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Sharma M, Yadav N, Ratre S, Bajaj J, Hadaoo K, Patidar J, Sinha M, Parihar V, Swamy NM, Yadav YR. Endoscopic Management of Chronic Subdural Hematoma Using a Novel Brain Retractor. World Neurosurg 2024; 188:e452-e466. [PMID: 38815922 DOI: 10.1016/j.wneu.2024.05.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Endoscopic procedures are useful in chronic subdural hematoma especially when there are septations, solid/organized hematoma, and the presence of bridging or neovessels in the cavity. Visualizing the distal hematoma cavity by a rigid scope is challenging in large and curved ones due to the hindrance by the brain surface. Combining rigid endoscopy and brain retractor can overcome this limitation. METHODS A retrospective study of 248 patients managed by endoscopic technique was performed and the relevant literature was reviewed. RESULTS The brain retractor was used in all patients. Average operative time, subgaleal drainage duration, and hospital stay were 56 minutes, 3.1 days, and 4.6 days, respectively. The average preoperative Glasgow coma scale (GCS) score was 12, which improved to 14 and 15 in 223 and 23 patients, respectively at discharge. There were solid clots, septations, bridging vessels, curved hematoma cavities, rapid expansion of the brain after partial hematoma removal, and recurrences in 59, 52, 15, 49, 19, and 2 patients, respectively. There were 2 deaths, without any procedure-related mortality. CONCLUSIONS Endoscope was very effective and safe in the management of chronic subdural hematoma, especially in about 51% patients with solid clots, septations, and bridging vessels which could have been difficult to treat by conventional burr hole. It can avoid craniotomy in such patients. Good visualization and complete hematoma removal were possible with the help of an endoscope and brain retractor in about 27% of patients which could have been difficult with a rigid endoscope alone.
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Affiliation(s)
- Mukesh Sharma
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Nishtha Yadav
- Department of Neuroradiology, NSCB Medical College, Jabalpur, India
| | - Shailendra Ratre
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Jitin Bajaj
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Ketan Hadaoo
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Jayant Patidar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Mallika Sinha
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Vijay Parihar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Narayan M Swamy
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India
| | - Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, India.
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Bhattarai HB, Sapkota S, Mandal P, Bhattarai M, Pathak R. Arachnoid cyst presenting as a neurosurgical emergency: a case report. Ann Med Surg (Lond) 2023; 85:6164-6167. [PMID: 38098583 PMCID: PMC10718336 DOI: 10.1097/ms9.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Arachnoid cysts are intra-arachnoid lesions filled with cerebrospinal fluid. They account for ~1% of all intracranial mass lesions and are non-neoplastic collections of cerebrospinal fluid within an anomalous arachnoid enclosure. Case presentation The authors report a 35-year-old Arabian male who presented to the ER with a history of sudden loss of consciousness, anisocoria, and right hemiparesis. Contrast tomography showed a large frontoparietotemporal cyst (7.7×5.8×5.4) with uncal herniation and a midline shift of 12 mm. An emergency left FTP craniotomy with an excision of the cyst was performed. Discussion Arachnoid cysts can be categorized as primary or secondary, arising congenitally or due to factors like trauma, infection, or neoplasia. It can rupture, leading to internal bleeding, causing symptoms such as headaches, seizures, and neurological decline. Rapid diagnosis is vital, with cranial computed tomography scans preferred for emergencies. Treatment options include surgical intervention like craniotomy, fenestration, or cyst peritoneal shunts. For uncal herniation, surgery can be successful and results depends on the amount of herniation. Conclusion Although benign, the arachnoid cysts led to uncal herniation when they become 'tension' cysts. A high level of suspicion is crucial for early recognition of the condition. Timely intervention has shown positive recovery outcomes.
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Affiliation(s)
| | | | - Prince Mandal
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Madhur Bhattarai
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Roshan Pathak
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
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Qian M, Chen X, Zhang LY, Wang ZF, Zhang Y, Wang XJ. " In situ bone flap" combined with vascular pedicled mucous flap to reconstruction of skull base defect. World J Clin Cases 2023; 11:7053-7060. [PMID: 37946785 PMCID: PMC10631404 DOI: 10.12998/wjcc.v11.i29.7053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND At present, neuroendoscopy technology has made rapid development, and great progress has been made in the operation of lesions in the saddle area of the skull base. However, the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications, which may lead to poor prognosis. AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect. METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery, Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed. All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap. The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed, and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed. RESULTS There were 5 cases of high flow cerebrospinal fluid (CSF) leakage and 7 cases of low flow CSF leakage. Postoperative cerebrospinal fluid leakage occurred in 2 patients (8.3%) and intracranial infection in 2 patients (8.3%), which were cured after strict bed rest, continuous drainage of lumbar cistern combined with antibiotic treatment, and no secondary surgical repair was required. The patients were followed up for 8 to 36 months after the operation, and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up. Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery. CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications, which has certain advantages and is worthy of clinical promotion.
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Affiliation(s)
- Ming Qian
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Xi Chen
- Department of Nursing, Affiliated Hospital 2 of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Long-Yao Zhang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Zhi-Feng Wang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Yi Zhang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Xue-Jian Wang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
- Department of Neurosurgery, Nantong Clinical Medical College, Kangda College, Nanjing Medical University, Nantong 226000, Jiangsu Province, China
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Xu J, Wang J, Liu T, Wang Y, Chen F, Yuan L, Zhai F, Ge M, Liang S. Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children. World Neurosurg 2023; 175:e73-e80. [PMID: 36907272 DOI: 10.1016/j.wneu.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to investigate factors that influence subdural haemorrhage (SDH) secondary to intracranial arachnoid cysts (IACs) in children. METHODS Data of children with unruptured IACs (IAC group) and those with SDH secondary to IACs (IAC-SDH group) were analyzed. Nine factors, sex, age, birth type (vaginal or caesarean), symptoms, side (left, right, or midline), location (temporal or nontemporal), image type (I, II, or III), volume, and maximal diameter, were selected. IACs were classified as types I, II, and III according to their morphological changes observed on computed tomography images. RESULTS There were 117 boys (74.5%) and 40 girls (25.5%); 144 (91.7%) patients comprised the IAC group and 13 (8.3%) comprised the IAC-SDH group. There were 85 (53.8%) IACs on the left side, 53 (33.5%) on the right side, 20 (12.7%) in the midline region, and 91 (58.0%) in the temporal region. The univariate analysis showed significant differences in age, birth type, symptoms, cyst location, cyst volume, and cyst maximal diameter (P < 0.05) between the 2 groups. Logistic regression using the synthetic minority oversampling technique model showed that image type III and birth type were independent factors that influenced SDH secondary to IACs (β0 = 4.143; β for image type = -3.979; β for birth type = -2.542) and that the representative area under the receiver-operating characteristic curve value was 0.948 (95% confidence interval, 0.898-0.997). CONCLUSIONS IACs are more common in boys than in girls. They can be divided into 3 groups according to their morphological changes on computed tomography images. Image type III and caesarean delivery were independent factors that influenced SDH secondary to IACs.
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Affiliation(s)
- Jinshan Xu
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Wang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tinghong Liu
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yangshuo Wang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liu Yuan
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Shuli Liang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
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Wang L, Yi Q, Ye C, Luo N, Wang E. Effects of Dezocine on the Reduction of Emergence Delirium after Laparoscopic Surgery: A Retrospective Propensity Score-Matched Cohort Study. J Pers Med 2023; 13:jpm13040590. [PMID: 37108976 PMCID: PMC10143985 DOI: 10.3390/jpm13040590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
In China, dezocine is commonly employed as a partial agonist of mu/kappa opioid receptors during anesthesia induction for surgical patients, yet evidence supporting its causal association with emergence delirium is limited. The objective of this investigation was to evaluate the impact of intravenous dezocine administered during anesthesia induction on emergence delirium. The retrospective studied existing data containing medical records of patients undergoing an elective laparoscopy procedure and the study was conducted with ethics-board approval. The primary outcome was the incidence of emergence delirium. Secondary outcomes included the VAS in the PACU and 24 h after surgery, the RASS score in the PACU, postoperative MMSE, hospital stay, and ICU stay. A total of 681 patients were analyzed, after being propensity score-matched, the dezocine and non-dezocine group each had 245 patients. Emergence delirium occurred in 26/245 (10.6%) of patients who received dezocine and 41/245 (16.7%) of patients did not receive dezocine. Patients on whom dezocine was used were associated with a significantly lower incidence of emergence delirium (absolute risk difference, −6.1%, 95% CI, −12% to −0.2%; relative risk [RR], 0.63; 95% CI, 0.18–0.74). All secondary outcome measures and adverse outcomes were not significantly different. The use of dezocine during anesthesia induction was associated with a decreased incidence of emergence delirium after elective laparoscopic surgeries.
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Affiliation(s)
- Lu Wang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Qiong Yi
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Chunyan Ye
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Ning Luo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China
- Correspondence: ; Tel./Fax: +86-0731-84327413
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Leavitt LA, Nanda P, Stemmer-Rachamimov A, Dunn GP, Jones PS. Spontaneous rupture of an arachnoid cyst in an adult: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22420. [PMID: 38015025 PMCID: PMC10550604 DOI: 10.3171/case22420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/12/2022] [Indexed: 11/29/2023]
Abstract
BACKGROUND Arachnoid cysts are common intracranial mass lesions frequently discovered as incidental findings on radiographic imaging. It is routine practice to monitor these lesions as a large majority remain stable. Although traumatic cyst rupture is a known risk, it is rare for patients to present with spontaneous rupture. OBSERVATIONS The authors report the case of a 32-year-old patient who required emergent neurosurgical intervention for spontaneous rupture of a left hemispheric arachnoid cyst. LESSONS Patients with ruptured arachnoid cysts can present with vague, nonspecific symptoms that may delay diagnosis. If not diagnosed and treated promptly, arachnoid cyst rupture can progress to a neurosurgical emergency as the subdural collection may cause extensive mass effect and even cerebral herniation.
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Affiliation(s)
- Lydia A. Leavitt
- University of Illinois College of Medicine, Rockford, Illinois; and
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