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Dreznik Y, Sher C, Baazuv A, Yekutiel G, Kravarusic D. Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery. World J Surg 2024; 48:1261-1265. [PMID: 38554245 DOI: 10.1002/wjs.12167] [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: 11/18/2023] [Accepted: 03/17/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Pilonidal sinus disease (PSD) is a common surgical disease. Multiple surgical methods exist in the literature, without clear consensus regarding which should be the first-line treatment. Minimally invasive methods such as the Gips procedure are gaining popularity in recent years. The aim of our study was to assess recurrence rates following the Gips procedure and to determine whether using the same surgical approach during re-operation is efficient and successful. METHODS This is a single-center retrospective observational study of pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022. RESULTS 565 pediatric patients underwent an elective surgery for PSD in the study period. Recurrence rate was 8.1% (n = 46). In all the patients with recurrence, re-operation took place on average 9 months following the first surgery and using the same surgical method. Following the second surgery, only 8 patients (1%) had multiple recurrences. CONCLUSIONS We found a relatively low recurrence rate in the pediatric population using the Gips method, and nearly 100% success rate following the second operation. Our findings set a new benchmark for pediatric recurrence following PSD operation, with clear recommendation to use the same method of surgery upon further recurrences as well.
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Affiliation(s)
- Yael Dreznik
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmel Sher
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Artur Baazuv
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Yekutiel
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dragan Kravarusic
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Havryliv T, Devinyak O, Yartym O, Smolanka A, Volodymyr S, Okoro EU. Single-Center Comparison of Chronic Subdural Hematoma Evacuation Outcomes Under Local Versus General Anesthesia. World Neurosurg 2024; 184:e39-e44. [PMID: 38154679 DOI: 10.1016/j.wneu.2023.12.116] [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: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a neurosurgical pathology of an aged populace. Pathogenetic risk factors include traumatic brain injury, prolonged use of antiplatelet drugs, hypertension, and some inflammatory processes. The incidence increases as patients age. Burr-hole evacuation is the most common approach in management of symptomatic cases. We compared evacuation of chronic subdural hematomas with general or local anesthesia (GA and LA, respectively) and evaluated the safety, economic benefits, effects of comorbidity, benefits, and shortcomings of both techniques. METHODS We conducted a retrospective study of 67 consecutive patients who had 74 procedures for CSDH in a single neurosurgical center, the Regional Clinic, Centre of Neurosurgery and Neurology, over a 3-year period. They were grouped into the GA group (n = 44) and LA group (n = 23). Mean duration of procedure, length of hospital stay, complications, and preoperative and postoperative neurologic statuses were compared. The distribution of nominal variables between groups was compared using the Fisher exact test. The average duration of operation and length of hospital stay were compared using the Mann-Whitney U-test due to violation of the normality assumption. RESULTS LA proved to be as effective as GA in CSDH evacuation. Seventy-four surgical procedures were performed on 67 patients due to recurrence in less than 30 days in 7 patients. Fifteen patients had tension pneumocephalus managed with fluid therapy to full recovery. LA was economical and required shorter hospital stays and surgical time. CONCLUSIONS In our studies, LA proved to be noninferior to GA, time conserving, and less prone to some of the adverse effects of GA on elderly patients with comorbidity, although some patients who are hyperactive or contraindicated to LA will require GA.
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Affiliation(s)
- Taras Havryliv
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine; Municipal Non-Profit Enterprise "Regional Clinic, Center of Neurosurgery and Neurology" Transcarpathian Regional Council, Uzhhorod, Ukraine
| | - Oleg Devinyak
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine
| | - Oleksandr Yartym
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine; Municipal Non-Profit Enterprise "Regional Clinic, Center of Neurosurgery and Neurology" Transcarpathian Regional Council, Uzhhorod, Ukraine
| | - Andriy Smolanka
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine; Municipal Non-Profit Enterprise "Regional Clinic, Center of Neurosurgery and Neurology" Transcarpathian Regional Council, Uzhhorod, Ukraine
| | - Smolanka Volodymyr
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine; Municipal Non-Profit Enterprise "Regional Clinic, Center of Neurosurgery and Neurology" Transcarpathian Regional Council, Uzhhorod, Ukraine
| | - Emmanuel Uzoma Okoro
- Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine; Municipal Non-Profit Enterprise "Regional Clinic, Center of Neurosurgery and Neurology" Transcarpathian Regional Council, Uzhhorod, Ukraine.
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Puhahn-Schmeiser B, Wegent H, Won SY, Zentner J, Freiman TM. Efficacy and safety of bedside percutaneous three-millimeter twist-drill trephination under local anesthesia-a retrospective study of 1000 patients. Acta Neurochir (Wien) 2024; 166:87. [PMID: 38366108 DOI: 10.1007/s00701-024-05958-7] [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: 10/11/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Percutaneous 3-mm twist-drill trephination (TDT) under local anesthesia as a bedside operative technique is an alternative to the conventional open surgical trephination in the operating theatre. The aim of this study was to verify the efficacy and safety of this minimal invasive procedure. METHODS This retrospective study comprises 1000 patients who were treated with TDT under local anesthesia at bedside due to chronic subdural hematoma (cSDH), intracerebral hemorrhage (ICH), and hydrocephalus (HYD) as a result of subarachnoid hemorrhage or non-hemorrhagic causes, increased intracranial pressure (IIP) in traumatic brain injury or non-traumatic brain edema, and other pathologies (OP) requiring drainage. Medical records, clinical outcome, and results of pre- and postoperative computed tomography (CT) and/or magnetic resonance tomography (MRT) were analyzed. RESULTS Indications for TDT were cSDH (n = 275; 27.5%), ICH (n = 291; 29.1%), HYD (n = 316; 31.6%), IIP (n = 112; 11.2%), and OP (n = 6; 0.6%). Overall, primary catheter placement was sufficient in 93.8% of trephinations. Complication rate was 14.1% and mainly related to primary catheter malposition (6.2%), infections (5.2%), and secondary hemorrhage (2.7%); the majority of which were clinically inapparent puncture channel bleedings not requiring surgical intervention. The revision rate was 13%. CONCLUSIONS Bedside TDT under local anesthesia has proven to be an effective and safe alternative to the conventional burr-hole operative technique as usually performed under general anesthesia in the operation theatre, and may be particularly useful in emergency cases as well as in elderly and multimorbid patients.
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Affiliation(s)
- Barbara Puhahn-Schmeiser
- Department of Neurosurgery, University Medical Center, Albert-Ludwigs-University, Breisacher Strasse 64, Freiburg, 79106, Germany.
| | - Hendrike Wegent
- Department of Neurosurgery, University Medical Center, Albert-Ludwigs-University, Breisacher Strasse 64, Freiburg, 79106, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medical Center Rostock, Schillingallee 35, Rostock, 18097, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Medical Center, Albert-Ludwigs-University, Breisacher Strasse 64, Freiburg, 79106, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, University Medical Center Rostock, Schillingallee 35, Rostock, 18097, Germany
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Schack A, Rønn Jensen TS, Jensen MH, Miscov R, Sindby AK, Fugleholm K, Bergholt B, Bjarkam CR, Poulsen FR, Grønhøj MH. Intraoperative Irrigation and Risk of Chronic Subdural Hematoma Recurrence. Oper Neurosurg (Hagerstown) 2024; 26:203-212. [PMID: 37819102 DOI: 10.1227/ons.0000000000000941] [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] [Received: 07/17/2023] [Accepted: 08/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In most neurosurgical centers, irrigation is an essential part of the surgical procedure for chronic subdural hematoma (CSDH). However, it is unknown whether the volume of irrigation fluid affects the risk of CSDH recurrence. This study aimed to investigate a potential association between the volume of irrigation fluid used during burr hole evacuation of CSDH and the risk of CSDH recurrence. METHODS This study is a subanalysis of 2 randomized trials (Drain Time & Drain Time 2) designed to investigate the effect of drainage duration on the recurrence of CSDH. Intraoperative irrigation volume was measured, and patients were followed for 90 days for recurrent CSDH. RESULTS A total of 525 patients with CSDH were included. There was no significant difference in the volume of irrigation fluid used between patients with recurrence (mean = 938 mL, SD = ±552) and without recurrence (mean = 852 mL, SD = ±454) ( P -value = .15). Patients with recurrent CSDH had larger primary CSDH volumes (mean = 134 cm 3 , SD = ±69) than patients without recurrence (mean = 119 cm 3 , SD = ±58) ( P = .04). Multiple logistic regression analysis revealed no association between irrigation volume and recurrence, also when stratified for hematoma size. CONCLUSION There was no significant association between irrigation volume and recurrent CSDH within 90 days in patients undergoing burr hole surgery for CSDH.
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Affiliation(s)
- Anders Schack
- Department of Neurosurgery, Odense University Hospital, Odense , Denmark
- Department of Clinical Research and BRIDGE (Brain Research - Inter Disciplinary Guided Excellence), University of Southern Denmark, Odense , Denmark
| | | | - Mette Haldrup Jensen
- Department of Neurosurgery, Odense University Hospital, Odense , Denmark
- Department of Clinical Research and BRIDGE (Brain Research - Inter Disciplinary Guided Excellence), University of Southern Denmark, Odense , Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus , Denmark
| | - Rares Miscov
- Department of Neurosurgery, Aalborg University Hospital, Aalborg , Denmark
| | | | - Kåre Fugleholm
- Department of Neurosurgery, Rigshospitalet, Copenhagen , Denmark
| | - Bo Bergholt
- Department of Neurosurgery, Aarhus University Hospital, Aarhus , Denmark
| | | | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense , Denmark
- Department of Clinical Research and BRIDGE (Brain Research - Inter Disciplinary Guided Excellence), University of Southern Denmark, Odense , Denmark
| | - Mads Hjortdal Grønhøj
- Department of Neurosurgery, Odense University Hospital, Odense , Denmark
- Department of Clinical Research and BRIDGE (Brain Research - Inter Disciplinary Guided Excellence), University of Southern Denmark, Odense , Denmark
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Sauvigny J, Mader MMD, Freundlieb N, Gempt J, Westphal M, Zöllner C, Mende A, Czorlich P. Patient perception and satisfaction in awake burr hole trepanation under local anesthesia for evacuation of chronic subdural hematoma. Clin Neurol Neurosurg 2024; 236:108085. [PMID: 38134758 DOI: 10.1016/j.clineuro.2023.108085] [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: 11/13/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Evacuation of chronic subdural hematoma (CSDH) will be one of the most common neurosurgical procedures in the future in the increasingly aging societies. Performing cranial surgery on awake patients may place a psychological burden on them. Aim of this study was to evaluate the psychological distress of patients during awake CSDH relief. Patients with awake evacuation of CSDH via burr hole trepanation were included in our monocentric prospective study. Patient perception and satisfaction were measured using standardized surveys 3-5 days and 6 months after surgery. Among other questionnaires, the Hospital Anxiety and Depression and the Impact of Event Scale, were used to quantify patients' stress. A total of 50 patients (mean age 72.9 years (range 51 - 92)) were included. During surgery, 28 patients reported pain (mean 4.1 (SD 3.3)). Postoperatively, 26 patients experienced pain (mean 2.7 (SD 2.6)). Patients' satisfaction with intraoperative communication was reported with a mean of 8.3 (SD 2.1). There was a significant negative correlation between intraoperatively perceived pain and satisfaction with intraoperative communication (p = 0.023). Good intraoperative communication during evacuation of CSDH in awake patients is associated with positive patient perception and correlates with pain reduction.
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Affiliation(s)
- Jennifer Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Nils Freundlieb
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Mende
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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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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Carrillo-Ruiz JD, Muratti-Molina EB, Cojuc-Konigsberg G, Carrillo-Márquez JR. Trephinations, Trephines, and Craniectomies: Contrast Between Global Ancient Civilizations and Pre-Hispanic Mexican Cultures. World Neurosurg 2023; 179:49-59. [PMID: 36966913 DOI: 10.1016/j.wneu.2023.03.088] [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: 01/30/2023] [Accepted: 03/21/2023] [Indexed: 06/18/2023]
Abstract
Mesoamerica is culturally rich in diverse aspects, such as nature, sociology, and archeology. Several neurosurgical techniques were described during the Pre-Hispanic era. In Mexico, various cultures, such as the Aztec, Mixtec, Zapotec, Mayan, Tlatilcan, and Tarahumara, developed surgical procedures using different tools to perform cranial and probably brain interventions. Trepanations, trephines, and craniectomies are different concepts utilized to describe skull operations, which were conducted to treat traumatic, neurodegenerative, and neuropsychiatric diseases, and as a prominent form of ritual practice. More than 40 skulls have been rescued and studied in this region. In addition to written medical sources, archeological vestiges allow a more profound comprehension of Pre-Columbian brain surgery. The purpose of this study is to present the existing evidence of cranial surgery in Pre-Hispanic Mexican civilizations and their worldwide counterparts, procedures that have contributed to the global neurosurgical armamentarium, and have significantly impacted the medical practice's evolution.
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Affiliation(s)
- José Damian Carrillo-Ruiz
- Faculty of Health Sciences, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico; Stereotactic and Functional Neurosurgery, Hospital General de Mexico, Mexico City, Mexico, Ciudad de México, CDMX, Mexico; Research Direction, Hospital General de Mexico, Mexico City, Mexico, Ciudad de México, CDMX, Mexico; Neurosciences Coordination, Faculty of Psychology, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico.
| | - Eugenia Beatriz Muratti-Molina
- Faculty of Health Sciences, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico; Alpha Health Sciences Leadership Program, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico
| | - Gabriel Cojuc-Konigsberg
- Faculty of Health Sciences, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico; Alpha Health Sciences Leadership Program, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico
| | - José Rodrigo Carrillo-Márquez
- Faculty of Health Sciences, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico; Alpha Health Sciences Leadership Program, Anahuac University, Mexico City, Mexico, Naucalpan de Juárez, Estado de México, Mexico
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Assumpcao de Monaco B, Benjamin CG, Doomi A, Taylor R, Stringfellow CE, Benveniste RJ, Jagid JR, Graciolli Cordeiro J. Safety Analysis of a New Portable Electrical Drill With a Smart Autostop Mechanism for Bedside Cranial Procedures. Oper Neurosurg (Hagerstown) 2023; 25:311-314. [PMID: 37543731 PMCID: PMC10468110 DOI: 10.1227/ons.0000000000000804] [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: 02/07/2023] [Accepted: 04/28/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bedside procedures are often helpful for neurosurgical patients, especially in neurocritical care. Portable drills with technological advancements may bring more safety and efficiency to the bedside. In this study, we compared the safety and efficiency of a new cordless electric drill with smart autostop ("HD"-Hubly Cranial Drill, Hubly Surgical) with those of a well-established standard traditional electrical neurosurgical perforator ("ST"). METHODS A cadaveric study was conducted using both drills to perform several burr holes in the fronto-temporo-parietal region of the skull. An evaluation was performed on the number of dura plunges, and complete burr hole success rates were compared. RESULTS A total of 174 craniotomies using the HD and 36 burr holes using the ST perforator were performed. Despite significantly exceeding intended drill bit tolerance by multiple uses of a single-use disposable HD, autostop engaged in 100% of the 174 craniotomies and before violating dura in 99.4% of the 174 craniotomies, with the single dura penetration occurring on craniotomy no. 128 after the single-use drill bit had significantly dulled beyond its single-use tolerance. Autostop engaged before dura penetration for 100% of the 36 burr holes drilled with the ST perforator ( P = .610). All the perforations were complete using the HD after resuming drilling. An autostop mechanism in a cranial drill is not commonly available for portable bedside perforators. In the operating room, most use a mechanical method to stop the rotation after losing bone resistance. This new drill uses an electrical mechanism (smart autostop) to stop drilling, making it a single-use cranial drill with advanced features for safety and efficiency at the bedside. CONCLUSION There was no difference in the safety and efficacy of the new cordless electric drill with smart autostop when performing craniotomies compared with a traditional well-established electric cranial perforator with mechanical autostop on a cadaveric model.
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Affiliation(s)
| | | | - Ahmed Doomi
- Neurosurgery, Jackson Memorial Hospital, University of Miami, Florida, USA
| | - Ruby Taylor
- Neurosurgery, Jackson Memorial Hospital, University of Miami, Florida, USA
| | | | | | - Jonathan R. Jagid
- Neurosurgery, Jackson Memorial Hospital, University of Miami, Florida, USA
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Satoh M, Nakajima T, Ohtani K, Konno T, Tetsuka M, Kawai K. Dual-floor Burr Hole Technique Optimized for Modern Burr Hole Caps with an Internal Electrode Locking Mechanism. Neurol Med Chir (Tokyo) 2023; 63:432-435. [PMID: 37423753 PMCID: PMC10556209 DOI: 10.2176/jns-nmc.2023-0047] [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: 04/27/2023] [Indexed: 07/11/2023] Open
Abstract
Insertion of a deep brain stimulating electrode is a commonly performed procedure. Burr hole caps play an important role in this procedure by immobilizing this electrode; however, burr hole caps could form scalp bumps, which can create further complications. The dual-floor burr hole technique could prevent the formation of scalp bumps. This technique has previously been used with older versions of burr hole caps and has proved to be successful. In recent years, modern burr hole caps with an internal electrode locking mechanism have become the mainstay for this procedure. However, modern burr hole caps differ considerably in diameter and shape from older burr hole caps. In the present study, a dual-floor burr hole technique was performed using modern burr hole caps. To accommodate the increase in diameters and changes in the shape of modern burr hole caps, a perforator with a 30-mm diameter was used for shaving the bone, and the bone shaving depth was altered. This surgical technique was applied to 23 consecutive deep brain stimulation surgeries without complications and was thus positively optimized for modern burr hole caps.
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Affiliation(s)
- Makoto Satoh
- Department of Neurosurgery, Jichi Medical University
| | | | | | | | | | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University
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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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Al-Salihi MM, Al-Jebur MS, Al-Salihi Y, Saha R, Hammadi F, Al Hajali A, Ayyad A. Comparison of Burr-Hole Craniostomy versus Twist-Drill Craniostomy Operations for Patients with Chronic Subdural Hematoma: A Systematic Review and Network Meta-Analysis. World Neurosurg 2023; 176:229-236.e7. [PMID: 37178912 DOI: 10.1016/j.wneu.2023.05.022] [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: 04/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) represents one of the most common neurologic disorders in the elderly. However, the optimum surgical option remains questionable. This study aims to compare the safety and efficacy of single burr-hole craniostomy (sBHC), double burr-hole craniostomy (dBHC), and twist-drill craniostomy (TDC) in patients with CSDH. METHODS We searched PubMed, Embase, Scopus, Cochrane, and Web of Science until October 2022 for prospective trials. Primary outcomes comprised recurrence and mortality. The analysis was performed using R software, and the results were reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS Data from 11 prospective clinical trials were included in this network meta-analysis. We found that dBHC significantly decreased recurrence and reoperation rates compared with TDC (RR = 0.55, CI, 0.33-0.90 and RR = 0.48, CI, 0.24-0.94, respectively). However, sBHC showed no difference compared with dBHC and TDC. There was no significant difference among dBHC, sBHC, and TDC regarding the hospitalization duration, complication rates, mortality, and cured rates. CONCLUSIONS dBHC seems to be the best modality for CSDH compared with sBHC and TDC. It showed significantly less recurrence and reoperation rates compared with TDC. On the other hand, dBHC showed no significant difference with the other comparators regarding complication, mortality, and cure rates in addition to the hospitalization duration.
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Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; College of Medicine, University of Baghdad, Baghdad, Iraq; Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
| | | | | | - Ram Saha
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Firas Hammadi
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
| | - Amro Al Hajali
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Baig AA, Hess RM, Khan A, Cappuzzo JM, Turner RC, Hashmi E, Bregy A, Kuo CC, Nyabuto E, Goyal AD, Davies JM, Levy EI, Siddiqui AH. Use of Novel Automated Active Irrigation With Drainage Versus Passive Drainage Alone for Chronic Subdural Hematoma-A Propensity Score-Matched Comparative Study With Volumetric Analysis. Oper Neurosurg (Hagerstown) 2023; 24:630-640. [PMID: 36723341 DOI: 10.1227/ons.0000000000000630] [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: 09/21/2022] [Accepted: 11/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications. OBJECTIVE To explore the use of a novel double-lumen active automated irrigation and aspiration system, IRRAflow (IRRAS), for patients with cSDH and compared procedural and clinical outcomes against passive drainage alone with propensity score matching (PSM) and volumetric analysis. METHODS A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded. RESULTS This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM) and passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigation-drainage group (0.5 ± 0.4 vs 0.4 ± 0.5 mL/day) and in the passive drainage group; odds ratio (OR) = 1.291 (CI: 1.062-1.570, P = .002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = .039). A nonsignificantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs 23.8%; OR = 0.127; P = .186). No statistical difference in all-cause in-hospital mortality or discharge Glasgow Coma Scale score was observed between groups. CONCLUSION Active and automated continuous irrigation plus drainage after cSDH surgical evacuation resulted in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared with passive irrigation.
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Affiliation(s)
- Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ryan C Turner
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Eisa Hashmi
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Amade Bregy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elizabeth Nyabuto
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Aditya D Goyal
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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de Paula MVCT, Ribeiro BDC, Melo MM, de Freitas PVV, Pahl FH, de Oliveira MF, Rotta JM. Effect of postoperative tranexamic acid on recurrence rate and complications in chronic subdural hematomas patients: preliminary results of a randomized controlled clinical trial. Neurosurg Rev 2023; 46:90. [PMID: 37071217 PMCID: PMC10111300 DOI: 10.1007/s10143-023-01991-9] [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: 01/12/2023] [Revised: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. A prospective, randomized, and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6 months and potential clinical and/or surgical complications impact of TXA. Twenty-six patients were randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 to 16 months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplatelet or anticoagulants, smoking, alcoholism, systemic arterial hypertension, diabetes mellitus, hematoma laterality, hematoma thickness, and drain use. Clinical and radiological recurrence occurred in three patients (6%), being two cases in TXA group (8.3%) and 1 in control group (3.8%). Postoperative complications occurred in two patients during follow-up (4%), being both cases in TXA group (8.3%), and none in the control group. Although TXA group had a higher recurrence rate (8.3%), there was no statistically significant difference between the two groups. Moreover, TXA group had two complications while control group had no complications. Although limited by experimental nature of study and small sample, our current data suggest that TXA should not be used as a potential agent to avoid recurrences of CSDH and might increase complication odds.
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Affiliation(s)
- Marcus Vinícius Carneiro Torres de Paula
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil
| | - Bernardo Duarte Chamon Ribeiro
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil
| | - Marina Mendes Melo
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil
| | - Pedro Victor Vidal de Freitas
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil
| | - Felix Hendrik Pahl
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil
| | - Matheus Fernandes de Oliveira
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil.
| | - José Marcus Rotta
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, 04029-000, Brazil
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14
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Li G, Du L, Yu F. Clinical efficacy of minimally invasive puncture and drainage versus trepanation and drainage for chronic subdural hematoma: Systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32860. [PMID: 36930074 PMCID: PMC10019251 DOI: 10.1097/md.0000000000032860] [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: 12/23/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the clinical efficacy of minimally invasive puncture and drainage (MIPD) versus trepanation and drainage in the treatment of chronic subdural hematoma (CSDH). METHODS PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched for studies on the treatment of CSDH by MIPD and trepanation and drainage. By reading the title, abstract and full text, and screening according to the inclusion and exclusion criteria, the qualified articles were confirmed. Subsequently, the literature quality was evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions, and the data of the research subjects and the primary outcome measures were extracted for meta-analysis with RevMan 5.1 software. RESULTS Ten articles were included, with a total of 1000 patients. According to the meta-analysis, the 2 groups showed no statistical difference in CSDH recurrence rate (P > .05). The operation time, intraoperative blood loss, and incidence of postoperative adverse reactions were lower and the cure rate was higher in the MIPD group compared with trepanation and drainage group (all P < .05). By drawing the funnel plot of the outcome measures with heterogeneity, it can be seen that the distribution on both sides of the funnel was basically symmetrical, suggesting a low deviation possibility of the analysis results and reliable reference significance of our findings. CONCLUSION Compared with trepanation and drainage, MIPD has better clinical effects and higher safety in treating CSDH and can effectively reduce surgery-induced damage, which is worth popularizing in clinical practice.
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Affiliation(s)
- Guangfeng Li
- Department of Neurosurgery, Liaocheng People’s Hospital and Liaocheng Brain Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng City, Shandong Province, People’s Republic of China
| | - Lele Du
- Department of Neurosurgery, Liaocheng People’s Hospital and Liaocheng Brain Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng City, Shandong Province, People’s Republic of China
| | - Fuhua Yu
- Department of Neurosurgery, Liaocheng People’s Hospital and Liaocheng Brain Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng City, Shandong Province, People’s Republic of China
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15
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Lee RP, Meggyesy M, Ahn J, Ritter C, Suk I, Machnitz AJ, Huang J, Gordon C, Brem H, Luciano M. First Experience With Postoperative Transcranial Ultrasound Through Sonolucent Burr Hole Covers in Adult Hydrocephalus Patients. Neurosurgery 2023; 92:382-390. [PMID: 36637272 PMCID: PMC10553054 DOI: 10.1227/neu.0000000000002221] [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: 03/09/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Managing patients with hydrocephalus and cerebrospinal fluid (CSF) disorders requires repeated head imaging. In adults, it is typically computed tomography (CT) or less commonly magnetic resonance imaging (MRI). However, CT poses cumulative radiation risks and MRI is costly. Ultrasound is a radiation-free, relatively inexpensive, and optionally point-of-care alternative, but is prohibited by very limited windows through an intact skull. OBJECTIVE To describe our initial experience with transcutaneous transcranial ultrasound through sonolucent burr hole covers in postoperative hydrocephalus and CSF disorder patients. METHODS Using cohort study design, infection and revision rates were compared between patients who underwent sonolucent burr hole cover placement during new ventriculoperitoneal shunt placement and endoscopic third ventriculostomy over the 1-year study time period and controls from the period 1 year before. Postoperatively, trans-burr hole ultrasound was performed in the clinic, at bedside inpatient, and in the radiology suite to assess ventricular anatomy. RESULTS Thirty-seven patients with sonolucent burr hole cover were compared with 57 historical control patients. There was no statistically significant difference in infection rates between the sonolucent burr hole cover group (1/37, 2.7%) and the control group (0/57, P = .394). Revision rates were 13.5% vs 15.8% (P = 1.000), but no revisions were related to the burr hole or cranial hardware. CONCLUSION Trans-burr hole ultrasound is feasible for gross evaluation of ventricular caliber postoperatively in patients with sonolucent burr hole covers. There was no increase in infection rate or revision rate. This imaging technique may serve as an alternative to CT and MRI in the management of select patients with hydrocephalus and CSF disorders.
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Affiliation(s)
- Ryan P. Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Michael Meggyesy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Jheesoo Ahn
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Christina Ritter
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - A. Judit Machnitz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Chad Gordon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
- Section of Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
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Krauss P, Van Niftrik CHB, Muscas G, Scheffler P, Oertel MF, Stieglitz LH. How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients. Acta Neurochir (Wien) 2021; 163:177-184. [PMID: 32960362 DOI: 10.1007/s00701-020-04588-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/27/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery. METHODS We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy. RESULTS We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus. CONCLUSION Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery.
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Affiliation(s)
- Philipp Krauss
- Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Christiaan Hendrik Bas Van Niftrik
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Muscas
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Careggi University Hospital Florence, Florence, Italy
| | - Pierre Scheffler
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Lennart Henning Stieglitz
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
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Piacentino M, Beggio G, Rustemi O, Zambon G, Pilleri M, Raneri F. Pneumocephalus in subthalamic deep brain stimulation for Parkinson's disease: a comparison of two different surgical techniques considering factors conditioning brain shift and target precision. Acta Neurochir (Wien) 2021; 163:169-175. [PMID: 33174114 DOI: 10.1007/s00701-020-04635-9] [Citation(s) in RCA: 12] [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: 06/03/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Precise placement of electrodes in deep brain stimulation (DBS) may be influenced by brain shift caused by cerebrospinal fluid leaking or air inflow. We compared accuracy and treatment outcomes between a standard technique and one aiming at reducing brain shift. METHODS We retrospectively reviewed 46 patients (92 targets) treated with bilateral subthalamic-DBS for Parkinson's disease. The patients were divided into two groups: group A surgery was performed in supine position with standard burr hole, dural opening, fibrin glue and gelfoam plugging. Group B patients were operated in a semi-sitting position with direct dural puncture to reduce CSF loss. We analysed target deviation on head CT performed immediately after surgery and at 1 month merged with preoperative MRI planning. We recorded pneumocephalus volume, brain atrophy and target correction by intraoperative neurophysiology (ION). RESULTS In group A, the mean pneumocephalus volume was 10.55 cm3, mean brain volume 1116 cm3, mean target deviation 1.09 mm and ION corrected 70% of targets. In group B, mean pneumocephalus was 7.60 cm3 (p = 0.3048), mean brain volume 1132 cm3 (p = 0.6526), mean target deviation 0.64 mm (p = 0.0074) and ION corrected 50% of targets (p = 0.4886). Most leads' deviations realigned to the planned target after pneumocephalus reabsorbtion suggesting a deviation caused by displacement of anatomical structures due to brain shift. Definitive lead position was always decided with ION. CONCLUSIONS The modified DBS technique significantly reduced errors of electrode placement, though such difference was clinically irrelevant. ION corrected a high amount of trajectories in both groups (70% vs 50%). The choice of either strategy is acceptable.
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Affiliation(s)
- Massimo Piacentino
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Giacomo Beggio
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Oriela Rustemi
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Giampaolo Zambon
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Manuela Pilleri
- Department of Neurology, Casa di Cura Villa Margherita Hospital, Via Costa Colonna, 6 36057, Arcugnano, Italy
| | - Fabio Raneri
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy.
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Ebel F, Guzman R, Soleman J. Burr hole trepanation and insertion of a subperiosteal drain for chronic subdural haematoma: how I do it. Acta Neurochir (Wien) 2020; 162:2707-2710. [PMID: 32519159 DOI: 10.1007/s00701-020-04442-2] [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: 12/20/2019] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Burr hole trepanation (BHT) is the most commonly used surgical method for the treatment of chronic subdural haematoma (cSDH). METHOD We give a brief overview on the indication for surgical treatment of cSDH, the surgical technique of BHT, and specific perioperative considerations. In particular, we emphasise on the technique of a subperiosteal drain placement. CONCLUSION BHT is a valid option to treat chronic subdural haematoma. Careful surgical technique and placement of a subperiosteal drain is required to minimise complications and improve outcome.
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Affiliation(s)
- Florian Ebel
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
- Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland.
- Faculty of Medicine, University of Basel, Basel, Switzerland.
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Thirunavukkarasu S, Kalashyan H, Jickling G, Jeerakathil TJ, Jayaprakash HK, Buck BH, Shuaib A, Butcher K. Successful dabigatran reversal after subdural hemorrhage using idarucizumab in a mobile stroke unit: A case report. Medicine (Baltimore) 2020; 99:e20200. [PMID: 32481289 PMCID: PMC7249931 DOI: 10.1097/md.0000000000020200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 02/24/2020] [Accepted: 04/08/2020] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Idarucizumab is a specific reversal agent for patients with bleeding related to the anticoagulant dabigatran. There are no prior descriptions of Idarucizumab administration in the prehospital setting for intracranial hemorrhage. PATIENT CONCERNS An 82-year-old woman treated with dabigatran for atrial fibrillation developed acute focal weakness. This led to activation of emergency medical services and assessment in the mobile stroke unit (MSU). DIAGNOSIS Computed tomography of the brain performed in the MSU revealed an acute subdural hematoma. INTERVENTIONS The patient was treated with Idarucizumab in the MSU. OUTCOMES The subdural hematoma was treated with a burr hole evacuation and the patient was discharged to a rehabilitation facility without residual focal neurological deficits. LESSONS Idarucizumab can be used safely and effectively to treat dabigatran-associated intracranial hemorrhage in the prehospital setting.
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MESH Headings
- Administration, Intravenous
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antithrombins/adverse effects
- Antithrombins/therapeutic use
- Atrial Fibrillation/drug therapy
- Dabigatran/adverse effects
- Dabigatran/therapeutic use
- Emergency Medical Services
- Female
- Hematoma, Subdural/chemically induced
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/drug therapy
- Hematoma, Subdural/surgery
- Humans
- Tomography, X-Ray Computed/methods
- Treatment Outcome
- Trephining/methods
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Bartley A, Jakola AS, Tisell M. The influence of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma. Acta Neurochir (Wien) 2020; 162:485-488. [PMID: 31802278 PMCID: PMC7046579 DOI: 10.1007/s00701-019-04150-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Abstract
Background Chronic subdural hematomas (cSDH) are one of the most common conditions requiring neurosurgical treatment. The reported recurrence after surgery is 3–21.5% with closed system drainage. In clinical practice, irrigation fluids at body temperature (37 °C) and at room temperature (22 °C) are routinely used in the evacuation of cSDH. Our hypothesis was that irrigation at body temperature might have more beneficial effects on coagulation and solubility of the chronic subdural hematoma than irrigation at room temperature. The aim of this study was to compare the effects of different intraoperative irrigation fluid temperatures on recurrence rates. Methods This was a retrospective study where we included all consecutive patients from a defined geographical area of western Sweden between September 2013 and November 2014. In the course of 6 months, we performed intraoperative irrigation at body temperature (37 °C, BT-group) during burr hole evacuation of chronic subdural hematoma. This was then compared with the previous 6-month period, when irrigation fluid at room temperature (22 °C, RT-group) was used. The primary endpoint was same-sided recurrence in need of reoperation within 6 months. Results Recurrence occurred in 11 of 84 (13.1%) patients in the RT-group compared with 4 of 88 (4.5%) in the BT-group (p = 0.013). There were no significant between-group differences regarding age, sex, duration of surgery, frequency of bilateral hematomas, hematoma density, and use of anticoagulant/antithrombotic therapy. Conclusion Our study demonstrates that intraoperative irrigation fluid at body temperature is associated with lower recurrence rates compared with irrigation fluid at room temperature. To investigate this further, a prospective randomized controlled trial has been initiated (clinicaltrials.gov, NCT0275235). Trial registration ClinicalTrials.gov Identifier: NCT0275235
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Affiliation(s)
- Andreas Bartley
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå stråket 5, 41345, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Box 430, 40530, Gothenburg, Sweden.
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå stråket 5, 41345, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Box 430, 40530, Gothenburg, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå stråket 5, 41345, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Box 430, 40530, Gothenburg, Sweden
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Stienen MN, Akeret K, Vasella F, Velz J, Jehli E, Scheffler P, Voglis S, Bichsel O, Smoll NR, Bozinov O, Regli L, Germans MR. COveRs to impRove AesthetiC ouTcome after Surgery for Chronic subdural haemAtoma by buRr hole trepanation (CORRECT-SCAR): protocol of a Swiss single-blinded, randomised controlled trial. BMJ Open 2019; 9:e031375. [PMID: 31811007 PMCID: PMC6924766 DOI: 10.1136/bmjopen-2019-031375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Outcomes rated on impairment scales are satisfactory after burr hole trepanation for chronic subdural haematoma (cSDH). However, the surgery leads to bony defects in the skull with skin depressions above that are frequently considered aesthetically unsatisfactory by the patients. Those defects could be covered by the approved medical devices (burr hole covers), but this is rarely done today. We wish to assess, whether the application of burr hole covers after trepanation for the evacuation of cSDH leads to higher patient satisfaction with the aesthetical result at 90 days postoperative, without worsening disability outcomes or increasing the complication rate. METHODS AND ANALYSIS This is a prospective, single-blinded, randomised, controlled, investigator-initiated clinical trial enrolling 80 adult patients with first-time unilateral or bilateral cSDH in Switzerland. The primary outcome is the difference in satisfaction with the aesthetic result of the scar, comparing patients allocated to the intervention (burr hole cover) and control (no burr hole cover) group, measured on the Aesthetic Numeric Analogue scale at 90 days postoperative. Secondary outcomes include differences in the rates of skin depression, complications, as well as neurological, disability and health-related quality of life outcomes until 12 months postoperative. ETHICS AND DISSEMINATION The institutional review board (Kantonale Ethikkommission Zürich) approved this study on 29 January 2019 under case number BASEC 2018-01180. This study determines, whether a relatively minor modification of a standard surgical procedure can improve patient satisfaction, without worsening functional outcomes or increasing the complication rate. The outcome corresponds to the value-based medicine approach of modern patient-centred medicine. Results will be published in peer-reviewed journals and electronic patient data will be safely stored for 15 years. TRIAL REGISTRATION NUMBER NCT03755349.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Kevin Akeret
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Julia Velz
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Elisabeth Jehli
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Pierre Scheffler
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Stefanos Voglis
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Oliver Bichsel
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Nicolas Roydon Smoll
- School of Population and Global Health, University of Melbourne, Melbourne, Sydney, Australia
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Menno R Germans
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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22
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Abstract
RATIONALE Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. However, complicated subdural empyema rarely occurs after trepanation and drainage of chronic subdural hematoma. PATIENT CONCERNS A male patient (77 years old) was admitted to the hospital on the 2nd day of fever after an undergoing a "trepanation and drainage of chronic subdural hematoma" operation at a local hospital. After admission, the patient was treated with an emergency operation in which a subdural abscess was diagnosed and then administered antibiotics after the operation. DIAGNOSIS According to the clinical manifestations, intraoperative findings of imaging examination and the results of pus culture, the diagnosis was subdural empyema. INTERVENTION We surgically removed the subdural empyema. Postoperative antibiotics were administered according to the results of bacterial culture. OUTCOMES At 3 months after the operation, the patient returned to the hospital for reexamination and was found to have achieved a good recovery and good self-care. LESSONS Subdural empyema after trepanation and drainage of chronic subdural hematoma is a very rare and severe disease. Early diagnosis and operative intervention as well as the intravenous administration of antibiotics can improve the prognosis of patients and enhance their quality of life.
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Affiliation(s)
- Hang Xue
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University
| | - Weitao Zhang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University
| | - Lin Shi
- Department of Neurosurgery, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin
| | - Yiming Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Ji’nan, Shandong
| | - Bing Yu
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Hongfa Yang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University
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Watanabe S, Kato N, Sato M, Aiyama H, Fujiwara Y, Goto M, Yamazaki T, Yasuda S, Ishikawa E, Matsumura A. Treatment Outcomes of Burr-Hole Surgery for Chronic Subdural Hematoma in the Elderly Living Beyond Life Expectancy: A Study Comparing Cure, Recurrence, and Complications in Patients Aged ≥80 Years versus ≤79 Years. World Neurosurg 2019; 132:e812-e819. [PMID: 31404689 DOI: 10.1016/j.wneu.2019.08.003] [Citation(s) in RCA: 10] [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: 04/14/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few reports have focused on chronic subdural hematoma (CSDH) in the very elderly, who have lived beyond average life expectancy. Our aim is to appraise treatment outcomes of burr-hole craniotomy for CSDH in the elderly, focusing on cure, recurrence, and complications. METHODS Fifty patients ≤79 years of age (group A) and 73 patients ≥80 years of age (group B) were studied. Recurrence was defined as requiring reoperation for hematoma regrowth or symptomatic failure. A cure was regarded as having been achieved in the absence of hematoma on postoperative computed tomography. Complications were defined as any harmful event related to the treatment procedure for CSDH. RESULTS Cure was documented in 31 patients in group A (63%) and 24 patients in group B (33%) (P = 0.0017). Median intervals to cure were 2.76 and 3.73 months, respectively (P = 0.06). Cumulative cure rates were 51%/76% and 36%/59%, respectively, at the sixth/twelfth postoperative months. Recurrence was documented in 2 patients (4%) and 11 patients (15%), respectively (P = 0.07). Median intervals to recurrence were 0.81 and 1.25 months, respectively (P = 0.049). Cumulative recurrence-free rates were 96%/92% and 87%/75%, respectively, at the third/sixth postoperative months. Complications were observed in 2 patients (4%) and 4 patients (5%), respectively (P = 1.00). CONCLUSIONS With advancing age, CSDH might show a greater tendency to recur and a longer time is required to achieve a cure. However, complications developed only in high-risk patients. Thus, surgical treatment for CSDH in elderly patients, even those who have lived beyond life expectancy, might provide acceptably effective results.
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Affiliation(s)
- Shinya Watanabe
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan; Department of Neurosurgery, Mito Medical Center, Ibaraki-machi, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center, Ibaraki-machi, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hitoshi Aiyama
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yusuke Fujiwara
- Department of Neurosurgery, Sapporo Shuyukai Hospital, Sapporo, Japan
| | - Masayuki Goto
- Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Sakai-machi, Japan
| | - Tomosato Yamazaki
- Department of Neurosurgery, Mito Medical Center, Ibaraki-machi, Japan
| | - Susumu Yasuda
- Department of Neurosurgery, Mito Medical Center, Ibaraki-machi, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Toi H, Fujii Y, Iwama T, Kinouchi H, Nakase H, Nozaki K, Ohkuma H, Ohta H, Takeshima H, Tokumasu H, Yoshimoto Y, Uno M. Determining if Cerebrospinal Fluid Prevents Recurrence of Chronic Subdural Hematoma: A Multi-Center Prospective Randomized Clinical Trial. J Neurotrauma 2018; 36:559-564. [PMID: 29901422 DOI: 10.1089/neu.2018.5821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/18/2022] Open
Abstract
Over the decades, the problem of postoperative recurrence of chronic subdural hematoma (CSDH) has not been resolved. The objective of our study was to investigate whether the recurrence rate of CSDH is decreased when artificial cerebrospinal fluid (ACF) is used as irrigation solution for CSDH surgery. The present study was a multi-center, prospective, randomized, open parallel group comparison test of patients enrolled from 10 hospitals in Japan. Eligible patients with CSDH were randomly assigned to undergo burr hole drainage with either normal saline (NS) or ACF irrigation. The primary end-point was postoperative recurrence of ipsilateral CSDH. A total of 402 patients with newly diagnosed CSDH were enrolled during the study period. After applying inclusion and exclusion criteria, and taking into consideration cases lost to follow-up, our final study cohorts consisted of 177 ACF patients and 165 NS patients, representing 85.7% of the initial cohort. The overall recurrence rate was 11.4%, occurring in 39 of the 342 analyzed patients during 90 days of follow-up. Recurrence rates in the ACF and NS groups were 11.9% (21 of 177) and 10.9% (18 of 165), respectively. No significant difference was evident between groups (p = 0.87). In addition, no significant difference in time to recurrence was seen between groups (p = 0.74). No serious adverse effects related to irrigation fluid were seen in either group. Regarding the irrigation fluid for CSDH surgery, no differences in recurrence rate or time to recurrence were seen between the ACF and NS groups. However, ACF offers sufficient safety as irrigation fluid for CSDH.
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Affiliation(s)
- Hiroyuki Toi
- 1 Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
| | - Yukihiko Fujii
- 2 Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan
| | - Toru Iwama
- 3 Department of Neurosurgery, Gifu University, Gifu City, Japan
| | - Hiroyuki Kinouchi
- 4 Department of Neurosurgery, University of Yamanashi, Yamanashi, Japan
| | - Hiroyuki Nakase
- 5 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Kazuhiko Nozaki
- 6 Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
| | - Hiroki Ohkuma
- 7 Department of Neurosurgery, Hirosaki University, Aomori, Japan
| | - Hajime Ohta
- 8 Department of Neurosurgery, Miyakonojo Medical Association Hospital, Miyazaki, Japan
| | - Hideo Takeshima
- 9 Department of Neurosurgery, Miyazaki University, Miyazaki, Japan
| | - Hironobu Tokumasu
- 10 The Clinical Research Institute, Kurashiki Central Hospital, Okayama, Japan
| | - Yuhei Yoshimoto
- 11 Department of Neurosurgery, Gunma University, Maebashi, Japan
| | - Masaaki Uno
- 1 Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
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25
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Flores G, Vicenty JC, Pastrana EA. Post-operative seizures after burr hole evacuation of chronic subdural hematomas: is prophylactic anti-epileptic medication needed? Acta Neurochir (Wien) 2017; 159:2033-2036. [PMID: 28808801 DOI: 10.1007/s00701-017-3298-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/20/2017] [Accepted: 08/02/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There are limited data with regards to the associated risk of post-operative seizures in patients with surgically treated chronic subdural hematomas (CSDHs). The use of anti-epileptic drugs (AEDs) is associated with significant side effects. METHODS A retrospective chart review was performed on patients operated via burr hole for CSDH in our institution from 2004 to 2013. Post-operative seizures at 1-year follow-up were identified. Demographic data, medical history, and imaging characteristics were recorded. RESULTS A total of 220 patients were included in the study. Post-operative seizures occurred in 2.3%. The mean time of onset of seizures was 8.4 days. No difference in age and gender between seizing and non-seizing groups was identified p > 0.05. Mean midline shift was 4.6 mm in seizing group vs. 4.2 mm in non-seizing group, p > 0.05. Mean thickness was 14.6 mm in patients without post-operative seizures and 18.4 mm in patients with post-operative seizures, p > 0.05. There was no significant difference in post-operative seizure incidence related to the side or location of the CSDHs. CONCLUSIONS The incidence of post-operative seizures in patients with CSDH evacuated via burr holes was low. Prophylactic AEDs should not be routinely administered if no other risk factor for seizure exists. Demographic and clinical factors did not appear to influence post-operative seizures.
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Affiliation(s)
- Gabriel Flores
- Department of Surgery - Neurosurgery Section, University of Puerto Rico - Medical Sciences Campus, PO Box 365067, San Juan, 00936, Puerto Rico
| | - Juan C Vicenty
- Department of Surgery - Neurosurgery Section, University of Puerto Rico - Medical Sciences Campus, PO Box 365067, San Juan, 00936, Puerto Rico
| | - Emil A Pastrana
- Department of Surgery - Neurosurgery Section, University of Puerto Rico - Medical Sciences Campus, PO Box 365067, San Juan, 00936, Puerto Rico.
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Sheng HS, You CG, Yang L, Zhang N, Lin J, Lin FC, Wang MD. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients. Chin J Traumatol 2017; 20:212-215. [PMID: 28688799 PMCID: PMC5555239 DOI: 10.1016/j.cjtee.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy. METHODS We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015. RESULTS During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications. CONCLUSION Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.
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Affiliation(s)
- Han-Song Sheng
- Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China; Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao-Guo You
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Yang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fen-Chun Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mao-De Wang
- Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China.
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Murai Y, Ishisaka E, Tsukiyama A, Nakagawa S, Matano F, Tateyama K, Morita A. Reuse of a Reversed "Bone Pad" to Perforate Incompletely Penetrated Burr Holes Created by Automatic-Releasing Cranial Perforators. Oper Neurosurg (Hagerstown) 2017; 13:324-328. [PMID: 28521348 DOI: 10.1093/ons/opw043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 12/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It can be difficult to make complete burr holes using a perforator with automatic releasing systems in cases of a soft diploe or thick calvarial bone. OBJECTIVE To demonstrate the utility of a flipped "bone pad" (BP) in recovery of penetration failure when using an automatic releasing perforator. METHODS For craniotomy or ventricular drainage, the first step is to make 1 or more burr holes using a craniotome. Neurosurgeons sometimes incompletely penetrate the skull using the latest tools. As a countermeasure for such cases, we have developed a simple and practical method. When making a perforation using a high-speed perforator, a round bone piece we call the BP is formed just above the dura. We pulled the BP from a completed burr hole, and placed the reversed BP in position at the bottom of the incompletely perforated burr hole. The BP acted as a new hard surface, preventing the automatic releasing system from activating, and allowed the burr hole to be completed by the craniotome without the need for additional tools. RESULTS With this technique, we have successfully completed 6 out of 7 imperfectly perforated burr holes using a perforator with an automatic releasing system. There were no technique-related complications, such as plunging or dural laceration. CONCLUSIONS The method has the advantage that the BP can be obtained without drilling an additional burr hole, and can be completed without the need for increasing cost, time, or instrument usage.
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Guilfoyle MR, Hutchinson PJA, Santarius T. Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. Acta Neurochir (Wien) 2017; 159:903-905. [PMID: 28349381 PMCID: PMC5385189 DOI: 10.1007/s00701-017-3095-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
Abstract
Background Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. Methods In the original trial patients at a single neurosurgical centre from 2004–2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016—a minimum of 8 years following enrollment—via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. Results At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). Conclusion Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.
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Affiliation(s)
- Mathew R Guilfoyle
- Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Peter J A Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas Santarius
- Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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29
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Abstract
Chronic subdural hematoma (cSDH) is a common condition, the frequency of which further increases due to an aging population and more frequent use of antithrombotic drugs. It leads to unspecific symptoms and neurological deficits and is usually treated surgically. Burr hole trepanation and twist drill craniostomy have become the therapeutic standards with craniotomy being rarely used for recurrent cases. Although recurrences are relatively common, in most cases a good outcome can be achieved even in the elderly; however, as cSDH is associated with other comorbidities, it is indicative of an increased morbidity and mortality. Controlled trials need to be carried out to determine whether pharmacological therapies can also be beneficial in addition to surgical treatment.
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MESH Headings
- Aged, 80 and over
- Anticoagulants/adverse effects
- Anticoagulants/therapeutic use
- Craniotomy
- Female
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/mortality
- Hematoma, Subdural, Chronic/surgery
- Humans
- Male
- Neurologic Examination/methods
- Platelet Aggregation Inhibitors/adverse effects
- Platelet Aggregation Inhibitors/therapeutic use
- Population Dynamics
- Prognosis
- Recurrence
- Risk Factors
- Tomography, X-Ray Computed/methods
- Trephining/methods
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Affiliation(s)
- T A Juratli
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - J Klein
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - G Schackert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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Caudal V, Snead EC, Starrak GS, Sathya S, Feng CX. Computed tomographic assessment of a new nonsurgical sinus trephination technique using a medical bone marrow drill. Can J Vet Res 2017; 81:53-58. [PMID: 28154464 PMCID: PMC5220599] [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] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/25/2016] [Indexed: 06/06/2023]
Abstract
The objective of this study was to determine the feasibility of trephination of the frontal sinus and injection of antifungal cream using a medical bone marrow drill in dogs. Results were compared with frontal sinus trephination using a standard surgical technique. Bilateral trephination of the frontal sinuses was carried out in the heads of 11 cadavers using a medical bone marrow drill and a surgical bone chuck. The time taken to carry out the procedure using both techniques was compared. Before and after injection of antifungal cream into the frontal sinuses, computed-tomography (CT) scanning was done to assess for iatrogenic trauma and to determine the degree to which the sinuses were filled with each technique and evaluate the diffusion of the cream into the nasal cavity of each dog. The mean volume of the sinuses was 8.8 mL (3.1 to 14.3 mL). Trephination, flushing, and injecting of antifungal cream were significantly faster using the medical technique. There was no significant difference in the mean filling of the frontal sinuses between the medical (82.7%) and the surgical (82.4%) technique (P-value = 0.3). Filling of the nasal cavity was classified as very good in 6/11 cases, with evidence of trauma caused by the surgical trephination technique in 1 head. Findings suggest that use of the medical bone marrow drill is highly feasible for frontal sinus trephination. Injection of antifungal cream into the frontal sinuses using the bone marrow needle resulted in good diffusion into the ipsilateral nasal cavity and could be used to treat aspergillosis when debridement or sinusoscopy is not deemed necessary.
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Affiliation(s)
- Victor Caudal
- Address all correspondence to Dr. Victor Caudal; telephone: 1-508-667-9742; fax: 1-502-839-7951; e-mail:
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Jiang L, Kvasha MS, Kondratiuk VV, Nykyforak ZM, Tsymbaliuk IV, Ukrainets OV, Mosiychuk SS, Gerasenko KM. [COMPARATIVE ESTIMATION OF THE SURGICAL TREATMENT RESULTS IN CYSTIC MENINGIOMAS OF THE BRAIN, USING THE STANDARD METHODS AND NEW TECHNOLOGIES]. Klin Khir 2017:41-44. [PMID: 30272940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The results of surgical treatment of 54 patients, suffering the brain cystic meningiomas of various localization, were analyzed. The patients were operated on in universal conditions by neurosurgeons of one operative team, of them 24 – using new technologies. Wide application of new technologies in surgery of the brain cystic meningiomas have permitted to reduce the surgical intervention invasiveness essentially, and, as a consequence, to reduce trustworthily the operation time essentially, as well as the intraoperative blood loss severity.
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Jensen TS, Carlsen JG, Sørensen JC, Poulsen FR. Fewer complications with bolt-connected than tunneled external ventricular drainage. Acta Neurochir (Wien) 2016; 158:1491-4. [PMID: 27324657 DOI: 10.1007/s00701-016-2863-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/13/2014] [Accepted: 06/02/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventriculostomy/external ventricular drain (EVD) is a common neurosurgical procedure. Various techniques are used to fixate the drain and the objective of this study was, in a retrospective setting, to compare the incidence of complications when using bolt-connected EVD (BC-EVD) versus tunneled EVD (T-EVD). METHODS All patients subjected to an EVD performed through a new burr hole from 2009 through 2010 at two Depts. of Neurosurgery in Denmark (Odense and Aarhus) were retrospectively identified. Patient files were evaluated for EVD fixation technique (tunneled or bolt-connected EVD) and complications including unintended removal, catheter obstruction, infection, CSF leakage, and mechanical problems. RESULTS A total of 271 patients with 272 separate EVDs met the inclusion criteria. There was a statistically higher rate of complications leading to reinsertion in the tunneled EVD group (40 %), compared to the bolt-connected EVD group (6.5 %). There was no significant difference in infection rates. CONCLUSIONS Tunneled EVD has a relatively high frequency of complications leading to reinsertion. The use of Bolt-connected EVD technique can lower this frequency significantly. The number needed to treat is three for preventing a complication requiring reinsertion. Infection rates are low for both types of ventriculostomies. Accordingly, we recommend use of Bolt-connected EVDs in neurosurgical practice.
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Affiliation(s)
- Torben Slott Jensen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
| | - Jakob Gram Carlsen
- Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark
| | - Jens Christian Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute, University of Southern Denmark, 5000, Odense, Denmark
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Ansari I, Futane S, Ansari A. Endoscope-assisted, minimally invasive evacuation of sub-acute/chronic epidural hematoma: Novelty or paradox of Theseus? Acta Neurochir (Wien) 2016; 158:1473-8. [PMID: 27255655 DOI: 10.1007/s00701-016-2851-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/23/2015] [Accepted: 05/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sub-acute/chronic epidural hematoma (EDH) may present with nagging symptoms of headache, nausea, vomiting, lethargy, etc. We attempted to offer a minimally invasive, single burr hole, endoscope-assisted evacuation of EDHs instead of a conventional craniotomy. METHODS Seven patients with sub-acute/chronic EDH (six supratentorial and one infratentorial) presented to us 3 to 7 days after low-velocity road traffic accidents with complaints of headache and lethargy. The EDH volumes measured between 20 to 50 ml, and the patients were operated on using a single burr hole made through a small incision. We used 0-, 30- and 70-degree, angulated, rigid, high-definition endoscopes to identify and evacuate the organized clots in the extradural space. Flexible catheters were used for suction and irrigation. After achieving hemostasis, the dura was hitched back to the burr hole site. The wound was closed over a negative suction drain. RESULTS All patients had prompt recovery from symptoms. Postoperative CT scans showed complete or near complete evacuation of the hematomas. The hospital stay and analgesic requirements were minimal. There was no infective complication or conversion to conventional open surgery. The average time for surgery was 77.8 min, and average blood loss was 328.5 ml. CONCLUSION Endoscope-assisted evacuation of sub-acute/chronic EDH is a novel concept, which offers quick relief from symptoms in a minimally invasive fashion and a cosmetically acceptable way. None of the standard principles of surgery are hampered. It avoids extensive dissection of the temporalis or sub-occipital muscles. However, achieving hemostasis can be difficult. Further study and better equipment will validate the procedure.
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Affiliation(s)
- Ishtyaque Ansari
- Department of Neurosurgery, MGM Medical College and Hospital, Aurangabad, 431005, Maharashtra, India
| | - Sameer Futane
- Department of Neurosurgery, MGM Medical College and Hospital, Aurangabad, 431005, Maharashtra, India.
| | - Ashfaque Ansari
- Department of Otolaryngology, MGM Medical College and Hospital, Aurangabad, 431005, Maharashtra, India
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Tarrats LA, Torre-León C, Almodóvar G, Portela JC. Endoscopic- Assisted Trephination approach for repair of Frontal Sinus posterior wall fracture in a Child. Bol Asoc Med P R 2015; 107:27-28. [PMID: 26434078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 9 year-old male sustained multiple maxillofacial fractures after falling from a two-store building. Frontal sinuses suffered a bilateral non-displaced linear fractures extending into the anterior and posterior walls. Magnetic resonance imaging (MRI) at this time showed a small encephalocele extending into the right frontal sinus. Operative repair was performed using an Endoscopic-Assisted Trephination approach.
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Burkhardt JK, Serra C, Neidert MC, Woernle CM, Fierstra J, Regli L, Bozinov O. High-frequency intra-operative ultrasound-guided surgery of superficial intra-cerebral lesions via a single-burr-hole approach. Ultrasound Med Biol 2014; 40:1469-1475. [PMID: 24680295 DOI: 10.1016/j.ultrasmedbio.2014.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/24/2013] [Revised: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 06/03/2023]
Abstract
The study described here examined the feasibility of using high-frequency intra-operative ultrasound (hfioUS) guidance to resect superficial intra-cerebral lesions through a single burr hole. A cohort of 23 consecutive patients with a total of 24 intra-cerebral lesions (9 intra-cerebral metastases, 8 gliomas, 4 infections, 2 lymphomas and 1 cavernoma) were studied. All lesions could be localized and successfully resected, biopsied or aspirated, and histopathological diagnoses were obtained in all cases. The mean operating time was 59.6 ± 23.9 min. The mean cross-sectional lesion size was 6.4 ± 7.6 cm(2), and the mean cortex surface-to-lesion distance was 0.6 ± 0.8 cm. Our results illustrate the feasibility of identifying and resecting superficial intra-cerebral lesions under hfioUS guidance via a single-burr-hole approach. We were able to achieve short resection times with no post-operative complications in all patients, favorable conditions under which to start adjuvant therapy when indicated.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland.
| | - Carlo Serra
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Christoph M Woernle
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
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Hu T, Luo W, Fu M, Feng J, Liang J. [Endoscopic minitrephination combined with endoscopic frontal sinusotomy for management of chronic frontal sinusitis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:531-537. [PMID: 25007666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy of endoscopic minitrephination combined with endoscopic frontal sinusotomy in the management of complex chronic frontal sinusitis. METHOD Twenty-six patients suffering from chronic frontal sinusitis with complex frontal drainage approach were analyzed. Eleven patients (13 sides) received endoscopic minitrephination combined with endoscopic frontal sinusotomy, while the other 15 patients (18 sides) received endoscopic frontal sinusotomy only. Postoperatively all cases were followed up to evaluate the efficacy. RESULT The ostia of frontal sinus were successfully opened in the group of patients received endoscopic minitrephination combined with endoscopic frontal sinusotomy without any complications. In the endoscopic frontal sinusotomy only group, three cases of complications were observed, one with the injury of anterior ethmoidal artery and the other two with the injury of papyraceous lamina. After 10 to 24 months of follow up postoperatively, the symptoms were relieved in all cases without recurrence. The combined surgery group with endoscopic minitrephination showed an endoscopic frontal sinus patency rate of 85%, and the endoscopic frontal sinusotomy only group exhibited an endoscopic frontal sinus patency rate of 83%. CONCLUSION Endoscopic minitrephination combined with endoscopic frontal sinusotomy is a simple, convenient, safe and effective method for management of complex chronic frontal sinusitis.
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Galindo-de León S, Hernández-Rodríguez AN, Morales-Ávalos R, Theriot-Girón MDC, Elizondo-Omaña RE, Guzmán-López S. [Morphometric characteristics of the asterion and the posterolateral surface of the skull: its relationship with dural venous sinuses and its neurosurgical importance]. CIR CIR 2013; 81:269-273. [PMID: 25063890] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The knowledge of the location and morphometric of the lateral venous sinus (transverse and sigmoid), and their relationship with the asterion and other surface anatomical landmarks, it is imperative for posterolateral approaches to the posterior cranial fossa to avoid vascular structures injury and surgical complications. OBJECTIVE Determine an anatomical area security for a drill that allows entry into the posterior cranial fossa without damaging adjacent structures, and study the morphometric characteristics asterion, the lateral sinus and bony landmarks of the posterolateral surface of the skull. METHODS With a 1.3 mm drill drilled both sides of 88 dry skulls (176 hemicranias). The anatomical landmarks studied were the asterion, the apex of the mastoid process, spina suprameatal, the Frankfurt horizontal plane, the posterior root of the zygomatic arch, the external occipital protuberance and its relationship with the sinus transversus. RESULTS The asterion type I prevails in 74.4% of the pieces. In 82.4% of the skulls asterion level is, sinus transversus in less than 12.5% and above this at 5.1%. CONCLUSIONS With the data obtained from this and other research, the initial trephine should be placed below the 15 mm and 15 mm asterion post this to reduce the risk of injury from sinus transversus.
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Affiliation(s)
- Salvador Galindo-de León
- Departamento de Anatomía Humana, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey NL, Mexico
| | | | - Rodolfo Morales-Ávalos
- Departamento de Anatomía Humana, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey NL, Mexico
| | - María Del Carmen Theriot-Girón
- Departamento de Anatomía Humana, Facultad de Odontología, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
| | - Rodrigo Enrique Elizondo-Omaña
- Departamento de Anatomía Humana, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey NL, Mexico
| | - Santos Guzmán-López
- Departamento de Anatomía Humana, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey NL, Mexico
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Thanaviratananich S, Kasemsiri P, Sinawat P. Two-hole trephination (Muntarbhorn) technique for a large frontal sinus osteoma: a case report. J Med Assoc Thai 2012; 95 Suppl 11:S168-S171. [PMID: 23961639] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To present an alternative surgical option for frontal sinus osteoma. MATERIAL AND METHOD A woman presented with a symptomatic large osteoma in right frontal sinus. Two-hole trephination was planned to remove the osteoma using nasal endoscope and a drill in each hole. RESULTS The osteoma was drilled and removed transnasally. Two months later, two small fragments of osteoma were detected remaining in the lateral aspect of the sinus. The fragments were removed successfully with the same technique. The patient was asymptomatic six months postoperatively. CONCLUSION Two-hole trephination technique or Muntarbhorn technique is an attractive option for frontal sinus osteoma.
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Gaster RN, Dumitrascu O, Rabinowitz YS. Penetrating keratoplasty using femtosecond laser-enabled keratoplasty with zig-zag incisions versus a mechanical trephine in patients with keratoconus. Br J Ophthalmol 2012; 96:1195-9. [PMID: 22790433 PMCID: PMC3598602 DOI: 10.1136/bjophthalmol-2012-301662] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS This paper will compare the visual outcomes of two different penetrating keratoplasty (PKP) techniques in patients with keratoconus. It is a retrospective comparative surgical case series of 116 keratoconus patients (137 eyes) who had PKP at the Cornea Eye Institute, Beverly Hills, California, USA. METHODS 56 keratoconus patients (66 eyes) underwent femtosecond laser-enabled keratoplasty (FLEK) with a zig-zag incision configuration. Their visual parameters were compared with those of 60 patients (71 eyes) who had traditional blade mechanical trephination PKP. The range of follow-up was between 3 and 6 months. The main outcome measures included uncorrected visual acuity and best spectacle-corrected visual acuity (BSCVA), manifest refractive spherical equivalent and topographically determined astigmatism. RESULTS BSCVA was significantly better as early as 3 months postoperatively (p=0.001) in the FLEK group. Visual recovery to 20/40 after 3 months was significantly better in the FLEK group (p<0.001). Topographic astigmatism was lower in the FLEK group, but the difference between the two groups reached significance only at 3 months of follow-up (p=0.001). Postoperative complications noted were not different between the two groups. CONCLUSIONS Faster visual recovery and better long-term outcomes were observed in keratoconus patients who had FLEK compared with those who had the mechanical PKP procedure with 6 months of postoperative follow-up.
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Adeolu AA, Rabiu TB, Adeleye AO. Post-operative day two versus day seven mobilization after burr-hole drainage of subacute and chronic subdural haematoma in Nigerians. Br J Neurosurg 2012; 26:743-6. [PMID: 22905886 DOI: 10.3109/02688697.2012.690912] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rinaldi V, Portmann D, Boudard P. [Unilateral frontal sinus aspergillosis: the combined endoscopic and mini-trephination approach]. Rev Laryngol Otol Rhinol (Bord) 2012; 133:97-99. [PMID: 23393745] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Aspergillosis is a common fungal infection of the paranasal sinuses. Localization in the frontal sinus is usually secondary to involvement of one of the other sinuses. Isolated frontal sinus aspergillosis is rare and only 5 cases are described in literature. CLINICAL CASE We report a case of a patient with a frontal sinus aspergilloma associated with ipsilateral chronic ethmoidal and maxillary sinusitis, successfully treated with a combined endoscopic and mini-trephination approach "Lemoyne technique". DISCUSSION AND CONCLUSION The endoscopic approach to the frontal sinus is considered the best way to deal with frontal sinus aspergilloma, but it is sometimes not sufficient to guarantee the complete removal of the fungus ball. In such cases a mini-trephination of the frontal sinus with associated irrigation provides a more accurate visualization and toilette of the sinus.
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Pahatouridis D, Alexiou GA, Voulgaris S. Comment on "Single versus double burr hole drainage of chronic subdural hematomas". J Clin Neurosci 2011; 18:446-7. [PMID: 21236686 DOI: 10.1016/j.jocn.2010.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 07/01/2010] [Indexed: 11/19/2022]
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Low SW, Ng YJ, Yeo TT, Chou N. Use of Osteoplug polycaprolactone implants as novel burr-hole covers. Singapore Med J 2009; 50:777-780. [PMID: 19710975] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the outcome of Osteoplug, a novel biodegradable polymer burr-hole cover implant, used in patients with burr holes done for drainage of chronic subdural haematoma. METHODS 12 patients with chronic subdural haematoma had Osteoplug implants inserted into their burr holes after evacuation of the haematoma. Osteoplug is a biodegradable polycaprolactone implant with a mushroom-button shape, designed specifically to fit into a 14-mm diameter burr hole. It has an upper rim of 16-mm diameter and a body diameter of 14 mm, with a honeycomb-like architecture of 400-600 mum pore size. The Osteoplug snaps onto the 14-mm diameter burr hole snugly after the evacuation of the liquefied haematoma is done. All 12 patients were followed up for a period ranging from ten months to two years (mean 16 months) postoperatively. They were evaluated for their clinical, radiological and cosmetic outcomes. RESULTS Osteoplug provided good cosmesis by preventing unsightly depressions over the skull postoperatively in all the 12 patients. Postoperative computed tomography, done at one year, showed signs of good osteointegration into the surrounding calvarial bone, with multifoci mineralisation throughout the scaffold in one patient. There was no case of infection or any adverse systemic reaction noted. Patient satisfaction was high. CONCLUSION The Osteoplug polycaprolactone burr-hole covers are suitable, biodegradable implants with good medium-term results. They provide an ideal scaffold for osteogenesis and excellent cosmesis. There were no adverse events in all 12 patients, with a mean follow-up of 16 months.
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Affiliation(s)
- S W Low
- Division of Neurosurgery, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
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Smith SW, Clark M, Nelson J, Heegaard W, Lufkin KC, Ruiz E. Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly. J Emerg Med 2009; 39:377-83. [PMID: 19535215 DOI: 10.1016/j.jemermed.2009.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 11/21/2008] [Revised: 12/30/2008] [Accepted: 04/11/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Blunt head trauma patients who have been alert but are deteriorating (talk and deteriorate [T&D]) due to a rapidly expanding epidural hematoma (EDH) usually have poor outcome if they must wait for hospital transfer for evacuation. We therefore have continued to teach skull trephination to emergency physicians (EPs). We are unaware of any literature on EP trephination for EDH in the age of computed tomography (CT) scanning. METHODS Patients with EDH from blunt trauma, either in our institution or known to our graduate network, who were T&D with anisocoria despite intubation plus medical therapy, and who had pre-transfer EP trephination, were compared to those who were transferred without trephination. RESULTS There were 5 patients with blunt trauma and CT-proven EDH who were T&D with anisocoria who underwent Emergency Department (ED) trephination at outlying hospitals before transfer. All 5 had improvement in condition and good outcomes. Three had complete recovery without disability and 2 others had mild disability with good cognitive function. None had complications. Two patients with T&D and anisocoria were transferred without trephination. Both had good neurologic outcomes. The mean time to pressure relief in the trephination group vs. transfer group was 55 vs. 207 min, respectively. CONCLUSION In T&D patients with CT-proven EDH and anisocoria, ED skull trephination before transfer resulted in uniformly good outcomes without complications. Time to relief of intracranial pressure was significantly shorter with trephination. Neurologic outcomes were not different.
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Affiliation(s)
- Stephen W Smith
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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Krupa M. [Chronic subdural hematoma: a review of the literature. Part 2]. Ann Acad Med Stetin 2009; 55:13-19. [PMID: 20698172] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The second part of this review is concerned with methods and results of treatment in chronic subdural hematoma (CSDH). Surgical evacuation is the generally accepted approach to treatment in CSDH. There are two neurosurgical methods of evacuation: 1. Burr hole in the cranial vault and evacuation of hematoma fluid. 2. Craniotomy and removal of hematoma with surrounding membranes. According to the literature, priority should be given to burr hole evacuation of the hematoma on the following premises: 1. High effectiveness with lower risk of complications and better treatment outcome for trepanation. 2. Craniotomy with removal of hematoma membranes, although radical, does not eliminate the risk of recurrence of hematoma. 3. Reduction in the volume of hematoma fluid through the burr hole and drainage may lead to total resorption of hematoma together with membranes.
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Affiliation(s)
- Mariusz Krupa
- Klinika Neurochirurgii i Neurotraumatologii Uniwersytetu Jagiellońskiego Collegium Medicum ul. Botaniczna 3, 31-503 Kraków
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Affiliation(s)
- David B Wexler
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Pollock R, Alcelik I, Bhatia C, Chuter G, Lingutla K, Budithi C, Krishna M. Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques. Eur Spine J 2008; 17:845-52. [PMID: 18389294 DOI: 10.1007/s00586-008-0648-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 12/30/2007] [Accepted: 02/29/2008] [Indexed: 11/26/2022]
Abstract
We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting.
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Affiliation(s)
- Raymond Pollock
- Spinal Unit, University Hospital of North Tees, Stockton on Tees, TS19 8PE, UK
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McIntosh DL, Mahadevan M. Frontal sinus mini-trephination for acute sinusitis complicated by intracranial infection. Int J Pediatr Otorhinolaryngol 2007; 71:1573-7. [PMID: 17628703 DOI: 10.1016/j.ijporl.2007.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/04/2007] [Accepted: 06/10/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acute bacterial sinusitis is common in the pediatric population. Intracranial spread of infection is a rare but life-threatening complication of acute sinusitis. Due to the infrequent presentation of this complication, there are no well-defined management protocols for the acute sinusitis. CASE SERIES We present three pediatric cases where children presented with intracranial sepsis, and the underlying source of infection was from the paranasal sinuses. In all cases, endoscopic sinus surgery was performed in the acute setting, with the use of frontal sinus mini-trephines playing a significant role. DISCUSSION We describe our experience and review the available literature.
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Affiliation(s)
- D L McIntosh
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Auckland Starship Children's Hospital, Park Road, Grafton, New Zealand.
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Sucu HK, Gökmen M, Ergin A, Bezircioğlu H, Gökmen A. Is there a way to avoid surgical complications of twist drill craniostomy for evacuation of a chronic subdural hematoma? Acta Neurochir (Wien) 2007; 149:597-9. [PMID: 17486289 DOI: 10.1007/s00701-007-1162-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 01/05/2007] [Accepted: 04/11/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although twist drill craniostomy for evacuation of a chronic subdural hematoma is a rapid and minimally invasive procedure, it carries the risk of complications because it is a 'blind' technique. Our aim was to analyse the complications in a series of patients treated by this technique in order to identify methods of avoidance by modifications in the surgical technique. METHOD Thirty-nine patients with a chronic subdural hematoma underwent twist drill craniostomy between November 2002 and December 2005 in our clinic. When a surgical complication happened we modified our surgical technique to see if this avoided it in future patients. FINDINGS Surgical complications happened in 7 patients (17.9%) including inadequate drainage, brain penetration, acute epidural hematoma and catheter folding. After preventive modifications these complications did not recur. CONCLUSIONS Modifications in the technique of twist drill craniostomy are described in this paper which may minimise the occurrence of surgical complications.
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Affiliation(s)
- H K Sucu
- Izmir Atatürk Research and Training Hospital, Izmir, Turkey.
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Piltcher OB, Antunes M, Monteiro F, Schweiger C, Schatkin B. Is there a reason for performing frontal sinus trephination at 1 cm from midline? A tomographic study. Braz J Otorhinolaryngol 2007; 72:505-7. [PMID: 17143429 PMCID: PMC9445702 DOI: 10.1016/s1808-8694(15)30996-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2005] [Accepted: 04/25/2006] [Indexed: 11/18/2022] Open
Abstract
The complex anatomy of the frontoethmoidal recess, as well as its anatomical relationship with the vital adjacent structures in the region explain the reason for considerable surgical care to protect these structures and minimize complications related to healing. Trephination is an accepted procedure to access the frontal sinus. Aim Discuss the best location for performing frontal sinus trephination. Methods Measuring sinus frontal depth at 3 points equidistant to the midline (crista galli) through the axial tomographic sections. Results We measured 138 frontal sinus (69 patients). Frontal sinus depth at 0,5 cm was statistically larger than 1 cm and 1,5 cm, as well as the 1 cm trephine point was significantly larger than 1,5 cm (12,22±4,25 vs 11,78±4,65 p<0,05; 12,22±4,25 vs 10,78±5,98 p<0,001; 11,78±4,65 vs 10,78±5,98 p<0,05). The trephine set used (maximum depth of penetration of 0,7 cm) is safe to be applied in approximately 80% of the patients. Conclusion Analizing the results, the trephination may be performed at variable points of the frontalsinus, but the distance of 1 cm from midline appears to be safer and shows better aestethic results.
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