neurosci 2019; 67:244-248. [PMID: 31279699 DOI: 10.1016/j.jocn.2019.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022]
Abstract
Chronic subdural haematomas are common neurosurgical conditions, especially in the elderly patients, with straightforward surgical treatments. However, infrequently, tumours are misdiagnosed as subdural haematoma on initial brain CT scans and are only discovered intraoperatively. In this case series, we presented 3 different patients who were initially thought to have subdural haematoma but later found to be tumour mimics of different histological origin. A literature review and discussion of recently published tumour mimics of subdural haematoma was also performed. It is recommended that in patients with suggestive oncological or haematological history, or unusual characteristics on the plain CT brain, a high level of suspicion of tumour mimics needs to be maintained. A full workup with contrast-enhanced magnetic resonance imaging is important to distinguish from subdural haematoma, as the treatment paradigms and prognoses are vastly different.
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Affiliation(s)
| | | | - Liming Qiu
- Department of Neurosurgery, National Neuroscience Institute, Singapore.
| | - Yew Poh Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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Bourdillon P, Apra C, Cornu P, Chauvet D. An Unexpected Subdural Collection: Story of a Prostatic Metastasis. Clin Genitourin Cancer 2016; 14:e405-7. [PMID: 26873433 DOI: 10.1016/j.clgc.2016.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 01/17/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; University of Lyon, Université Claude Bernard Lyon 1, Lyon, France; Sorbonne University, Université Pierre et Marie Curie Paris 6, Paris, France.
| | - Caroline Apra
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; Sorbonne University, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; Sorbonne University, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Dorian Chauvet
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurosurgery, Fondation Rothschild, Paris, France
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Nzokou A, Magro E, Guilbert F, Fournier JY, Bojanowski MW. Subdural Metastasis of Prostate Cancer. J Neurol Surg Rep 2015; 76:e123-7. [PMID: 26251788 PMCID: PMC4520961 DOI: 10.1055/s-0035-1549224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/10/2015] [Indexed: 11/12/2022] Open
Abstract
Dural metastasis from prostate cancer is rare and may mimic a subdural hematoma (SDH). Preoperatively diagnosis may be difficult and only reveal its presence during surgery. We present such a case and review the literature to identify common characteristics. A 65-year-old man presented with headache, confusion, and progressive right upper limb weakness. Past history included a prostate adenocarcinoma with bone metastasis 3 years earlier. Head computed tomography (CT) scan without contrast revealed a multinodular bilateral hyperdense extra-axial lesion interpreted as acute SDH. At surgery planned for SDH drainage no blood was found; instead there was an en plaque subdural yellowish tumor. Histopathologic examination was consistent with metastatic adenocarcinoma of the prostate. We found 11 cases reported as dural metastasis of prostate cancer mimicking SDH. Surgery was performed on nine cases with no suspicion of dural metastasis. On preoperative nonenhanced CT scan images, three types of image patterns can be described: a nodule in SDH, multinodular metastasis surrounded by SDH, and large en plaque subdural tumor. The latter group consists of those cases where no blood but rather an en plaque subdural tumor was found at surgery. Even though rare, dural metastasis should be considered among the differential diagnoses in a patient known for prostate cancer.
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Affiliation(s)
- Andre Nzokou
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Elsa Magro
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - François Guilbert
- Department of Radiology, Section of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Jean Yves Fournier
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada ; Department of Neurosurgery, Hôpital Cantonal, St. Gall, Switzerland
| | - Michel W Bojanowski
- Department of Surgery, Section of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
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