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Asserson DB, Kassicieh AJ, Ghatalia DV, Kassicieh CS, Shah SP, Kazim SF, Cole KL, Schmidt MH, Bowers CA. Novel Case of Streptococcus Mitis-infected Chronic Subdural Hematoma. Acta Neurol Taiwan 2024; 33(3):134-137. [PMID: 37968845] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE Subdural hematoma (SDH) is a common pathology found in neurosurgery. Infected SDH, however, is less common, and reports have typically identified Escherichia coli as the causative organism. CASE REPORT We present here a case of an infected chronic SDH caused by Streptococcus mitis, likely for the first time, following a burn injury in a 40-year-old male patient. CONCLUSION The workup for infected SDH should now include S. mitis as a possible culprit.
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Affiliation(s)
- Derek B Asserson
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | | | - Desna V Ghatalia
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | | | - Smit P Shah
- Department of Neurology, Prisma Health- Midlands/University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Syed F Kazim
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Kyril L Cole
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
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Cohen-Cohen S, Jabal MS, Rinaldo L, Savastano LE, Lanzino G, Cloft H, Brinjikji W. Middle meningeal artery embolization for chronic subdural hematoma: A single-center experience and predictive modeling of outcomes. Neuroradiol J 2024; 37:192-198. [PMID: 38147825 DOI: 10.1177/19714009231224431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Remarkable interest is rising around middle meningeal artery embolization (MMAE) as an emerging alternative therapy for chronic subdural hematoma (cSDH). The study aims to highlight a large center experience and the variables associated with treatment failure and build experimental machine learning (ML) models for outcome prediction. MATERIAL AND METHODS A 2-year experience in MMAE for managing patients with chronic subdural hematoma was analyzed. Descriptive statistical analysis was conducted using imaging and clinical features of the patients and cSDH, which were subsequently used to build predictive models for the procedure outcome. The modeling evaluation metrics were the area under the ROC curve and F1-score. RESULTS A total of 100 cSDH of 76 patients who underwent MMAE were included with an average follow-up of 6 months. The intervention had a per procedure success rate of 92%. Thrombocytopenia had a highly significant association with treatment failure. Two patients suffered a complication related to the procedure. The best performing machine learning models in predicting MMAE failure achieved an ROC-AUC of 70%, and an F1-score of 67%, including all patients with or without surgical intervention prior to embolization, and an ROC-AUC of 82% and an F1-score of 69% when only patients who underwent upfront MMAE were included. CONCLUSION MMAE is a safe and minimally invasive procedure with great potential in transforming the management of cSDH and reducing the risk of surgical complications in selected patients. An ML approach with larger sample size might help better predict outcomes and highlight important predictors following MMAE in patients with cSDH.
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Schmolling ÁH, Pérez-García C, Trejo C, López-Frías A, Jaroenngarmsamer T, Rosati S, Arrazola J, Moreu M. Middle Meningeal Artery Embolization for Management of Chronic Subdural Hematoma. Radiographics 2024; 44:e230158. [PMID: 38451847 DOI: 10.1148/rg.230158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Chronic subdural hematoma (CSDH) is a prevalent medical condition with potentially severe consequences if left untreated. While surgical removal has traditionally been the standard approach for treatment, middle meningeal artery (MMA) embolization has emerged as a promising minimally invasive alternative to reduce recurrences. This comprehensive review provides the general radiology community with an overview of MMA embolization as a therapeutic option for managing CSDH. The authors base their insights on existing evidence and their institutional experience. This overview encompasses the pathophysiology of CSDH as well as the potential advantages and limitations, safety profile, and potential complications of MMA embolization as compared with surgical treatment. The imaging findings seen before and after MMA, as well as insights into the procedural techniques used at the authors' institution, are described. On the basis of reports in the current literature, MMA embolization appears to be a safe and effective therapeutic option for managing CSDH, especially in patients who are unsuitable for surgery or at risk for recurrence. Nonetheless, further research is needed to validate these findings. Results from ongoing clinical trials hold promise for future validation and the establishment of scientific evidence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Chatterjee in this issue.
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Affiliation(s)
- Ángela H Schmolling
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Carlos Pérez-García
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Carmen Trejo
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Alfonso López-Frías
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Tanaporn Jaroenngarmsamer
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Santiago Rosati
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Juan Arrazola
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
| | - Manuel Moreu
- From the Departments of Interventional Neuroradiology (A.H.S., C.P.G., C.T., A.L.F., S.R., M.M.) and Radiology (J.A.), Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain; and Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.J.)
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Stienen MN, Jehli E, Bozinov O, Regli L, Germans MR. Burr Hole Covers or Not? The Relevance of Aesthetic Outcome in Patients with Chronic Subdural Hematoma. World Neurosurg 2024; 184:337-338. [PMID: 38368154 DOI: 10.1016/j.wneu.2024.01.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, Kantonsspital St.Gallen & Medical School of St.Gallen, St. Gallen, Switzerland
| | - Elisabeth Jehli
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St.Gallen & Medical School of St.Gallen, St. Gallen, 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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Vargas J, Pease M, Snyder MH, Blalock J, Wu S, Nwachuku E, Mittal A, Okonkwo DO, Kellogg RT. Automated Preoperative and Postoperative Volume Estimates Risk of Retreatment in Chronic Subdural Hematoma: A Retrospective, Multicenter Study. Neurosurgery 2024; 94:317-324. [PMID: 37747231 DOI: 10.1227/neu.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Several neurosurgical pathologies, ranging from glioblastoma to hemorrhagic stroke, use volume thresholds to guide treatment decisions. For chronic subdural hematoma (cSDH), with a risk of retreatment of 10%-30%, the relationship between preoperative and postoperative cSDH volume and retreatment is not well understood. We investigated the potential link between preoperative and postoperative cSDH volumes and retreatment. METHODS We performed a retrospective chart review of patients operated for unilateral cSDH from 4 level 1 trauma centers, February 2009-August 2021. We used a 3-dimensional deep learning, automated segmentation pipeline to calculate preoperative and postoperative cSDH volumes. To identify volume thresholds, we constructed a receiver operating curve with preoperative and postoperative volumes to predict cSDH retreatment rates and selected the threshold with the highest Youden index. Then, we developed a light gradient boosting machine to predict the risk of cSDH recurrence. RESULTS We identified 538 patients with unilateral cSDH, of whom 62 (12%) underwent surgical retreatment within 6 months of the index surgery. cSDH retreatment was associated with higher preoperative (122 vs 103 mL; P < .001) and postoperative (62 vs 35 mL; P < .001) volumes. Patients with >140 mL preoperative volume had nearly triple the risk of cSDH recurrence compared with those below 140 mL, while a postoperative volume >46 mL led to an increased risk for retreatment (22% vs 6%; P < .001). On multivariate modeling, our model had an area under the receiver operating curve of 0.76 (95% CI: 0.60-0.93) for predicting retreatment. The most important features were preoperative and postoperative volume, platelet count, and age. CONCLUSION Larger preoperative and postoperative cSDH volumes increase the risk of retreatment. Volume thresholds may allow identification of patients at high risk of cSDH retreatment who would benefit from adjunct treatments. Machine learning algorithm can quickly provide accurate estimates of preoperative and postoperative volumes.
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Affiliation(s)
- Jan Vargas
- Division of Neurosurgery, PRISMA Health, Greenville , South Carolina , USA
| | - Matthew Pease
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - M Harrison Snyder
- Department of Neurosurgery, Tufts Medical Center, Boston , Massachusetts , USA
| | - Jonathan Blalock
- University of South Carolina School of Medicine Greenville, Greenville , South Carolina , USA
| | - Shandong Wu
- Department of Neurosurgery, UPMC Healthcare System, Pittsburgh , Pennsylvania , USA
| | - Enyinna Nwachuku
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland , Ohio , USA
| | - Aditya Mittal
- Department of Neurosurgery, University of Pittsburgh Medical Center Medical School, Pittsburgh , Pennsylvania , USA
| | - David O Okonkwo
- Department of Neurosurgery, UPMC Healthcare System, Pittsburgh , Pennsylvania , USA
| | - Ryan T Kellogg
- Department of Neurosurgery, University of Virginia, Charlottesville , Virginia , USA
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Wang C, Liu C. Clinical Characteristics and Prognoses of Chronic Subdural Hematoma Patients with and without Head Trauma: A Retrospective Comparative Study. World Neurosurg 2024; 182:e837-e846. [PMID: 38101546 DOI: 10.1016/j.wneu.2023.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Head trauma is considered as the main cause of chronic subdural hematoma (CSDH). However, many patients develop CSDH with no identified cause. Herein, we conduct a comparative study to investigate the differences in clinical characteristics and surgical outcomes of CSDH patients with and without a history of head trauma. METHODS We retrospectively reviewed CSDH patients who underwent surgical treatment in our hospital between January 2013 and December 2021. Patients were categorized into a with head trauma (WHT) group and a without head trauma (WOHT) group for comparative analysis. RESULTS A total of 219 patients were included, 119 (54.3%) cases in the WHT group and 100 (45.7%) cases in the WOHT group. More cancer patients were found in the WOHT group than in the WHT group (P = 0.045). Both at discharge and 6-month follow-up, patients in the WOHT group achieved better clinical outcomes than the WHT group cases (P = 0.025 and 0.034, respectively). Furthermore, ordered multiclass logistic regression analyses indicated that a history of head trauma (odds ratio 2.151, 95% confidence interval 1.052-4.386; P = 0.036) was a risk factor significantly related to the unfavorable outcomes at 6-month follow-ups of CSDH. However, we did not find significant differences between the 2 groups in clinical manifestations, radiological characteristics, postoperative complications, mortality, and recurrence rates. CONCLUSIONS CSDH patients with a history of head trauma may be more susceptible to unfavorable outcomes; thus, they should be carefully evaluated and given more attention during hospitalization and after discharge.
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Affiliation(s)
- Chengjun Wang
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Cang Liu
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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Yang C, Lin G, Zhang J, Xie J, Yang J. Granuloma formation as a late complication of burr-hole surgery for chronic subdural hematoma. Brain Inj 2024; 38:3-6. [PMID: 38225760 DOI: 10.1080/02699052.2024.2304860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Surgical treatment remains the mainstream therapeutic regimen for chronic subdural hematoma (CSDH), and burr-hole craniostomy with subdural drainage is the preferable approach. Herein, we reported a case of intracranial granuloma formation as a late complication of burr-hole surgery for CSDH. CASE PRESENTATION A 31-year-old man presented with a 1-month history of headache. Head computed tomography (CT) showed a subdural hematoma in the left frontal-temporal-parietal region with significant midline shifting. A burr-hole evacuation of the hematoma with closed-system drainage was performed. CT obtained immediately after the surgery demonstrated that the hematoma was mostly evacuated. Nine months later, he presented to us again due to intermittent headache in the left temporoparietal region. Brain magnetic resonance imaging revealed a space-occupying mass at the site of the original hematoma. A bone-flap craniotomy was performed for resecting the mass. Histopathological examination revealed a granuloma. The microbial cultivation of the resected specimen was negative. The postoperative course was uneventful, and the headache was relieved. CONCLUSION Granuloma formation is an extremely rare late complication of burr-hole surgery for CSDH. Physicians involved in the perioperative management of CSDH should be aware of this condition, and bone-flap craniotomy may be warranted.
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Affiliation(s)
- Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Guozhong Lin
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | | | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
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Li J, Zhao J, Sun S, Shen S, Zhong B, Dong X. Peptidomics insights: neutrophil extracellular traps (NETs) related to the chronic subdural hemorrhage. PeerJ 2023; 11:e16676. [PMID: 38144176 PMCID: PMC10749094 DOI: 10.7717/peerj.16676] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Chronic subdural hemorrhage (CSDH) refers to a hematoma with an envelope between the dura mater and the arachnoid membrane and is more common among the elderly. It was reported that the dura mater, which is highly vascularized with capillary beds, precapillary arterioles and postcapillary venules play an important role in the protection of the central nervous system (CNS). Numerous evidences suggests that peptides play an important role in neuroprotection of CNS. However, whether dura mater derived endogenous peptides participate in the pathogenesis of CSDH remains undetermined. In the current study, the peptidomic profiles were performed in human dura of CSDH (three patients) and the relative control group (three non-CSDH samples) by LC-MS (liquid chromatography-mass spectrometry). The results suggested that a total of 569 peptides were differentially expressed in the dura matter of CSDH compared with relative controls, including 217 up-regulated peptides and 352 down-regulated peptides. Gene Ontology (GO) analysis demonstrated that the precursor proteins of those differentially expressed peptides were involved in the various biological processes. Interestingly, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis suggested that NETs participated in the pathogenies of CSDH. Further investigate showed that H3Cit was significantly elevated in the dural and hematoma membranes of patients with CSDH compared to patients without CSDH. Taken together, our results showed the differentially expressed peptides in human dura mater of CSDH and demonstrated that NETs formation in the dural and hematoma membranes might be involved in the pathogenesis of CSDH. It is worth noting that pharmacological inhibition of NETs may have potential therapeutic implications for CSDH.
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Affiliation(s)
- Jie Li
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhao
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuchen Sun
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sen Shen
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bincheng Zhong
- Department of Emergency, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohua Dong
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Shi XY, Zhang JX, Tang ZX, Sun H, Shen Z. Severe spontaneous acute arterial subdural hematoma as an initial symptom of chronic myeloid leukemia. Br J Neurosurg 2023; 37:1721-1724. [PMID: 33605812 DOI: 10.1080/02688697.2021.1885625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examination、cytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.
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MESH Headings
- Humans
- Hematoma, Subdural, Acute/surgery
- Arteries
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Tomography, X-Ray Computed/adverse effects
- Computed Tomography Angiography
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
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Affiliation(s)
- Xiao-Yong Shi
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Xia Zhang
- Department of Clinical Psychology(Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310000, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Hu Sun
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Zheng Shen
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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Wasfie T, Young C, Naisan M, Senger B, Brimmeier A, Sobell FA, Stanbaugh C, Hille J, Hella J, Barber K. Acute Traumatic Subdural Hematoma in the Elderly and Associated Factors that May Influence Chronicity. Am Surg 2023; 89:6298-6300. [PMID: 36802907 DOI: 10.1177/00031348231157856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Traumatic acute subdural hematomas (TASDH) is by far the most common traumatic brain injury in adult patients with blunt trauma, who presented to the Emergency Department (ED). One of the serious sequale of TASDH is the development of Chronic Subdural Hematomas (CSD) with associated deterioration in mental status and convulsion.1,2 Studies to identify the risk factors that favors development of chronicity of TASDH are few and inconclusive. As seen in our prior initial study, there were few factors which were common in those who developed chronicity of their TASDH, and we elected to expand our pool of patients to include those admitted between the years of 2015 and 2021 with ATSDH and identify the common factors associated with development of CSD.
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MESH Headings
- Adult
- Humans
- Aged
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Brain Injuries/complications
- Brain Injuries, Traumatic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/surgery
- Risk Factors
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Affiliation(s)
- Tarik Wasfie
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Carly Young
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | | | | | - Alexis Brimmeier
- Central Michigan University Medical School, Mount Pleasant, MI, USA
| | | | | | - Jennifer Hille
- Department of Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
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Maroufi SF, Farahbakhsh F, Macdonald RL, Khoshnevisan A. Risk factors for recurrence of chronic subdural hematoma after surgical evacuation: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:270. [PMID: 37843688 DOI: 10.1007/s10143-023-02175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Surgical evacuation has remained the primary treatment despite many advancements in the endovascular field. Regardless, recurrence requiring reoperation is commonly observed during the postoperative follow-up. Herein, we aimed to investigate risk factors for recurrence after surgical evacuation. A review of MEDLINE, EMBASE, Web of Science, and Scopus was conducted using the designed search string. Studies were reviewed based on the predefined eligibility criteria. Data regarding sixty potential risk factors along with operational information were extracted for analysis. A meta-analysis using the random-effect model was conducted, and each risk factor affecting the postoperative recurrence of CSDH was then evaluated and graded. A total of 198 records met the eligibility criteria. A total number of 8523 patients with recurrent CSDH and 56,096 with non-recurrent CSDH were included in the study. The recurrence rate after surgical evacuation was 12%. Fifteen preoperative, nine radiologic, four hematoma-related, and three operative and postoperative factors were associated with recurrence. Risk factors associated with recurrence after surgical evacuation are important in neurosurgical decision-making and treatment planning. Found risk factors in this study may be used as the basis for pre-operative risk assessment to choose patients who would benefit the most from surgical evacuation.
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Affiliation(s)
- Seyed Farzad Maroufi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad Hwy, Tehran, 14117-13135, Iran
| | - Farzin Farahbakhsh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad Hwy, Tehran, 14117-13135, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Khoshnevisan
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Jalal-e-Al-e-Ahmad Hwy, Tehran, 14117-13135, Iran.
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Morales-Gómez JA, Garcia-Estrada E, Garza-Báez A, Mercado-Flores M, de León AMP. Subdural open drains as an effective and low-cost modality for the treatment of chronic subdural hematomas. Br J Neurosurg 2023; 37:1078-1081. [PMID: 33322934 DOI: 10.1080/02688697.2020.1858024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We present a series that describes the presenting features and clinical outcomes in patients with CSDH treated with a standardised technique and an open-drain placement. METHODS We reviewed the medical records of 155 consecutive patients at a single centre who underwent CSDH evacuation by placing burr holes, accompanied by intraoperative irrigation and a subdural Penrose drain between 2014 and 2018. RESULTS The mean age was 65.9 years, 81.9% were males. The most common clinical characteristics were an altered mental state (21.9%) and headache (12.9%). It was necessary to perform a second surgical intervention due to the evidence in the postoperative tomography of a residual hematoma in 10.3% of the cases; there were 2 cases of recurrence in 6 months (1.3%). Pneumonia (6.5%) and seizures (5.8%) were the most frequent medical complications. Intracranial infections accounted for 1.9%, and the mortality rate was 6.4% of cases. CONCLUSIONS We provided our experience with a low-cost and less-commonly used technique in the management of CSDH. This technique showed similar recurrence, mortality and intracranial infection rates to those reported in the literature for closed drainage systems. Additional studies will be required to assess this technique.
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Affiliation(s)
- Jesús Alberto Morales-Gómez
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Everardo Garcia-Estrada
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Azalea Garza-Báez
- Neuroradiology Division, University Center for Diagnostic Imaging, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mariana Mercado-Flores
- Neuroradiology Division, University Center for Diagnostic Imaging, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Angel Martínez-Ponce de León
- Neurosurgery and Neuroendovascular Therapy Department, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, México
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Mowla A, Abdollahifard S, Farrokhi A, Yousefi O, Valibeygi A, Azami P. Middle Meningeal Artery Embolization with Liquid Embolic Agents for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2023; 34:1493-1500.e7. [PMID: 37182671 DOI: 10.1016/j.jvir.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Abstract
PURPOSE To assess the efficacy and safety of middle meningeal artery (MMA) embolization with liquid embolic agents and the outcomes of patients following this procedure. MATERIALS AND METHODS A review of the literature was conducted to identify studies investigating the efficacy and safety of MMA embolization with liquid embolic agents in patients with chronic subdural hematoma (cSDH) in PubMed, Scopus, Embase, and Web of Science. The keywords "liquid embolic agent," "middle meningeal artery," "cSDH," and "embolization" as well as their synonyms were used to build up the search strategy. The R statistical software and random-effects model were used for analysis. Heterogeneity was reported as I2, and publication bias was calculated using the Egger test. RESULTS Of 628 articles retrieved, 14 studies were eligible to be included in this study. Data of 276 patients were analyzed. n-Butyl cyanoacrylate and ethylene vinyl alcohol copolymer were the most commonly used embolic agents. This study revealed a pooled mortality rate of 0% (95% confidence interval [CI], 0.00%-100%), recurrence and failure rate of 3% (95% CI, 1%-10%), reoperation/reintervention rate of 4% (95% CI, 2%-12%), rate of size decrease of 94% (95% CI, 79%-98%), technical success rate of 100% (95% CI, 76%-100%), and adverse event rate of 1% (95% CI, 0.00%-4%). CONCLUSIONS With low mortality, recurrence, reoperation, and adverse event rates and a remarkable decrease in the size of hematomas, MMA embolization with liquid embolic agents may be considered a safe and effective treatment option in patients in whom surgical intervention has previously failed and as an alternative to conventional treatments.
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Affiliation(s)
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California.
| | - Saeed Abdollahifard
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz
| | - Amirmohammad Farrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz
| | - Adib Valibeygi
- Fasa Neuroscience Circle, Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Pouria Azami
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz
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14
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Sioutas GS, Mannam SS, Corral Tarbay A, Nia AM, Salem MM, Vivanco-Suarez J, Burkhardt JK, Jankowitz BT, Srinivasan VM. Dexamethasone and Statins in Patients Undergoing Primary Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Propensity-Matched Study in the TriNetX Research Network. World Neurosurg 2023; 176:e83-e90. [PMID: 37164211 DOI: 10.1016/j.wneu.2023.04.127] [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: 03/10/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Middle meningeal artery embolization (MMAE) is an effective minimally invasive option for chronic subdural hematoma (cSDH). Dexamethasone and statins have been reported to improve the resolution of cSDH and reduce its recurrence. However, only 1 study has investigated the role of statins in patients treated with MMAE, and there is no such study on dexamethasone. Thus, we used the TriNetX research network to determine whether adding dexamethasone or statin along with primary MMAE is associated with a benefit in outcomes. METHODS We queried all primary MMAE cases for cSDH between January 1st, 2012, and July 1st, 2022, in the TriNetX research network. We included patients greater than or equal to 18 years old and separated them regarding statin and dexamethasone use around the time of MMAE. Outcomes were evaluated within 6 months and 3 years after MMAE, and analyses were performed before and after propensity score matching. RESULTS The study included 372 patients with chronic subdural hematoma who underwent MMAE and were on dexamethasone, 339 not on dexamethasone, 391 on statins, and 278 not on statins. After propensity score matching, the dexamethasone cohorts included 250 patients each and only headache remained more prevalent in the dexamethasone cohort at both 6 months (21.2% vs. 10.0%, P = 0.001) and 3 years (23.6% vs. 12.4%, P = 0.001). After propensity score matching, the statin cohorts included 150 patients each and no differences in outcomes were found at both 6 months and 3 months after MMAE. CONCLUSIONS Patients treated with primary MMAE and were on dexamethasone or statins had no differences in mortality and functional/provider dependence compared to those who were not on dexamethasone or statins. Patients on dexamethasone had a higher prevalence of headaches.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Sneha Sai Mannam
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Antonio Corral Tarbay
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Anna M Nia
- Department of Neurological Surgery, Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Juan Vivanco-Suarez
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
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Abstract
OBJECTIVE To describe a case of persistent facial nerve palsy after middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH). METHODS A literature search was conducted for publications within the last 10 years of facial nerve palsy following cerebral circulation embolization procedures. RESULTS With inconsistencies between previously believed pathophysiology and clinical features, other mechanisms causing cSDH such as angiogenesis and capillary formation have been proposed. MMA embolization has evolved as a therapeutic approach to reduce recurrence of subdural hematoma; however, postoperative neural complications such as cranial nerve palsies are poorly described in the literature. CONCLUSIONS cSDH is increasingly more common and is on trajectory to become the most prevalent cranial neurosurgical condition. MMA embolization is described as a safe and minimally invasive procedure; however, as a relatively new procedure further research is needed to elucidate associated complications.
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Affiliation(s)
- Ally Ferber
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
| | - Brian Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
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16
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Karibe H, Narisawa A, Nagai A, Yamanouchi S, Kameyama M, Nakagawa A, Tominaga T. Incidence of Chronic Subdural Hematoma after Mild Head Trauma in Elderly Patients with or without Pre-traumatic Conditioning of Anti-thrombotic Drugs. Neurol Med Chir (Tokyo) 2023; 63:91-96. [PMID: 36682795 PMCID: PMC10072887 DOI: 10.2176/jns-nmc.2022-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Anti-thrombotic drugs may increase the risk for chronic subdural hematoma (CSDH). However, whether to continue or discontinue/counteract these drugs has not been investigated in patients with mild head trauma. CSDH incidence after mild head trauma, as well as the risk for CSDH in patients with anti-thrombotic drugs, were investigated in this study. The study included 765 consecutive elderly (>65 y.o.) patients with mild head trauma and an initial Glasgow Coma Scale (GCS) score of 14 or 15. All patients received initial CT within 24 hours after trauma and were re-examined 30 days after trauma to detect CSDH formation, repeating for every 30 days to examine symptomatic CSDH progression. Patients were divided into two groups, with anti-thrombotic drugs (n = 195) or without them (n = 263), to investigate the influence of pre-traumatic conditioning with anti-thrombotic drugs on CSDH. The whole sample was 458 out of 765 cases. The incidence of CSDH formation was 91 out of 458 cases (19.9%) after mild head trauma, with no significant difference between with and without anti-thrombotic drugs. CSDH progressed as symptomatic in 21 out of 458 cases (4.6%), with no significant difference between with and without anti-thrombotic drugs. Pre-traumatic conditioning with anti-thrombotic drugs and its continuation after trauma did not affect the incidence of formation or symptomatic progression of CSDH. This finding suggests that discontinuing and/or counteracting anti-thrombotic drugs may be unnecessary in patients with mild head trauma.
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Affiliation(s)
| | | | - Arata Nagai
- Department of Neurosurgery, Sendai City Hospital
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | | | | | - Atsuhiro Nakagawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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17
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Erwood A, Wheelus J, Nguyen K, Reisner A, Chern JJ. Case Series on Removal of Subdural to Peritoneal Shunt After Resolution of Subdural Collection in the First 2 Years of Life. Oper Neurosurg (Hagerstown) 2022; 23:8-13. [PMID: 35726924 DOI: 10.1227/ons.0000000000000182] [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: 02/03/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subdural to peritoneal shunt (SPS) placement is an established treatment option for chronic subdural hematoma (SDH) in the pediatric population. Practice patterns vary between institutions, with some advocating shunt removal while others leave the SPS in place after SDH resolution. There remain a paucity of data to document the safety and outcomes after removal of SPS. OBJECTIVE To support the safety and efficacy of SPS placement and subsequent removal for chronic SDH in children younger than 2 years. METHODS A total of 26 patients younger than 2 years underwent SPS removal procedures over a 5-year period from 2015 to 2019 at a single institution. Patient characteristics, hospital course, and outcomes were prospectively recorded in the hospital electronic medical record. Attention was given to change in head circumference, size of subdural collection, need for reoperation, or complications because of shunt removal. RESULTS Patients who underwent SPS placement presented with macrocephaly, signs and symptoms of increased intracranial pressure, and radiographical evidence of subdural collections. The most common etiology of chronic SDH was nonaccidental head trauma (18 of 26 patients). SDS was kept in place for an average of 10 months. Resolution of SDH was demonstrated on imaging for all 26 patients. One patient did require reinsertion of SPS 2 weeks after SPS removal. CONCLUSION Removal of SPS remains controversial, and careful consideration of patient, family, and provider preferences and potential risks associated with SPS removal must be taken into consideration.
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Affiliation(s)
- Andrew Erwood
- Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Jennifer Wheelus
- Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Khoi Nguyen
- Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Andrew Reisner
- Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Joshua J Chern
- Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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18
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Hamou H, Alzaiyani M, Pjontek R, Kremer B, Albanna W, Ridwan H, Clusmann H, Hoellig A, Veldeman M. Risk factors of recurrence in chronic subdural hematoma and a proposed extended classification of internal architecture as a predictor of recurrence. Neurosurg Rev 2022; 45:2777-2786. [PMID: 35461433 PMCID: PMC9349063 DOI: 10.1007/s10143-022-01790-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022]
Abstract
Chronic subdural hematomas (cSDHs) constitute one of the most prevalent intracranial disease entities requiring surgical treatment. Although mostly taking a benign course, recurrence after treatment is common and associated with additional morbidity and costs. Aim of this study was to develop hematoma-specific characteristics associated with risk of recurrence. All consecutive patients treated for cSDH in a single university hospital between 2015 and 2019 were retrospectively considered for inclusion. Size, volume, and midline shift were noted alongside relevant patient-specific factors. We applied an extended morphological classification system based on internal architecture in CT imaging consisting of eight hematoma subtypes. A logistic regression model was used to assess the classification’s performance on predicting hematoma recurrence. Recurrence was observed in 122 (32.0%) of 381 included patients. Apart from postoperative depressed brain volume (OR 1.005; 95% CI 1.000 to 1.010; p = 0.048), neither demographic nor factors related to patient comorbidity affected recurrence. The extended hematoma classification was identified as a significant predictor of recurrence (OR 1.518; 95% CI 1.275 to 1.808; p < 0.001). The highest recurrence rates were observed in hematomas of the homogenous (isodense: 41.4%; hypodense: 45.0%) and sedimented (50.0%) types. Our results support that internal architecture subtypes might represent stages in the natural history of chronic subdural hematoma. Detection and treatment at a later stage of spontaneous repair can result in a reduced risk of recurrence. Based on their high risk of recurrence, we advocate follow-up after treatment of sedimented and homogenous hematomas.
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Affiliation(s)
- Hussam Hamou
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Mohamed Alzaiyani
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Rastislav Pjontek
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Benedikt Kremer
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Walid Albanna
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anke Hoellig
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Michael Veldeman
- Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Yamaguchi I, Kanematsu Y, Mizobuchi Y, Tada Y, Miyamoto T, Sogabe S, Ishihara M, Kagusa H, Yamamoto Y, Matsuda T, Kitazato KT, Okayama Y, Takagi Y. Chronic subdural hematoma associated with dural metastasis leads to early recurrence and death: A single-institute, retrospective cohort study. J Clin Neurosci 2021; 94:244-249. [PMID: 34863446 DOI: 10.1016/j.jocn.2021.10.037] [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: 08/21/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022]
Abstract
The prevalence of chronic subdural hematoma (CSDH) associated with dural metastasis is uncertain, and appropriate treatment strategies have not been established. This study aimed to investigate the characteristics of and appropriate treatment strategies for CSDH associated with dural metastasis. We retrospectively reviewed the charts of 214 patients who underwent surgery for CSDH. The patients were divided into the dural metastasis group (DMG; n = 5, 2.3%) and no dural metastasis group (No-DMG; n = 209, 97.3%). Patient characteristics, treatment, and outcomes were compared between the two groups. Active cancer was detected in 31 out of 214 patients, 5 of whom (16.1%) had dural metastasis. In-hospital death (80.0% vs. 0%; p < 0.001) and recurrence within 14 days (80.0% vs. 2.9%; p < 0.001) and 60 days (80.0% vs. 13.9%; p = 0.002) were significantly prevalent in the DMG. All patients in the DMG developed subdural hematoma re-accumulation requiring emergent surgery because of brain herniation, and patients in the DMG had significantly worse recurrence-free survival (p < 0.001). This relationship remained significant (p < 0.001) even when the analysis was limited to the active cancer cohort (n = 31). CSDH associated with dural metastasis leads to early recurrence and death because of the difficulty in controlling subdural hematoma re-accumulation by common drainage procedures. Depending on the primary cancer status, withdrawal of active treatment and change to palliative care should be discussed after diagnosing CSDH associated with dural metastasis.
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Affiliation(s)
- Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshifumi Mizobuchi
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Miyamoto
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Manabu Ishihara
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroshi Kagusa
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoko Yamamoto
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Taku Matsuda
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Keiko T Kitazato
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshihiro Okayama
- Clinical Trial Center for Development Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Erdogan B, Is M, Tural Emon S, Ceman D, Orakdogen M, Engin T. Retrospective analysis of 195 surgically treated cases of chronic subdural hematoma. Int J Clin Pract 2021; 75:e15014. [PMID: 34808025 DOI: 10.1111/ijcp.15014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/17/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition. METHODS We retrospectively analysed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018. RESULTS The average age of the patients was 65.7 ± 19.6 years. The most common symptom was headache (53.3%). The case background was the use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was 13.4 ± 2.9, early postop 13.8 ± 2.5, and late postop was 14.6 ± 1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of the brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH. CONCLUSIONS CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.
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Affiliation(s)
- Baris Erdogan
- Department of Neurosurgery, Sanliurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Merih Is
- Department of Neurosurgery, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Selin Tural Emon
- Department of Neurosurgery, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Duygu Ceman
- Department of Neurosurgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Metin Orakdogen
- Department of Neurosurgery, University of Trakya, Edirne, Turkey
| | - Taner Engin
- Department of Neurosurgery, University of Health Sciences Mehmet Akif İnan Training and Research Hospital, Istanbul, Turkey
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Yang L, Li N, Yang L, Wang D, Qiang S, Zhao Z. Atorvastatin-Induced Absorption of Chronic Subdural Hematoma Is Partially Attributed to the Polarization of Macrophages. J Mol Neurosci 2021; 72:565-573. [PMID: 34569007 DOI: 10.1007/s12031-021-01910-x] [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: 01/03/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022]
Abstract
As one of the main types of secondary craniocerebral injury, the onset, progression, and prognosis of chronic subdural hematoma (CSDH) are closely related to the local inflammation of intracranial hematoma. Atorvastatin is reported to be effective in the conservative treatment of CSDH. This study aimed to clarify whether atorvastatin regulated the inflammatory responses in CSDH by interfering with the function of macrophages. The rat CSDH model was prepared by repeated intracranial blood injection with velocity gradient, and MRI was applied to calculate the intracranial hematoma volume. Changes in rat nerve functions were evaluated by foot-fault and Morris water maze tests. Flow cytometry was applied to detect the number of total macrophages and the percentage of M1 or M2 macrophages. The expression of inflammatory factors was examined by ELISA and western blot. Western bolt was applied to detect the expression of proteins involved in the colony-stimulating factor 1 receptor (CSF-1R) signaling pathway. Our results showed that atorvastatin significantly accelerated the absorption of hematoma and improved the nerve functions of CSDH rats. In addition, atorvastatin treatment effectively suppressed the expression of TNF-α, IL-6, and IL-8 and promoted the expression of IL-10. The total number of macrophages was decreased, and the percentage of M2 macrophages was increased in the intracranial hematoma following atorvastatin treatment. Furthermore, atorvastatin increased the levels of M2-related genes and surface markers in BMDMs stimulated by lipopolysaccharides and IFNγ, and activated the CSF-1R signaling pathway. In conclusion, our study shows that atorvastatin could alleviate the symptoms of CSDH and promote hematoma ablation by polarizing macrophages to M2 type and regulating the inflammatory responses.
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Affiliation(s)
- Liang Yang
- Department of Neurosurgery, the Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Nan Li
- Department of Gynecology, the Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Lijun Yang
- Department of Neurosurgery, the Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin, 300052, China
| | - Shuke Qiang
- Department of Neurosurgery, the Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei, China
| | - Zongmao Zhao
- Department of Neurosurgery, the Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang 050000, Hebei, China.
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Edlmann E, Whitfield PC, Kolias A, Hutchinson PJ. Pathogenesis of Chronic Subdural Hematoma: A Cohort Evidencing De Novo and Transformational Origins. J Neurotrauma 2021; 38:2580-2589. [PMID: 33787358 DOI: 10.1089/neu.2020.7574] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 12/30/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a common neurosurgical pathology, yet conflicting opinions exist concerning the pathophysiological processes involved. Many consider CSDH a product of an aged acute subdural hematoma (ASDH) secondary to trauma. Serial imaging, however, has demonstrated CSDH formation in patients without any initial ASDH. To understand the relevance of acute hemorrhage in a cohort of patients with CSDH, transformation from an ASDH were categorized as CSDH-acute transformed (CSDH-AT) and those without any acute hemorrhage at the outset as CSDH-de-novo (CSDH-DN). A cohort of 41 eligible patients with CSDH were included, with baseline imaging after trauma (or spontaneous ASDH) available for assessment of acute hemorrhage. Volumetric analysis of all subdural collections and measurements of baseline atrophy were performed. In 37% of cases, there was an ASDH present on baseline imaging (CSDH-AT), whereas 63% had no acute hemorrhage at baseline (CSDH-DN). The CSDH-ATs developed more rapidly (mean 16 days from baseline to diagnosis) and were smaller in volume than the CSDH-DNs, which developed at a mean delay of 57 days. In 54% of the CSDH-DNs, a subdural hygroma was present on baseline imaging, and there was a wide range of baseline cerebral atrophy. This study provides radiological evidence for two distinct pathways in the formation of CSDH, with CSDH-DN occurring more commonly and often involving subdural hygroma. Further work is needed to understand whether the pathological origin has implications for patient outcome.
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Affiliation(s)
- Ellie Edlmann
- South West Neurosurgical Centre, University Hospitals Plymouth NHS t\Trust, Plymouth, United Kingdom
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, United Kingdom
| | - Peter C Whitfield
- South West Neurosurgical Centre, University Hospitals Plymouth NHS t\Trust, Plymouth, United Kingdom
| | - Angelos Kolias
- Department of Clinical Neurosciences, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Peter J Hutchinson
- Department of Clinical Neurosciences, Cambridge Biomedical Campus, Cambridge, United Kingdom
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Gregori F, Colistra D, Mancarella C, Chiarella V, Marotta N, Domenicucci M. Arachnoid cyst in young soccer players complicated by chronic subdural hematoma: personal experience and review of the literature. Acta Neurol Belg 2020; 120:235-246. [PMID: 31654391 DOI: 10.1007/s13760-019-01224-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Abstract
Arachnoid cysts (ACs) are congenital intracranial benign cavities originating from the meninges during embryological development. Several studies have shown the existence of a relationship between AC and a higher risk to develop ipsilateral chronic subdural hematoma (CSH) especially in a young population. In the presence of an AC, the practice of sport activities may expose young patients to minor head trauma and to an increased risk of developing CSH. We describe three cases of young soccer players with AC associated with CSH. Then, we performed a literature review of all the reported cases in the literature of patients younger than 18 years with AC-associated CSH related to sport practice. A total of 33 cases, including the three cases reported by us, are analyzed. Soccer is the most represented sport activity in this association (39% of cases). The treatment of choice is surgical in all patients, with burr hole or craniotomy in similar proportions. In one-third of patients, the AC has been fenestrated. Outcome is good in all the reported cases. We reviewed the main pathogenic theories, the main surgical strategies described in literature, as well as recurrence rate of CSH, the association of AC and cranial deformities, and the clinical outcome. AC might be associated with skull deformities, but their real incidence remains unclear. The clinical detection of such anomalies should suggest performing further radiological investigations. If the presence of AC is confirmed, the practice of sport activities should not be avoided, as the real incidence of AC-associated CSH is not clear yet and the reported outcomes in literature are good. Surgical treatment of AC-associated CSH should be hematoma removal through burr hole, reserving AC fenestration only for cases with intracystic bleeding or recurrences. The surgeon should adequately advise and inform the young patients and their families that they could have an increased risk of developing CSH given by the presence of the AC, and that they should be referred to a neurosurgical center if they become symptomatic.
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Affiliation(s)
- Fabrizio Gregori
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
| | - Davide Colistra
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | | | - Vito Chiarella
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Nicola Marotta
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Domenicucci
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
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Zahl SM, Wester K, Gabaeff S. Examining perinatal subdural haematoma as an aetiology of extra-axial hygroma and chronic subdural haematoma. Acta Paediatr 2020; 109:659-666. [PMID: 31637736 PMCID: PMC7154632 DOI: 10.1111/apa.15072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/22/2019] [Revised: 09/29/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
AIM Benign external hydrocephalus (BEH), hygroma and chronic subdural haematoma are extra-axial fluid collections in infants. MRI studies have shown that almost half of all new-borns have perinatal subdural blood, generally referred to as subdural haematoma (SDH) or perinatal SDH. Epidemiologically there are striking similarities between chronic SDH and BEH in infants. METHODS Discussion of pathophysiological mechanisms for BEH and chronic SDH, based on existing literature. RESULTS Perinatal SDH is common, and we hypothesise that this condition in some infants develop into extra-axial fluid collections, known as hygroma, BEH or chronic subdural haematoma. The mechanism seems to be an intradural bleeding that creates an obstructive layer preventing normal CSF absorption. The site where the bleeding originates from and those areas enveloped in blood from the primary damaged area are prone to later rebleeds, seen as 'acute on chronic' haematomas. With steady production of CSF and the blockage, increased intracranial pressure drives the accelerated skull growth seen in many of these children. CONCLUSION Perinatal SDH hampers CSF absorption, possibly leading to BEH and chronic SDH, with a high risk of false accusations of abuse. Close monitoring of head circumference could prove vital in detecting children with this condition.
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Affiliation(s)
| | - Knut Wester
- Department of Clinical Medicine K1University of BergenBergenNorway
- Department of NeurosurgeryHaukeland University HospitalBergenNorway
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25
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Dobran M, Iacoangeli M, Scortichini AR, Mancini F, Benigni R, Nasi D, Gladi M, Scerrati M. Spontaneous chronic subdural hematoma in young adult: the role of missing coagulation facto. G Chir 2019; 38:66-70. [PMID: 28691669 DOI: 10.11138/gchir/2017.38.2.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Chronic subdural hematoma (CSDH) is typically in elderly and rarely in young people. To prevent complications and re-bleeding after surgical treatment of CSDH it is important to assess the risk factors as coagulation disorders especially in young patients (below 65 years) with no history of head trauma, alcohol abuse or anticoagulant therapy. PATIENTS AND METHODS This study consists of 16 patients (12 males, 4 females) with age ranging from 27 to 59 years (median 48,25 years) operated for CSDH. All patients are submitted to routine coagulation parameters pre-operatively and complete screening for unknown coagulation deficit in the follow-up. RESULTS Factor VII was altered in 6 out of 16 patients and one patient had the alteration of the Von Willebrand factor. Recurrence occurred in 4 out of 16 patients and all of these patients were positive for factor VII deficiency. Three pts were in therapy with ASA. No patients were alcoholists or suffered from hematological disease. CONCLUSION In this study we documented that the decreased activity of VII factor may play a role in the pathophysiology and recurrence of spontaneous CSDH in young adults. We suggest that for young patients aged under 65 y.o. suffered from CSDH the screening of coagulation factors is useful to planning a safely and correct surgical therapy.
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Kanazawa T, Miwa T, Akiyama T, Ohara K, Kosugi K, Nishimoto M, Yoshida K. A Case of Aggressive Recurrent Intracranial Subdural Hematoma Associated with Angiosarcoma Originating from the Skull. World Neurosurg 2019; 126:120-123. [PMID: 30862578 DOI: 10.1016/j.wneu.2019.02.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 09/11/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Angiosarcoma often arises as a cutaneous disease in the scalp and the face; however, subdural hematoma (SDH) associated with angiosarcoma is extremely rare. CASE DESCRIPTION A 72-year-old woman visited our hospital with gait disorder and progressive consciousness disturbance approximately 3 months after a minor head injury. Initially, on reviewing the results of imaging studies, she was diagnosed with traumatic chronic SDH. Despite repeated operations thereafter, including the embolization of the middle meningeal artery, her general condition progressively worsened, and computed tomography of head repeatedly showed the recurrence of SDH. Based on histopathologic and intraoperative findings, she was finally diagnosed with angiosarcoma originating from the skull. She died shortly thereafter because of aggressive recurrent intracranial SDH caused by leptomeningeal dissemination. CONCLUSIONS In addition to cancers metastatic to the skull or dura mater, angiosarcoma should be included in the differential diagnosis for patients with repeated SDH and bone defect. An effective treatment for angiosarcoma with SDH that shows an unfavorable prognosis has not been established; however, an early diagnosis might be useful for a novel treatment.
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Affiliation(s)
- Tokunori Kanazawa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Ohara
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaaki Nishimoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Kostić A, Kehayov I, Stojanović N, Nikolov V, Kitov B, Milošević P, Kostić E, Zhelyazkov H. Spontaneous chronic subdural hematoma in elderly people - Arterial hypertension and other risk factors. J Chin Med Assoc 2018; 81:781-786. [PMID: 29929831 DOI: 10.1016/j.jcma.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/17/2017] [Accepted: 03/28/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The risk factors implicated in the genesis of chronic subdural hematomas include old age, alcoholism, diabetes mellitus, arachnoid cysts, coagulopathy, anticoagulant (ACTh) and antiplatelet drugs. However, no study has reported an association between arterial hypertension (HTA) and chronic subdural hematomas. Therefore, the aim of this study was to investigate whether HTA is a risk factor for spontaneous chronic subdural hematomas (SCSDHs). METHODS This multicenter study included patients aged over 60 years and was conducted from January 2009 to the end of 2015. One hundred and twenty-two patients with SCSDHs and 111 controls treated for other reasons with no evidence of intracranial hemorrhages on brain computed tomography were enrolled. The patients were separated into three age subgroups to provide a better insight into the role of risk factors with age. RESULTS The average age in the SCSDH group was 74.45 ± 8.16 years, compared to 71.28 ± 6.69 years in the control group. The SCSDH group was significantly older than the control group (p = 0.0014). The patients in the 60-69 years age group diagnosed with SCSDHs had significantly higher rates of HTA (p = 0.0519), ACTh treatment (p = 0.0292) and alcoholism (p = 0.0300) than the control group. The patients in the 70-79 years age group diagnosed with SCSDHs had significantly higher rates of HTA (p = 0.0071) and ACTh treatment (p = 0.0158) than the control group. In the subgroup of patients older than 80 years, there were no statistical differences. CONCLUSION The incidence of HTA had borderline significance in the patients aged 60-69 years with SCSDHs and statistical significance in the patients aged 70-79 years with SCSDHs. Anticoagulant therapy was the most significant risk factor. Among the patients with SCSDHs aged 60-69 years, the percentage of heavy drinkers was significantly higher than in the control group.
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Affiliation(s)
- Aleksandar Kostić
- Clinic for Neurosurgery, Clinical Center Nis, Medical University-Nis, Nis, Serbia.
| | - Ivo Kehayov
- Department of Neurosurgery, Faculty of Medicine, Medical University-Plovdiv, Plovdiv, Bulgaria
| | - Nebojša Stojanović
- Clinic for Neurosurgery, Clinical Center Nis, Medical University-Nis, Nis, Serbia
| | - Vesna Nikolov
- Clinic for Neurosurgery, Clinical Center Nis, Medical University-Nis, Nis, Serbia
| | - Borislav Kitov
- Department of Neurosurgery, Faculty of Medicine, Medical University-Plovdiv, Plovdiv, Bulgaria
| | - Predrag Milošević
- Clinic for Neurosurgery, Clinical Center Nis, Medical University-Nis, Nis, Serbia
| | - Emina Kostić
- Clinic for Nephrology, Clinical Center Nis, Medical University-Nis, Nis, Serbia
| | - Hristo Zhelyazkov
- Department of Neurosurgery, Faculty of Medicine, Medical University-Plovdiv, Plovdiv, Bulgaria
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28
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Metin KM, Güzel II, Oskovi A, Guzel AI. Chronic subdural hematoma following spinal anesthesia for cesarean section. J Exp Ther Oncol 2017; 11:97-99. [PMID: 28976131] [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] [Received: 03/03/2015] [Accepted: 04/25/2015] [Indexed: 06/07/2023]
Abstract
Intracranial subdural hematoma after spinal anesthesia is a rare and life-threatening complication of spinal anesthesia. The most common complication of spinal anesthesia is the postdural puncture headache. When severe and persistent headache after spinal anesthesia occur, differential diagnosis can be explored. In this report, we aimed to evaluate a patient with persistent headache following spinal anesthesia for cesarean section in a 31-year-old woman ,and emphasize a rare complication of spinal anesthesia which is subdural hematoma.
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Affiliation(s)
- Kübra Mehel Metin
- Clinic of Neurology, Dr. Nafiz Korez Sincan State Hospital, Ankara, Turkey
| | - Is Il Güzel
- Clinic of Neurology, Numune Education and Research Hospital, Ankara, Turkey
| | - Aslı Oskovi
- Clinic of Obstetrics and Gynecology, Zekai Tahir Burak Health of Woman Education and Research Hospital, Ankara, Turkey
| | - Ali Irfan Guzel
- Clinic of Obstetrics and Gynecology, Zekai Tahir Burak Health of Woman Education and Research Hospital, Ankara, Turkey
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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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30
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Castro-Rodríguez C, Román-Pena P, Arán-Echabe E, Gelabert-González M. [Chronic subdural haematomas in very elderly patients]. Rev Esp Geriatr Gerontol 2016; 51:309-316. [PMID: 27345661 DOI: 10.1016/j.regg.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 03/29/2016] [Revised: 05/09/2016] [Accepted: 05/13/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. PATIENTS AND METHODS A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. RESULTS A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). CONCLUSIONS CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality.
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Affiliation(s)
| | - Paula Román-Pena
- Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España; Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Eduardo Arán-Echabe
- Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España; Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Miguel Gelabert-González
- Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España; Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
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Takata T, Kokudo Y, Kume K, Ikeda K, Kamada M, Touge T, Deguchi K, Masaki T. Dialysis-induced Subdural Hematoma in an Arachnoid Cyst Associated with Autosomal Dominant Polycystic Kidney Disease. Intern Med 2016; 55:2065-7. [PMID: 27477416 DOI: 10.2169/internalmedicine.55.6295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/06/2022] Open
Abstract
Arachnoid cyst (AC) is a neurological complication of autosomal dominant polycystic kidney disease (ADPKD). Although an AC can increase the risk of a subdural hematoma, the clinical presentation of bleeding into an AC associated with ADPKD is not well known. We herein report the case of a 59-year-old woman in whom the initiation of hemodialysis for renal failure led to AC bleeding. A change of anticoagulant from heparin to nafamostat mesilate allowed dialysis to continue without rebleeding. These findings suggest that hemodialysis in patients with an AC associated with ADPKD may increase the risk of bleeding. Nafamostat mesilate may be useful in such cases.
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Affiliation(s)
- Tadayuki Takata
- Department of Intractable Neurological Research, Kagawa University Faculty of Medicine, Japan
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Yamada K, Kurahashi H, Ogaya S, Kurahashi N, Umemura A, Kawamura Y, Kato M, Maruyama K, Nagasaka M. [Two pediatric cases of chronic progressive subdural hematoma with brain atrophy following acute encephalitis/encephalopathy requiring surgical hematoma removal]. No To Hattatsu 2016; 48:49-51. [PMID: 27012112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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TAKAHASHI K, MIMA T, AKIBA Y. Chronic Subdural Hematoma Associated with Spontaneous Intracranial Hypotension: Therapeutic Strategies and Outcomes of 55 Cases. Neurol Med Chir (Tokyo) 2015; 56:69-76. [PMID: 26489406 PMCID: PMC4756246 DOI: 10.2176/nmc.oa.2015-0032] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 09/16/2015] [Indexed: 01/03/2023] Open
Abstract
Spontaneous intracranial hypotension (SIH) has increasingly been recognized, and it is well known that SIH is sometimes complicated by chronic subdural hematoma (SDH). In this study, 55 cases of SIH with SDH were retrospectively analyzed, focusing on therapeutic strategies and outcomes. Of 169 SIH cases (75 males, 84 females), 55 (36 males, 19 females) were complicated by SDH. SIH was diagnosed based on clinical symptoms, neuroimaging, and/or low cerebrospinal fluid pressure. Presence of orthostatic headache and diffuse meningeal enhancement on magnetic resonance imaging were regarded as the most important criteria. Among 55 SIH with SDH cases, 13 improved with conservative treatment, 25 initially received an epidural blood patch (EBP), and 17 initially underwent irrigation of the hematomas. Of the 25 initially treated with EBP, 7 (28.0%) needed SDH surgery and 18 (72.0%) recovered fully without surgery. Of 17 SDH cases initially treated with surgery, 6 (35.7%) required no EBP therapy and the other 11 (64.3%) needed EBP and/or additional SDH operations. In the latter group, 2 cases had transient severe complications during and after the procedures. One of these 2 cases developed a hoarse voice complication. Despite this single, non-severe complication, all enrolled in this study achieved good outcomes. The present study suggests that patients initially receiving SDH surgery may need additional treatments and may occasionally have complications. If conservative treatment is insufficient, EBP should be performed prior to hematoma irrigation.
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Affiliation(s)
| | - Tatsuo MIMA
- Department of Neurosurgery, Sanno Hospital, Minato-ku, Tokyo
| | - Yoichi AKIBA
- Department of Neurosurgery, Akiba Hospital, Saitama, Saitama
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Gondar R, Rogers A, Momjian S. Subdural hematoma after endoscopic third ventriculostomy: Struggling against the Laplace law. Neurochirurgie 2015; 61:347-51. [PMID: 26255033 DOI: 10.1016/j.neuchi.2015.06.003] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/27/2015] [Accepted: 06/05/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) is an ideal treatment for obstructive hydrocephalus. Although ETV is a safe procedure, several complications related to this procedure have been reported in the literature. We present a rare case of late onset symptomatic bilateral subdural hematoma after an uneventful ETV that proved particularly difficult to solve. CASE DESCRIPTION A 61-year-old male patient presented in our neurosurgery department three months after ETV (aqueductal stenosis) with progressive headaches and anomic aphasia. The MRI revealed bilateral chronic subdural hematomas (chSDH). They were treated via a burr hole evacuation, subduroperitoneal and external subdural drains proving to be refractory to the first two strategies. Postoperatively, his headaches improved. At the last follow-up the patient's status remains improved and there is no radiological evidence of significant residual collections. CONCLUSION This case confirms that chSDH formation is a rare possible complication following ETV even in the presence of a normal early postoperative image. Patients should be followed-up more closely for possible subdural collection formation. In the cases of very long-term hydrocephalus with a thin cerebral mantle, brain elastic properties are likely to be altered. As there is no possibility to close the internal shunt, the stoma, we advocate external subdural drainage to reinflate the brain, in the first intention or at least after an initial failed burr hole evacuation.
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Affiliation(s)
- R Gondar
- Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - A Rogers
- Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - S Momjian
- Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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35
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Wittschieber D, Karger B, Niederstadt T, Pfeiffer H, Hahnemann ML. Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol 2015; 36:432-9. [PMID: 24948499 PMCID: PMC8013070 DOI: 10.3174/ajnr.a3989] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Are subdural hygromas the result of abusive head trauma? CT and MR imaging represent important tools for the diagnosis of abusive head trauma in living infants. In addition, in-depth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Therefore, the current knowledge on subdural hygromas is summarized and forensic conclusions are drawn. The most important diagnostic pitfalls, benign enlargement of the subarachnoid space, and chronic subdural hematoma, are discussed in detail. Illustrative cases from forensic practice are presented. Literature analysis indicates that subdural hygromas can occur immediately or be delayed. If other infrequent reasons can be excluded, the presence of subdural hygromas strongly suggests a posttraumatic state and should prompt the physician to search for other signs of abuse. To differentiate subdural hygromas from other pathologies, additional MR imaging of the infant's head is indispensable after initial CT scan.
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Affiliation(s)
- D Wittschieber
- From the Departments of Forensic Medicine (D.W., B.K., H.P.)
| | - B Karger
- From the Departments of Forensic Medicine (D.W., B.K., H.P.)
| | - T Niederstadt
- Clinical Radiology (T.N.), University Hospital Münster, Münster, Germany
| | - H Pfeiffer
- From the Departments of Forensic Medicine (D.W., B.K., H.P.)
| | - M L Hahnemann
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.L.H.), University Hospital Essen, Essen, Germany
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Nau JY. [Miscellaneous, July 2014]. Rev Med Suisse 2014; 10:1476-1477. [PMID: 25141571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Affiliation(s)
| | - Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Sakakura K, Ayuzawa S, Masuda Y, Kin H, Matsumura A. [A case of bilateral chronic subdural hematoma due to spontaneous intracranial hypotension without orthostatic headache]. No Shinkei Geka 2014; 42:341-345. [PMID: 24698895] [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: 06/03/2023]
Abstract
We herein present a case of bilateral chronic subdural hematoma(bilateral CSDH)caused by spontaneous intracranial hypotension(SIH)without orthostatic headache. A 67-year-old male patient with mild head injury suffered from a chronic, non-postural headache. Computed tomography of the brain showed bilateral CSDH. The hematomas were surgically evacuated using a closed drainage method. His headache immediately disappeared, but it recurred after 2 weeks. We further performed hematoma irrigation;however, his neurological status deteriorated with the development of pneumocephalus. Magnetic resonance imaging with gadolinium-DTPA showed diffuse pachymeningeal enhancement. His cerebrospinal fluid pressure was 3cmH2O, and radioisotope cisternography revealed cerebrospinal fluid leakage at the level of the cervicothoracic transition. No recurrence was found after 6 weeks of horizontal bed rest. The possibility of SIH should be considered in patients with CSDH, especially bilateral CSDH, even in elderly patients with a history of mild head trauma, and absence of orthostatic headache. Closed drainage method may be preferable in cases where surgical treatment is used.
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Thirumal Y, Alugolu R. Spontaneous chronic subdural hematoma following Plasmodium vivax malaria: a rare association. J Vector Borne Dis 2014; 51:73-74. [PMID: 24717209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
| | - Rajesh Alugolu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad-500 082, India
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MATSUBARA T, ISHIKAWA E, HIRATA K, MATSUDA M, AKUTSU H, MASUMOTO T, ZABORONOK A, MATSUMURA A. A new mechanism of cerebrospinal fluid leakage after lumboperitoneal shunt: a theory of shunt side hole--case report. Neurol Med Chir (Tokyo) 2013; 54:572-7. [PMID: 24305015 PMCID: PMC4533463 DOI: 10.2176/nmc.cr2013-0067] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/01/2013] [Indexed: 03/22/2024] Open
Abstract
Cerebrospinal fluid (CSF) overdrainage after lumboperitoneal (LP) shunt placement for the patients with idiopathic normal pressure hydrocephalus (iNPH) is mainly caused by insufficient management of pressure settings of the shunt valve and/or siphon effect of shunt systems induced by the patient's postural changes. We here report a unique case of intracranial hypotension (IH) due to CSF leakage after LP shunt placement in which another mechanism leads to the CSF leakage. A 67-year-old man suffered from persistent headache worsening with postural change 2 months after LP shunt reconstruction for iNPH. Brain computed tomography scan showed bilateral chronic subdural hematomas (CSDH). Lumbar images including shuntography and magnetic resonance imaging showed the tip of the lumbar catheter was spontaneously pulled out close to the dura mater with expansion of the epidural space due to CSF leakage from a shunt side hole of the lumbar catheter to the epidural space. Shunt removal and subsequent irrigation of CSDH improved his headache. CSF leakage in our case differs from those in previous reports, because early and enormous CSF leakage into the epidural space can be explained only by a different mechanism through a side hole just located in the epidural space in our case. We must pay attention to the possibility of this rare cause of IH due to CSF leakage in patients suffering from postural headache after LP shunt placement.
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Affiliation(s)
- Teppei MATSUBARA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Eiichi ISHIKAWA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Koji HIRATA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Masahide MATSUDA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Hiroyoshi AKUTSU
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Tomohiko MASUMOTO
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Alexander ZABORONOK
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Akira MATSUMURA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
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Tan VES, Liew D. A case of chronic subdural hematoma following lumbar drainage for the management of iatrogenic cerebrospinal fluid rhinorrhea: pitfalls and lessons. Ear Nose Throat J 2013; 92:513-515. [PMID: 24170465] [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: 06/02/2023] Open
Abstract
Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.
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Affiliation(s)
- Vincent Eng-Soon Tan
- Department of Otorhinolaryngology-Head and Neck Surgery, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching, Sarawak 93400, Malaysia.
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Luongo M, Pizzuti M, Godano U. Chronic subdural non traumatic hematoma associated with von Willebrand's disease: a real clinical association or just a mere coincidence? Clin Neurol Neurosurg 2013; 115:1569-70. [PMID: 23276476 DOI: 10.1016/j.clineuro.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 11/27/2012] [Accepted: 12/02/2012] [Indexed: 02/07/2023]
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Tanaka Y, Ohno K. Chronic subdural hematoma - an up-to-date concept. J Med Dent Sci 2013; 60:55-61. [PMID: 23918031] [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: 01/25/2013] [Accepted: 03/08/2013] [Indexed: 06/02/2023]
Abstract
Chronic subdural hematoma (CSDH) is prevalent among elderly populations worldwide, and its mysterious pathogenesis has been discussed in the literature for decades. The issues remaining to be solved in regard to CSDH include the initiating events; the bleeding into the subdural space and the formation of the outer and inner membranes, its development; increase and liquefaction of hematoma, the optimal treatments, and the natural history. The pathophysiology is becoming more clear due to recent findings from computed tomography studies and human models of CSDH. In this work, we review previous studies on CSDH and present a new integrated concept about the development of this common condition after head injuries.
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Affiliation(s)
- Yoji Tanaka
- Neurosurgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University(TMDU), Tokyo, Japan
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Kudo K, Naraoka M, Shimamura N, Ohkuma H. [Chronic subdural hematoma (CSH) complicated by bilateral occipital lobe infarction: two case reports]. No Shinkei Geka 2013; 41:319-322. [PMID: 23542794] [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
Chronic subdural hematoma (CSH) is a common disease that is treated with burr hole drainage by neurosurgeons. The outcome of CSH is mostly favorable. We treated 2 cases with bilateral occipital lobe infarction due to CSH. A 57-year-old woman was ambulatory when she visited a clinic for evaluation of headache. One hour after the CT was taken, she developed acute impairment of consciousness, so that she was referred to our hospital. The second patient was a 73-year-old woman with a history of depression who was involved in a traffic accident 5 weeks before admission to our hospital. She was at first admitted to a psychiatric hospital for evaluation of gait disturbance. Three weeks after she was admitted to the psychiatric hospital, she fell into a coma. She was referred to our hospital. Their brain CT on admission revealed compressed ambient and interpeduncular cistern and bilateral CSH. Although burr hole drainage surgery was performed, the 2 patients developed severe sequelae due to occipital lobe infarction caused by central transtentorial herniation.
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Affiliation(s)
- Kanae Kudo
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hiroshaki-city, Aomori, Japan
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Stanišić M, Hald J, Rasmussen IA, Pripp AH, Ivanović J, Kolstad F, Sundseth J, Züchner M, Lindegaard KF. Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients. Acta Neurochir (Wien) 2013; 155:323-33; discussion 333. [PMID: 23229873 PMCID: PMC3552365 DOI: 10.1007/s00701-012-1565-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [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: 03/28/2012] [Accepted: 11/12/2012] [Indexed: 11/30/2022]
Abstract
Background Chronic subdural haematoma (CSDH) is a common entity in neurosurgery with a considerable postoperative recurrence rate. Computerised tomography (CT) scanning remains the most important diagnostic test for this disorder. The aim of this study was to characterise the relationship between the recurrence of CSDH after treatment with burr-hole irrigation and closed-system drainage technique and CT scan features of these lesions to assess whether CT findings can be used to predict recurrence. Methods We investigated preoperative and postoperative CT scan features and recurrence rate of 107 consecutive adult surgical cases of CSDH and assessed any relationship with univariate and multivariate regression analyses. Results Seventeen patients (15.9 %) experienced recurrence of CSDH. The preoperative haematoma volume, the isodense, hyperdense, laminar and separated CT densities and the residual total haematoma cavity volume on the 1st postoperative day after removal of the drainage were identified as radiological predictors of recurrence. If the preoperative haematoma volume was under 115 ml and the residual total haematoma cavity volume postoperatively was under 80 ml, the probability of no recurrence was very high (94.4 % and 97.4 % respectively). Conclusions These findings from CT imaging may help to identify patients at risk for postoperative recurrence.
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Affiliation(s)
- Milo Stanišić
- Department of Neurosurgery, Oslo University Hospital, Nydalen, Po. Box 4950, 0424, Oslo, Norway.
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Goto T, Ohshima S, Miura K, Shibuya T, Sato W, Dohmen T, Kamada K, Kanata R, Sakai T, Chiba M, Sugimoto Y, Minami S, Ohnishi H. A chronic subdural hematoma in a patient receiving combination therapy with pegylated interferon alfa-2b and ribavirin for chronic hepatitis C. Intern Med 2013; 52:2057-60. [PMID: 24042512 DOI: 10.2169/internalmedicine.52.0791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old man who suffered from chronic hepatitis C was infected with HCV genotype 1 and exhibited a high viral load. He had hypertension and had consumed the equivalent of 50 g of ethanol per day. He was treated with pegylated interferon and ribavirin. After 51 weeks, he developed an unsteady gait while walking and demonstrated Barre's sign on the right foot and a headache. Contrast computed tomography showed a subdural hematoma with a mass effect. The patient was treated with drainage and aspiration surgery via a burr hole. Following the drainage procedure, there were no neurological sequelae. Treatment with pegylated interferon and ribavirin was discontinued. Fortunately, a sustained virological response was achieved.
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MESH Headings
- Aged
- Antiviral Agents/administration & dosage
- Antiviral Agents/adverse effects
- Drug Therapy, Combination
- Hematoma, Subdural, Chronic/diagnosis
- Hematoma, Subdural, Chronic/etiology
- Hematoma, Subdural, Chronic/surgery
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/virology
- Humans
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-alpha/adverse effects
- Male
- Polyethylene Glycols/administration & dosage
- Polyethylene Glycols/adverse effects
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/adverse effects
- Ribavirin/administration & dosage
- Ribavirin/adverse effects
- Tomography, X-Ray Computed
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Affiliation(s)
- Takashi Goto
- Department of Gastroenterology, Akita University Graduate School of Medicine, Japan
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Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E. Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir (Wien) 2012; 154:1549-54. [PMID: 22772400 DOI: 10.1007/s00701-012-1434-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [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: 04/17/2012] [Accepted: 06/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic subdural haematoma (cSDH) is a common disease in neurosurgical practise, especially in elderly patients. This is of growing importance as the number of elderly people in the population is increasing steadily. There are scarce data focussing especially on elderly patients with cSDH. This study intended to evaluate the outcome and peri-operative risks in elderly patients with cSDH. METHODS We retrospectively reviewed medical records of 322 consecutive patients aged ≥65 years treated at our department between 2002 and 2009 focussing on outcome, aetiology, peri-operative risks, recurrence rate, and co-factors such as concomitant diseases and therapy with anticoagulants. The surgical procedure included burr-hole craniostomy followed by insertion of a subdural drain in each case. The outcome was classified according to the Karnofsky performance status (KPS) and modified Rankin Scale (mRS) score. Patients were divided into three groups according to age (group I: age 65-74 years, group II: 75-84 years, group III: 85-94 years). RESULTS Three hundred twenty-two patients underwent burr-hole craniostomy for cSDH in 399 surgical procedures. The mean age was 76 ± 7.9 years. After surgery, the mean neurological status improved in all three groups. Overall favourable outcome (mRS 0-2) was achieved in 83 % in group I, 68 % in group II and 51 % in group III, respectively. The rate of recurrence was lower in group III (7.5 %) compared to groups I (21.5 %) and II (27.37 %, p = 0.004). Overall, complication rates and peri-operative mortality (2.75 %) did not differ significantly between the age groups. CONCLUSION The data of the current study suggest that treatment of cSDH is safe in elderly patients. Patients aged above 85 years carry a greater risk for peri-operative complications, i.e. aSDH, and therefore have to be examined and monitored meticulously in order to prevent complications.
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Affiliation(s)
- Valeri Borger
- Department of Neurosurgery, Johann Wolfgang Goethe-University Frankfurt am Main, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
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Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012; 154:1541-8. [PMID: 22653496 DOI: 10.1007/s00701-012-1399-9] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [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: 04/09/2012] [Accepted: 05/15/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. In this study, we evaluated the independent risk factors of recurrence. METHODS We analyzed data for 420 patients with chronic subdural hematoma treated by the standard surgical procedure for hematoma evacuation at our institution. RESULTS Ninety-two (21.9 %) patients experienced at least one recurrence of chronic subdural hematoma during the study period. We did not identify any significant differences between chronic subdural hematoma recurrence and current antiplatelet therapy. The recurrence rate was 7 % for the homogeneous type, 21 % for the laminar type, 38 % for the separated type, and 0 % for the trabecular type. The rate of recurrence was significantly lower in the homogeneous and trabecular type than in the laminar and separated type. We performed a multivariate logistic regression analysis and found that postoperative midline shifting (OR, 3.6; 95 % CI, 1.618-7.885; p = 0.001), diabetes mellitus (OR, 2.2; 95 % CI, 1.196-3.856; p = 0.010), history of seizure (OR, 2.6; 95 % CI, 1.210-5.430; p = 0.014), width of hematoma (OR, 2.1; 95 % CI, 1.287-3.538; p = 0.003), and anticoagulant therapy (OR, 2.7; 95 % CI, 1.424-6.960; p = 0.005) were independent risk factors for the recurrence of chronic subdural hematoma. CONCLUSIONS We have shown that postoperative midline shifting (≥5 mm), diabetes mellitus, preoperative seizure, preoperative width of hematoma (≥20 mm), and anticoagulant therapy were independent predictors of the recurrence of chronic subdural hematoma. According to internal architecture of hematoma, the rate of recurrence was significantly lower in the homogeneous and the trabecular type than the laminar and separated type.
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Affiliation(s)
- Kyu-Hyon Chon
- Department of Neurosurgery, Chonbuk National University Hospital & Medical School, 664-14, Deokjin-Gu, Jeonju, Jeonbuk, 561-756, Republic of Korea
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Juković M, Kojadinović Z, Popovska B, Till V. Complete spontaneous resolution of compressive chronic subdural hematoma in a patient with liver failure. Med Glas (Zenica) 2012; 9:417-420. [PMID: 22926390] [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: 01/02/2012] [Accepted: 04/12/2012] [Indexed: 06/01/2023]
Abstract
Chronic subdural hematoma is usually caused by minor head trauma and occurs frequently with older people. Predisposing factors include alcohol abuse, epilepsy and coagulopathy. This report presents a 65-year old woman who had a large, mixed density, left sided compressive chronic subdural hematoma diagnosed by computed tomography. She also displayed a moderate neurological deficit on admission, confusion and behavioral disorder with Glasgow Coma Score 10. The computed tomography and neurological parameters indicated the necessity of surgery. A difficult general condition and coagulation factor disorder in this patient were determinative for the decision for non-operative treatment. It is very rare that a large chronic subdural hematoma is resolved completely spontaneously, but in our case conservative treatment gave an excellent result.
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Affiliation(s)
- Mirela Juković
- Radiology Centre, Clinical Centre of Vojvodina, Novi Sad, Serbia
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