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Catapano JS, Koester SW, Hanalioglu S, Farhadi DS, Naik A, Hartke JN, Tunc O, Winkler EA, Chang SW, Lawton MT, Jadhav AP, Ducruet AF, Albuquerque FC. Middle meningeal artery embolization associated with reduced chronic subdural hematoma volume and midline shift in the acute postoperative period. J Neurointerv Surg 2024; 16:478-481. [PMID: 37321836 DOI: 10.1136/jnis-2022-020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Middle meningeal artery (MMA) embolization for endovascular treatment of chronic subdural hematoma (cSDH) is growing in popularity. cSDH volume and midline shift were analyzed in the immediate postoperative window after MMA embolization. METHODS A retrospective analysis of cSDHs managed via MMA embolization from January 1, 2018 to March 30, 2021 was performed at a large quaternary center. Pre- and postoperative cSDH volume and midline shift were quantified with CT. Postoperative CT was obtained 12 to 36 hours after embolization. Paired t-tests were used to determine significant reduction. Multivariate analysis was performed using logistic and linear regression for percent improvement from baseline volume. RESULTS In total, 80 patients underwent MMA embolization for 98 cSDHs during the study period. The mean (SD) initial cSDH volume was 66.54 (34.67) mL, and the mean midline shift was 3.79 (2.85) mm. There were significant reductions in mean cSDH volume (12.1 mL, 95% CI 9.32 to 14.27 mL, P<0.001) and midline shift (0.80 mm, 95% CI 0.24 to 1.36 mm, P<0.001). In the immediate postoperative period, 22% (14/65) of patients had a>30% reduction in cSDH volume. A multivariate analysis of 36 patients found that preoperative antiplatelet and anticoagulation use was significantly associated with an expansion in volume (OR 0.028, 95% CI 0.000 to 0.405, P=0.03). CONCLUSION MMA embolization is safe and effective for the management of cSDH and is associated with significant reductions in hematoma volume and midline shift in the immediate postoperative period.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Sahin Hanalioglu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dara S Farhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anant Naik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joelle N Hartke
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Osman Tunc
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ethan A Winkler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steven W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Cohen-Cohen S, Jabal MS, Rinaldo L, Savastano LE, Lanzino G, Cloft H, Brinjikji W. Middle meningeal artery embolization for chronic subdural hematoma: A single-center experience and predictive modeling of outcomes. Neuroradiol J 2024; 37:192-198. [PMID: 38147825 DOI: 10.1177/19714009231224431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Remarkable interest is rising around middle meningeal artery embolization (MMAE) as an emerging alternative therapy for chronic subdural hematoma (cSDH). The study aims to highlight a large center experience and the variables associated with treatment failure and build experimental machine learning (ML) models for outcome prediction. MATERIAL AND METHODS A 2-year experience in MMAE for managing patients with chronic subdural hematoma was analyzed. Descriptive statistical analysis was conducted using imaging and clinical features of the patients and cSDH, which were subsequently used to build predictive models for the procedure outcome. The modeling evaluation metrics were the area under the ROC curve and F1-score. RESULTS A total of 100 cSDH of 76 patients who underwent MMAE were included with an average follow-up of 6 months. The intervention had a per procedure success rate of 92%. Thrombocytopenia had a highly significant association with treatment failure. Two patients suffered a complication related to the procedure. The best performing machine learning models in predicting MMAE failure achieved an ROC-AUC of 70%, and an F1-score of 67%, including all patients with or without surgical intervention prior to embolization, and an ROC-AUC of 82% and an F1-score of 69% when only patients who underwent upfront MMAE were included. CONCLUSION MMAE is a safe and minimally invasive procedure with great potential in transforming the management of cSDH and reducing the risk of surgical complications in selected patients. An ML approach with larger sample size might help better predict outcomes and highlight important predictors following MMAE in patients with cSDH.
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Chatterjee AR. Invited Commentary: A New Era in the Treatment of Chronic Subdural Hematomas. Radiographics 2024; 44:e240038. [PMID: 38451849 DOI: 10.1148/rg.240038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Arindam Rano Chatterjee
- From the Mallinckrodt Institute of Radiology and Departments of Neurosurgery and Neurology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Schmolling ÁH, Pérez-García C, Trejo C, López-Frías A, Jaroenngarmsamer T, Rosati S, Arrazola J, Moreu M. Middle Meningeal Artery Embolization for Management of Chronic Subdural Hematoma. Radiographics 2024; 44:e230158. [PMID: 38451847 DOI: 10.1148/rg.230158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Chronic subdural hematoma (CSDH) is a prevalent medical condition with potentially severe consequences if left untreated. While surgical removal has traditionally been the standard approach for treatment, middle meningeal artery (MMA) embolization has emerged as a promising minimally invasive alternative to reduce recurrences. This comprehensive review provides the general radiology community with an overview of MMA embolization as a therapeutic option for managing CSDH. The authors base their insights on existing evidence and their institutional experience. This overview encompasses the pathophysiology of CSDH as well as the potential advantages and limitations, safety profile, and potential complications of MMA embolization as compared with surgical treatment. The imaging findings seen before and after MMA, as well as insights into the procedural techniques used at the authors' institution, are described. On the basis of reports in the current literature, MMA embolization appears to be a safe and effective therapeutic option for managing CSDH, especially in patients who are unsuitable for surgery or at risk for recurrence. Nonetheless, further research is needed to validate these findings. Results from ongoing clinical trials hold promise for future validation and the establishment of scientific evidence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chatterjee in this issue.
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Affiliation(s)
- Ángela H Schmolling
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Carlos Pérez-García
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Carmen Trejo
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Alfonso López-Frías
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Tanaporn Jaroenngarmsamer
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Santiago Rosati
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Juan Arrazola
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Manuel Moreu
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
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Heinonen A, Rauhala M, Isokuortti H, Raj R, Kataja A, Nikula M, Öhman J, Iverson GL, Luoto T. Incidence of surgically treated chronic subdural hematoma after head injury with normal initial computed tomography. Acta Neurochir (Wien) 2024; 166:144. [PMID: 38514587 PMCID: PMC10957655 DOI: 10.1007/s00701-024-06040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT). METHODS A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital's emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39-79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%). RESULTS Two (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma. CONCLUSION The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.
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Affiliation(s)
- Aaro Heinonen
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Minna Rauhala
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anneli Kataja
- Department of Radiology, Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Milaja Nikula
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Juha Öhman
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
| | - Teemu Luoto
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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Levitt MR, Hirsch JA, Chen M. Middle meningeal artery embolization for chronic subdural hematoma: an effective treatment with a bright future. J Neurointerv Surg 2024; 16:329-330. [PMID: 38365442 DOI: 10.1136/jnis-2024-021602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Michael R Levitt
- Departments of Neurological Surgery, Radiology, Neurology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Joshua A Hirsch
- Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Chen
- Neurology, Neurosurgery and Radiology, Rush University Medical Center, Chicago, Illinois, USA
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Tsutsumi S, Sugiyama N, Ueno H, Ishii H. Are there characteristic indicators for increased pressure in chronic subdural hematoma? J Clin Neurosci 2024; 121:42-46. [PMID: 38354650 DOI: 10.1016/j.jocn.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical disorders. However, no study has yet documented biomarkers indicating increased CSDH pressure. This study aimed to explore such indicators. A total of 50 patients underwent measurement for CSDH pressure during burr-hole irrigation. The mean hematoma pressure was 16.8 ± 7.6 cmH2O with no significant difference between new-onset and recurrent CSDHs. In 12 patients with a CSDH pressure ≥25 cmH2O, further analyses were carried out. Eight of them had bilateral CSDHs. All six patients with a CSDH pressure ≥28 cmH2O suffered headaches before surgery. Two out of three patients with a CSDH pressure ≥29 cmH2O felt nauseous. In statistical analyses, headache was positively correlated with a high CSDH pressure, whereas age and hematoma thickness were negatively correlated with it. Patients' sex, initial Glasgow coma scale score, motor weakness, midline shift on computed tomography scans, and administration of anticoagulants/antiplatelet agents, showed no significant correlation. When patients with bilateral CSDHs are not older adults and suffering headaches, an increased CSDH pressure should be assumed. For such patients, a prompt hematoma evacuation is indicated.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Natsuki Sugiyama
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hideaki Ueno
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
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Chaliparambil RK, Nandoliya KR, Jahromi BS, Potts MB. Charlson Comorbidity Index and Frailty as Predictors of Resolution Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. World Neurosurg 2024; 183:e877-e885. [PMID: 38218440 DOI: 10.1016/j.wneu.2024.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Research on variables associated with chronic subdural hematoma (cSDH) resolution following middle meningeal artery embolization (MMAE) is limited. This study investigated the clinical utility of age-adjusted Charlson Comorbidity Index (ACCI) and modified 5-item Frailty Index (mFI - 5) for predicting cSDH resolution following MMAE. METHODS We identified patients who underwent MMAE at our institution between January 2018 and December 2022, with at least 20 days of follow-up and one radiographic follow-up study. Patient demographics, characteristics, and outcomes were collected. Complete resolution was defined as absence of subdural collections on CT-scan at last follow-up. Nonage adjusted CCI (CCI), ACCI, and mFI - 5 scores were calculated. Univariate and multivariable logistic regression analyzed the relationship between cSDH resolution and variables. A receiver operating characteristic (ROC) curve established the utility of ACCI and mFI - 5 in predicting hematoma resolution. RESULTS The study included 85 MMAE procedures. In univariate analysis, patients without resolution were older, had higher CCI, higher ACCI, higher mFI - 5, and were more likely to have diabetes mellitus. In multivarible analysis, CCI (OR: 0.66, 95% CI: 0.48, 0.91) was independently associated with resolution controlling for age and antithrombotic resumption. The area under the ROC (AUROC) curve was 0.75 (95% CI: 0.65-0.85) for ACCI and 0.64 (95% CI: 0.52-0.76) for mFI - 5. The optimal cutoffs for predicting resolution were ACCI ≥5 (sensitivity = 0.63, specificity = 0.77), and mFI - 5 > 0 (sensitivity = 0.84, specificity = 0.43). CONCLUSIONS ACCI and mFI - 5 moderately predict MMAE resolution and may aid in medical decision-making.
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Affiliation(s)
- Rahul K Chaliparambil
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Ken and Ruth Davee Department of Neurology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Ken and Ruth Davee Department of Neurology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Sha Z, Wu D, Dong S, Liu T, Wu C, Lv C, Liu M, Jiang W, Yuan J, Nie M, Gao C, Liu F, Zhang X, Jiang R. The value of computed tomography texture analysis in identifying chronic subdural hematoma patients with a good response to polytherapy. Sci Rep 2024; 14:3559. [PMID: 38347043 PMCID: PMC10861511 DOI: 10.1038/s41598-024-53376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
This study aimed to investigate the predictive factors of therapeutic efficacy for chronic subdural hematoma (CSDH) patients receiving atorvastatin combined with dexamethasone therapy by using clinical imaging characteristics in conjunction with computed tomography (CT) texture analysis (CTTA). Clinical imaging characteristics and CT texture parameters at admission were retrospectively investigated in 141 CSDH patients who received atorvastatin combined with dexamethasone therapy from June 2019 to December 2022. The patients were divided into a training set (n = 81) and a validation set (n = 60). Patients in the training data were divided into two groups based on the effectiveness of the treatment. Univariate and multivariate analyses were performed to assess the potential factors that could indicate the prognosis of CSDH patients in the training set. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the significant factors in predicting the prognosis of CSDH patients and was validated using a validation set. The multivariate analysis showed that the hematoma density to brain parenchyma density ratio, singal min (minimum) and singal standard deviation of the pixel distribution histogram, and inhomogeneity were independent predictors for the prognosis of CSDH patients based on atorvastatin and dexamethasone therapy. The area under the ROC curve between the two groups was between 0.716 and 0.806. As determined by significant factors, the validation's accuracy range was 0.816 to 0.952. Clinical imaging characteristics in conjunction with CTTA could aid in distinguishing patients with CSDH who responded well to atorvastatin combined with dexamethasone.
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Affiliation(s)
- Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Di Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Tao Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Chenrui Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Chuanxiang Lv
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Mingqi Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Feng Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury, Neuro-Repair, and Regeneration in the Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China.
- State Key Laboratory of Experimental Hematology, Tianjin Medical University General Hospital, Tianjin, China.
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Khorasanizadeh M, Paul U, Chang YM, Moore JM, Ogilvy CS, Thomas AJ. The effect of patient age on the degree of midline shift caused by chronic subdural hematomas: a volumetric analysis. J Neurosurg 2024; 140:537-543. [PMID: 37877977 DOI: 10.3171/2023.6.jns222890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/04/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Chronic subdural hematomas (CSDHs) are the among the most common conditions treated by neurosurgeons. Midline shift (MLS) is used as a radiological marker of CSDH severity and the potential need for urgent surgical evacuation. However, a patient's age may affect the degree of MLS for a given hematoma volume. This study aimed to investigate the correlation between the patient's age and the MLS caused by CSDH. METHODS The database of patients treated for CSDH was reviewed in a single institution. Patients with unilateral CSDH were included. To measure CSDH volume, the preprocedural head CT scans underwent 3D volumetric reconstruction using the TeraRecon software. The effect of age on MLS after adjusting for CSDH volume was investigated using linear regression analysis. RESULTS Sixty-nine hematomas in 69 patients were included. The age of patients ranged from 25 to 94 years (mean 71.6 years). Hematoma volume and MLS ranged from 27.8 to 215 mL (mean 99.3 mL) and 0-17 mm (mean 6.5 mm), respectively. On multivariate regression analysis, MLS showed a significant independent negative correlation with age after adjusting for CSDH volume (OR -0.11, 95% CI -0.16 to -0.06; p < 0.001), meaning that for a fixed CSDH volume, with each 10-year increase in age the MLS will reduce by 1.1 mm. Moreover, MLS-to-volume ratio showed a significant negative linear correlation with age (r2 = 0.32; p < 0.001). Ten-milliliter increments in CSDH volume resulted in a 1.09-mm increase in MLS in patients younger than 60 years, which is 2.4-fold higher compared to the 0.46-mm increase in those older than 75 years (p < 0.001). CONCLUSIONS For a fixed CSDH volume, older age correlates with significantly lower MLS. This could be explained by higher parenchymal compliance in older individuals due to increased brain atrophy, and a larger subdural space. Clinical use of MLS to estimate severity of CSDH and gauge treatment decisions should take the patient's age into account.
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Affiliation(s)
- MirHojjat Khorasanizadeh
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Umika Paul
- 2UMass Chan Medical School, Worcester, Massachusetts
| | - Yu-Ming Chang
- 3Department of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Justin M Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- 4Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
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11
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Vargas J, Pease M, Snyder MH, Blalock J, Wu S, Nwachuku E, Mittal A, Okonkwo DO, Kellogg RT. Automated Preoperative and Postoperative Volume Estimates Risk of Retreatment in Chronic Subdural Hematoma: A Retrospective, Multicenter Study. Neurosurgery 2024; 94:317-324. [PMID: 37747231 DOI: 10.1227/neu.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Several neurosurgical pathologies, ranging from glioblastoma to hemorrhagic stroke, use volume thresholds to guide treatment decisions. For chronic subdural hematoma (cSDH), with a risk of retreatment of 10%-30%, the relationship between preoperative and postoperative cSDH volume and retreatment is not well understood. We investigated the potential link between preoperative and postoperative cSDH volumes and retreatment. METHODS We performed a retrospective chart review of patients operated for unilateral cSDH from 4 level 1 trauma centers, February 2009-August 2021. We used a 3-dimensional deep learning, automated segmentation pipeline to calculate preoperative and postoperative cSDH volumes. To identify volume thresholds, we constructed a receiver operating curve with preoperative and postoperative volumes to predict cSDH retreatment rates and selected the threshold with the highest Youden index. Then, we developed a light gradient boosting machine to predict the risk of cSDH recurrence. RESULTS We identified 538 patients with unilateral cSDH, of whom 62 (12%) underwent surgical retreatment within 6 months of the index surgery. cSDH retreatment was associated with higher preoperative (122 vs 103 mL; P < .001) and postoperative (62 vs 35 mL; P < .001) volumes. Patients with >140 mL preoperative volume had nearly triple the risk of cSDH recurrence compared with those below 140 mL, while a postoperative volume >46 mL led to an increased risk for retreatment (22% vs 6%; P < .001). On multivariate modeling, our model had an area under the receiver operating curve of 0.76 (95% CI: 0.60-0.93) for predicting retreatment. The most important features were preoperative and postoperative volume, platelet count, and age. CONCLUSION Larger preoperative and postoperative cSDH volumes increase the risk of retreatment. Volume thresholds may allow identification of patients at high risk of cSDH retreatment who would benefit from adjunct treatments. Machine learning algorithm can quickly provide accurate estimates of preoperative and postoperative volumes.
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Affiliation(s)
- Jan Vargas
- Division of Neurosurgery, PRISMA Health, Greenville , South Carolina , USA
| | - Matthew Pease
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - M Harrison Snyder
- Department of Neurosurgery, Tufts Medical Center, Boston , Massachusetts , USA
| | - Jonathan Blalock
- University of South Carolina School of Medicine Greenville, Greenville , South Carolina , USA
| | - Shandong Wu
- Department of Neurosurgery, UPMC Healthcare System, Pittsburgh , Pennsylvania , USA
| | - Enyinna Nwachuku
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Aditya Mittal
- Department of Neurosurgery, University of Pittsburgh Medical Center Medical School, Pittsburgh , Pennsylvania , USA
| | - David O Okonkwo
- Department of Neurosurgery, UPMC Healthcare System, Pittsburgh , Pennsylvania , USA
| | - Ryan T Kellogg
- Department of Neurosurgery, University of Virginia, Charlottesville , Virginia , USA
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12
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Wang C, Liu C. Clinical Characteristics and Prognoses of Chronic Subdural Hematoma Patients with and without Head Trauma: A Retrospective Comparative Study. World Neurosurg 2024; 182:e837-e846. [PMID: 38101546 DOI: 10.1016/j.wneu.2023.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Head trauma is considered as the main cause of chronic subdural hematoma (CSDH). However, many patients develop CSDH with no identified cause. Herein, we conduct a comparative study to investigate the differences in clinical characteristics and surgical outcomes of CSDH patients with and without a history of head trauma. METHODS We retrospectively reviewed CSDH patients who underwent surgical treatment in our hospital between January 2013 and December 2021. Patients were categorized into a with head trauma (WHT) group and a without head trauma (WOHT) group for comparative analysis. RESULTS A total of 219 patients were included, 119 (54.3%) cases in the WHT group and 100 (45.7%) cases in the WOHT group. More cancer patients were found in the WOHT group than in the WHT group (P = 0.045). Both at discharge and 6-month follow-up, patients in the WOHT group achieved better clinical outcomes than the WHT group cases (P = 0.025 and 0.034, respectively). Furthermore, ordered multiclass logistic regression analyses indicated that a history of head trauma (odds ratio 2.151, 95% confidence interval 1.052-4.386; P = 0.036) was a risk factor significantly related to the unfavorable outcomes at 6-month follow-ups of CSDH. However, we did not find significant differences between the 2 groups in clinical manifestations, radiological characteristics, postoperative complications, mortality, and recurrence rates. CONCLUSIONS CSDH patients with a history of head trauma may be more susceptible to unfavorable outcomes; thus, they should be carefully evaluated and given more attention during hospitalization and after discharge.
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Affiliation(s)
- Chengjun Wang
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Cang Liu
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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13
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Abdollahifard S, Farrokhi A, Yousefi O, Valibeygi A, Azami P, Mowla A. Particle embolic agents for embolization of middle meningeal artery in the treatment of chronic subdural hematoma: A systematic review and meta-analysis. Interv Neuroradiol 2024; 30:94-104. [PMID: 36112765 PMCID: PMC10956449 DOI: 10.1177/15910199221125977] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/25/2022] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE In this systematic review and meta-analysis, we investigated the efficacy and safety of middle meningeal artery embolization (MMAE) using particle embolic agents to treat cSDH. METHODS To retrieve articles investigating outcomes of patients following MMAE with particle agents and to compare their outcome with conventional treatment, Scopus, PubMed, Embase, and Web of Science were searched using relevant keywords. Original articles with more than 10 cases were included. The meta-analysis was carried out using the R studio and the random-effects model. Publication bias was assessed using Peter's test and quality assessment using NIH tools. RESULTS Eleven studies with 359 patients were included. The analysis revealed a pooled recurrence rate of 5% (CI: 3-8%), a need for reoperation rate of 5% (3-9%), and a peri-procedural complication rate of 4% (CI:2-9%) following MMAE with particle embolic agents. The pooled rates of decrease in size or resolution of the hematoma were 85% (CI:66-94%) and 66% (39-86%), respectively. Comparing MMAE using particulate embolysate with conventional treatments, risk ratio (RR) of 0.10 (CI:0.04-0.27) was achieved for recurrence, 0.25(CI:0.13-0.49) for reoperation, and 0.34 (CI:0.16-0.27) for peri-procedural complications. 91% of cSDH cases responded to MMAE with particles in the way they showed either down-sizing or complete resolution of the hematoma on follow-up imaging. In comparison, this rate was found to be 63% following conventional treatment. CONCLUSION Middle meningeal artery embolization using particle embolysates is a safe and effective technique for the treatment of cSDH, whether as a standalone intervention or in combination with conventional treatments.
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Affiliation(s)
- Saeed Abdollahifard
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research center for neuromodulation and pain, Shiraz, Iran
| | - Amirmohammad Farrokhi
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research center for neuromodulation and pain, Shiraz, Iran
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Adib Valibeygi
- Fasa Neuroscience Circle (FNC), Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Pouria Azami
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
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14
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Petrov A, Kashevnik A, Haleev M, Ali A, Ivanov A, Samochernykh K, Rozhchenko L, Bobinov V. AI-Based Approach to One-Click Chronic Subdural Hematoma Segmentation Using Computed Tomography Images. Sensors (Basel) 2024; 24:721. [PMID: 38339438 PMCID: PMC10857356 DOI: 10.3390/s24030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
This paper presents a computer vision-based approach to chronic subdural hematoma segmentation that can be performed by one click. Chronic subdural hematoma is estimated to occur in 0.002-0.02% of the general population each year and the risk increases with age, with a high frequency of about 0.05-0.06% in people aged 70 years and above. In our research, we developed our own dataset, which includes 53 series of CT scans collected from 21 patients with one or two hematomas. Based on the dataset, we trained two neural network models based on U-Net architecture to automate the manual segmentation process. One of the models performed segmentation based only on the current frame, while the other additionally processed multiple adjacent images to provide context, a technique that is more similar to the behavior of a doctor. We used a 10-fold cross-validation technique to better estimate the developed models' efficiency. We used the Dice metric for segmentation accuracy estimation, which was 0.77. Also, for testing our approach, we used scans from five additional patients who did not form part of the dataset, and created a scenario in which three medical experts carried out a hematoma segmentation before we carried out segmentation using our best model. We developed the OsiriX DICOM Viewer plugin to implement our solution into the segmentation process. We compared the segmentation time, which was more than seven times faster using the one-click approach, and the experts agreed that the segmentation quality was acceptable for clinical usage.
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Affiliation(s)
- Andrey Petrov
- Polenov Russian Research Institute of Neurosurgery, Almazov National Medical Research Center, 191014 St. Petersburg, Russia; (A.P.); (A.I.); (K.S.); (L.R.); (V.B.)
| | - Alexey Kashevnik
- St. Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia;
| | - Mikhail Haleev
- St. Petersburg Federal Research Center of the Russian Academy of Sciences (SPC RAS), 199178 St. Petersburg, Russia;
| | - Ammar Ali
- Information Technologies and Programming Faculty, ITMO University, 197101 St. Petersburg, Russia;
| | - Arkady Ivanov
- Polenov Russian Research Institute of Neurosurgery, Almazov National Medical Research Center, 191014 St. Petersburg, Russia; (A.P.); (A.I.); (K.S.); (L.R.); (V.B.)
| | - Konstantin Samochernykh
- Polenov Russian Research Institute of Neurosurgery, Almazov National Medical Research Center, 191014 St. Petersburg, Russia; (A.P.); (A.I.); (K.S.); (L.R.); (V.B.)
| | - Larisa Rozhchenko
- Polenov Russian Research Institute of Neurosurgery, Almazov National Medical Research Center, 191014 St. Petersburg, Russia; (A.P.); (A.I.); (K.S.); (L.R.); (V.B.)
| | - Vasiliy Bobinov
- Polenov Russian Research Institute of Neurosurgery, Almazov National Medical Research Center, 191014 St. Petersburg, Russia; (A.P.); (A.I.); (K.S.); (L.R.); (V.B.)
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15
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Yang C, Lin G, Zhang J, Xie J, Yang J. Granuloma formation as a late complication of burr-hole surgery for chronic subdural hematoma. Brain Inj 2024; 38:3-6. [PMID: 38225760 DOI: 10.1080/02699052.2024.2304860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Surgical treatment remains the mainstream therapeutic regimen for chronic subdural hematoma (CSDH), and burr-hole craniostomy with subdural drainage is the preferable approach. Herein, we reported a case of intracranial granuloma formation as a late complication of burr-hole surgery for CSDH. CASE PRESENTATION A 31-year-old man presented with a 1-month history of headache. Head computed tomography (CT) showed a subdural hematoma in the left frontal-temporal-parietal region with significant midline shifting. A burr-hole evacuation of the hematoma with closed-system drainage was performed. CT obtained immediately after the surgery demonstrated that the hematoma was mostly evacuated. Nine months later, he presented to us again due to intermittent headache in the left temporoparietal region. Brain magnetic resonance imaging revealed a space-occupying mass at the site of the original hematoma. A bone-flap craniotomy was performed for resecting the mass. Histopathological examination revealed a granuloma. The microbial cultivation of the resected specimen was negative. The postoperative course was uneventful, and the headache was relieved. CONCLUSION Granuloma formation is an extremely rare late complication of burr-hole surgery for CSDH. Physicians involved in the perioperative management of CSDH should be aware of this condition, and bone-flap craniotomy may be warranted.
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Affiliation(s)
- Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Guozhong Lin
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | | | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
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16
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Nagashima Y, Araki Y, Nishida K, Kuramitsu S, Wakabayashi K, Shimato S, Kinkori T, Nishizawa T, Kano T, Hasegawa T, Noda A, Maeda K, Yamamoto Y, Suzuki O, Koketsu N, Okada T, Iwasaki M, Nakabayashi K, Fujitani S, Maki H, Kuwatsuka Y, Nishihori M, Tanei T, Nishikawa T, Nishimura Y, Saito R. Efficacy of intraoperative irrigation with artificial cerebrospinal fluid in chronic subdural hematoma surgery: study protocol for a multicenter randomized controlled trial. Trials 2024; 25:6. [PMID: 38166992 PMCID: PMC10759626 DOI: 10.1186/s13063-023-07889-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The surgical techniques for treatment of chronic subdural hematoma (CSDH), a common neurosurgical condition, have been discussed in a lot of clinical literature. However, the recurrence proportion after CSDH surgery remains high, ranging from 10 to 20%. The standard surgical procedure for CSDH involves a craniostomy to evacuate the hematoma, but irrigating the hematoma cavity during the procedure is debatable. The authors hypothesized that the choice of irrigation fluid might be a key factor affecting the outcomes of surgery. This multicenter randomized controlled trial aims to investigate whether intraoperative irrigation using artificial cerebrospinal fluid (ACF) followed by the placement of a subdural drain would yield superior results compared to the placement of a subdural drain alone for CSDH. METHODS The study will be conducted across 19 neurosurgical departments in Japan. The 1186 eligible patients will be randomly allocated to two groups: irrigation using ACF or not. In either group, a subdural drain is to be placed for at least 12 h postoperatively. Similar to what was done in previous studies, we set the proportion of patients that meet the criteria for ipsilateral reoperation at 7% in the irrigation group and 12% in the non-irrigation group. The primary endpoint is the proportion of patients who meet the criteria for ipsilateral reoperation within 6 months of surgery (clinical worsening of symptoms and increased hematoma on imaging compared with the postoperative state). The secondary endpoints are the proportion of reoperations within 6 months, the proportion being stratified by preoperative hematoma architecture by computed tomography (CT) scan, neurological symptoms, patient condition, mortality at 6 months, complications associated with surgery, length of hospital stay from surgery to discharge, and time of the surgical procedure. DISCUSSION We present the study protocol for a multicenter randomized controlled trial to investigate our hypothesis that intraoperative irrigation with ACF reduces the recurrence proportion after the removal of chronic subdural hematomas compared with no irrigation. TRIAL REGISTRATION ClinicalTrials.gov jRCT1041220124. Registered on January 13, 2023.
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Affiliation(s)
- Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Kazuki Nishida
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shunichiro Kuramitsu
- Department of Neurosurgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | | | - Shinji Shimato
- Department of Neurosurgery, Handa City Hospital, Handa, Japan
| | - Takeshi Kinkori
- Department of Neurosurgery, Okazaki City Hospital, Okazaki, Japan
| | | | - Takahisa Kano
- Department of Neurosurgery, Anjo Kosei Hospital, Anjo, Japan
| | | | - Atsushi Noda
- Department of Neurosurgery, Nishio Municipal Hospital, Nishio, Japan
| | - Kenko Maeda
- Department of Neurosurgery, JCHO Chukyo Hospital, Nagoya, Japan
| | - Yu Yamamoto
- Department of Neurosurgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Osamu Suzuki
- Department of Neurosurgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Naoki Koketsu
- Department of Neurosurgery, Tosei General Hospital, Seto, Japan
| | - Takeshi Okada
- Department of Neurosurgery, Kainan Hospital, Yatomi, Japan
| | - Masashige Iwasaki
- Department of Neurosurgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kiyo Nakabayashi
- Department of Neurosurgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Shigeru Fujitani
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hideki Maki
- Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohide Nishikawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Shi XY, Zhang JX, Tang ZX, Sun H, Shen Z. Severe spontaneous acute arterial subdural hematoma as an initial symptom of chronic myeloid leukemia. Br J Neurosurg 2023; 37:1721-1724. [PMID: 33605812 DOI: 10.1080/02688697.2021.1885625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examination、cytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.
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MESH Headings
- Humans
- Hematoma, Subdural, Acute/surgery
- Arteries
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Tomography, X-Ray Computed/adverse effects
- Computed Tomography Angiography
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
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Affiliation(s)
- Xiao-Yong Shi
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Xia Zhang
- Department of Clinical Psychology(Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310000, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Hu Sun
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Zheng Shen
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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Sato K, Horiguchi G, Teramukai S, Yoshida T, Shimizu F, Hashimoto N. Time-of-flight magnetic resonance angiography for detection of postoperative recurrence in patients with chronic subdural hematoma. Acta Neurol Belg 2023; 123:2167-2175. [PMID: 36478545 DOI: 10.1007/s13760-022-02154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Chronic subdural hematoma (CSDH) is associated with postoperative recurrence. Although various factors are involved in postoperative recurrence of CSDH, blood flow, especially in the middle meningeal artery (MMA), is considered to play an important role. We investigated whether the degree of signal intensity (SI) of the MMA on time-of-flight magnetic resonance angiography (TOF MRA) and various clinical factors are involved in recurrence of CSDH. METHODS The maximum SI of both MMAs was measured on TOF MRA images within 1 month before or after the initial surgery. RESULTS In total, 185 patients (20 with and 165 without recurrence of CSDH) were included in the analysis. The SI ratio and dementia were significant predictors of recurrence of CSDH (SI ratio: odds ratio [95% confidence interval (CI)] = 1.71 [1.32, 2.22], p < 0.0001; dementia: odds ratio [95% CI] = 7.41 [1.83, 30.1], p = 0.005). The estimated regression coefficients in the final model were 6.14 for the SI ratio and 1.28 for dementia. The risk score was derived according to these regression coefficients as follows: score = 5 × SI ratio + 1 (dementia: yes). With a score of 5, the predicted probability of recurrence was 2% [95% CI 0.7, 5.7], whereas with scores of 8 and 10, the probability was 43.3% [27.0, 61.1] and 89.5% [65.7, 97.5], respectively, which increased the risk of recurrence. CONCLUSION Patients with an increased SI ratio of the affected MMA on TOF MRA who underwent surgery for CSDH were significantly more likely to experience recurrence.
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Affiliation(s)
- Kimitoshi Sato
- Department of Neurosurgery, Seijinkai Shimizu Hospital, 12-2 Nakayoshimi-Cho, Nishikyo-Ku, Kyoto, 615-8237, Japan.
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Takashi Yoshida
- Department of Neurosurgery, Seijinkai Shimizu Hospital, 12-2 Nakayoshimi-Cho, Nishikyo-Ku, Kyoto, 615-8237, Japan
| | - Fuminori Shimizu
- Department of Neurosurgery, Seijinkai Shimizu Hospital, 12-2 Nakayoshimi-Cho, Nishikyo-Ku, Kyoto, 615-8237, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Zhang X, Sha Z, Gao C, Yuan J, He L, Huang J, Jiang R. Factors influencing wait-and-watch management in mild primary chronic subdural hematoma: a retrospective case-control study. Acta Neurol Belg 2023; 123:2277-2286. [PMID: 37269419 DOI: 10.1007/s13760-023-02293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To identify prognostic factors in patients with primary chronic subdural hematoma (CSDH) undergoing wait-and-watch management. METHODS A case-control study was conducted in a single center from February 2019 to November 2021 to identify independent influencing factors of wait-and-watch management in mild CSDH patients using wait-and-watch as monotherapy. A total of 39 patients who responded to wait-and-watch management (cases) and 24 nonresponders (controls) matched for age, sex, height, weight, MGS-GCS (Markwalder grading scale and Glasgow Coma Scale), and bilateral hematoma were included. Demographics, blood cell counts, serum biochemical levels, imaging data, and relevant clinical features at baseline were collected. RESULTS Univariate analysis revealed significant differences between cases and controls in hematoma volume, ability to urinate, maximal thickness of the hematoma, and hypodensity of the hematoma. Hypodense hematoma and hematoma volume were independently associated with the outcome in multivariate analysis. Combining these independently influencing factors revealed an area under the receiver operator characteristic curve of 0.741 (95% CI 0.609-0.874, sensitivity = 0.783, specificity = 0.667). CONCLUSIONS The results of this study may aid in identifying patients with mild primary CSDH who could benefit from conservative management. While wait-and-watch management may be an option in some cases, clinicians need to suggest medical interventions, such as pharmacotherapy, when appropriate.
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Affiliation(s)
- Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei He
- Department of Neurology, Chengde Central Hospital, Chengde, 067000, Hebei, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
- Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Tianjin, China.
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21
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Wasfie T, Young C, Naisan M, Senger B, Brimmeier A, Sobell FA, Stanbaugh C, Hille J, Hella J, Barber K. Acute Traumatic Subdural Hematoma in the Elderly and Associated Factors that May Influence Chronicity. Am Surg 2023; 89:6298-6300. [PMID: 36802907 DOI: 10.1177/00031348231157856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Traumatic acute subdural hematomas (TASDH) is by far the most common traumatic brain injury in adult patients with blunt trauma, who presented to the Emergency Department (ED). One of the serious sequale of TASDH is the development of Chronic Subdural Hematomas (CSD) with associated deterioration in mental status and convulsion.1,2 Studies to identify the risk factors that favors development of chronicity of TASDH are few and inconclusive. As seen in our prior initial study, there were few factors which were common in those who developed chronicity of their TASDH, and we elected to expand our pool of patients to include those admitted between the years of 2015 and 2021 with ATSDH and identify the common factors associated with development of CSD.
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MESH Headings
- Adult
- Humans
- Aged
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Brain Injuries/complications
- Brain Injuries, Traumatic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/surgery
- Risk Factors
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Affiliation(s)
- Tarik Wasfie
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Carly Young
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | | | | | - Alexis Brimmeier
- Central Michigan University Medical School, Mount Pleasant, MI, USA
| | | | | | - Jennifer Hille
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
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22
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Ren H, Wang L, Wang B, Fu Y, Zhang G, Yao A. Prediction of the prognosis of chronic/subacute subdural hematoma based on the ratio of volume to surface area. Minerva Gastroenterol (Torino) 2023; 69:591-594. [PMID: 37013388 DOI: 10.23736/s2724-5985.23.03419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Hao Ren
- Xinxiang Medical University, Xinxiang, China
- Department of Neurosurgery, The 988 Hospital of PLA, Zhengzhou, China
| | - Lei Wang
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Benhan Wang
- Department of Neurosurgery, The 988 Hospital of PLA, Zhengzhou, China
| | - Yu Fu
- Department of Neurosurgery, The 988 Hospital of PLA, Zhengzhou, China
| | - Guanglin Zhang
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Anhui Yao
- Department of Neurosurgery, The 988 Hospital of PLA, Zhengzhou, China -
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23
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Cheng PW, Tsai RA, Lee CH, Chen WC. Chronic subdural haematoma mimicking extrapyramidal symptoms. BMJ Case Rep 2023; 16:e255286. [PMID: 38050397 PMCID: PMC10693859 DOI: 10.1136/bcr-2023-255286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
A male patient in his 70s with chronic schizophrenia, who could previously walk independently, developed a gait disturbance without any significant neurological deficit. Initially, his short step length and unstable gait were thought to be related to extrapyramidal symptoms caused by medication side effects. We tapered his antipsychotic medication, but the unstable gait persisted. After 2 weeks of observation, we noted general weakness with left-side dominance, leading us to consider a focal brain lesion despite there being no recent history of falling or trauma. A CT scan of the brain showed chronic subdural haematoma and the patient underwent emergency surgery. After 14 days of treatment, he was discharged back to the chronic ward.
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Affiliation(s)
- Po Wen Cheng
- General Psychiatry Department, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| | - Ruei An Tsai
- General Psychiatry Department, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| | - Chien-Hui Lee
- Department of Neurosurgery, Buddhist Tzu-Chi General Hospital and Tzu-Chi University, Hualien, Taiwan
| | - Wen-Ching Chen
- General Psychiatry Department, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
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24
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Coyle AM, Graves EKM, Lang SS, Kennedy BC, Flanders TM, Tucker AM, Storm PB, Cahill AM, Pukenas BA, Madsen PJ. Middle meningeal artery embolization in the management of chronic subdural hematoma in medically complex pediatric neurosurgical patients: technical note. J Neurosurg Pediatr 2023; 32:617-622. [PMID: 37657116 DOI: 10.3171/2023.7.peds2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023]
Abstract
Middle meningeal artery (MMA) embolization has gained acceptance as a treatment for chronic subdural hematoma (cSDH) in adult patients but has not been well described in pediatric patients. Standard cSDH treatment has historically consisted of burr hole drainage with or without subdural drain placement. However, due to the high rate of recurrence and frequency of comorbidities within this population, as both pediatric and adult patients with cSDH frequently have concurrent cardiac disease and a need for anticoagulant therapies, MMA embolization has increasingly demonstrated its value as both an adjunctive and primary treatment. In this report, the authors present 3 cases of successful MMA embolization in medically complex children at a single institution. MMA embolization was used as a primary treatment modality and as an adjunctive therapy in the acute setting following surgical hematoma evacuation. Two patients were receiving anticoagulation treatment requiring reversal. Technical considerations specific to the pediatric population as well as those common to both the pediatric and adult populations are addressed. Further work is needed to define the optimal indications and outcomes for MMA embolization in children with cSDH.
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Affiliation(s)
- Anne M Coyle
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- 2Department of Neurosurgery, Temple University, Philadelphia
| | - Erin K M Graves
- 2Department of Neurosurgery, Temple University, Philadelphia
| | - Shih-Shan Lang
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- Departments of3Neurosurgery and
| | - Benjamin C Kennedy
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- Departments of3Neurosurgery and
| | - Tracy M Flanders
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- Departments of3Neurosurgery and
| | - Alexander M Tucker
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- Departments of3Neurosurgery and
| | - Phillip B Storm
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- Departments of3Neurosurgery and
| | - Anne Marie Cahill
- 4Division of Interventional Radiology, Children's Hospital of Philadelphia, Pennsylvania
- 5Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - Bryan A Pukenas
- Departments of3Neurosurgery and
- 5Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - Peter J Madsen
- 1Division of Neurosurgery, Children's Hospital of Philadelphia
- Departments of3Neurosurgery and
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25
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Mignucci-Jiménez G, Matos-Cruz AJ, Koskay G, Hanalioglu S, Gonzalez-Romo NI, Xu Y, Kovacs MS, Preul MC, Feliciano-Valls CE. Modified Puerto Rico Recurrence Scale for chronic subdural hematomas: augmenting the grading scale with postoperative pneumocephalus volume. Acta Neurochir (Wien) 2023; 165:3229-3238. [PMID: 37648846 DOI: 10.1007/s00701-023-05737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/30/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Chronic subdural hematomas (CSDHs) are common in the elderly, with a relatively high rate of recurrence after initial surgical intervention. Our research team previously created a predictive grading system, the Puerto Rico Recurrence Scale (PRRS), to identify patients at high risk of CSDH recurrence. In this study, we introduce a modification of the (mPRRS) that includes pneumocephalus volume, which has been independently associated with recurrence. METHODS A single-center Puerto Rican population-based retrospective study was performed to analyze data for patients treated for CSDH at 1 institution between July 1, 2017, and December 31, 2019. Univariate and multivariate analyses were used to create a grading scale predictive of recurrence. Retrospective validation was conducted for the cohort. RESULTS Of 108 patients included in the study, 42 had recurrence, and 66 had nonrecurrence. Postoperative subdural space, postoperative midline shift, and pneumocephalus volume were all higher with recurrence (P = 0.002, P = 0.009, and P < 0.001, respectively). Multivariate analysis was used to create a 6-point grading scale comprising 3 variables (pneumocephalus volume [< 10, 10-20, 21-30, and > 30 cm3], postoperative midline shift [< 0.4, 0.41-1.0, and > 1.0 cm], and laterality [unilateral and bilateral]). Recurrence rates progressively increased in low-risk to high-risk groups (2/18 [11%] vs 21/34 [62%]; P < 0.003). CONCLUSION The mPRRS incorporating pneumocephalus measurement improves CSDH recurrence prediction. The mPRRS indicated that patients with higher scores have a greater risk of recurrence and emphasized the importance of measuring postoperative variables for prediction. The mPRRS grading scale for CSDHs may be applicable not only to the Puerto Rican population but also to the general population.
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Affiliation(s)
- Giancarlo Mignucci-Jiménez
- Neurosurgery Section, Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
| | - Alejandro J Matos-Cruz
- Neurosurgery Section, Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Grant Koskay
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
| | - Sahin Hanalioglu
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
| | - Nicolas I Gonzalez-Romo
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
| | - Yuan Xu
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
| | - Melissa S Kovacs
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, C/O Neuroscience Publications, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
| | - Caleb E Feliciano-Valls
- Neurosurgery Section, Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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26
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Bodanapally UK, Aarabi B, Liang Y, Khalid M, Fleiter TR, Gandhi D. Quantitative DECT of Iodine in Chronic Subdural Hematoma as Surrogate of Membrane Exudation: A Pilot Feasibility Study. J Comput Assist Tomogr 2023; 47:951-958. [PMID: 37948371 DOI: 10.1097/rct.0000000000001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
OBJECTIVE We explore the feasibility to estimate the exudation from chronic subdural hematoma (CSDH) membranes, by using dual-energy computed tomography (DECT) quantification of iodine leak and test if the derived quantitative variables and membrane morphology correlates with hematoma volume, internal architecture (homogeneous, laminar, separated, and trabecular types), and fractional hyperdense hematoma at presentation. METHODS In this retrospective study, consecutive CSDH patients with postcontrast DECT head images from January 2020 and June 2021 were analyzed. Predictor variables derived from DECT were correlated with outcome variables followed by mixed-effects regression analysis. RESULTS The study included 36 patients with 50 observations (mean age, 72.6 years; standard deviation, 11.6 years); 31 were men. Dual-energy CT variables that correlated with hematoma volume were external membrane volume (ρ, 0.37; P = 0.008) and iodine concentration (ρ, -0.29; P = 0.04). Variables that correlated with separated type of hematoma were total iodine leak (median [Q 1 , Q 3 ], 68.3 mg [48.5, 88.9] vs 38.8 mg [15.5, 62.9]; P = 0.001) and iodine leak per unit membrane volume (median [Q 1 , Q 3 ], 16.47 mg/mL [10.19, 20.65] vs 8.68 mg/mL [5.72, 11.41]; P = 0.002). Membrane grade was the only variable that correlated with fractional hyperdense hematoma (ρ, 0.28; P = 0.05). Regression analysis showed total iodine leak as the strongest predictor of separated type hematoma (odds ratio [95% confidence interval], 1.06 per mg [1.01, 1.1]). CONCLUSIONS Dual-energy CT demonstrates iodine leak from CSDH membranes. The variables derived from DECT correlated with hematoma volume, internal architecture, and fractional hyperdense hematoma.
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Affiliation(s)
| | | | | | - Mazhar Khalid
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Dheeraj Gandhi
- From the Department of Diagnostic Radiology and Nuclear Medicine
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27
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Liu Z, Wang Y, Tang T, Zhang Y, Sun Y, Kuang X, Wei T, Zhou L, Peng A, Cao D, Hongsheng W, Qi W, Chenyi W, Shan Q. Time and Influencing Factors to Chronic Subdural Hematoma Resolution After Middle Meningeal Artery Embolization. World Neurosurg 2023; 179:e6-e14. [PMID: 36924886 DOI: 10.1016/j.wneu.2023.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE We sought to describe the resolution time of chronic subdural hematoma (CSDH) after middle meningeal artery embolization (MMAE) and potential variables that may affect hematoma resolution. METHODS A retrospective analysis was performed on CSDH patients between December 2018 and December 2021. Patient characteristics, radiologic manifestations, and data of hematoma resolution were recorded. Univariate and multivariate analyses were conducted to identify predictors of CSDH resolution time. RESULTS A total of 53 patients were enrolled including 53 hematomas. Only 1 participant relapsed and did not require surgical evacuation. Hematoma resolution was observed in 27 (50.9%) at 4 months and 48 (90.6%) cases at the last radiologic follow-up. The median MMAE-to-resolution time was 19 weeks (interquartile range: 8-24). The burr-hole irrigation + MMAE group showed faster hematoma resolution than MMAE alone during early follow-up periods, but no significant difference was found at 6 months. Increased thickness of residual hematoma, excessive postoperative midline shift, high-density hematoma, mixed-density hematoma, separated hematoma, and anticoagulant or antiplatelet agents used were predictive of nonresolution at 4 months as determined by univariate analysis, whereas anticoagulant or antiplatelet agents used and high-density hematoma were not significant on multivariate analysis. No significant association was noted between hematoma resolution and comorbidities or other hematoma radiologic features. CONCLUSIONS MMAE is an effective and minimally invasive treatment for CSDH with a lower recurrence rate. The median resolution time of CSDH following MMAE was 19 weeks (interquartile range: 8-24). Burr-hole irrigation contributed to early hematoma resolution but had no significant effect at 6 months. In addition, residual hematoma thickness, postoperative midline shift, and specific type of hematoma were associated with delayed hematoma resolution at 4 months.
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Affiliation(s)
- Zhensheng Liu
- Department of Interventional Radiology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Youwei Wang
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Tieyu Tang
- Department of Neurology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yunfeng Zhang
- Department of Neurology, the Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yong Sun
- Department of Interventional Radiology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - XiongWei Kuang
- Department of Interventional Radiology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Tingfeng Wei
- Department of Interventional Radiology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Longjiang Zhou
- Department of Interventional Radiology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Aijun Peng
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Demao Cao
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Wang Hongsheng
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Wentao Qi
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Wu Chenyi
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Qing Shan
- Stroke Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China.
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28
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Moser M, Coluccia D, Watermann C, Lehnick D, Marbacher S, Kothbauer KF, Nevzati E. Reducing morbidity associated with subdural drain placement after burr-hole drainage of unilateral chronic subdural hematomas: a retrospective series comparing conventional and modified Nelaton catheter techniques. Acta Neurochir (Wien) 2023; 165:3207-3215. [PMID: 36877329 DOI: 10.1007/s00701-023-05537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Placement of a subdural drain after burr-hole drainage of chronic subdural hematoma (cSDH) significantly reduces risk of its recurrence and lowers mortality at 6 months. Nonetheless, measures to reduce morbidity related to drain placement are rarely addressed in the literature. Toward reducing drain-related morbidity, we compare outcomes achieved by conventional insertion and our proposed modification. METHODS In this retrospective series from two institutions, 362 patients underwent burr-hole drainage of unilateral cSDH with subsequent subdural drain insertion by conventional technique or modified Nelaton catheter (NC) technique. Primary endpoints were iatrogenic brain contusion or new neurological deficit. Secondary endpoints were drain misplacement, indication for computed tomography (CT) scan, re-operation for hematoma recurrence, and favorable Glasgow Outcome Scale (GOS) score (≥ 4) at final follow-up. RESULTS The 362 patients (63.8% male) in our final analysis included drains inserted in 56 patients by NC and 306 patients by conventional technique. Brain contusions or new neurological deficits occurred significantly less often in the NC (1.8%) than conventional group (10.5%) (P = .041). Compared with the conventional group, the NC group had no drain misplacement (3.6% versus 0%; P = .23) and significantly fewer non-routine CT imaging related to symptoms (36.5% versus 5.4%; P < .001). Re-operation rates and favorable GOS scores were comparable between groups. CONCLUSION We propose the NC technique as an easy-to-use measure for accurate drain positioning within the subdural space that may yield meaningful benefits for patients undergoing treatment for cSDH and vulnerable to complication risks.
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Affiliation(s)
- Manuel Moser
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
| | - Daniel Coluccia
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Christoph Watermann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, Justus-Liebig-University, Gießen, Germany
| | - Dirk Lehnick
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Karl F Kothbauer
- Formerly Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland, and University of Basel, Basel, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Guo C, Zhang X, Hu Z, Guo K, Li Z, Li J, Peng J. Middle Meningeal Artery Embolization Combined With Endoscopic Treatment for Chronic Subdural Hematoma. J Craniofac Surg 2023; 34:2529-2532. [PMID: 37665073 DOI: 10.1097/scs.0000000000009715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE To explore the clinical feasibility of middle meningeal artery (MMA) embolization combined with endoscopic treatment for new or recurrent chronic subdural hematoma (CSDH). METHODS Twenty patients with CSDH treated in the Binzhou Medical University Hospital from June 2020 to October 2022 were analyzed retrospectively. The clinical information, prognosis, imaging results, and surgical results of the patients were collected and analyzed. The authors first performed MMA embolization, and then endoscopic treatment of CSDH was performed after successful embolization of MMA. Results: All 20 patients with CSDH were successfully treated with MMA embolization combined with endoscope-assisted evacuation. The symptoms of all patients were relieved, no surgical complications occurred, and no rebleeding and recurrence were found in follow-up computed tomography. CONCLUSION Middle meningeal artery embolization combined with endoscopic treatment of CSDH has a good clinical effect, and it may prevent postoperative recurrence.
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Affiliation(s)
- Chong Guo
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Xinfan Zhang
- Department of Neurosurgery, Binzhou People's Hospital, Binzhou, Shandong, China
| | - Zhongbo Hu
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Ke Guo
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Jianmin Li
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Jiangtao Peng
- Department of Neurosurgery, Binzhou Medical University Hospital
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Morales-Gómez JA, Garcia-Estrada E, Garza-Báez A, Mercado-Flores M, de León AMP. Subdural open drains as an effective and low-cost modality for the treatment of chronic subdural hematomas. Br J Neurosurg 2023; 37:1078-1081. [PMID: 33322934 DOI: 10.1080/02688697.2020.1858024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We present a series that describes the presenting features and clinical outcomes in patients with CSDH treated with a standardised technique and an open-drain placement. METHODS We reviewed the medical records of 155 consecutive patients at a single centre who underwent CSDH evacuation by placing burr holes, accompanied by intraoperative irrigation and a subdural Penrose drain between 2014 and 2018. RESULTS The mean age was 65.9 years, 81.9% were males. The most common clinical characteristics were an altered mental state (21.9%) and headache (12.9%). It was necessary to perform a second surgical intervention due to the evidence in the postoperative tomography of a residual hematoma in 10.3% of the cases; there were 2 cases of recurrence in 6 months (1.3%). Pneumonia (6.5%) and seizures (5.8%) were the most frequent medical complications. Intracranial infections accounted for 1.9%, and the mortality rate was 6.4% of cases. CONCLUSIONS We provided our experience with a low-cost and less-commonly used technique in the management of CSDH. This technique showed similar recurrence, mortality and intracranial infection rates to those reported in the literature for closed drainage systems. Additional studies will be required to assess this technique.
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Affiliation(s)
- Jesús Alberto Morales-Gómez
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Everardo Garcia-Estrada
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Azalea Garza-Báez
- Neuroradiology Division, University Center for Diagnostic Imaging, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mariana Mercado-Flores
- Neuroradiology Division, University Center for Diagnostic Imaging, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Angel Martínez-Ponce de León
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
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31
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Shimohigoshi W, Takase H, Haze T, Kobayashi Y, Manaka H, Kawasaki T, Sakata K, Yamamoto T. Renin-angiotensin-aldosterone system inhibitors as a risk factor for chronic subdural hematoma recurrence: A matter of debate. J Stroke Cerebrovasc Dis 2023; 32:107291. [PMID: 37579641 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/28/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES Chronic subdural hematoma (cSDH) is a common central nervous system condition. Recent reports indicate that cSDH affects long-term prognosis; however, its definitive risk factors remain unknown. An antihypertensive drug, renin-angiotensin-aldosterone system inhibitors (RAASi), can affect vascular permeability and cell proliferation processes, which may suppress the recurrence of cSDH. However, several studies have reported negative results to this effect. Therefore, we aimed to evaluate antihypertensive drugs, including RAASi, as risk factors for recurrent cSDH. MATERIALS AND METHODS A total of 203 consecutive cases of surgically treated cSDH were retrospectively reviewed. Clinical and radiological parameters were compared between the groups with and without cSDH recurrence to identify risk factors. RESULTS Of the included cases, 68 (33.5%) used RAASi and 37 (18.2%) developed recurrence within 60 days of surgery. In the multiple logistic regression analysis adjusted by composite risk score, the odds ratios (95% confidence interval) of RAASi, calcium channel blockers, diuretics, β and α blockers, for the recurrent risk of cSDH after surgery were 2.49 (1.16, 5.42), 1.79 (0.84, 3.82), 1.83 (0.62, 4.87), 0.90 (0.28, 2.44), and 0.96 (0.21, 3.20), respectively. The Cox proportional hazard model also demonstrated that RAASi-use was an independent risk factor for cSDH recurrence. CONCLUSIONS Present series suggests RAASi-use as a risk factor for cSDH recurrence, although the role of RAASi-use in cSDH remains debatable. Further studies for deeper understanding of the microenvironment of hematoma and the surroundings are preferable. (235 words).
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Affiliation(s)
- Wataru Shimohigoshi
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hajime Takase
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Tatsuya Haze
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.; Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Kobayashi
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawasaki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Acevedo-Aguilar L, Gaitán-Herrera G, Lozada-Martinez I, Bosque-Varela P, Moscote-Salazar L. Letter to the editor regarding "Unilateral chronic subdural hematoma due to spontaneous intracranial hypotension: a report of four cases". Br J Neurosurg 2023; 37:1426-1427. [PMID: 33538205 DOI: 10.1080/02688697.2021.1881761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Laura Acevedo-Aguilar
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia
| | - Gustavo Gaitán-Herrera
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia
| | - Ivan Lozada-Martinez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia
- Colombian Clinical Research Group in Neurocritical Care, School of Medicine, University of Cartagena, Cartagena, Colombia
- Latin American Council of Neurocritical Care, Cartagena, Colombia
| | - Pilar Bosque-Varela
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Austria
| | - Luis Moscote-Salazar
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia
- Colombian Clinical Research Group in Neurocritical Care, School of Medicine, University of Cartagena, Cartagena, Colombia
- Latin American Council of Neurocritical Care, Cartagena, Colombia
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Lichtblau N, Aliaga-Arias J, Kalaitzoglou D, Bodi I, Ashkan K, Bhangoo R, Vergani F, Joe D, Stanton B, Galloway J, Carlton-Jones L, Lavrador JP. IgG4-related hypertrophic pachymeningitis with chronic subdural haematoma. Pract Neurol 2023; 23:441-445. [PMID: 37460210 DOI: 10.1136/pn-2023-003750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 10/04/2023]
Abstract
Hypertrophic pachymeningitis is a rare disorder of the dura mater of the spine or brain. It can be caused by inflammatory, infective or neoplastic conditions or can be idiopathic. We report a man with hypertrophic pachymeningitis and bilateral chronic subdural haematoma caused by IgG4-related disease. We highlight the diagnostic challenges and discuss possible underlying mechanisms of subdural haematoma formation in inflammatory conditions. Isolated IgG4-related hypertrophic pachymeningitis with chronic subdural haematoma is very rare; previously reported cases have suggested a possible predilection for men in their sixth decade, presenting with headache as the dominant symptom. Given the rarity and complexity of the condition, it should be managed in a multidisciplinary team setting.
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Affiliation(s)
- Nicole Lichtblau
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jahard Aliaga-Arias
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita degli Studi di Brescia, Brescia, Italy
| | | | - Istvan Bodi
- Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ranj Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Dorothy Joe
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
- Neuropsychiatry Service, South London and Maudsley NHS Trust, London, UK
| | - James Galloway
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Lalani Carlton-Jones
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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Housley SB, Monteiro A, Khawar WI, Donnelly BM, Lian MX, Fritz AG, Waqas M, Cappuzzo JM, Snyder KV, Siddiqui AH, Levy EI, Davies JM. Volumetric resolution of chronic subdural hematomas treated with surgical evacuation versus middle meningeal artery embolization during immediate, early, and late follow up: propensity-score matched cohorts. J Neurointerv Surg 2023; 15:943-947. [PMID: 36137743 DOI: 10.1136/jnis-2022-019427] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Literature on volumetric resolution and recurrence over time between surgical evacuation alone (SEA) and standalone middle meningeal artery embolization (MMAE) in comparable chronic subdural hematoma (cSDH) patients is limited. METHODS A retrospective database analysis of cSDH patients managed with either SEA or MMAE was conducted. Propensity-score matching was performed for axial and coronal lengths, maximum diameter, and midline shift. Volumetric measurements at multiple time intervals and recurrence were compared between the groups. RESULTS 48 matched hematoma pairs in patients with similar demographics, comorbidities, medications, and symptoms were obtained. Median volume was significantly lower at 24 hours in the SEA group (12.6 mL vs 52.7 mL, p<0.001) but not at remaining intervals. Median volume reduction was significantly greater in the SEA group at 24 hours (39.1 mL vs 8.8 mL in the MMAE group, p<0.001) and at 3-12 weeks (50.8 mL vs 23.7 mL, p<0.001), but not at remaining intervals. The SEA group had a significantly greater median hematoma resolution rate at 24 hours (39.1 mL/day vs 8.8 mL/day, p<0.001) and 3-12 weeks (1 mL/day vs 0.4 mL/day, p<0.001), but not at remaining intervals. Near-complete resolution at 3-12 weeks and 12-60 weeks was not significantly different between groups. Overall, the recurrence rate was significantly higher in the SEA group (22.9% vs 4.2%, p=0.01). CONCLUSIONS In comparable cSDH patients, SEA resulted in better volumetric outcomes in immediate postoperative and early follow-up periods, as expected. However, this difference was not significant at more distant follow-up intervals. Furthermore, surgical patients experienced a significantly higher rate of recurrence.
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Affiliation(s)
- Steven B Housley
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Wasiq I Khawar
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Brianna M Donnelly
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ming Xia Lian
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Alexander G Fritz
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kenneth V Snyder
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jason M Davies
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Gao C, Wei Y, Zhang X, Huang J, Nie M, Liu X, Yuan J, Wang D, Tian Y, Jiang W, An S, Sun J, Sha Z, Fan Y, Feng J, Liu M, Dong S, Wu D, Zhang J, Wang J, Jiang R. Craniocervical Manual Lymphatic Drainage Increases the Efficiency of Atorvastatin-Based Treatment of Chronic Subdural Hematoma. Transl Stroke Res 2023; 14:667-677. [PMID: 35907128 DOI: 10.1007/s12975-022-01062-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
The objective of this study is to explore whether craniocervical manual lymphatic drainage (cMLD) can promote hematoma absorption and increase the efficiency of atorvastatin-based conservative treatment in chronic subdural hematoma (CSDH) patients. All CSDH patients treated with atorvastatin-based therapy between October 2020 and February 2022 in our department were retrospectively screened for enrollment. The patients were divided into the control and cMLD groups according to whether cMLD was performed. Head CT or MR images in both groups were obtained before the treatment and 2 weeks and 4 weeks after the treatment. MR images of the deep cervical lymphatic nodes (dCLNs) in 23 patients were obtained in the cMLD group before and approximately 2 weeks after treatment. The volumes of the dCLNs and hematoma were calculated. The primary outcomes are the differences in hematoma volume reduction after 4 weeks of treatment. The secondary outcomes were (1) the differences in hematoma volume reduction between the patients in these two groups in the 2nd week, (2) the dCLN volume change in the cMLD group before and after 2 weeks of treatment, and (3) the percentage of patients who transitioned to surgery because of failure to the conservative treatment. A total of 106 consecutive patients were enrolled in this study for analysis; 54 patients received atorvastatin-based treatment (control group), and 52 were treated with both atorvastatin-based treatment and cMLD (cMLD group). At baseline, the mean hematoma volume was 76.53 ± 42.97 ml in the control group and 88.57 ± 49.01 ml in the cMLD group (p = 0.181). In the 4th week, the absolute number of hematoma reductions (20.79 ± 34.73 ml vs. 37.28 ± 28.24 ml, p = 0.009) and percentage of hematoma reductions (22.58% ± 60.01% vs. 46.43% ± 30.12%, p = 0.012) in the cMLD group were greater than those in the control group. After 2 weeks of treatment, the absolute number of hematoma reductions showed no difference in the two groups, while the percentage of hematoma reduction was higher in the cMLD group (18.18% ± 24.61% vs. 2.08% ± 25.72%, p = 0.001). One patient in cMLD and 8 patients in the control group were transitioned to receive surgical treatment. The dCLN volumes in 23 experimental patients increased significantly after 2 weeks of treatment in the cMLD group (p = 0.032). There were no severe side effects that needed to be reported. Combined with atorvastatin-based therapy, cMLD can promote hematoma absorption and decrease the surgery rate, which provides a new therapeutic strategy for CSDH.
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Affiliation(s)
- Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jiancheng Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Mingqi Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Di Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China.
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, China.
- Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education and Tianjin, Tianjin Neurological Institute, Tianjin, China.
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Fukunaga M, Yokota H, Nakagawa I, Nakase H. Acute-on-Chronic Subdural Hematoma Causing Uncal Herniation. Neurol India 2023; 71:1094-1095. [PMID: 37929488 DOI: 10.4103/0028-3886.388057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Motoki Fukunaga
- Department of Neurosurgery, Osaka General Medical Center, Osaka; Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroshi Yokota
- Department of Neurosurgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Mowla A, Abdollahifard S, Farrokhi A, Yousefi O, Valibeygi A, Azami P. Middle Meningeal Artery Embolization with Liquid Embolic Agents for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2023; 34:1493-1500.e7. [PMID: 37182671 DOI: 10.1016/j.jvir.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Abstract
PURPOSE To assess the efficacy and safety of middle meningeal artery (MMA) embolization with liquid embolic agents and the outcomes of patients following this procedure. MATERIALS AND METHODS A review of the literature was conducted to identify studies investigating the efficacy and safety of MMA embolization with liquid embolic agents in patients with chronic subdural hematoma (cSDH) in PubMed, Scopus, Embase, and Web of Science. The keywords "liquid embolic agent," "middle meningeal artery," "cSDH," and "embolization" as well as their synonyms were used to build up the search strategy. The R statistical software and random-effects model were used for analysis. Heterogeneity was reported as I2, and publication bias was calculated using the Egger test. RESULTS Of 628 articles retrieved, 14 studies were eligible to be included in this study. Data of 276 patients were analyzed. n-Butyl cyanoacrylate and ethylene vinyl alcohol copolymer were the most commonly used embolic agents. This study revealed a pooled mortality rate of 0% (95% confidence interval [CI], 0.00%-100%), recurrence and failure rate of 3% (95% CI, 1%-10%), reoperation/reintervention rate of 4% (95% CI, 2%-12%), rate of size decrease of 94% (95% CI, 79%-98%), technical success rate of 100% (95% CI, 76%-100%), and adverse event rate of 1% (95% CI, 0.00%-4%). CONCLUSIONS With low mortality, recurrence, reoperation, and adverse event rates and a remarkable decrease in the size of hematomas, MMA embolization with liquid embolic agents may be considered a safe and effective treatment option in patients in whom surgical intervention has previously failed and as an alternative to conventional treatments.
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Affiliation(s)
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California.
| | - Saeed Abdollahifard
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz
| | - Amirmohammad Farrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz
| | - Adib Valibeygi
- Fasa Neuroscience Circle, Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Pouria Azami
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz
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Aarabi B. Commentary: Recurrent Chronic Subdural Hematoma After Burr-Hole Surgery and Postoperative Drainage: A Systematic Review and Meta-Analysis. Oper Neurosurg (Hagerstown) 2023; 25:e121-e123. [PMID: 37427949 DOI: 10.1227/ons.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Tefera EA, Assefa MA, Molla YD. Symptomatic calcified chronic subdural hematoma in an elderly patient: a case report. J Med Case Rep 2023; 17:348. [PMID: 37580801 PMCID: PMC10426188 DOI: 10.1186/s13256-023-04078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Calcified chronic subdural hematoma is a rare and infrequent diagnosis made in clinical practice according to the literature. Calcification of chronic subdural hematoma is found more frequently in children and young adults than in the aged. The proposed mechanism of calcification may involve poor circulation and absorption in the subdural space together with intravascular thrombosis and prolonged existence of the hematoma in the subdural space. CLINICAL PRESENTATION An 84-year-old Ethiopian male patient presented with progressive right-sided body weakness of 8-month duration. The weakness started in the right lower extremity and progressively involved the upper extremity. Associated with the above complaint, he had had also a globalized headache of the same duration. Pre- and post-contrast brain computed tomography scans showed a right hemispheric extra-axial collection that crossed the suture line, with a maximum depth of 2.3 cm. Subsequently, craniotomy and hematoma evacuation were carried out and the patient was discharged improved. CONCLUSION The most common symptom of calcified chronic subdural hematoma is headache followed by lethargy, confusion, memory impairment weakness, and seizures. A diminished level of consciousness is relatively common and motor deficits are usually manifested as hemiparesis or gait disturbance. Most calcified chronic subdural hematomas can be diagnosed by computed tomography or magnetic resonance imaging and differentiated from the usual chronic subdural hematoma by imaging studies and gross pathology. Surgical treatment is advised in symptomatic patients when feasible, and often results in neurological improvement. Here we presented a patient with an uncommon calcified chronic subdural hematoma, which was successfully evacuated, resulting in a good recovery.
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Affiliation(s)
- Esayas Adefirs Tefera
- Department of Surgery, Collage of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Alemneh Assefa
- Department of Surgery, Collage of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannis Derbew Molla
- Department of Surgery, Collage of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Svedung Wettervik T, Sundblom J, Ronne-Engström E. Inflammatory biomarkers differentiate the stage of maturation in chronic subdural hematomas. J Neuroimmunol 2023; 381:578127. [PMID: 37364514 DOI: 10.1016/j.jneuroim.2023.578127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Inflammation is a major pathophysiological driver of the development of chronic subdural hematomas (CSDH), but there is still limited knowledge on the key molecular processes and corresponding biomarkers involved in this disease. In this study, the aim was to study a subset of inflammatory biomarkers and their relation to the clinical status of the patient and the radiological characteristics of the CSDH. METHODS In this observational study, 58 patients who were operated on with CSDH evacuation, at the Department of Neurosurgery, Uppsala, Sweden, between 2019 and 2021, were prospectively included. The CSDH fluid was collected peri-operatively and was later analyzed with proximity extension assay (PEA) technique (Olink) for a panel of 92 inflammatory biomarkers. Demographic, neurological (Markwalder), radiological (general (Nakaguchi classification) and focal (septa below the burr holes)), and outcome variables were collected. RESULTS In 84 of the 92 inflammatory biomarkers, the concentration was above the detection limit in >50% of the patients. There was a significant difference in GDNF, NT-3, and IL-8 depending on the Nakaguchi class, with higher values in the trabeculated CSDH subtype. In addition, those with septa at the focal area of CSDH collection, had higher levels of GDNF, MCP-3, NT-3, CXCL1, CXCL5, IL8, and OSM. There was no association between Markwalder grade and the inflammatory biomarkers. CONCLUSIONS Our findings support the presence of local inflammation in the CSDH, a shift in biomarker pattern as the CSDH matures towards the trabeculated state, potentially differences in biomarker patterns within the CSDH depending on the focal environment with presence of septa, and that the brain might develop protective mechanisms (GDNF and NT-3) in case of mature and long-standing CSDHs.
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Affiliation(s)
- Teodor Svedung Wettervik
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Jimmy Sundblom
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Elisabeth Ronne-Engström
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85 Uppsala, Sweden
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Ryu HS, Kim SS, Hong WJ, Kim TS, Joo SP. Differences in gross appearance and histopathology of the outer membrane of the subdural hematoma envelope over time: A respective case series and literature review. Medicine (Baltimore) 2023; 102:e34257. [PMID: 37478245 PMCID: PMC10662858 DOI: 10.1097/md.0000000000034257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 07/23/2023] Open
Abstract
RATIONALE Chronic subdural hematoma (CSDH) is a common disorder among elderly males. The most common theory of its cause is a minor brain injury resulting in the rupture of a bridging vein. The outer membrane of subdural hematoma (SDH) evolves like cutaneous wound healing with different phases. This report aims to use a surgical microscope and an electron microscope to show the pathophysiological differences in the temporal flow of the outer membrane of SDH. PATIENT CONCERNS This study retrospectively reviewed the cases of 6 patients who underwent craniotomy from 2016 to 2021 at the single center of Chonnam National University Hospital. DIAGNOSES These patients had a history of intracranial hematoma (ICH) at the surgical site on brain computed tomography (CT) before craniotomy. This study aimed to observe the morphological changes over time in the outer membrane of SDH and analyzed them through macroscopic and pathological findings. INTERVENTIONS AND OUTCOMES The outer membrane of SDH was confirmed in all six patients who underwent surgery, and macroscopic analysis was performed using an operating microscope. Three patients underwent pathological analysis through histological examination, and through this, the difference according to ICH occurrence and detection time was analyzed. LESSONS This study suggests that the outer membrane of SDH contains inflammatory and collagen cells in the early stages and thickens over time. This healing response is similar to cutaneous wound healing.
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Affiliation(s)
- Han Seung Ryu
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung Sun Kim
- Department of Pathology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Woo Jun Hong
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
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Vasoya P, Raj V, Khan K, Thakar S, Aryan S. Primary intracranial sarcoma masquerading as a chronic subdural haematoma: illustrative case and review of an unusual phenomenon. Childs Nerv Syst 2023; 39:1957-1962. [PMID: 36932253 DOI: 10.1007/s00381-023-05919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
It is very unusual for a primary intracranial malignancy to present as a chronic subdural hematoma. This case report describes one such case in a 3-year-old girl who presented with raised intracranial pressure following a mild head injury. Imaging of her brain revealed bilateral chronic subdural hematomas with an enhancing subdural mass and multiple nodular lesions infiltrating the brain parenchyma. She underwent a craniotomy, drainage of the subdural collections and resection of the subdural mass. Histopathology revealed an undifferentiated sarcoma, and she was referred for adjuvant therapy. This case underlines the importance of evaluating paediatric subdural collections for a possible underlying malignancy, even in the background of a preceding head injury. The cause-effect relationship of sarcomas with subdural collections remains unclear because of the scarcity of available literature on the subject.
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Affiliation(s)
- Pavan Vasoya
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India
| | - Khurram Khan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India.
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, ITPL Main Road, Bangalore, 560066, Karnataka, India
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Aarabi B. Commentary: Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review. Oper Neurosurg (Hagerstown) 2023; 24:e466-e467. [PMID: 37040099 DOI: 10.1227/ons.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 04/12/2023] Open
Affiliation(s)
- Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
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Abstract
OBJECTIVE To describe a case of persistent facial nerve palsy after middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH). METHODS A literature search was conducted for publications within the last 10 years of facial nerve palsy following cerebral circulation embolization procedures. RESULTS With inconsistencies between previously believed pathophysiology and clinical features, other mechanisms causing cSDH such as angiogenesis and capillary formation have been proposed. MMA embolization has evolved as a therapeutic approach to reduce recurrence of subdural hematoma; however, postoperative neural complications such as cranial nerve palsies are poorly described in the literature. CONCLUSIONS cSDH is increasingly more common and is on trajectory to become the most prevalent cranial neurosurgical condition. MMA embolization is described as a safe and minimally invasive procedure; however, as a relatively new procedure further research is needed to elucidate associated complications.
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Affiliation(s)
- Ally Ferber
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
| | - Brian Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
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Takroni R, Zagzoog N, Patel N, Martyniuk A, Singh S, Farrokhyar F, Trivedi A, Alotaibi M, Algird A. Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence. J Neurol Surg A Cent Eur Neurosurg 2023; 84:157-166. [PMID: 34784622 DOI: 10.1055/a-1698-6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. METHODS We retrospectively analyzed the charts of 172 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: group A (n = 123) received a pediatric size nasogastric tube [NGT]), whereas group B (n = 49) had a drain commonly used for external ventricular drainage (EVD). Various demographic and radiologic data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. RESULTS In all, 212 cases of CSDH were treated in 172 patients. The majority of patients were male (78%) and had a history of previous head trauma (73%). Seventeen cases had recurrence, 11 in group A and 6 in group B. The use of antiplatelet and anticoagulation agents was associated with recurrence (p = 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence (odds ratio [OR] = 1.42; 95% confidence interval [CI]: 0.49-4.08; p = 0.573). CONCLUSION CSDH is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to reduce the incidence of recurrence, little is known about the best type of drain to use. Our analysis showed no difference in the recurrence rate between using the pediatric size NGT and the EVD catheter post-TDC.
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Affiliation(s)
- Radwan Takroni
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
- King Faisal Medical City for Southern Regions, Abha, Saudi Arabia
| | - Nirmeen Zagzoog
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Nimita Patel
- Department of Health, Evidence and Impact, McMaster University, Ontario, Canada
| | - Amanda Martyniuk
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Sheila Singh
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health, Evidence and Impact, McMaster University, Ontario, Canada
| | - Arunachala Trivedi
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Mazen Alotaibi
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Almunder Algird
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
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Familiari P, Lapolla P, Relucenti M, Battaglione E, Cristiano L, Sorrentino V, Aversa S, D'Amico A, Puntorieri P, Bruzzaniti L, Mingoli A, Brachini G, Barbaro G, Scafa AK, D'Andrea G, Frati A, Picotti V, Berra LV, Petrozza V, Nottola S, Santoro A, Bruzzaniti P. Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties. Sci Rep 2023; 13:3400. [PMID: 36854960 PMCID: PMC9975247 DOI: 10.1038/s41598-023-30135-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.
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Affiliation(s)
- Pietro Familiari
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Oxford University Hospital, Headington, Oxford, OX3 9DU, UK.
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy.
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy.
| | - Michela Relucenti
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy
| | - Ezio Battaglione
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Loredana Cristiano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Veronica Sorrentino
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Sara Aversa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessia D'Amico
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
- Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Rome, Italy
| | | | - Lucia Bruzzaniti
- DICEAM Department, University Mediterranea of Reggio Calabria, Reggio Calabria, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Giuseppe Barbaro
- DICEAM Department, University Mediterranea of Reggio Calabria, Reggio Calabria, Italy
| | | | | | - Alessandro Frati
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy
| | - Veronica Picotti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
- Division of Neurosurgery, Policlinico Tor Vergata, University Tor Vergata of Rome, Rome, Italy
| | | | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Stefania Nottola
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Placido Bruzzaniti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
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Miah IP, Blanter A, Tank Y, Zwet EWV, Rosendaal FR, Peul WC, Dammers R, Holl DC, Lingsma HF, den Hertog HM, van der Naalt J, Jellema K, der Gaag NAV. Change in Hematoma Size after Dexamethasone Therapy in Chronic Subdural Hematoma Subtypes: A Prospective Study in Symptomatic Patients. J Neurotrauma 2023; 40:228-239. [PMID: 36029208 DOI: 10.1089/neu.2022.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The main treatment strategy for chronic subdural hematoma is surgical intervention. When a conservative pharmacological approach is considered in symptomatic patients, mainly dexamethasone therapy is applied. Recent trials revealed dexamethasone therapy to be an ineffective treatment in symptomatic patients with chronic subdural hematoma. Whether the efficacy of dexamethasone therapy differs in radiological hematoma subtypes is unknown. The aim of this substudy was to identify which hematoma subtype might be favorable for dexamethasone therapy. As part of a randomized controlled trial, symptomatic chronic subdural hematoma patients received 19-days dexamethasone therapy. The primary outcome measure was the change in hematoma size as measured on follow-up computed tomography (CT) after 2 weeks of dexamethasone in six hematoma (architectural and density) subtypes: homogeneous total, laminar, separated and trabecular architecture types, and hematoma without hyperdense components (homogeneous hypodense, isodense) and with hyperdense components (homogeneous hyperdense, mixed density). We analyzed hematoma thickness, midline shift, and volume using multi-variable linear regression adjusting for age, sex and baseline value of the specific radiological parameter. From September 2016 until February 2021, 85 patients were included with a total of 114 chronic subdural hematoma. The mean age was 76 years and 25% were women. Larger decrease in hematoma thickness and midline shift was revealed in hematoma without hyperdense components compared with hematoma with hyperdense components (adjusted [adj.] b -2.2 mm, 95% confidence interval [CI] -4.1 to -0.3 and adj. b -1.3 mm, 95% CI -2.7 to 0.0 respectively). Additional surgery was performed in 57% of patients with the highest observed rate (81%) in separated hematoma. Largest hematoma reduction and better clinical improvement was observed in chronic subdural hematoma without hyperdense components after dexamethasone therapy. Evaluation of these parameters can be part of an individualized treatment strategy.
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Affiliation(s)
- Ishita P Miah
- Department of Neurology, Amphia Hospital, Breda, the Netherlands
- Department of Neurology and Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Anastassia Blanter
- Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Yeliz Tank
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik W van Zwet
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco C Peul
- Department of Neurology and Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dana C Holl
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health and Medical Decision Making, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Korné Jellema
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Niels A Van der Gaag
- Department of Neurology and Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
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Bodanapally UK, Fleiter TR, Aarabi B, Malhotra A, Gandhi D. Dual-energy CT imaging of chronic subdural hematoma membranes: technical note. Eur Radiol 2023; 33:797-802. [PMID: 35999369 DOI: 10.1007/s00330-022-09064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 02/03/2023]
Abstract
This technical note describes a novel dual-energy CT (DECT) protocol with iodine map reconstruction that will enable visualization of chronic subdural hematoma (CSDH) membranes. We describe the technique and discuss the potential implications for surgical management. The cohort included 36 patients with 50 hematomas. Enhancing external membrane was demonstrated in all the 50 hematomas, incomplete internal membrane in 13, and complete internal membrane in 23 hematomas. A spandrel sign at the transition zone that indicates partial or complete formation of internal membrane was demonstrated in 36 hematomas. KEY POINTS: • Iodine maps from 5-min delayed post-contrast DECT provide spectral contrast difference and facilitate segregation of chronic subdural hematoma membranes. • The ability to image the membranes helps in assessing the degree of organization of the hematoma by providing the information about the membrane thickness, volume, complexity of the membranes, and the proportion of the liquefied component within the hematoma before surgical procedures are undertaken. • Membrane visualization helps in the localization of the transition zone and extension of the membranes over the cerebral lobes helping in the determination of craniotomy location and size, during membranectomy.
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Affiliation(s)
- Uttam K Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD, 21201, USA.
| | - Thorsten R Fleiter
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Dheeraj Gandhi
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD, 21201, USA
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Henry J, Amoo M, Crockett MT, Javadpour M. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma-A New Treatment Paradigm? World Neurosurg 2023; 172:3-4. [PMID: 36682525 DOI: 10.1016/j.wneu.2023.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jack Henry
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland; Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Amoo
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland; Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew T Crockett
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland; Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | - Mohsen Javadpour
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland; Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Academic Neurology, Trinity College Dublin, Dublin, Ireland
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50
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Wang L. Regarding "Emergency Department Visits for Chronic Subdural Hematomas within 30 Days after Surgical Evacuation with and without Middle Meningeal Artery Embolization". AJNR Am J Neuroradiol 2023; 44:E2. [PMID: 36549847 PMCID: PMC9835900 DOI: 10.3174/ajnr.a7654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- L Wang
- Department of NeurosurgeryZhongnan Hospital of Wuhan UniversityWuhan, China
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