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Supratentorial Acute Subdural Hematoma During Fully Endoscopic Microvascular Decompression Surgery for Hemifacial Spasm. J Craniofac Surg 2023; 34:e187-e190. [PMID: 36731056 DOI: 10.1097/scs.0000000000008987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/30/2022] [Indexed: 02/04/2023] Open
Abstract
The endoscope has been widely used in microvascular decompression (MVD), which is the best curative treatment for hemifacial spasm. Supratentorial subdural hematoma (SDH) is rarely happened in MVD. The authors report 2 cases of SDH during full endoscopic MVD. The origin of bleeding is not confirmed during the operation. Rapid and excessive drainage of cerebrospinal fluid and the operation position may result the rupture of bridging veins, which result in the occurrence of SDH. However, there is no clear evidence to explain the clinical symptoms.
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Efficacy and safety of the endoscopic "wet-field" technique for removal of supratentorial cavernous malformations. Acta Neurochir (Wien) 2022; 164:2587-2594. [PMID: 35732840 DOI: 10.1007/s00701-022-05273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/11/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique. METHODS We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the "wet-field technique." Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records. RESULTS The average maximum CM diameter was 35.3 mm (range: 10-65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed. CONCLUSIONS The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs.
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Wang J, Chong Y, Jiang C, Dai Y, Liang W, Ding L. Supratentorial subdural hematoma following microvascular decompression. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yue Y, Zhao ZR, Liu DC, Liu HJ, Lu DL, Zhang H, Jin P. Life-threatening complications after microvascular decompression procedure: Lessons from a consecutive series of 596 patients. J Clin Neurosci 2021; 86:64-70. [PMID: 33775349 DOI: 10.1016/j.jocn.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 12/11/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
The microvascular decompression procedure (MVD) is widely utilized on patients with neurovascular compression syndromes, such as trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, which have failed medical therapy. However, surgical complications are an ongoing problem. We retrospectively reviewed a total of 596 patients undergoing MVD in the Affiliated Hospital of Qingdao University from January 2008 to December 2018. Furthermore, we discussed the cases with life-threatening complications to determine the potential causes, aiming to achieve the goal of safer microvascular decompression. There were seven cases with life-threatening complications. Of those complications, one was cerebellar infarction with acute hydrocephalus, one was infarction of the cerebellum and the brain stem with acute hydrocephalus and serious intracranial infection, two were cerebellar haematoma, one was multiple haemorrhage with acute hydrocephalus, one was supratentorial subdural haematoma, and one was cerebellar swelling with acute hydrocephalus. After therapy, one patient died, one was in a persistent vegetative state, and five were discharged from the hospital upon recovery. In brief, MVD is a safe operation, and life-threatening complications accompanying MVD are rare, but require attention. The causes of some life-threatening complications are still not completely clear. Surgeons should continuously improve surgical techniques and perioperative care to reduce potential risks.
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Affiliation(s)
- Yong Yue
- Department of Neurosurgery, Mianyang Central Hospital, Mianyang, Sichuan Province, China
| | - Zhen-Ran Zhao
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - De-Cai Liu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Heng-Jian Liu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Dong-Lin Lu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Heng Zhang
- Department of Neurosurgery, Langzhong People's Hospital, Langzhong,Sichuan Province, China
| | - Peng Jin
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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Welling-up of cerebrospinal fluid is a sign of remote supratentorial hemorrhage during microvascular decompression: a case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1186/s41984-020-00079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Subdural hematoma (SDH) at a remote operative site is uncommon following neurosurgical procedures. However, supratentorial SDH is one of the rare complications following microvascular decompression (MVD). We report a case of supratentorial SDH following MVD. The welling of cerebrospinal fluid (CSF) in the cerebellomedullary fissure was observed unexpectedly during the dissection. It is a signal case that can improve our understanding of the occurrence of such rare complications and of possible mechanisms.
Case presentation
A 54-year-old woman was diagnosed with left hemifacial spasm (HFS) and had been receiving botulinum toxin injections since 10 years before surgery. CSF welling-up in the cerebellopontine cistern was noticed by the surgeon during the arachnoid dissection. MVD was performed completely. A thin supratentorial SDH was found on the right side (contralateral) on immediate postoperative computed tomography (CT). The SDH was asymptomatic, and the size of hematoma did not increase in follow-up CT scans after surgery. During the follow-up period, she was relieved of HFS. CSF welling-up can be considered the time of initiation of the hemorrhage.
Conclusion
Limited case reports of supratentorial SDH following MVD have been published, and none of them have reported time of initiation of the hemorrhage. The phenomenon of abnormal CSF welling-up in the cistern could be a sign of remote supratentorial hemorrhage.
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Supratentorial subdural hematoma after surgery for vestibular schwannoma: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pradhan RR, Shrestha GS, Sedain G. Remote Supratentorial Subdural Hematoma Following Craniectomy and Evacuation of Hypertensive Cerebellar Hematoma. Cureus 2020; 12:e6977. [PMID: 32201656 PMCID: PMC7075514 DOI: 10.7759/cureus.6977] [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] [Indexed: 11/21/2022] Open
Abstract
Remote acute subdural hematoma following a decompressive craniotomy or craniectomy is a rare phenomenon. Only few cases of postoperative contralateral acute subdural hematomas have been reported in the literature review till date. This case report details a case of a 32-year-old hypertensive male who presented with severe headache, multiple episodes of vomiting, slurring of speech, nystagmus and ataxic gait for one day. Computed tomography (CT) scan of head revealed a right sided cerebellar hemorrhage with effacement of fourth ventricle and upstream hydrocephalus. A right suboccipital craniectomy and hematoma evacuation were performed. A repeat CT scan of head was done at six hours post surgery; which revealed a contralateral (left-sided) subdural hematoma involving the fronto-parieto-temporal region. The patient improved following conservative management. Contralateral acute subdural hematoma following evacuation of hematoma is a rare, but a potentially life-threatening complication; therefore, we should try to detect such contralateral hematoma and prevent clinical deterioration.
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Affiliation(s)
- Ravi R Pradhan
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Gentle S Shrestha
- Critical Care, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, NPL
| | - Gopal Sedain
- Neurosurgery, Tribhuvan University Institute of Medicine, Kathmandu, NPL
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Shi L, Gu X, Sun G, Guo J, Lin X, Zhang S, Qian C. After microvascular decompression to treat trigeminal neuralgia, both immediate pain relief and recurrence rates are higher in patients with arterial compression than with venous compression. Oncotarget 2018; 8:44819-44823. [PMID: 28122347 PMCID: PMC5546521 DOI: 10.18632/oncotarget.14765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/11/2017] [Indexed: 11/25/2022] Open
Abstract
We explored differences in postoperative pain relief achieved through decompression of the trigeminal nerve compressed by arteries and veins. Clinical characteristics, intraoperative findings, and postoperative curative effects were analyzed in 72 patients with trigeminal neuralgia who were treated by microvascular decompression. The patients were divided into arterial and venous compression groups based on intraoperative findings. Surgical curative effects included immediate relief, delayed relief, obvious reduction, and invalid result. Among the 40 patients in the arterial compression group, 32 had immediate pain relief of pain (80.0%), 5 cases had delayed relief (12.5%), and 3 cases had an obvious reduction (7.5%). In the venous compression group, 12 patients had immediate relief of pain (37.5%), 13 cases had delayed relief (40.6%), and 7 cases had an obvious reduction (21.9%). During 2-year follow-up period, 6 patients in the arterial compression group experienced recurrence of trigeminal neuralgia, but there were no recurrences in the venous compression group. Simple artery compression was followed by early relief of trigeminal neuralgia more often than simple venous compression. However, the trigeminal neuralgia recurrence rate was higher in the artery compression group than in the venous compression group.
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Affiliation(s)
- Lei Shi
- Department of Neurosurgery and Anesthesiology, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, P. R. China
| | - Xiaoyan Gu
- Department of Rehabilitation, The 454th Hospital of Chinese PLA, Nanjing, Jiangsu, China
| | - Guan Sun
- Department of Neurosurgery, Fourth Affiliated Yancheng Hospital of Nantong University, Yancheng, P. R. China
| | - Jun Guo
- Department of Neurosurgery, Fourth Affiliated Yancheng Hospital of Nantong University, Yancheng, P. R. China
| | - Xin Lin
- Department of Neurosurgery and Anesthesiology, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, P. R. China
| | - Shuguang Zhang
- Department of Neurosurgery and Anesthesiology, The First People's Hospital of Kunshan affiliated with Jiangsu University, Suzhou, P. R. China
| | - Chunfa Qian
- Department of Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, P. R. China
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Amagasaki K, Takusagawa Y, Kanehashi K, Abe S, Watanabe S, Shono N, Nakaguchi H. Supratentorial acute subdural haematoma during microvascular decompression surgery: report of three cases. J Surg Case Rep 2017; 2017:rjx004. [PMID: 28740635 PMCID: PMC5516808 DOI: 10.1093/jscr/rjx004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/29/2016] [Accepted: 01/15/2017] [Indexed: 12/01/2022] Open
Abstract
Supratentoiral haemorrhage during posterior fossa surgery is very rare. Authors report three cases of acute subdural haematoma occurred during microvascular decompression (MVD). Bleeding was observed in the suboccipital surgical area during operation but the origin of the bleeding was not confirmed intraoperatively in all cases. Decompression procedure was completed and immediate postoperative computed tomography revealed supratentorial subdural haematoma. This complication was observed during MVD in healthy young patients with hemifacial spasm in our cases. Flexion of the head with reduction of cerebrospinal fluid may have induced rotational movement of the cerebrum resulting in rupture of bridging veins, but no definitive mechanism that fulfils the clinical characteristics was clearly determined.
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Affiliation(s)
| | | | - Kyoko Kanehashi
- Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Shoko Abe
- Department of Radiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Saiko Watanabe
- Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naoyuki Shono
- Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan
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